Abstract
Antiplatelet agents for the treatment of deep venous thrombosis
Flumignan CDQ, Nakano LC, Baptista-Silva JCC, Flumignan RLG. 2022 Cochrane Database Syst Rev Jul 25; 7(7):CD012369.
The authors conducted a review of the literature available in order to better understand the premise that, in addition to best medical practice (BMP), including anticoagulation, compression, exercise, and skin care, antiplatelet agents may also be helpful in minimizing the risk of post thrombotic syndrome (PTS) and pulmonary embolism (PE).
The authors concluded that in chronic deep vein thrombosis (DVT) following initial standard treatment with anticoagulants, there is low certainty evidence that antiplatelets in addition to BPM may reduce recurrent venous thromboembolism compared to BPM + placebo. There is no discernable increase in adverse events in patients treated with BPM + antiplatelet agents. The authors suggest further study.
Ovarian vein thrombosis after coronavirus disease (COVID-19) mimicking acute abdomen: two case reports
Fatimazahra M, El Harras M, Bensahi I, Kassimi M, Oualim S, Elouarradi A, Abdeladim S, Sabry M. J Thromb Thrombolysis. Aug; 52(2):493-496.
The authors reported on two patients who presented with ovarian vein thrombosis after infection with COVID-19. The first patient was a 58 year old female who presented with severe abdominal pain, nausea, and fever. A CT scan showed right ovarian vein thrombosis. Bloodwork showed a white blood cell count of 10,000, D-dimer was 1000 ng/mL, and SARS-CoV-2 swab was positive. She was treated with anticoagulation. She was closely monitored and followed up, and by one month, her blood tests had normalized. The second patient was a 38-year-old woman presenting 5 days postpartum. She complained of 48 hour history of right lower quadrant pain, nausea, and fever. She was originally thought to have salpingitis. The patient also tested positive for COVID-19. She was treated with antibiotics. A CT scan showed ovarian vein thrombosis and she was anticoagulated.
The cases studied are an interesting demonstration of COVID-19 complication presenting as ovarian vein thrombosis.
Genomewide association study identifies copy number variants associated with warfarin dose response and risk of venous thromboembolism in African Americans
Zhang H, Alarcon C, Cavallari LH, Nutescu E, Carvill GL, Perera MA, Hernandez W. 2022 Clinical pharmacol Ther Dec 12. online ahead of print.
The authors conducted the first genome-wide analysis of copy number variants (CNV) to account for the contribution of genetic variation in warfarin does requirements and venous thromboembolism risk (VTE) among African Americans. The authors found two CNV regions associated with increased warfarin does requirements. One CNV region was associated with decreased warfarin dose requirement.
The authors concluded that they found robust evidence that CNV regions could contribute to warfarin dose requirements and risk of VTE in African Americans. A specific deletion, 10q26.3del, in HepG2 cells revealed that the deletion can result in decreased fibrinogen gene expression, decreased fibrinogen and additional pathogenic issues, and it describes a mechanism that leads to difficulty with anticoagulation in this patient population.
Cancer-associated venous thromboembolism: Incidence and features in a racially diverse population
Raskob GE, Wendelboe AM, Campbell J, Ford L, Ding K, Bratzler DW, McCumber M, Adamski A, Abe K, Beckman MG, Reyes NL, Richardson LC. 2022 Thromb Haemost Oct;20(10):2366-2378. doi: 10.1111/jth.15818. Epub 2022 Aug 7.
The authors conducted surveillance of venous thromboembolism (VTE) at tertiary care facilities and outpatient clinics in Oklahoma from 2021-2014. Cancer status was determined by linkage to the Oklahoma Central Cancer Registry. The age adjusted incidence rate (AAIR) for non-Hispanic blacks was 85.9, 79.5 for non-Hispanic whites, 18.8 for Native Americans, 15.6 for Asian/Pacific Islanders, and 15.2 for Hispanics. Recurrent VTE up to 2 years after the initial diagnosis occurred in 12.5% of patients with active cancer, and 8% of patients with a history of cancer.
The authors suggest that AAIR of cancer associated VTE vary greatly by race and ethnicity.
Lymphatic malformations
Goss JA, Zamakhshary M, Langer JC, Christison-Lagay E. Pediatric Surgery pp 609–623. https://doi.org/10.1007/978-3-030-81488-5_47
In this article, the authors explore lymphatic malformations as a larger group of benign, congenital lesions resulting from embryologic errors in lymphangiogenesis. They range in presentation from small, localized masses to large and sometimes debilitating, disfiguring, or invasive lesions with an infiltrative growth pattern, which may complicate treatment. Morbidity includes bleeding, infection, lymphorrhea, obstruction of vital structures, disfigurement, and psychosocial distress. For complex lesions, sclerotherapy and surgical therapy remain the foundation of care, with increasing interest in novel agents (e.g., sirolimus) for systemic therapy.
The authors address that there is no single treatment consensus. They propose that a management algorithm must be established based on the experience and strengths of a multidisciplinary team and the specific details of the individual lesion in terms of size, location, and risk profile.
Two-year results of a first-in-human study in patients surgically implanted with a bioprosthetic venous valve, the VenoValve, in patients with severe chronic venous insufficiency
Ulloa JH, Cifuentes S, Figueroa V, Glickman M. Vascular and Endovascular Surgery 2023, Vol. 0(0) 1–8
The authors, in this article, describe the two-year results from a first-in-human study of patients implanted with the VenoValve, a bioprosthetic valve for the treatment of deep venous reflux. Currently, there is no cure for severe chronic venous insufficiency (CVI) and treatment options are limited. Eleven patients with C5 & C6 CVI were implanted with VenoValve into the midthigh femoral vein and followed for 2 years. Assessed clinical outcomes include device-related adverse events, reflux time, disease severity, and pain scores. All 11 implant procedures were successful. Two-year follow-up data was obtained for 8 subjects: 1 patient died of non-device-related causes, 1 was lost to follow-up, and 1 refused to follow-up due to the COVID-19 pandemic. No device-related adverse events occurred between the first and second years of follow-up. Reported 2-year clinical performance outcomes included significant decreases in mean reflux times of the mid-popliteal vein (61%), and significant improvements in mean scores for disease severity rVCSS (56%) and VAS pain (87%).
The authors conclude that these results support long-term safety and effectiveness of the VenoValve for improving CVI severity by reducing reflux and thereby venous pressures in the lower extremities. This device is a novel therapy and a pivotal trial in the United States is currently being conducted to assess the device in a larger number of patients.
Long-term changes of health-related quality of life in patients with peripheral vascular malformations—a prospective observational study
Berger S, Andersen R, Smaastuen MC, Rosseland LA, Dorenberg E. Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 77, 2023, Pages 46-53, ISSN 1748-6815. https://doi.org/10.1016/j.bjps.2022.10.024
The authors present an observational study to assess health-related quality of life (HRQOL) changes in patients with vascular malformations over almost eight years and to assess clinical and demographic characteristics possibly associated with HRQOL changes. Eighty out of 111 patients included in a previously published comparative HRQOL study accepted inclusion in the present follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. 86.5% of patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems. No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change.
The authors conclude that over almost eight years, significant improvement of SF-36 scores was observed in the physical domains of RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.
Combined endovenous laser and mechanochemical ablation to reduce sclerosant for three or four veins with chronic venous insufficiency
Choi K, Kwon Y, Jun H, Yoon M. J. Vasc. Dis. 2023, 2(1), 32-39. https://doi.org/10.3390/jvd2010004
The authors state that a large amount of sclerosant is needed for treating saphenous vein insufficiency with mechanochemical ablation (MOCA) for three or four veins with chronic venous insufficiency. In addition, what constitutes a safe amount is not clearly defined. They evaluate the feasibility of the combined endovenous laser and mechanochemical ablation to reduce the amount of sclerosant compared to mechanochemical ablation monotherapy. 327 patients were diagnosed with superficial vein insufficiency between June 2018 and May 2020 and treated in a single center.
There were 130 patients treated with MOCA (Group I) and 197 patients treated with combined EVLA and MOCA (Group II). The amount of sodium tetradecyl sulfate (STD) used per number of limbs was 5.5 ± 2.05 mL in Group I and 4.51 ± 1.2 mL in Group II (p < 0.001). The amount of STD used per number of veins was 4.77 ± 1.91 mL versus 3.12 ± 1.02 mL in Groups I and II, respectively (p < 0.001). Recanalization rates within 52 weeks were 0% (0/130) in Group I and 5.58% (11/197) in Group II, while after 52 weeks, they were 2.31% (3/130) in Group I and 6.60% (13/197) in Group II and were not statistically significant.
The authors conclude that combined EVLA and MOCA reduce the amount of sclerosant per the number of veins and legs treated compared to MOCA monotherapy for three or four veins with chronic venous insufficiency. EVLA and MOCA treatment in patients with three or four varicose veins has few side effects and can be an effective treatment method for inducing venous occlusion.