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Diagnostic and Interventional Radiology... Mar 2022PURPOSE The aim of this meta-analysis is to summarize the diagnostic accuracies of point shear wave elas- tography (pSWE) and two-dimensional (2D) SWE for esophageal... (Meta-Analysis)
Meta-Analysis
PURPOSE The aim of this meta-analysis is to summarize the diagnostic accuracies of point shear wave elas- tography (pSWE) and two-dimensional (2D) SWE for esophageal varices (EV) and varices needing treatment (VNT). METHODS We conducted a systematic review and meta-analysis of diagnostic accuracy studies. We searched for studies reporting the EV and VNT diagnostic accuracy of pSWE and 2D SWE using PubMed Cen- tral, SCOPUS, MEDLINE, Embase, and Cochrane databases. STATA software"Midas"package was used for meta-analysis. RESULTS A total of 24 studies with 3867 patients were included in the review. Pooled score sensitivities of pSWE were 91% (95% CI, 80%-96%) for EV, and 94% (95% CI, 86%-97%) for VNT. Pooled score sensi- tivities of 2D SWE were 78% (95% CI, 69%-85%) for EV, and 79% (95% CI, 72%-85%) for VNT. Pooled score specificities of pSWE were 70% (95% CI, 60%-78%) for EV, and 59% (95% CI, 40%-75%) for VNT. Pooled score specificities of 2D SWE for EV were 79% (95% CI, 72%-85%) 72% (95% CI, 66%-77%) for VNT. We found significant heterogeneity for all the elastography-based measurements with the chi- square test results and an I2 statistic >75%. CONCLUSION Both pSWE and 2D SWE can diagnose EV and VNT with moderate diagnostic accuracy. Further large- scale setting-specific longitudinal studies are required to establish the best modality.
Topics: Elasticity Imaging Techniques; Esophageal and Gastric Varices; Humans; Liver Cirrhosis; Varicose Veins
PubMed: 35548898
DOI: 10.5152/dir.2022.21730 -
Phlebology Aug 2022To verify the differences in ankle range of motion (ROM), muscle strength of dorsi and plantar flexors, and gait speed among healthy subjects, and patients with chronic... (Meta-Analysis)
Meta-Analysis
Impairments in ankle range of motion, dorsi and plantar flexors muscle strength and gait speed in patients with chronic venous disorders: A systematic review and meta-analysis.
OBJECTIVE
To verify the differences in ankle range of motion (ROM), muscle strength of dorsi and plantar flexors, and gait speed among healthy subjects, and patients with chronic venous disorders (CVD) with and without venous leg ulcer.
METHODS
A systematic review and meta-analysis (http://osf.io/b7n3k) were conducted following a search of MEDLINE, Web of Science, CINAHL, LILACS, Scopus, and EMBASE databases.
RESULTS
Eight papers were included. The ankle ROM was significantly lower both in dorsiflexion and plantar flexion in patients with venous leg ulcer when compared to healthy individuals and CVD patients without venous leg ulcer. The muscle strength of the plantar flexors and gait speed were reduced in CVD patients when compared to healthy ones.
CONCLUSION
Impaired muscle strength and gait speed can be detected in CVD patients compared to healthy individuals, and ankle ROM tends to be reduced in CVD patients even in the absence of venous leg ulcers.
Topics: Ankle; Chronic Disease; Gait; Humans; Muscle Strength; Muscle, Skeletal; Range of Motion, Articular; Varicose Ulcer; Vascular Diseases; Walking Speed
PubMed: 35506743
DOI: 10.1177/02683555221094642 -
Vascular Oct 2023Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if... (Review)
Review
OBJECTIVES
Few studies have reported on the safety and durability of adipose-derived stem cells (ADSCs) to support healing in patients with venous leg ulcers (VLU). To establish if there is any evidence to support ADSC use in VLU patients, a systematic review was conducted.
METHODS
A systematic review was conducted following the PRISMA guidelines. PubMed and Embase databases were searched for relevant papers. References from retrieved papers were reviewed to identify any extra eligible studies.
RESULTS
After duplicate removal, 950 papers were screened for eligibility of which 932 were excluded based on title and abstract. Four papers were included in the final analysis (one randomised study and three non-randomised studies). 66 patients in total received ADSCs for VLU treatment. The only randomised paper reported 6-month healing rates of 75% with ADSCs compared to 50% in controls. 100% healing was achieved in one study. The remaining 2 studies reported 25% and 58% healing; however, they included patients with relatively large VLUs. Pain scores decreased after ADSCs application where reported. No serious procedure related complications were reported.
CONCLUSION
ADSCs may enhance ulcer healing in patients with chronic VLU and appears safe based on initial reports. Large, randomised trials are needed to definitively establish the technique's role in VLU patients.
Topics: Humans; Varicose Ulcer; Ulcer; Wound Healing; Stem Cells
PubMed: 35491989
DOI: 10.1177/17085381221098279 -
Phlebology Aug 2022This study examines the influence of Earth's gravity field on the prevalence of varicose veins in geophysical area.
AIM
This study examines the influence of Earth's gravity field on the prevalence of varicose veins in geophysical area.
MATERIAL AND METHODS
We performed a systematic review (OVID and Google Scholar) of studies focusing on prevalence of varicose veins to determine the influence of Earth's gravity field-GRACE GGM05S gravity model-on the disease prevalence. PROSPERO: CRD42021279513.
RESULTS
81 studies met inclusion and quality criteria. Areas with stronger gravity have significantly higher prevalence of varicose veins with adjustment for age, gender and body mass index (BMI) (-values < 0.02). Adjusted for age, prevalence of varicose veins in areas with gravity field +20 mGal and more is 1.37 time higher than in areas with gravity field less than +20 mGal, -value 0.005 (95% CI: -12.5 to -2.4): mean disease prevalence for gravity field +20 mGal and more-27.5% (mean age, 40.1 years; mean gravity field, +27.1 mGal; 63.9% females, 37 studies, 123,164 participants) vs mean disease prevalence for gravity field less than +20 mGal - 20.1% (mean age, 42.2 years; mean gravity field, +5.7 mGal; 56.8% females, 44 studies, 205,925 participants). Older age is the main risk factor for varicose veins (-values < 0.005). Female gender and high BMI are insignificantly associated with high prevalence of varicose veins (-values > 0.4 for gender, -values > 0.2 for BMI).
CONCLUSION
Stronger gravity field is significantly associated with higher prevalence of varicose veins-risk factor. The potential mechanism of this phenomenon is that high gravity field alters systemic venous return, pooling blood and fluid in the peripheral, gravity-dependent regions of the body in upright humans constantly living in the defined geophysical area.
Topics: Adult; Body Mass Index; Chronic Disease; Female; Humans; Male; Prevalence; Risk Factors; Varicose Veins
PubMed: 35471106
DOI: 10.1177/02683555221090054 -
Journal of Vascular Surgery. Venous and... Sep 2022Minimally invasive techniques have been increasingly used to treat pathologic perforator veins (PVs). The goal of the present study was to summarize the current... (Review)
Review
OBJECTIVE
Minimally invasive techniques have been increasingly used to treat pathologic perforator veins (PVs). The goal of the present study was to summarize the current literature and determine the outcomes of treating PVs with or without the great saphenous vein/small saphenous vein using endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided sclerotherapy (USGS).
METHODS
A systematic review of the literature on the percutaneous treatment of PVs (35 studies) was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Studies reported up to March 2020 were included. The incidence of several end points at different follow-up periods were calculated according to the availability of data within 3 to 12 months after the index procedure.
RESULTS
Of the 35 studies, 15 (n = 1677) had reported on EVLA with or without sclerotherapy and/or microphlebectomy, 12 (n = 1477) had investigated the outcomes of RFA ablation with/without sclerotherapy, and 8 (n = 331) had investigated USGS alone. All techniques were safe in terms of periprocedural adverse events, with only a few complications occurring in each group. Immediate procedural success (within 30 days) was 95% in the EVLA group, 91% in the RFS group, and 58% to 70% in the USGS group. At 12 months of follow-up, the occlusion rates were 89%, 77%, and 83% in the EVLA, RFA, and USGS groups, respectively. The 12-month pooled estimate of ulcer healing between the EVLA and RFA groups was similar, although no direct comparisons were performed.
CONCLUSIONS
Treatment of PVs with percutaneous techniques, such as EVLA, RFA, and USGS, is safe and associated with high technical success. EVLA and RFA exhibited the most favorable outcomes. Additional research is needed to validate these results, which were based on the limited level of evidence available to better determine the most optimal treatment approach for lower limb pathologic PVs.
Topics: Catheter Ablation; Humans; Laser Therapy; Saphenous Vein; Sclerotherapy; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 35364302
DOI: 10.1016/j.jvsv.2022.03.005 -
Alimentary Pharmacology & Therapeutics May 2022The presence of esophageal varices is considered a relative contraindication to transesophageal echocardiography (TEE) by cardiology professional societies, so... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The presence of esophageal varices is considered a relative contraindication to transesophageal echocardiography (TEE) by cardiology professional societies, so gastroenterologists are often consulted to perform upper endoscopy prior to TEE in patients with cirrhosis.
AIM
To perform a systematic review to quantify the risk of bleeding complications in patients with cirrhosis following TEE.
METHODS
Two reviewers searched Ovid MEDLINE, MEDLINE In-Process and EMBASE databases from January 1992 to May 2021 for studies reporting bleeding complications from TEE in patients with cirrhosis. We calculated the pooled incidence rate of bleeding events using the metaprop command with a random effect model.
RESULTS
We identified 21 studies comprising 4050 unique patients with cirrhosis; 9 studies (n = 3015) assessed the risk of intraoperative TEE during liver transplant (LT) and 12 studies (n = 1035) assessed bleeding risk in patients undergoing TEE for other indications. The pooled incidence of bleeding post-TEE was 0.37% (95% CI 0.04-0.94%) across all studies. Bleeding complications were low among patients undergoing TEE during LT as well as those undergoing TEE for other diagnostic reasons (0.97% vs. 0.004%) and among studies with mean MELD >18 compared to those with mean MELD <18 (0.43% vs. 0.08%). Few studies had a comparator arm, and data on patient-level factors impacting bleeding complications (including degree of liver dysfunction and coagulopathy) were limited across studies.
CONCLUSIONS
The risk of bleeding complications following TEE is low in patients with cirrhosis, suggesting TEE is safe and risk stratification with upper endoscopy may not be necessary.
Topics: Echocardiography, Transesophageal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Incidence; Liver Cirrhosis; Varicose Veins
PubMed: 35343613
DOI: 10.1111/apt.16860 -
Advances in Wound Care Jun 2023Percent area reduction (PAR) is commonly reported in trials including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). It is unclear how well PAR performs as a... (Review)
Review
Percent area reduction (PAR) is commonly reported in trials including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). It is unclear how well PAR performs as a surrogate marker for complete wound closure. This review aimed to summarize all available evidence evaluating PAR as a predictor of complete DFU and VLU healing. A review searching the CENTRAL, MEDLINE, EMBASE, and EMCARE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Randomized-controlled trials and observational studies reporting PAR and any measure of its predictive ability were included. Outcomes included performance measures of PAR, timing of PAR, outcome measurement, and specific PAR cutoffs. Meta-analysis was not possible due to high variability in wound duration at study start (2-48 weeks), PAR timing (2-8 weeks), PAR cutoff (-3% to 90%; determined in most studies), and outcome assessment (10-24 weeks). Six studies (21,430 DFU patients) report PAR as having acceptable to outstanding discriminatory ability (C-statistic 0.720-0.910). Five studies (29,775 VLU patients) report PAR as having poor to excellent discriminatory ability (C-statistic 0.680-0.830). One study (241 DFU and VLU patients) reports PAR sensitivity and specificity of 58.5% and 90.5%, respectively. All studies were determined to have high risk of bias. Despite promising discriminatory ability, most studies report analysis of patients in randomized trials, are highly heterogenous in study design, and have high risk of bias. There is scant evidence to support PAR in isolation as a surrogate for complete DFU or VLU healing in routine clinical practice.
Topics: Humans; Prognosis; Diabetic Foot; Varicose Ulcer; Wound Healing; Diabetes Mellitus
PubMed: 35343244
DOI: 10.1089/wound.2021.0203 -
Journal of Vascular Surgery. Venous and... Jul 2022Incompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Incompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification. The objective of the present study was to systematically review and synthesize the current literature regarding the surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation, ultrasound-guided sclerotherapy, and radiofrequency ablation.
METHODS
English-language literature reported before November 2021 was reviewed from the PubMed, EMBASE, and MEDLINE databases for primary studies reporting safety and efficacy outcomes in the surgical treatment of IPVs. Study quality and risk of bias were assessed using the Cochrane risk of bias tool for comparative studies and a modified version of the Newcastle-Ottawa scale for noncomparative studies. A random effects model was used to pool the effect sizes for efficacy outcomes of wound healing and freedom from wound recurrence.
RESULTS
A total of 81 studies were included for qualitative synthesis, representing 7010 patients, with a mean age of 54.7 years. The overall evidence quality was low to intermediate, with a moderate to high risk of bias in the comparative studies. An 11.3% complication rate was found across the interventions, with no reported incidence of stroke or air embolism. Regarding efficacy, the pooled estimates for short-term (≤1 year) wound healing were 99.9% for ultrasound-guided sclerotherapy (95% confidence interval [CI], 0.81%-1%), 72.2% for open ligation (95% CI, 0.04%-0.94%), and 96.0% for SEPS (95% CI, 0.79%-0.99%). For short-term freedom from wound recurrence, the pooled estimate for SEPS was 91.0% (95% CI, 0.3%-0.99%).
CONCLUSIONS
The current evidence regarding the treatment of IPVs is limited owing to the low adherence to reporting standards in the observational studies and the lack of randomization, blinding, and allocation concealment in the comparative studies. Additional comparative studies are needed to guide clinical decision-making regarding the invasive treatment options for IPVs.
Topics: Humans; Middle Aged; Sclerotherapy; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures; Veins; Venous Insufficiency
PubMed: 35217217
DOI: 10.1016/j.jvsv.2021.12.088 -
JPMA. the Journal of the Pakistan... Feb 2022To assess the types and effectiveness of simulators present for open varicose vein surgery.
OBJECTIVE
To assess the types and effectiveness of simulators present for open varicose vein surgery.
METHODS
The systematic review was conducted at The Aga Khan University Hospital Karachi and comprised studies published from 1st January 2000 to 30th June 2020 related to open varicose vein surgical procedures done on simulators. Databases searched were PubMed, Medline, Google Scholar, Cochrane and Scopus using appropriate key words. The primary outcome of the review was to assess the effectiveness of different types of simulators used for varicose vein surgery.
RESULTS
Of the 286 articles found, 6(2%) were included. A variety of simulators ranging from animal models, homemade simulators and commercially designed models with high fidelity options had been used. Technical competence was the major domain assessed in most of the studies 5(83.3%), while 1(16.6%) study focussed on self-assessment. Blinding was done in 4(66.6%) studies for assessment purpose, and videorecording of the trainees' performance was done in 5(83.3%) studies. Most studies 4(66.6%) found the use of simulation to be an effective tool in achieving technical competence.
CONCLUSION
The use of simulation in the training of surgical residents for open varicose vein surgery was found to be beneficial, but most studies were heterogeneous in terms of design, simulator types and study participants. This makes it difficult to establish the superiority of any one type of simulator over the rest. Further research is needed to develop and validate simulators in open varicose vein surgery procedures.
Topics: Animals; Clinical Competence; Humans; Pakistan; Simulation Training; Varicose Veins; Vascular Surgical Procedures
PubMed: 35202370
DOI: 10.47391/JPMA.AKU-10 -
Journal of Wound Care Feb 2022is a Gram-negative bacillus that commonly colonises lower limb venous ulcers. Its effects on venous ulcer healing are widely debated. It produces exotoxins and...
OBJECTIVE
is a Gram-negative bacillus that commonly colonises lower limb venous ulcers. Its effects on venous ulcer healing are widely debated. It produces exotoxins and elastase, as well as forming biofilms in hard-to-heal wounds. It is postulated that these virulence factors lead to slower healing times in patients with lower limb venous ulcers colonised with . This review aimed to summarise the available evidence pertaining to this topic.
METHOD
A systematic review was performed in August 2019, where the Pubmed, Cochrane and Embase databases were searched for relevant literature according to PRISMA guidelines. Retrospective and prospective studies examining the effect of colonisation on any measure of ulcer healing were included.
RESULTS
Some 282 articles were screened, of which seven studies including 491 patients were ultimately included for analysis. Of these, no study demonstrated a significant association between colonisation and delayed healing of venous ulcers. In five of the seven studies, the effect of on initial ulcer size at presentation was recorded.
CONCLUSION
All the studies demonstrated an association between ulcer size and the presence of . While may colonise larger ulcers or those with a worse prognosis, no evidence was found to support the hypothesis that this colonisation had a negative impact on lower limb venous ulcer healing.
Topics: Humans; Lower Extremity; Prospective Studies; Pseudomonas aeruginosa; Retrospective Studies; Ulcer; Varicose Ulcer
PubMed: 35148629
DOI: 10.12968/jowc.2022.31.2.186