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Journal of Vascular Surgery. Venous and Lymphatic Disorders

Emire Seyahi, Migena Gjoni, Emine Şebnem Durmaz, Serkan Akbaş, Necdet Sut, Atilla Süleyman Dikici, Ismail Mihmanli, Hasan Yazici
OBJECTIVE: Lower extremity (LE) deep venous thrombosis (DVT) is the main feature of vascular involvement in Behçet disease (BD). We thought that vein wall thickness (VWT) could be a surrogate marker for venous inflammation and hence predict future vascular involvement. We assessed VWT in proximal LE veins in BD patients without DVT, BD patients with DVT, and healthy controls in a formal, masked protocol. METHODS: We studied 50 (43 male and 7 female) BD patients with LE DVT (group 1), 50 (43 male and 7 female) BD patients without any vascular involvement (group 2), and 50 (43 male and 7 female) age- and sex-matched apparently healthy controls (group 3)...
February 15, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Julie Bitner, Ulka Sachdev, Eric S Hager, Ellen D Dillavou
BACKGROUND: Venous ulcers are painful, recurrent, and difficult to heal. Electronic medical records (EMRs) are often not optimized to track wounds. Specialized wound care programs may not interface with office-based records, creating a need to standardize the process of venous ulcer measurement and dressing documentation within existing systems. This work describes the creation of an EMR protocol to track venous ulcer size, to standardize dressings, to address related health issues, and to improve education of the patient...
February 15, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Sangchul Yun
OBJECTIVE: Preoperative mapping of great saphenous vein (GSV) escape points to tributary veins (TVs) and targeted intervention of escape points may reduce recurrence rates of varicose veins (VVs) after endovascular treatment of saphenous veins and prevent saphenous nerve complications. The aim of this study was to perform an analysis of cartography after Doppler ultrasound mapping of escape points in patients with VVs and to suggest one point that may prevent recurrence and nerve complications...
February 15, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Ross M Clark, Dyann Weingardt, James M Goff, Erika R Ketteler
OBJECTIVE: Vascular laboratory (VL) venous duplex ultrasound is the "gold standard" for diagnosis of lower extremity deep venous thrombosis (DVT), which is linked to many morbid conditions. Decreasing night and weekend use of VL services in the emergency department (ED) represents a potentially viable means of reducing costs as skilled personnel must remain on call and receive a wage premium when activated. We investigated the effects of workflow changes that required ED providers to use a computerized decision-making tool, integrated into the electronic medical record, to calculate a Wells score for each patient considered for an after-hours venous duplex ultrasound study for suspected DVT...
February 11, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Nuttawut Sermsathanasawadi, Kanin Pruekprasert, Wacharaphong Pitaksantayothin, Khamin Chinsakchai, Chumpol Wongwanit, Chanean Ruangsetakit, Pramook Mutirangura
OBJECTIVE: The aim of this study was to investigate the prevalence and clinical predictors of >50% iliocaval venous obstruction (ICVO) in Thai patients with lipodermatosclerosis and healed or active venous ulcers and the diagnostic accuracy of duplex ultrasound (DUS) compared with computed tomography venography (CTV). METHODS: Limbs with lipodermatosclerosis, healed venous leg ulceration, or active venous leg ulceration were prospectively evaluated by DUS and CTV...
February 11, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Gregory Eckenrode, Becky Baltich Nelson, Andre Belarmino, Stephanie Ashley Chen, Shokhi Goel, Andrew J Meltzer
OBJECTIVE: Percutaneous endovenous intervention (PEVI) is gaining acceptance for select patients with symptomatic proximal lower extremity deep venous thrombosis (DVT), but the benefits are uncertain in patients with isolated femoropopliteal DVTs. We performed a systematic review and meta-analysis of the literature to assess the safety and effectiveness of PEVI vs systemic anticoagulation for patients with isolated femoropopliteal DVT. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from inception to March 2018...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Brett Doliner, Jose A Jaller, Alberto J Lopez, Hadar Lev-Tov
OBJECTIVE: This systematic review and meta-analysis aimed to assess whether compression stockings or other interventions reduce the incidence of venous ulceration after acute deep venous thrombosis. METHODS: We searched PubMed and Embase for randomized controlled trials (RCTs), restricted to English, Spanish, and Hebrew, related to post-thrombotic syndrome and venous ulceration in participants with confirmed deep venous thrombosis. Our primary statistical assessment was the Peto odds ratio (OR)...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Yushi Suzuki, Hisashi Sakuma, Shun Yamazaki
OBJECTIVE: Lymphaticovenous anastomosis (LVA) is one of the surgical treatments of lymphedema. However, only a few reports have evaluated LVA directly. This study aimed to evaluate the patency of LVA using indocyanine green fluorescence lymphography and to determine the optimal anastomosis site in patients with lower extremity lymphedema. METHODS: Thirty-six patients, with a total of 123 anastomoses for lower extremity lymphedema including 3 cases of idiopathic lymphedema, who underwent LVA for the first time between March 2014 and March 2017 were selected for enrollment in this study...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Efthymios D Avgerinos, Zein Saadeddin, Adham N Abou Ali, Yash Pandya, Eric Hager, Michael Singh, George Al-Khoury, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: Iliac vein stenting is recommended to treat venous outflow obstruction after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis (DVT). Data on the outcome of proximal and distal stent extension are limited. Proximal stent extension to the vena cava may obstruct the contralateral iliac vein, whereas distal extension below the inguinal ligament contradicts common practice for arterial stents. The aim of this retrospective study was to assess outcomes and predictors of failure of iliac vein stents and contralateral iliac vein thrombosis, taking into consideration stent positioning...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Charles Hsu, Anand Brahmandam, Kirstyn E Brownson, Nancy Huynh, Jesse Reynolds, Alfred I Lee, Wassim H Fares, Cassius Iyad Ochoa Chaar
OBJECTIVE: Statin therapy has been associated with a decreased incidence of venous thromboembolism (VTE) in clinical trials and enhanced thrombus resolution in animal models. The effect of statins on thrombus resolution has not been reported clinically. This study investigates the association of statins with thrombus resolution or improvement in patients with deep venous thrombosis (DVT). METHODS: A retrospective study of the electronic medical records of consecutive adult patients presenting with lower extremity DVT was performed...
January 16, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Cengiz Ovalı, Mustafa Behçet Sevin
OBJECTIVE: In this study, the clinical results of radiofrequency ablation (RFA) and n-butyl-cyanoacrylate embolization (CAE) methods were compared in the treatment of incompetent great saphenous veins (GSVs). METHODS: We analyzed retrospectively 244 patients (128 patients in the RFA group, 116 patients in the CAE group) with incompetent GSVs who were treated with RFA and CAE according to the patients' choice between June 2013 and June 2016. All patients were thoroughly examined preoperatively and at 1, 3, 6, and 12 months after the operation, and the clinical results and the quality of life were evaluated...
January 14, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Ricardo Lopez, Randall DeMartino, Mark Fleming, Haraldur Bjarnason, Melissa Neisen
OBJECTIVE: The use of catheter-directed thrombolysis (CDT) may provide clinical benefit in patients with acute deep venous thrombosis (DVT), but significant doubt remains about its indications and risks. We assessed technical success in resolution of acute iliofemoral or central DVT after single-session treatment with a novel mechanical aspiration thrombectomy device as an alternative to initiation of CDT. METHODS: This was a single-center retrospective review of patients with acute iliofemoral or central DVT treated with the Indigo continuous aspiration mechanical thrombectomy 8 system (Penumbra, Inc, Alameda, Calif) from 2016 to 2017...
January 10, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
John T Baber, Jialin Mao, Art Sedrakyan, Peter H Connolly, Andrew J Meltzer
OBJECTIVE: The objective of this study was to assess the association between provider characteristics and intensity of endovenous therapy (EVT) utilization in the Medicare population. METHODS: The Medicare Provider Utilization and Payment Data Public Use Files (2012-2014) were queried to construct a database of providers performing EVT using laser or radiofrequency ablation techniques for treatment of lower extremity venous reflux. A utilization index (UI; EVT procedure per patient treated per year) was calculated for each provider, and median services per county were determined...
January 9, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Behzad S Farivar, Shahab Toursavadkohi, Thomas S Monahan, Jashank Sharma, Areck A Ucuzian, Rishi Kundi, Rajabrata Sarkar, Brajesh K Lal
OBJECTIVE: Chronic venous leg ulcers (VLUs) affect up to 2% of the general population, resulting in a significant socioeconomic burden. Placental tissue that contains mesenchymal stem cells and active growth factors has been shown to be beneficial in healing of chronic wounds. We compared the efficacy of a human viable wound matrix (hVWM) of cryopreserved placental tissue for the treatment of refractory VLUs with standard therapy. METHODS: This prospective single-center open-label single-arm study enrolled patients with Clinical, Etiology, Anatomy, and Pathophysiology clinical class C6 VLUs...
January 6, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Jin Ho Hwang, Sang Woo Park, Ki Hyun Kim, Woo Young Yang, Jae Joon Hwang, Song Am Lee, Jun Seok Kim, Jae Bum Park, Hyun Keun Chee, Ik Jin Yun
OBJECTIVE: The objective of this study was to evaluate the effectiveness and safety of endovenous cyanoacrylate closure (CAC) of incompetent great saphenous vein (GSV) and to assess the regression of varicose vein following CAC without a concomitant procedure. METHODS: A total of 63 limbs in 48 patients treated with CAC because of an incompetent GSV between December 2016 and November 2017 were retrospectively evaluated. In five limbs, incompetent GSV and small saphenous vein were treated simultaneously in the same session...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Kush R Desai, Nicholas Xiao, Jennifer Karp, Riad Salem, Heron Rodriguez, Mark Eskandari, Omar M Uddin, Robert J Lewandowski
OBJECTIVE: The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter. METHODS: From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Mohammad Esmaeil Barbati, Alexander Gombert, Karina Schleimer, Drosos Kotelis, Cees H A Wittens, Philip Bruners, Houman Jalaie
BACKGROUND: Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. This procedure is rapidly emerging as a minimally invasive alternative to traditional open surgical operations. However, the patient will be exposed to a significant amount of radiation during preoperative planning and operation. The aim of this study was to evaluate the amount of radiation exposure to patients during venous recanalization. METHODS: All patients undergoing endovenous recanalization from February 2016 to February 2018 were included in this study...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Katarzyna Powezka, Tricia Adjei, Wilhelm von Rosenberg, Pasha Normahani, Valentin Goverdovsky, Nigel J Standfield, Danilo P Mandic, Usman Jaffer
OBJECTIVE: Local anesthetic endovenous procedures were shown to reduce recovery time, to decrease postoperative pain, and to more quickly return the patient to baseline activities. However, a substantial number of patients experience pain during these procedures. The autonomic nervous system modulates pain perception, and its influence on stress response can be noninvasively quantified using heart rate variability (HRV) indices. The aim of our study was to evaluate whether preoperative baseline HRV can predict intraoperative pain during local anesthetic varicose vein surgery...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
James Wall, Eric Johnson, Bonnie Johnson, Anup Singh, Raymond Shaheen, Thomas Fogarty
BACKGROUND: Guidelines as well as multiple RTCs support the use of intermittent pneumatic compression (IPC) for the treatment of venous leg ulcers when conservative measures fail. Unfortunately, the clinical usefulness of IPC is significantly limited by the physical limitations of pneumatic motors, which leads to bulky devices with slow inflation cycles, uncomfortable sleeves, lack of patient mobility, and ultimately poor patient compliance with therapy. A novel mechanical device for lower leg graded intermittent sequential compression was designed to address these limitations of IPC therapy for venous leg ulcer treatment by providing rapid compression cycles in a truly wearable device that offers the additional benefit of monitoring compression dose and patient compliance...
January 3, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Arjun Jayaraj, William Buck, Alexander Knight, Blake Johns, Seshadri Raju
OBJECTIVE: May-Thurner syndrome (MTS) patients with lifestyle-limiting symptoms undergo stenting of the iliac vein for relief of compressive disease. The impact of degree of stenosis on clinical symptoms and outcomes after stenting is unknown and examined in our study. METHODS: Retrospective review of contemporaneously entered data of 202 patients who underwent stenting for MTS between 2005 and 2011 was performed. Classification into three groups based on luminal area obtained by intraoperative intravascular ultrasound interrogation of the involved femoroiliocaval segments was carried out...
December 12, 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
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