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Journal of Vascular Surgery. Venous and... Jul 2023We assessed the mid-term efficacy and safety of thermal and nonthermal endovenous ablation for the treatment of lower limb superficial venous insufficiency. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We assessed the mid-term efficacy and safety of thermal and nonthermal endovenous ablation for the treatment of lower limb superficial venous insufficiency.
METHODS
We performed a systematic review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and a Bayesian network meta-analysis. The primary end points were great saphenous vein (GSV) closure and venous clinical severity score (VCSS) improvement. A meta-regression using GSV diameter as a covariate was undertaken for the two primary end points.
RESULTS
We included 14 studies and 4177 patients, with a mean follow-up of 25.7 months. Radiofrequency ablation (RFA; odds ratio [OR], 3.99; 95% confidence interval [CI], 1.82-10.53), cyanoacrylate ablation (CAC; OR, 3.09; 95% CI, 1.35-8.37), and endovenous laser ablation (EVLA; OR, 2.72; 95% CI, 1.23-7.38) displayed increased odds for GSV closure compared with mechanochemical ablation (MOCA). MOCA inferiority compared with RFA (mean difference [MD], 0.96; 95% CI, 0.71-1.20), EVLA (MD, 0.94; 95% CI, 0.61-1.24), and CAC (MD, 0.89; 95% CI, 0.65-1.15) was also depicted regarding VCSS improvement. EVLA resulted in an increased risk of postoperative paresthesia compared with MOCA (risk ratio [RR], 9.61; 95% CI, 2.32-62.29), CAC (RR, 7.90; 95% CI, 2.44-38.16), and RFA (RR, 6.96; 95% CI, 2.31-28.04). Although the overall analysis identified nonstatistically significant differences for Aberdeen varicose vein questionnaire score improvement, thrombophlebitis, ecchymosis, and pain, further investigation revealed an increase pain profile for EVLA at 1470 nm compared with RFA (MD, 3.22; 95% CI, 0.93-5.47) and CAC (MD, 3.04; 95% CI, 1.05-4.97). A sensitivity analysis displayed a persistent underperformance of MOCA compared with RFA (OR, 4.33; 95% CI, 1.15-55.54) for GSV closure and both RFA (MD, 0.99; 95% CI, 0.22-1.77) and CAC (MD, 0.84; 95% CI, 0.08-1.65) regarding VCCS improvement. Although no regression model reached statistical significance, the GSV closure regression model revealed a trend for considerably decreased efficacy for both CAC and MOCA with larger GSV diameters compared with RFA and EVLA.
CONCLUSIONS
Although our analysis has produced skepticism regarding the efficacy of MOCA in the mid-term period for VCSS improvement and GSV closure rates, CAC showed equivalent results compared with both RFA and EVLA. Additionally, CAC displayed a decreased risk of postprocedural paresthesia and pigmentation and induration compared with EVLA. Also, both RFA and CAC had an improved pain profile compared with EVLA 1470 nm. The potential underperformance of nonthermal, nontumescent ablation modalities in ablating large GSVs necessitates further research.
Topics: Humans; Network Meta-Analysis; Bayes Theorem; Paresthesia; Treatment Outcome; Venous Insufficiency; Saphenous Vein; Pain
PubMed: 37030442
DOI: 10.1016/j.jvsv.2023.03.011 -
Indian Journal of Dermatology 2022Previous studies have shown that erythema nodosum-like lesions in patients with Behçet's disease show cutaneous vasculitis of either phlebitis or dermal venulitis. To...
Previous studies have shown that erythema nodosum-like lesions in patients with Behçet's disease show cutaneous vasculitis of either phlebitis or dermal venulitis. To analyse the clinicopathological characteristics of superficial thrombophlebitis as well as cutaneous venulitis in Behçet's disease. We re-evaluated the histopathological features of superficial thrombophlebitis in patients with Behçet's disease. Five patients, one man and four women, developed superficial thrombophlebitis on the lower extremities. Two of the patients had vascular Behçet's disease, both also developed deep vein thrombosis. One patient had intestinal Behçet's disease. In all cases, venulitis in the overlying lower dermis or adjacent subcutis spreading from the main affected subcutaneous thrombophlebitis lesions was observed. Both neutrophilic venulitis (n = 2) and lymphocytic venulitis (n = 3) were observed at the same depth level or upper/lower location of the thrombophlebitis in the same specimens. In addition, concurrent venulitis with fibrin thrombus and fibrinoid necrosis was observed in one case, suggesting that fibrin thrombus affected both venules and muscular veins. By contrast, arteritis or arteriolitis at the same depth level was not observed. Our results showed histopathological features of coexistent thrombophlebitis and venulitis without involvement of either arteries or arterioles in the biopsied specimens of superficial thrombophlebitis. Further studies are necessary to support that those unique histopathological findings are the characteristic features and significant diagnostic indicators of Behçet's disease.
PubMed: 36998880
DOI: 10.4103/ijd.ijd_229_22 -
European Journal of Vascular and... Jun 2023
Topics: Humans; Thrombophlebitis; Foreign Bodies
PubMed: 36958481
DOI: 10.1016/j.ejvs.2023.03.031 -
Vascular and Endovascular Surgery Jul 2023Mondor's disease of the penis, or superficial thrombophlebitis affecting penile veins, is a rare condition. Common causes include prothombotic states, venous stasis or...
INTRODUCTION
Mondor's disease of the penis, or superficial thrombophlebitis affecting penile veins, is a rare condition. Common causes include prothombotic states, venous stasis or excessive manipulation. The literature includes one case report of Mondor's Disease after endovenous laser ablation and foam sclerotherapy and a case series after open saphenofemoral junction ligation. However, there have been no noted cases of this rare complication after mechanochemical ablation of the GSV.
CASE DETAILS
A 50-year-old man with bilateral great saphenous venous incompetence had truncal mechanochemical ablation of both above-knee GSV segments with the Clarivein device with adjunctive 1% Fibrovein foam to varicose tributaries. Day three post-operatively he began experiencing suprapubic pain and noted tender "cord-like" veins along the penile shaft. Duplex investigation of the penis demonstrated occlusive thrombus in the superficial veins draining into the dorsal vein of the penis. The patient was treated with 75 mg oral Clopidogrel for four weeks and his symptoms resolved without functional impairment.
CONCLUSIONS
Vascular surgeons should be aware that this rare albeit self-limiting thrombotic complication can occur after endovenous mechanochemical ablation of the great saphenous vein with adjunct foam sclerotherapy, particularly as this procedure is performed very frequently. Interestingly, the majority of reported cases have occurred after bilateral interventions. The patients can be reassured that their symptoms will likely settle and the use of anti-thrombotic therapy is largely at the surgeon's discretion.
Topics: Male; Humans; Middle Aged; Sclerotherapy; Varicose Veins; Treatment Outcome; Thrombophlebitis; Laser Therapy; Lower Extremity; Saphenous Vein; Venous Insufficiency
PubMed: 36683267
DOI: 10.1177/15385744231154329 -
Cureus Nov 2022A 60-year-old male patient presented to the emergency department of our hospital with right-sided chest wall pain and a palpable subcutaneous cord-like structure along...
A 60-year-old male patient presented to the emergency department of our hospital with right-sided chest wall pain and a palpable subcutaneous cord-like structure along the right anterior chest wall. Examination revealed tenderness over the cord-like structure, and the skin overlying the structure was freely mobile and did not have any sign of infection or inflammation. Bedside ultrasonography revealed an uncompressible tubular structure with the absence of a color Doppler flow signal. The patient's presentation was suggestive of Mondor's disease. The patient was discharged with instructions to utilize anti-inflammatory drugs, perform warm compresses, and seek primary care follow-up to ensure resolution. Mondor's disease is a rare disorder characterized by a superficial thrombophlebitis of the subcutaneous veins of the chest wall. For its diagnosis, a thorough examination of the patient's medical history and physical condition is suggested; further, the performance of point-of-care ultrasonography has also been suggested. Once recognized, further emergency department workup is typically unnecessary in cases of primary Mondor's disease. Despite being a mostly self-limited condition, greater awareness of this rare disease entity is required to ensure and coordinate close outpatient follow-up as well as monitor resolution due to its association with secondary causes such as vascular and breast carcinoma, vasculitis, and hypercoagulable disorders.
PubMed: 36579201
DOI: 10.7759/cureus.31894 -
The Israel Medical Association Journal... Dec 2022Data regarding risk factors for superficial thrombophlebitis (STP) cases presenting to a hospital is limited.
BACKGROUND
Data regarding risk factors for superficial thrombophlebitis (STP) cases presenting to a hospital is limited.
OBJECTIVES
To investigate and stratify clinical and laboratory risk factors for STP.
METHODS
We conducted a retrospective case control study comparing patients presenting to the emergency department with STP and age- and gender-matched controls. We collected data on multiple risk factors and five blood indices.
RESULTS
The study comprised 151 patients and matched controls. Patients with STP were more likely to have varicose veins (43.7% vs. 5.3%, P < 0.001), recent immobilization (14.6% vs. 1.3%, P < 0.001), obesity (36.4% vs. 18.5%, P = 0.001), a history of venous thromboembolism (VTE) or STP (27.2% vs. 0.7%, P < 0.001), and inherited thrombophilia (9.3% vs. 1.3%, P = 0.002). Following multivariate analysis, all five risk factors remained significant, with a history of VTE or STP associated with the largest risk (odds ratio [OR] 35.7), followed by immobilization (OR 22.3), varicose veins (OR 12.1), inherited thrombophilia (OR 6.1), and obesity (OR 2.7). Mean platelet volume was higher (8.5 vs 7.9 fl, P = 0.003) in STP cases.
CONCLUSIONS
A history of VTE or STP, immobilization, varicose veins, inherited thrombophilia, and obesity serve as independent clinical risk factors for STP presenting to hospital.
Topics: Humans; Retrospective Studies; Case-Control Studies; Venous Thromboembolism; Thrombophlebitis; Risk Factors; Varicose Veins; Obesity; Thrombophilia
PubMed: 36573782
DOI: No ID Found -
The Journal of the Royal College of... Mar 2023Inflammatory bowel disease (IBD) is recognised to be a prothrombotic state and an increased risk of venous thrombosis has been documented with IBD. However, reports of...
Inflammatory bowel disease (IBD) is recognised to be a prothrombotic state and an increased risk of venous thrombosis has been documented with IBD. However, reports of superficial venous thrombosis are less common, and there is a degree of uncertainty in the appropriate management of such patients. We report about a 55-year-old lady who presented with a flare of ulcerative colitis when cyclosporine (started for a previous episode of acute severe ulcerative colitis) was stopped. This flare was associated with the appearance of cord-like structures on the right lateral abdominal wall, which were confirmed to be thrombosed veins consistent with Mondor's disease. The patient did not have additional predisposing factors and carcinoma breast was excluded.
Topics: Female; Humans; Middle Aged; Colitis, Ulcerative; Thrombophlebitis; Venous Thrombosis; Breast Neoplasms; Inflammatory Bowel Diseases
PubMed: 36544351
DOI: 10.1177/14782715221145615 -
Frontiers in Immunology 2022In the broad range of human diseases, thrombo-inflammation appears as a clinical manifestation. Clinically, it is well characterized in context of superficial... (Review)
Review
In the broad range of human diseases, thrombo-inflammation appears as a clinical manifestation. Clinically, it is well characterized in context of superficial thrombophlebitis that is recognized as thrombosis and inflammation of superficial veins. However, it is more hazardous when developed in the microvasculature of injured/inflamed/infected tissues and organs. Several diseases like sepsis and ischemia-reperfusion can cause formation of microvascular thrombosis subsequently leading to thrombo-inflammation. Thrombo-inflammation can also occur in cases of antiphospholipid syndrome, preeclampsia, sickle cell disease, bacterial and viral infection. One of the major contributors to thrombo-inflammation is the loss of normal anti-thrombotic and anti-inflammatory potential of the endothelial cells of vasculature. This manifest itself in the form of dysregulation of the coagulation pathway and complement system, pathologic platelet activation, and increased recruitment of leukocyte within the microvasculature. The role of platelets in hemostasis and formation of thrombi under pathologic and non-pathologic conditions is well established. Platelets are anucleate cells known for their essential role in primary hemostasis and the coagulation pathway. In recent years, studies provide strong evidence for the critical involvement of platelets in inflammatory processes like acute ischemic stroke, and viral infections like Coronavirus disease 2019 (COVID-19). This has encouraged the researchers to investigate the contribution of platelets in the pathology of various thrombo-inflammatory diseases. The inhibition of platelet surface receptors or their intracellular signaling which mediate initial platelet activation and adhesion might prove to be suitable targets in thrombo-inflammatory disorders. Thus, the present review summarizes the concept and mechanism of platelet signaling and briefly discuss their role in sterile and non-sterile thrombo-inflammation, with the emphasis on role of platelets in COVID-19 induced thrombo-inflammation. The aim of this review is to summarize the recent developments in deciphering the role of the platelets in thrombo-inflammation and discuss their potential as pharmaceutical targets.
Topics: Humans; Female; Pregnancy; Endothelial Cells; Ischemic Stroke; COVID-19; Blood Platelets; Inflammation
PubMed: 36451834
DOI: 10.3389/fimmu.2022.1039843