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Phlebology Apr 2023A meta-analysis to determine if patients with varicose veins are at an increased risk of venous thromboembolism (VTE) when undergoing major lower limb arthroplasty. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A meta-analysis to determine if patients with varicose veins are at an increased risk of venous thromboembolism (VTE) when undergoing major lower limb arthroplasty.
METHODS
Medline, Embase, and Cochrane Library databases were searched using appropriate terms for studies that reported post-operative VTE in patients who had lower limb arthroplasty with any history of varicose veins. Methodological quality of included studies was quantified using the Risk of Bias (ROB) assessment tools. Findings were reported using the meta-analysis of observational studies in epidemiology (MOOSE) checklist.
RESULTS
A total of 129 studies were identified with 11 observational studies being eligible for inclusion. This consisted of 265,194 patients who underwent lower limb arthroplasty, 2188 of which had pre-existing varicose veins. Overall, VTE occurred in 1845 patients, and 122 cases had varicose veins present at time of arthroplasty. Meta-analysis indicates that patients undergoing lower limb arthroplasty with varicose veins are at increased risk of having a VTE, OR 2.37, 95% CI 1.54-3.63, ( < 0.001). One study evaluated if previous varicose veins surgery influenced the risk of VTE in arthroplasty patients, OR 0.96 (95% CI 0.7-1.28), = 0.429.
CONCLUSIONS
Varicose veins and lower limb arthroplasty are known independent risk factors for VTE. There is a paucity of data regarding the risk of VTE in patients undergoing lower limb arthroplasty who have co-existing varicose veins. This meta-analysis shows that patients with varicose veins are at an increased risk of VTE when undergoing major lower limb arthroplasty. Further studies are required in order to determine if such patients should undergo varicose vein surgery before undertaking major lower limb joint replacement.
Topics: Humans; Venous Thromboembolism; Varicose Veins; Risk Factors; Arthroplasty; Risk Assessment
PubMed: 36609190
DOI: 10.1177/02683555221150563 -
Journal of Vascular Surgery. Venous and... Mar 2024Recanalization of the saphenous vein trunk after endovenous radiofrequency ablation (RFA) is often associated with recurrent varicose veins (RVVs) or recanalization....
OBJECTIVE
Recanalization of the saphenous vein trunk after endovenous radiofrequency ablation (RFA) is often associated with recurrent varicose veins (RVVs) or recanalization. This study aimed to assess the long-term results of RFA of the great saphenous vein (GSV) and identify the risk factors for GSV recanalization and RVVs during follow-up for patients presenting to dedicated outpatient vein centers.
METHODS
All consecutive patients with incompetent GSVs who underwent RFA between 2009 and 2019 were retrospectively analyzed. The primary study end points were freedom from GSV recanalization and the RVV rate during follow-up. The secondary study end points were the postoperative complication rate and the risk factors for GSV recanalization and RVVs. Univariate and multivariate analyses were performed to identify the potential risk factors for GSV recanalization and RVVs.
RESULTS
During the study period, 1568 limbs were treated in 1300 consecutive patients (mean age, 53.5 ± 12.9 years; 71.9% women; CEAP [clinical, etiology, anatomy, pathophysiology] C2-C6; venous clinical severity score >5). Technical success was achieved in 99.7% of cases. At a mean follow-up of 57.2 ± 25.4 months, the GSV occlusion and freedom from reintervention rates were 100% and 100% within 1 week, 97% and 95.7% at 1 year, 95.2% and 93.1% at 3 years, and 92.4% and 92.8% at 5 years, respectively. The recurrence rate was 10% (n = 158) during the follow-up period. On multivariate analysis, a direct confluence of the accessory saphenous vein into the saphenofemoral junction (odds ratio [OR], 1.561; 95% confidence interval [CI], 1.0-7.04; P = .032), a history of pregnancy >2 (OR, 3.68; 95% CI, 1.19-11.36; P = .023), C4 (OR, 6.41; 95% CI, 1.36-30.28; P = .019), and preoperative GSV diameter >10 mm (OR, 1.82; 95% CI, 1.65-4.03; P = .043) were risk factors for GSV recanalization. Moreover, age >70 years (OR, 1.04; 95% CI, 1.01-1.06; P = .014) and incompetent perforator veins (OR, 1.17; 95% CI, 0.65-2.03; P = .018) were also risk factors for RVVs.
CONCLUSIONS
RFA is a safe technique to ablate the GSV with a low complication rate and durability during 5 years of follow-up. However, patients with a high clinical score and those with direct confluence of the accessory saphenous vein into the saphenofemoral junction experienced higher long-term GSV recanalization and RVV rates.
Topics: Humans; Female; Adult; Middle Aged; Aged; Male; Retrospective Studies; Catheter Ablation; Varicose Veins; Radiofrequency Ablation; Saphenous Vein; Venous Insufficiency; Treatment Outcome
PubMed: 37703941
DOI: 10.1016/j.jvsv.2023.08.014 -
European Journal of Dermatology : EJD 2011To evaluate a novel score (HVVSS) for varicose vein patients combining subjective symptoms, clinical findings and functional data of venous insufficiency. 91 patients... (Comparative Study)
Comparative Study
To evaluate a novel score (HVVSS) for varicose vein patients combining subjective symptoms, clinical findings and functional data of venous insufficiency. 91 patients (118 legs) with primary varicose veins of the great, small or accessory anterior saphenous vein were treated with conventional surgery. HVVSS was assessed pre- and 3 months postoperatively. The data were compared with established clinical and disease-related life quality scores (VCSS, AVVQ, CIVIQ). Test responsiveness, validity and reliability were determined using correlations with CEAP stage and venous refilling time as hemodynamic parameter, and inter-observer variability was assessed. All scores were highly responsive to varicose vein surgery (p<0.001). HVVSS(0-100) decreased from 34.1 ± 13.0 to 9.6 ± 6.9 postoperatively. The relative score change of HVVSS was superior to VCSS (69.5% vs. 58.8%, p=0.005). HVVSS revealed highly significant correlations with the clinical CEAP stage and was exclusively able to differentiate mild from severe disease as defined by venous refilling time (p=0.009). Inter-observer reliability of HVVSS was confirmed by correlation coefficients of 0.977 and 0.950 pre- and postoperatively (p<0.001). HVVSS is a suitable and reliable tool to assess disease severity in varicose vein patients and to quantify therapeutic effects of varicose vein treatment.
Topics: Adult; Aged; Female; Humans; Leg; Male; Middle Aged; Prospective Studies; Quality of Life; Reproducibility of Results; Severity of Illness Index; Statistics, Nonparametric; Surveys and Questionnaires; Treatment Outcome; Varicose Veins
PubMed: 21680286
DOI: 10.1684/ejd.2011.1368 -
Seminars in Vascular Surgery Mar 2012New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance,... (Review)
Review
New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance, and during many procedures. Ultrasound has also altered our understanding of the pathophysiology of chronic venous disease. Laser and radiofrequency saphenous ablations are common. Classic techniques, such as sclerotherapy, high ligation, stripping, and phlebectomy, have been improved. Magnetic resonance venography, computed tomographic venography, and intravascular ultrasound have improved diagnostic capabilities. New strategies like ambulatory selective varices ablation under local anesthesia (ASVAL) and conservative hemodynamic treatment for chronic venous insufficiency (CHIVA) raise important questions about how to manage these patients.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Catheter Ablation; Hemodynamics; Humans; Laser Therapy; Ligation; Magnetic Resonance Angiography; Phlebography; Predictive Value of Tests; Sclerotherapy; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Varicose Veins; Vascular Surgical Procedures
PubMed: 22595477
DOI: 10.1053/j.semvascsurg.2012.02.002 -
The British Journal of Surgery Jun 2010The aim of this case-control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral...
BACKGROUND
The aim of this case-control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein.
METHODS
One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2-C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score.
RESULTS
Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14.0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29.0 per cent had Hobbs' class A or B and 82.0 per cent developed recurrence (P < 0.001).
CONCLUSION
Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection.
Topics: Ambulatory Surgical Procedures; Case-Control Studies; Chronic Disease; Female; Femoral Vein; Humans; Male; Middle Aged; Preoperative Care; Recurrence; Saphenous Vein; Treatment Outcome; Ultrasonography, Doppler, Duplex; Varicose Veins; Venous Insufficiency
PubMed: 20473994
DOI: 10.1002/bjs.7022 -
Seminars in Cutaneous Medicine and... Dec 2008Superficial venous insufficiency is a common problem associated with varicose veins. Venous insufficiency and varicose veins can be symptomatic, but more commonly they... (Review)
Review
Superficial venous insufficiency is a common problem associated with varicose veins. Venous insufficiency and varicose veins can be symptomatic, but more commonly they are a cosmetic concern. In this article, we discuss the relevant anatomy and pathophysiology of superficial venous insufficiency, review the current literature for varicose vein treatment, and cover the technical aspects of diagnosing and treating superficial venous insufficiency. Saphenofemoral junction incompetence with resultant greater saphenous vein reflux is the most common cause of varicose veins; because this condition constitutes the majority of patients encountered in practice, we will concentrate on this area. Endovenous laser ablation and sclerotherapy are covered, including patient workup and selection, procedure set-up, and anesthesia.
Topics: Humans; Laser Therapy; Saphenous Vein; Sclerotherapy; Varicose Veins
PubMed: 19150298
DOI: 10.1016/j.sder.2008.08.001 -
Annales de Chirurgie 1997
Topics: Hemodynamics; History, 20th Century; Humans; Varicose Veins; Vascular Surgical Procedures
PubMed: 9501541
DOI: No ID Found -
Phlebology Mar 2022The aim of this study was to assess occlusion rates of saphenous veins treated with the VariClose vein sealing system.
OBJECTIVES
The aim of this study was to assess occlusion rates of saphenous veins treated with the VariClose vein sealing system.
METHODS
A retrospective analysis including a total of 64 patients from four centres from the Czech Republic. Occlusion was defined as a non-compressible vein with absence of flow with exception to the first 3 cm from the saphenofemoral or saphenopopliteal junction on duplex ultrasound.
RESULTS
In 64 patients a total of 79 veins were treated. Technical success of the procedure was achieved in 74 (94%) of cases. The mean follow-up was 5.5 months. The closure rates calculated by the Kaplan-Meier method at 1, 3, 6 and 12 months were 94%, 85%, 69% and 36%, respectively, and there were no significant differences between centers. The average difference in VCSS score before and after the procedure was 1.8.
CONCLUSIONS
The present study demonstrated surprisingly worse occlusion rates than the current literature.
Topics: Czech Republic; Humans; Retrospective Studies; Saphenous Vein; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 34644196
DOI: 10.1177/02683555211051500 -
Magyar Sebeszet Sep 2018With the development of medicine, technical inventions have been intoduced into the therapy of varicose veins, such as ultrasound examination and laser treatment.
INTRODUCTION
With the development of medicine, technical inventions have been intoduced into the therapy of varicose veins, such as ultrasound examination and laser treatment.
PATIENTS AND METHODS
Over 11 years 1729 laser surgery were performed on varicose veins. Junctions of saphenous veins, saphenous stems and perforator veins were treated with lasers, but reticular and spider veins were treated with other methods. The most important elements of laser surgery are the introduction of the laser fibre into the lumen of the vein and delivering the laser energy. All of this is performed without incisions under ultrasound guidance. Laser crossectomy is an innovation in our technique. This procedure is performed under a combination of local and intravenous anaesthesia.
RESULTS
After 1 year 58% of operated legs (998) were checked (mean 3.3 years) and recurrent varicosity was found in 114 legs (11.4%). Recurrences were found mainly in those cases which would have been excluded from other studies, but in everyday practice they occur in a high percentage, such as being overweight, after delivery and previously operated cases. In selected cases, the recurrence rate is only 6.0%. Complications after laser surgery are less frequent than following classic varicose vein surgery.
CONCLUSIONS
According to international guidelines and this study, endovascular interventions can be recommended instead of classic varicose vein surgery because they are less demanding, and cause fewer complications. Using laser crossectomy, the number of early recurrences decreases. All stem varicosities are suitable for laser surgery.
Topics: Adult; Female; Humans; Laser Therapy; Treatment Outcome; Varicose Veins
PubMed: 30231633
DOI: 10.1556/1046.71.2018.3.4 -
Phlebology Apr 2019To reach consensus on which complications of varicose vein treatments physicians consider major or minor, in order to standardize the informed consent procedure and... (Review)
Review
OBJECTIVE
To reach consensus on which complications of varicose vein treatments physicians consider major or minor, in order to standardize the informed consent procedure and improve shared decision-making.
METHODS
Using the e-Delphi method, expert physicians from 10 countries were asked to rate complications as "major" or "minor" on a 5-point Likert scale. Reference articles from a Cochrane review on varicose veins were used to compose the list of complications.
RESULTS
Participating experts reached consensus on 12 major complications: allergic reaction, cellulitis requiring intravenous antibiotics/intensive care, wound infection requiring debridement, hemorrhage requiring blood transfusion/surgical intervention, pulmonary embolism, skin necrosis requiring surgery, arteriovenous fistula requiring repair, deep venous thrombosis, lymphocele, thermal injury, transient ischemic attack/stroke, and permanent discoloration.
CONCLUSION
An international consensus was reached about what physicians consider to be major complications of varicose vein treatments. This consensus may assist in standardizing the information physicians discuss with patients prior to varicose vein treatment.
Topics: Consensus; Delphi Technique; Female; Hemorrhage; Humans; Male; Pulmonary Embolism; Varicose Veins; Venous Thrombosis
PubMed: 30012048
DOI: 10.1177/0268355518785482