Abstract
Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center
WY Shi, JP Gu, CJ Liu, et al.
Eur J Radiol 2016; 85: 7–14
Two hundred and thirty-three consecutive patients with iliac vein compression syndrome (IVCS) were treated with endovascular treatment and followed up. The therapeutic strategies and complications were recorded. Cumulative patency was assessed with Kaplan-Meier curves. Independent predictors of in-stent obstruction were calculated with the Cox regression model. Endovascular treatment was technically successful in 225 of the 233 patients (96.6%). All of 225 patients were treated with percutaneous transluminal angioplasty and stent placement. No severe procedure-related complications occurred. The cumulative one-, three- and five-year primary patency rates over a median follow-up time of 34 months (range 0.3–82 months) were 93.2%, 84.3% and 74.5%, respectively. Independent predictors for in-stent obstruction included use of multiple stents and irregular stocking wearing. The cumulative one-, three- and five-year secondary patency rates were 100%, 93.3% and 92%, respectively. The investigators concluded that endovascular treatment could achieve favorable mid-term patency in patients with IVCS with or without deep vein thrombosis.
Low incidence of cancer after venous thromboembolism: An update from the French OPTIMEV Cohort
AC Arnoult, G Pernod, C Genty, et al.
J Mal Vasc 2016; Epub ahead of print, DOI : 10.1016/j.jmv.2016.03.001.
The authors studied the risk of cancer in patients with clinical symptoms of venous thromboembolism (VTE) with or without confirmed VTE. Data were obtained from OPTIMEV, a French prospective multicenter observational study of patients with suspected VTE presenting to hospital and community vascular medicine specialists. Patients with confirmed VTE (1565) and matched controls without VTE (1847) were followed for three years. The primary outcome was occurrence of cancer at three years, and death was a censoring event. A total of 5.0% of patients with VTE and 3.8% without VTE developed cancer during follow-up. The adjusted hazard ratio (HR) was 1.2 [0.9–1.8] for patients with confirmed VTE (P = 0.22). The overall standardized incidence ratio was 1.4 [1.1–1.6] for our population, VTE+ and VTE−, compared with the general population, statistically significant (P < 0.05).
The authors found a lower occurrence of cancer after VTE than previously described and concluded that their results provide no argument in favor of an extensive screening for cancer in case of VTE.
Role of thromboxane-dependent platelet activation in venous thrombosis: Aspirin effects in mouse model
E Tarantino, P Amadio, I Squellerio, et al.
Pharmacol Res 2016; 107: 415–425
In this study, the authors assessed the effects of ASA in venous thrombosis mouse model induced by inferior vena cava (IVC) ligation and investigated the mechanisms responsible for this effect. ASA (3 mg/Kg, daily for two days) treatment decreased the thrombus size, the amounts of tissue factor activity in plasma microvesicles (TF-MP) and the levels of 2,3-dinor Thromboxane B2 (TXB-M) in urine compared to control mice. Interestingly, the thrombus size positively correlated with both TF-MP activity and TXB-M. In addition, positive correlation was observed between TF-MP activity and TXB-M. A reduced number of neutrophils and monocytes and of TF-positive cells accompanied to a lower amount of fibrin and neutrophil extracellular traps (NETs) were also found in thrombi of ASA-treated mice. Similar results were obtained when mice were treated 24 h before IVC ligation with SQ29548 (1 mg/Kg), a selective thromboxane receptor antagonist. In addition, transfusion of platelets in SQ29548 treated-mice excluded the likelihood of a redundant role of platelet-TP receptor in this context. Finally, incubation of macrophages and neutrophils with SQ29548 prevented TF activity and/or NETs formation induced by supernatant of activated platelets or by IBOP, a selective thromboxane analogue. In conclusion, ASA, suppressing TXA2 prevents macrophages and neutrophils activation and markedly reduces thrombus size with a mechanism most likely dependent of the inhibition of TF activity and NETs formation. These results provide a new link between platelet-produced thromboxane and the occurrence of venous thrombosis.
Endovascular radiofrequency ablation. Effect on the vein diameter using the ClosureFast® catheter
H Bauzá Moreno, M Dotta, R Katsini, et al.
Cir Esp 2016; Epub ahead of print, DOI: 10.1016/j.ciresp.2016.02.008.
The authors, in a retrospective observational study, accessed the trunk size of 365 ablations using the ClosureFast© catheter to see if there was a difference in efficacy between the original. The great saphenous vein, small saphenous vein and anterior accessory vein was identified and studied. The average diameter of veins was 9 ± 3.1 mm with a reduction six months post ablation with a mean value of 5.2 ± 0.8 mm (P < .0001). There was 100% occlusion, DVT in 0.5% and endothermal heat induced thrombosis in 1.1% of the cases.
The authors concluded that there was significant reduction in venous diameters after endovascular treatment with the ClosureFast® catheters even in veins with diameters greater than 12 mm.
Is D-dimer used according to clinical algorithms in the diagnostic work-up of patients with suspicion of venous thromboembolism? A study in six European countries
AH Kristoffersen, E Ajzner, D Rogic, et al.; Joint Working Group on Postanalytical Phase (WG-POST) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and European Organisation for External Quality Assurance
Thromb Res 2016; 142: 1–7. DOI: 10.1016/j.thromres.2016.04.001.
The authors’ aim of this study was to explore how MDs working in emergency departments investigated patients suspected to have VTE. A questionnaire with two case histories related to the diagnosis of suspected pulmonary embolism (PE) (Case A) and deep venous thrombosis (DVT) (Case B) were sent to MDs in six European countries. The physicians were asked to estimate pre-test probability of VTE and indicate their clinical actions; 487 MDs were included in this study. 60% assessed in pre-test probability of PE to be high in Case A (correct); however, 7% would still request only D-dimer and 11% would exclude PE if the D-dimer was negative. For Case B, 92% assessed pre-test probability of DVT to be low (correct). Only D-dimer was requested by 66% of the physicians, while 26% requested imaging, alone or in addition to D-dimer.
The authors concluded that these results should encourage scientific societies to improve the dissemination and knowledge of current recommendations for the diagnosis of VTE.
Primary venous insufficiency increases risk of deep vein thrombosis
ME Shaydakov, AJ Comerota, F Lurie
J Vasc Surg: Venous and Lym Dis 2016; 4: 161–166
This study evaluated the association between primary valvular reflux and DVT. The authors performed a nested case-control study with enrollment of outpatients presenting to the vascular laboratory with signs and symptoms of DVT. All patients had a complete bilateral venous duplex examination evaluating for DVT and superficial and deep venous valvular reflux. A total of 87 patients with confirmed DVT on venous duplex were selected for the study group. The control group was randomly selected from the same cohort in a 4:1 ratio matched by age and gender (n = 348). Groups were compared for the prevalence of deep and superficial reflux. DVT outpatients were 4.7 times more likely to have primary valvular reflux than symptomatic controls (65.5% vs 29.0%; 95% CI, 2.8–7.7; P < .000001). Deep reflux was 2.1 times more prevalent (36.8% vs 21.6%; OR 2.12; 95% CI, 1.28–3.51; P < .005) and superficial reflux was 4.6 times more prevalent (43.7% vs 14.4%; OR 4.62; 95% CI, 2.75–7.77; P < .0000001) in DVT patients than in controls. DVT patients were also 2.1 times more likely to have combined deep and superficial reflux than non-DVT patients (13.8% vs 6.6%, 95% CI, 1.08–4.75; P = .044). The investigators concluded that the prevalence of primary valvular reflux in patients with DVT is significantly higher than expected. Reflux may be considered as a novel risk factor for DVT. Two-thirds of patients with DVT have pre-existent primary chronic venous disease, which is likely to contribute to postthrombotic morbidity.
Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy
ES Hager, C Washington, A Steinmetz, et al.
J Vasc Surg: Venous and Lym Dis 2016; 4: 51–56
A retrospective review of a prospectively managed database of perforator vein treatments performed at a three centers within a single institution from February 2013 to July 2014. The modality for perforator closure was left to the discretion of the treating physician. A Duplex scan was performed at two weeks after the procedure. Standard statistical methods were used to compare subgroup characteristics. Univariate and multivariate analyses were performed using SAS v9.3. A total of 112 patients received 296 perforator ablations. Superficial venous reflux was appropriately treated before perforator ablation. Of the 296 procedures, 62 (21%) underwent EVLA, 93 (31%) RFA, and 141 (48%) UGFS. The indications for intervention in most patients were C5 and C6 disease (67%). At two weeks, closure rates were significantly lower for UGFS (57%) compared with RFA (73%; P = .05) but failed to reach significance compared with EVLA (61%; P = .09). When patients were first treated with UGFS and closure failed, thermal ablation was then successful in 85% (P = .03) of EVLA and 89% (P = .003) of RFAs as a secondary procedure, compared with initial closure rates. Systemic anticoagulation, perforator size, and presence of deep vein reflux did not affect closure rates for any modality. Factors that were predictive of failure were body mass index >50 with closure rates of only 37% for all modalities. There were five postprocedure deep venous thromboses found (5%). One patient had an isolated gastrocnemius thrombus after undergoing UGFS, and the other four had focal tibial vein thrombosis without extension into the popliteal vein. The authors concluded that RFA was found to be the most reliable means of perforator closure and was significantly better than UGFS. Morbid obesity (body mass index >50) predicted failure of perforator closure in all groups. Failure of UGFS as an initial treatment led to increased perforator closure when thermal ablation was used as a secondary technique.
Psychometric evaluation of a new patient-reported outcome (PRO) symptom diary for varicose veins: VVSymQ® instrument
DD Wright, J Paty, DM Turner-Bowker, et al.
Patient 2016; Epub ahead of print, DOI: 10.1007/s40271-015-0159-3.
The authors’ objectives for this 40 patient study were to evaluate the psychometric properties of the VVSymQ instrument, a new five-item patient reported outcome (PRO) measure for symptoms of varicose veins. The following variables were studied: compliance with diary entry, item score variability, reliability, construct validity, sensitivity to change, and clinically meaningful change.
Patients completed >97% of scheduled diary assessments (at screening, baseline, and week 8). The VVSymQ® instrument captured patients’ pre-treatment symptoms (all VVSymQ® symptoms were endorsed by ≥75% of patients at baseline), and the change post-treatment (mean change in score −6.1), with a large Cohen effect size (1.6). Test–retest reliability was high (intraclass correlation coefficient 0.96); internal consistency was good (Cronbach’s alpha ≥ 0.76; baseline, week 8). VVSymQ® scores were more strongly associated with PRO scores that reflect symptoms and symptom impact (the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms [VEINES-QOL/Sym] instrument and the Chronic Venous Insufficiency Quality-of-Life Questionnaire [CIVIQ-20]) than with PRO scores that reflect appearance (the Patient Self-Assessment of Appearance of Visible Varicose Veins [PA-V3]) or clinician-reported outcome scores (the Clinical-Etiology-Anatomy-Pathophysiology [CEAP] Classification of Venous Disorders and Venous Clinical Severity Score [VCSS]), demonstrating construct validity. Patients reporting that symptoms were “moderately” or “much improved” on the Patient Global Impression of Change (PGIC) anchor (i.e., >97% of patients) had mean improvements of −6.3 VVSymQ® points, while a cumulative distribution curve showed that 50% of patients improved by ≥−5.8 points; thus, a score change of approximately −6 demonstrated a clinically meaningful change in this study. The clinically meaningful change in the VVSymQ® score was greater in patients with a greater baseline VVSymQ® symptom burden, and the VVSymQ® instrument captured clinically meaningful treatment benefit even in patients with a low baseline symptom burden.
The authors concluded that the VVSymQ® instrument is a useful tool for evaluating patient-reported varicose veins symptoms.
The effect of combined ultrasound and electric field stimulation on wound healing in chronic ulcerations
R Avrahami, J Rosenblum, M Gazes, et al.
Wounds 2015; 27: 199–208
The authors’ aim of this retrospective study was to access combined modulated ultrasound and electric field stimulation (CUSEFS) on a variety of wound types in four clinics. Wounds were evaluated by an independent assessor, and data were evaluated by an independent statistician. Of the 300 wounds treated with the CUSEFS device, only those classified as diabetic foot ulcers (DFUs) or venous leg ulcers (VLUs) were evaluated. A treatment was deemed successful if the wound was 50% closed within four weeks. Subjects were then followed to see if their wounds completely closed within 16 weeks. Of the 27 DFUs treated, 59.3% (16) achieved 50% closure within four weeks. Of the 38 VLUs treated, 71.1% (27) achieved 50% closure within four weeks. Gender, size of the wound at presentation, and longevity of the wound had no bearing on the outcome. Patients’ age had an effect on the outcome of the VLUs. The wound healing trajectory was supported in that there was a significant difference in the achievement of total closure between those subjects who had a successful trial and those who did not.
The authors concluded that combined modulated ultrasound and electric field stimulation has a place as adjunct therapy that aids wound healing and provides an effective noninvasive treatment option.