Response to "Re: European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. MG. De Maeseneer et al. Eur J Vasc Endovasc Surg 2022;63:184-267"

Systematic Review and Meta-analysis of Radial or Femoral Access for Carotid Stenting

PURPOSE

There is a growing interest in performing coronary artery and neurovascular interventions via the radial artery; however, few studies have examined the outcomes of transradial carotid stenting. Therefore, our study aimed to compare cerebrovascular outcomes and crossover rates in carotid stenting between transradial and traditional transfemoral approaches.

METHODS

A systematic review was performed by searching three electronic databases from inception to June 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, random effect meta-analysis was used to pool the odds ratios (ORs) for stroke, transient ischemic attack, major adverse cardiac events, death, major vascular access site complications, and procedure crossover rates between the transradial and transfemoral approaches.

RESULTS

A total of 6 studies were included involving a total of n = 567 transradial and n = 6176 transfemoral procedures. The ORs for stroke, transient ischemic attack, and major adverse cardiac events were 1.43 (95% confidence interval, CI 0.72-2.86, I2 = 0), 0.51 (95% CI 0.17-1.54, I2 = 0), and 1.08 (95% CI 0.62-1.86, I2 = 0), respectively. Neither the major vascular access site complication rate (OR 1.11, 95% CI 0.32-3.87, I2 = 0) nor crossover rate (OR 3.94, 95% CI 0.62-25.11, I2 = 57%) showed statistically significant differences between the two approaches.

CONCLUSION

The modest quality of the data suggested comparable procedural outcomes between the transradial and transfemoral approaches when performing carotid stenting; however, high level evidence regarding postoperative brain images and risk of stroke in transradial carotid stenting are lacking. Therefore, it is reasonable for interventionists to weigh up the risks of neurological events and potential benefits, including fewer access site complications, before choosing the radial or femoral arteries as access sites. Future large-scale randomized controlled trials are imperative.

Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis

The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities. Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment. Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%. Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.

MANAGEMENT OF MINIINVASIVE TREATMENT OF PRIMARY VARICOSE SUPERFICIAL VEINS

OBJECTIVE

The aim: Determination of the optimal method for surgical correction of stages C2-C6s varicose superficial veins.

PATIENTS AND METHODS

Materials and methods: The treatment results of 228 patients with stages C2-C6 of primary varicose according to the CEAP classification using thermal and non-thermal treatment methods were analyzed.

RESULTS

Results: All patients underwent operations under the control of ultrasound scanning. In patients after EVLA, total trunk obliteration was detected in 148 patients (98.7%) after 1 week, and in 100% after a year. In 2 patients, reflux was diagnosed in the PDSV and in the ZDSV after 1 week. In patients after RFA, inflow reflux on the leg was in 1 patient (5.2%), in others - complete obliteration (18 patients - 94.7%). In patients after MOCA, recanalization was performed in 5 patients (19.2%) with a control ultrasound investigation after 1 month. In patients after cyanoacrylate obliteration, inflow reflux on the leg after 1 month was in 2 patients (14.2%). In patients who underwent UGS of the GSV trunk, 5 patients (33.3%) had persistence of pathological reflux after 1 month with control ultrasound. All corrections were performed using Foam form sclerotherapy.

CONCLUSION

Conclusions: EVLA is the most effective method of treating varicose veins and gives the best long-term results. The advantage of non-thermal methods is the lack of influence on paravenous structures and no need for tumescent anesthesia, which is important in case of an allergic history. After applying cyanoacry¬late, there is no need for mandatory compression. The advantage of foam scleroobliteration is its lowest cost among all methods. Foam sclerotherapy was the method of choice for correction of postoperative treatment.

A Framework for Developing a Comprehensive Venous Practice

Chronic venous disease (CVD) of the lower extremities is a complex process encompassing abnormalities related to venous drainage secondary to thrombotic and non-thrombotic pathologies. CVD can have an untold economic impact due to lost productivity and the costs of treating its sequela and underlying aetiologies. Building a comprehensive venous service for the treatment of CVD requires a multifaceted approach with longitudinal care, similar to those that have been developed for peripheral arterial disease and oncology.

COVID-19-associated phlebopathy as a current problem of modern phlebology

Введение. SARS-CoV-2 сопровождается развитием дисфункции венозного эндотелия, которая может привести к развитию персистирующей флебопатии нижних конечностей, снижаю щей качество жизни пациентов.

Цель. Оценить эффективность фармакологической терапии пациентов с постковидной флебопатией.

Introduction. SARS-CoV-2 is accompanied by the development of venous endothelial dysfunction, which can lead to the development of persistent phlebopathy of the lower limbs, reducing the quality of life of patients.

Objective. To evaluate the efficacy of pharmacological therapy in patients with postcocclusive phlebopathy.

Materials and methods. 178 patients (125 women), mean age 34.8 ± 3.2 years, who underwent SARS-CoV-2, for their first veno-specific complaints received micronized purified flavonoid fraction (MPFF) 1,000 mg per day for 90 days. Complaints were monitored using a 10-cm visual analog scale and the CIVIQ-20 questionnaire. All patients underwent ultrasound examination of the venous system of both lower extremities and photoplethysmography. Laboratory biochemical examination with determination of endothelial dysfunction marker levels was performed in 30 patients before and after treatment.

Results. After 90 days of phlebotropic therapy, there was a significant reduction in the severity of all venous-specific complaints, except for intradermal vein dilation. The global quality of life index increased from 64.4 ± 11.2 to 86.6 ± 9.1% (p < 0.001). There was an improvement in photoplethysmography (PPG) scores. Return blood-flow time and tibial venous muscle pump strength increased significantly (p < 0.05) by 4.3 s and 3.5%, respectively. The 30 patients who underwent biochemical examination in the first blood samples obtained from the great saphenous vein showed a significant increase in IL-1 concentration (7.8 ± 0, 7 pg/ml), IL-6 (18.7 ± 1.8 pg/ml), VEGF (187.8 ± 11.6 pg/ml), TNF (7.8 ± 0.9 pg/ml), histamine (22.4 ± 11.4 nmol/L) and hsCRB (5.4 ± 0.3 mg/L), indicating that a proinflammatory phenotype of venous endothelium was formed. After 90 days of MOFF administration, these indices significantly decreased. The levels of IL-1 and IL-6 decreased by 3.2 and 10.4 pg/ml, respectively, the values of VEGF and TNF decreased by 114.6 pg/ml and 2.9 pg/ml. There was a gradual normalization of histamine and hsCRB to 6.1 ± 4.1 nmol/L and 1.1 ± 0.9 mg/L.

Conclusions. The data obtained indicate that the appearance of veno-specific symptoms and syndromes in patients who have undergone SARS-CoV-2 may be due to the development of phlebopathy, the correction of which requires the use of pharmacological drugs with relevant mechanisms of action.

Iliocaval stenting for May–Thurner syndrome: Initial experience

The aim of this report is to describe our experience in endovascular treatment of May–Thurner syndrome. We report three cases of iliocaval stenosis treated endovascularly at our institution. We included three patients age range from 41 to 85 years with two presenting with acute deep vein thrombosis and associated limb swelling and one with chronic lower limb symptoms. We reviewed the technical success, complications, and stent patency on follow-up, latter was monitored be serial imaging. The three cases of iliocaval stenosis were treated with endovascular stenting with follow-up imaging follow-up period ranged from 6 to 13 months (mean 5.6 months) with two out of the three cases maintaining stent patency. One case was complicated by intraprocedural reopening of previously venous bleed. Clinical symptoms resolved with no recurrence in two out of three cases. One case experienced symptomatic in-stent thrombosis following endovascular treatment. Endovascular treatment of iliocaval stenosis appears effective in immediate technical success. Periprocedural attention to anticoagulation and stent position are important in preventing in-stent restenosis.

Aneurysm of the lateral marginal vein of the foot

Superficial venous aneurysms are a very rare pathology. This case report describes a 21-years-old male patient, who developed a soft, slow-growing mass, in the lateral part of the dorsal foot. Based on clinical examination and EcocolorDoppler ultrasound exam, the diagnosis of venous aneurysm of the lateral marginal vein was confirmed. The treatment proposed was ultrasound-guided foam sclerotherapy. The purpose of this work is to describe for the first time a venous superficial aneurysm localized in the lateral marginal vein of the foot. It is the first case reported in English literature.