Abstract
FOVELASS—a randomized trial of EVLA versus polidocanol foam for SSV incompetence
Hamel-Desnos C, Nyamekye I, Chauzat B, Gracia S, Josnin M, Abbadie F. Eur J Vasc Endovasc Surg. 2022 Dec 2
The authors in a multicenter randomized controlled study (RCT) compared outcomes of ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA) for treating small saphenous vein (SSV) incompetence. UGFS-treated patients were allowed one additional truncal treatment at 6 weeks. Varicose vein treatments (phlebectomy or sclerotherapy) were permitted after 6 months. Participants were assessed at 8 days, 6 months, 1, 2, and 3 years. Primary endpoint was absence of SSV reflux (>0.5 s). Secondary outcomes included clinical scores and quality-of-life (QoL) scores. Only 3% of UGFS patients had the second treatment and 86% of patients completed the 3-year study. Three-year follow-up regarding complete absence of reflux was significantly better after EVLA (86.4%) than after UGFS (56%). Two DVTs and 1 EHIT2 occurred in the EVLA group. Seven DVTs were identified in the UGFS group. At 3 years, there was no difference between groups for the following: rate of visible varices (p = 0.868), rVCSS (p = 0.278), and QoL (p = 0.590). Patient satisfaction scores were high in both groups (median score: EVLA 97/100, UGFS 93/100; p = 0.080). Symptoms were significantly improved in both groups (p < 0.0001).
The authors concluded that technical success was better for EVLA compared to UGFS at 3 years after SSV treatment. However, improvements in clinical outcome were similar for both groups.
Design of a treatment satisfaction measure for patients undergoing varicose vein treatment: Venous Treatment Satisfaction Questionnaire (VenousTSQ)
Gilbride CJ, Wilson A, Bradley-Gilbride A, Bayfield J, Gibson K, Gohel M, Bradley C. Br J Surg. 2022 Dec 7
The authors’ aim of this study was to design a Venous Treatment Satisfaction Questionnaire (VenousTSQ) that would be ready for large-scale data collection and psychometric evaluation. Relevant items were selected from the TSQ Item Library, and new items were designed where necessary. A draft VenousTSQ was prepared using the existing AneurysmTSQ as a template. Fifteen interviews were conducted from 4 days to 16 months after the procedure. The interviews were designed to elicit important sources of satisfaction or dissatisfaction before completion of draft questionnaires. The VenousTSQ drafts were modified between sets of interviews until no further changes were deemed necessary. The final VenousTSQ consisted of 2 questionnaires: VenousTSQ early (VenousTSQe) and VenousTSQ status (VenousTSQs).
The VenousTSQ represents a condition-specific psychological outcome measure for varicose veins, enabling patient satisfaction or dissatisfaction with such treatments. Large-scale data collection is under way to establish optimal scoring, quantitative validity, and reliability of the VenousTSQ.
Venous wall of patients with chronic venous disease exhibits a glycolytic phenotype
Fraile-Martinez O, García-Montero C, Alvarez-Mon MA, Gomez-Lahoz AM, Monserrat J, Llavero-Valero M, Ruiz-Grande F, Coca S, Alvarez-Mon M, Buján J, García-Honduvilla N, Saz JV, Ortega MA. J Pers Med. 2022 Oct 3; 12(10): 1642.
The authors’ aim of the study was to analyze the gene and protein expression of glucose transporter 1 (GLUT-1) and the glycolytic enzymes PGK-1, ALD, GA3PDH, and LDH in the varicose veins of patients with chronic venous disease (CVeD) (n = 35) in comparison to those expressed in healthy subjects. Enhanced gene and protein expression of GLUT-1, PGK-1, ALD, GA3PDH, and LDH in patients with CVeD suggested a glycolytic switch of the venous tissue.
The authors concluded that greater understanding of the impact of this glycolytic switch in patients with CVeD is required to define a possible pathophysiological role or therapeutic implications of these changes.
Screening for occult cancer after unprovoked venous thromboembolism: Assessing the current literature and future directions
Patel S, Tao D, McMurry HS, Shatzel JJ. Eur J Haematol. 2023 Jan; 110(1): 24–31.
The authors’ aim was to examine the literature and evaluate the benefit of additional diagnostic strategies, review current guidelines on the issue, and provide guidance to the reader on the best practice for investigating undiagnosed malignancy in patients with unprovoked venous thromboembolism (VTE). There is a significant relationship regarding epidemiology and pathophysiology of VTE and cancer. A few studies have demonstrated an earlier time to diagnosis among the unprovoked VTE population. Extensive screening for cancer using PET/CT, endoscopy, and additional laboratory testing do not provide patients with unprovoked VTE any survival advantage even if they are diagnosed with cancer.
The authors recommend against extensive screening of asymptomatic patients with unprovoked VTE beyond age and gender-specific cancer screening, except otherwise guided by history and physical examination.
Nutcracker syndrome in children: Appearance, diagnostics, and treatment—A systematic review
Meyer J, Rother U, Stehr M, Meyer A. J Pediatr Surg 2022 Nov; 57(11): 716–722.
The authors reported a systematic literature review on pediatric nutcracker syndrome, defined as left renal vein compression leading to a variety of symptoms. Four hundred twenty three children with a mean age of 12 were included from 47 articles. Presentation included hematuria, proteinuria less commonly, and then flank pain in 19%. Ultrasound was the most widely used for evaluation. Conservative management was undertaken in 86.6% with complete resolution in almost half of the children studied. Interventions included open surgery with transposition of the renal vein, endovascular stenting, and laparoscopy.
The authors suggest conservative management for children. If intervention is chosen, close follow-up is necessary.
Daily persistent headache with nutcracker physiology and spinal epidural venous congestion: Treatment with lumbar vein embolization
Devcic Z, Rozen TD, Arora M, Caserta MP, Erben YM, Sandhu SS, Huynh T, Lewis AR, Toskich BB. Radiol Case Rep. 2022 Sep 14; 17(11): 4314–4318.
The authors present a case report of a patient with refractory headaches and imaging consistent with nutcracker phenomenon (NCP). The patient underwent magnetic resonance imaging, showing lumbar vein and epidural venous plexus reflux and congestion. The patient was treated with lumbar vein embolization. Her headaches resolved the following day after treatment and remained treatment free at 5 months post procedure.
Stent in left renal vein stuck at the opening of tricuspid valve
Zhang J, Li T. Annals of Thorac Surgery 2022 Feb; 113(2): e91–e94.
This is a case report of a patient who underwent stent of the left renal vein a month prior to presentation. The stent migrated into the opening of the mitral valve creating tricuspid insufficiency. An open thoracotomy had to be performed to remove the stent. The authors caution that stent migration is a real and dangerous complication of renal vein stenting.
Efficacy of traditional Chinese medicine combined with rivaroxaban in the treatment of lower extremity deep vein thrombosis: A meta-analysis
Zheng D, Qi G, Adu IK, Wu H, Mingyuan Zhu M. Medicine (Baltimore) 2022 30; 101(39): e29483.
The authors conducted a review of the literature comparing the use of traditional Chinese medicine (TCM) used in combination with rivaroxaban (368 patients) compared to patients only treated with rivaroxaban (362 patients) postoperatively. Clinical efficacy was greater in the test group. The affected limb circumference and pain were less in the test group. Laboratory tests were also improved better in the test group.
The authors suggest that TCM in combination with rivaroxaban reduces the risk of bleeding complications and adverse events. They also recommend further studies.