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Computational and Mathematical Methods... 2022To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities. (Comparative Study)
Comparative Study Observational Study
Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study.
OBJECTIVE
To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities.
METHODS
Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups.
RESULTS
There were no significant differences in baseline characteristics between the two groups ( > 0.05). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group ( > 0.05). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group ( < 0.05). There were no significant differences in recurrent varicose vein incidences ( > 0.05). After surgery, the venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation ( < 0.05). There was no significant difference in VCSS score or CIVIQ-14 scores between the two groups postoperation ( > 0.05). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively.
CONCLUSION
The modified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modified above-knee technique is worthy of clinical application.
Topics: Adult; Aged; Computational Biology; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Recurrence; Retrospective Studies; Saphenous Vein; Ultrasonography, Doppler, Color; Varicose Veins; Vascular Surgical Procedures
PubMed: 35069794
DOI: 10.1155/2022/7730960 -
EBioMedicine Feb 2015Clinical assessment and prognostic stratification of primary varicose veins have remained controversial and the molecular pathogenesis is unknown. Previous data have... (Clinical Trial)
Clinical Trial
BACKGROUND
Clinical assessment and prognostic stratification of primary varicose veins have remained controversial and the molecular pathogenesis is unknown. Previous data have suggested a contribution of the MTHFR (methylenetetrahydrofolate reductase) polymorphism c.677C>T.
METHODS
We collected blood and vein specimens from 159 consecutive patients undergoing varicose vein surgery, or autologous vein reconstruction for arterial occlusive disease as controls. We compared the frequencies of c.677C>T and another polymorphism of MTHFR, c.1298A>C, with morphology and types of complicated disease. Morphology was recorded as a trunk or perforator type and peripheral congestive complication was defined as chronic venous insufficiency (CEAP C3-6) associated with edema and skin manifestations.
FINDINGS
Multivariate analysis of genotypes for c.677C>T and c.1298A>C indicated that c.677C>T was associated significantly with the trunk phenotype (43/53 patients, 81%, p < 0.01), while c.1298A>C was associated significantly with the perforator phenotype (18/24 patients, 75%, p < 0.01) of primary varicose veins. Accordingly, when both c.677C>T and c.1298A>C displayed a heterozygous genotype, the patients were more likely to present with both phenotypes. Additionally, c.1298A>C was found to be strongly linked to the congestive complication (34/51 patients, 67%, p < 0.01).
INTERPRETATION
Both polymorphisms of MTHFR may be involved in the morphological specification of primary varicose veins and contribute to the development of complicated disease.
FUNDING
None.
Topics: Chronic Disease; Female; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Polymorphism, Genetic; Varicose Veins
PubMed: 26137554
DOI: 10.1016/j.ebiom.2015.01.006 -
Polski Przeglad Chirurgiczny Apr 2022To investigate the influence of iliac vein stenosis on clinical course and recurrence of primary varicose veins after surgeryMaterials and methods: Thirty-three patients...
INTRODUCTION
To investigate the influence of iliac vein stenosis on clinical course and recurrence of primary varicose veins after surgeryMaterials and methods: Thirty-three patients with primary varicose veins qualified for great saphenous vein stripping were analysed. The stenosis of common (CIV) and external (EIV) iliac vein was measured by IVUS and defined in three categories as minimal lumen area <90 mm2 for CIV and <75 mm2 for EIV, minimal lumen diameter <10 mm for CIV and <7.5 mm for EIV and area reduction >50%. The patients were assessed clinically and by Duplex ultrasound 48 to 72 months after the procedure. Any recurrence, the recurrence in the saphenofemoral junction (SFJ), change in Venous Clinical Severity Score ( VCSS), were analyzed in relation to the stenosis in the CIV and EIV.
RESULTS
The follow-up was completed in 27 patients. Any recurrence and the recurrence in the SFJ were observed in 70% and 18.5% of patients, respectively. There were no statistically significant differences in any recurrence, the recurrence in the SFJ and VCSS in relation to CIV and EIV stenosis in any category.
CONCLUSIONS
Iliac vein stenosis does not influence the clinical course and recurrence of primary varicose veins after surgery.
Topics: Humans; Iliac Vein; Constriction, Pathologic; Recurrence; Varicose Veins; Disease Progression; Treatment Outcome
PubMed: 36807090
DOI: 10.5604/01.3001.0015.8210 -
Value in Health : the Journal of the... Aug 2018To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS],... (Review)
Review
OBJECTIVES
To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years.
METHODS
A Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers' list prices. Univariate and probabilistic sensitivity analyses were undertaken.
RESULTS
CONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was £5,148/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures.
CONCLUSIONS
At a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.
Topics: Ablation Techniques; Conservative Treatment; Cost-Benefit Analysis; Elective Surgical Procedures; Humans; Laser Therapy; Markov Chains; Sclerotherapy; Varicose Veins
PubMed: 30098668
DOI: 10.1016/j.jval.2018.01.012 -
The Cochrane Database of Systematic... Jun 2013Varicose vein surgery is a common surgical procedure but there is no consensus regarding the best surgical technique. The use of tourniquets during varicose vein surgery... (Review)
Review
BACKGROUND
Varicose vein surgery is a common surgical procedure but there is no consensus regarding the best surgical technique. The use of tourniquets during varicose vein surgery has been advocated as a means of reducing the potential for blood loss during the operation.
OBJECTIVES
To identify whether the use of a tourniquet should be recommended when undertaking surgery for the management of primary varicose veins.
SEARCH METHODS
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2013) and the CENTRAL (2013, Issue 3).
SELECTION CRITERIA
All studies described as randomised controlled trials that examined the use of tourniquets during surgery for patients with primary varicose veins were included.
DATA COLLECTION AND ANALYSIS
Data from eligible studies were extracted and summarised independently by two authors. All studies were cross-checked independently by the authors.
MAIN RESULTS
No additional studies were included or excluded in the updated review. Twenty papers detailing 18 trials were considered. Only three trials were randomised controlled trials and were included in the review. The remaining fifteen studies were excluded for various reasons. All three included trials had a small sample size and reported the trial design, outcome measures and analysis poorly. There were also variations in the outcome measures used between the trials. In addition, there was no consistency on the reporting of mean and medians for blood loss during the operation. It was therefore not possible to pool the data to perform meta-analysis. However, the reported blood loss when using a tourniquet was between 0 and 16 ml compared to between 107 to 133 ml when not using a tourniquet (P < 0.01).
AUTHORS' CONCLUSIONS
Although there were significant quality issues with the available evidence, the use of a tourniquet would appear to reduce blood loss during surgery. There were no reported differences between the use or non-use of a tourniquet in terms of complications and morbidity. However, the available trials were not of sufficient size to detect rarer complications such as nerve damage.
Topics: Blood Loss, Surgical; Humans; Randomized Controlled Trials as Topic; Tourniquets; Varicose Veins
PubMed: 23749738
DOI: 10.1002/14651858.CD001486.pub2 -
European Journal of Vascular and... Dec 2013It has been suggested that the Aberdeen Varicose Vein Questionnaire (AVVQ) could be used to help inform a patient pathway for referral and treatment of varicose veins....
OBJECTIVES
It has been suggested that the Aberdeen Varicose Vein Questionnaire (AVVQ) could be used to help inform a patient pathway for referral and treatment of varicose veins. We aimed to determine 1) which patient and vein characteristics affected the AVVQ score, and 2) whether scores differed between those who were and were not offered treatment.
METHODS
Patients completed the AVVQ at the clinic prior to being seen. Treatment was offered to patients with symptoms, and duplex detected truncal incompetence by surgeons blinded to the score.
RESULTS
A total of 228 consecutive patients completed the AVVQ: 199 were valid questionnaires. On multivariate analysis, factors associated with a worse quality of life were female gender (p = .034, 3.14 mean unit increase in AVVQ), and bilateral varicose veins (10.25 unit increase, p < .001). For patients with C2 disease, only the presence of bilateral veins was significant. Overall, the AVVQ score was higher in those patients offered treatment than in those who were not (mean 20.3 [SD = 9.9] vs. 17.3 [SD = 10.3], p = .023), which equates to a 2.74 unit increase. This was not significant in patients with C2 disease.
CONCLUSION
It is unlikely that a threshold AVVQ score could be used to aid referral of patients with C2 disease. The distribution of veins (unilateral vs. bilateral) must be adjusted for when reporting AVVQ scores.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Multivariate Analysis; Quality of Life; Referral and Consultation; Severity of Illness Index; Sex Factors; Surveys and Questionnaires; Varicose Veins; Venous Insufficiency; Young Adult
PubMed: 24119467
DOI: 10.1016/j.ejvs.2013.08.019 -
Revista Da Associacao Medica Brasileira... Aug 2018This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction...
OBJECTIVE
This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose.
METHOD
This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers.
RESULTS
The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings.
CONCLUSIONS
The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease's clinical severity or reflux in the SFJ on a Doppler ultrasound.
Topics: Adult; Age Factors; Aged; Chronic Disease; Female; Femoral Vein; Humans; Male; Middle Aged; Prospective Studies; Saphenous Vein; Severity of Illness Index; Ultrasonography, Doppler, Color; Varicose Veins; Venous Insufficiency; Young Adult
PubMed: 30673044
DOI: 10.1590/1806-9282.64.08.729 -
Interactive Cardiovascular and Thoracic... Jan 2021We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2...
OBJECTIVES
We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits.
METHODS
A total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge.
RESULTS
There was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55).
CONCLUSIONS
Varicose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.
Topics: Adult; Aged; Female; Humans; Laser Therapy; Male; Middle Aged; Recurrence; Time Factors; Treatment Outcome; Varicose Veins
PubMed: 33212479
DOI: 10.1093/icvts/ivaa219 -
African Health Sciences Sep 2023This research was devoted to estimate the outcome of preventive nursing intervention on venous thromboembolism (VTE) after varicose vein surgery in lower extremities.
OBJECTIVE
This research was devoted to estimate the outcome of preventive nursing intervention on venous thromboembolism (VTE) after varicose vein surgery in lower extremities.
METHODS
A total of 516 subjects with varicose veins of lower extremities (from January 2020 to January 2022) treated in our hospital were separated into observation subgroup (n = 258) and control subgroup (n = 258) at random. The conventional nursing intervention was applied in the control subgroup, preventive nursing intervention, prophylactic anticoagulation and the use of Caprini score was applied in the observation subgroup. The levels of blood indexes [hemoglobin (Hb), platelet (PLT) and D-dimer (D-D)] were compared between the two subgroups before operation and 7 days postoperative, the occurrence of subcutaneous congestion, lower limb swelling and pain, VTE and nursing satisfaction of the subject 4 (four) weeks after discharge.
RESULTS
After intervention, the levels of PLT and D-D in the observation subgroup were notably lower than those in the control subgroup. Four weeks after discharge, the incidence of subcutaneous congestion, lower limb swelling and pain, there had no notable difference in two subgroups Versus the control subgroup, VTE in the observation subgroup was notably lower and nursing satisfaction was higher.
CONCLUSION
Preventive nursing intervention can reduce the level of PLT and D-D, restrain in the incidence of VTE and improve the nursing satisfaction of subjects with varicose veins of lower extremities after varicose vein surgery of lower limb.
Topics: Humans; Venous Thromboembolism; Risk Assessment; Risk Factors; Anticoagulants; Varicose Veins; Pain; Retrospective Studies
PubMed: 38357111
DOI: 10.4314/ahs.v23i3.72 -
The British Journal of Surgery Jan 2023Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins....
BACKGROUND
Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins. In the National Health Service (NHS) in England, commissioning of care for people with varicose veins is performed by Clinical Commissioning Groups (CCGs) and clinical guidelines have been developed by the National Institute for Health and Care Excellence (NICE CG168). The Evidence-Based Intervention (EBI) programme was introduced in the NHS with the aim of improving care quality and supporting implementation of NICE CG168. The aim of this study was to assess access to varicose vein treatments in the NHS and the impact of EBI.
METHODS
CCG policies for the delivery of varicose vein treatments in the NHS in England were obtained from 2017 (before EBI introduction) and 2019 (after EBI introduction) and categorized by two independent reviewers into levels of compliance with NICE CG168. Hospital Episode Statistics data were compared with the NICE commissioning model predictions. A quality-adjusted life-year was valued at £20 000 (Euro 23 000 15 November 2022).
RESULTS
Despite the introduction of the EBI programme, CCG compliance with NICE CG168 fell from 34.0 per cent (64 of 191) to 29.0 per cent (55 of 191). Some 33.0 per cent of CCG policies (63 of 191) became less compliant and only 7.3 per cent (14 of 191) changed to become fully compliant. Overall, 66.5 per cent of CCGs (127 of 191) provided less than the recommended intervention rate before EBI and this increased to 73.3 per cent (140 of191) after EBI. The overall proportion of patients estimated to require treatment annually who received treatment fell from 44.0 to 37.0 per cent. The associated estimated loss in net health benefit was between £164 and 174 million (Euro 188 million and 199 million 15 November 2022) over 3 years. A compliant policy was associated with a higher intervention rate; however, commissioning policy was associated with only 16.8 per cent of the variation in intervention rate (R2 = 0.168, P < 0.001).
CONCLUSION
Many local varicose vein commissioning policies in the NHS are not compliant with NICE CG168. More than half of patients who should be offered varicose vein treatment are not receiving it, and there is widespread geographical variation. The EBI programme has not been associated with any improvement in commissioning or access to varicose vein treatment.
Topics: Humans; State Medicine; England; Varicose Veins; Surveys and Questionnaires; Quality of Health Care
PubMed: 36448204
DOI: 10.1093/bjs/znac392