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Liu J, Guo Q. Early versus deferred endovenous sclerotherapy of superficial venous reflux in patients with venous ulceration. Int Wound J 2023; 21:e14445. [PMID: 37845810 PMCID: PMC10895194 DOI: 10.1111/iwj.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
This study aimed to compare early endovenous sclerotherapy with superficial venous reflux combined with compression therapy and deferred intervention in patients with venous leg ulcers (VLUs). A total of 80 patients with 80 VLUs treated at the Department of General Surgery, Shangjin Nanfu Hospital, Chengdu, China, between February 2022 and January 2023 were included in the study. The primary outcome was the time to ulcer healing from the date of compression therapy or endovenous sclerotherapy. Secondary outcome measures were the rate of ulcer healing at 6 months, the rate of ulcer recurrence at 6 months, and patient-reported health-related quality of life. A total of 54 patients received early intervention and 26 received deferred intervention. The patient and clinical characteristics at baseline were similar between the two treatment groups. The median time to ulcer healing was 1.5 months (95% confidence interval [CI], 1.3-1.7 months) in the early-intervention group and 3.5 months (95% CI, 2.9-4.1 months) in the deferred-intervention group. The time to ulcer healing was shorter in the early-intervention group than in the deferred-intervention group (p < 0.001). The rate of ulcer healing at 6 months was 94% in the early-intervention group and 92% in the deferred-intervention group. The rate of ulcer recurrence before the end of the 6-month follow-up period was 2% in the early-intervention group and 4% in the deferred-intervention group. In conclusion, early endovenous sclerotherapy for superficial venous reflux resulted in faster healing of VLUs than deferred endovenous sclerotherapy.
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Affiliation(s)
- Jiabin Liu
- Department of General Surgery, Shangjin Nanfu Hospital, Chengdu, Sichuan, China
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Guo
- Department of General Surgery, Shangjin Nanfu Hospital, Chengdu, Sichuan, China
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Özhan A, Bademci MS, Kocaaslan C, Bayraktar FA, Öztekin A, Aydın E. Points to consider in the management of post-phlebitic venous ulcers. Vascular 2023; 31:196. [PMID: 35038947 DOI: 10.1177/17085381211058680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abdulkerim Özhan
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Mehmet Senel Bademci
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Cemal Kocaaslan
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Fatih A Bayraktar
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Ahmet Öztekin
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Ebuzer Aydın
- Cardiovascular Surgery, 64071Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
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Guo Z, Li X, Wang T, Yang X, Fan L. Elevated serum homocysteine levels are associated with the development of chronic venous ulcers. Vasc Med 2022; 27:358-364. [PMID: 35361027 DOI: 10.1177/1358863x221080486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Venous ulceration is a multifactorial disease, and whether hyperhomocysteinemia (HHcy) promotes deterioration from primary varicose veins to venous ulcers remains unproven. METHODS This study retrospectively analyzed clinical data from 717 patients to investigate the potential correlation between HHcy and primary varicose veins ulcer formation, including 611 patients without ulcers (control group) and 106 with ulcers (case group). RESULTS In this study, 46.2% (49/106) of patients in the case group and 17.5% (107/611, p < 0.001) in the control group suffered from HHcy. Multivariate logistic analysis revealed that HHcy was closely associated with the incidence of venous ulceration in patients with primary varicose veins (p < 0.001). Propensity score matching created 101 matched pairs of patients with and without ulcers, and the analysis pointed to a potential link between HHcy and ulcer formation in the context of primary varicose veins (p < 0.001). Additional experiments showed that HHcy could induce endothelial dysfunction and phenotypic switching of vascular smooth muscle cells. CONCLUSION Both clinical and experimental findings implicated HHcy as a key factor in the development of venous ulceration. Further research is needed to appraise the effectiveness of HHcy-lowering therapy in the prevention of venous ulcers in patients with varicose veins.
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Affiliation(s)
- Zhenyu Guo
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xu Li
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Wang
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaohu Yang
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Longhua Fan
- Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Alozai T, Huizing E, Schreve MA, Mooij MC, van Vlijmen CJ, Wisselink W, Ünlü Ç. A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency. Phlebology 2021; 37:165-179. [PMID: 34965757 DOI: 10.1177/02683555211060998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. METHODS A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications. RESULTS The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur. CONCLUSION Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.
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Affiliation(s)
- Tamana Alozai
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Eline Huizing
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Michiel A Schreve
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
| | - Michael C Mooij
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | | | - Willem Wisselink
- Department of Vascular Surgery, 1209Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Çağdaş Ünlü
- Department of Surgery, 1140Northwest Clinics, Alkmaar, The Netherlands
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Finlayson KJ, Parker CN, Miller C, Edwards HE, Campbell J. Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study. Phlebology 2021; 37:206-215. [PMID: 34965772 DOI: 10.1177/02683555211063986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. METHODS A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. DESIGN Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. RESULTS A sample of 143 participants was recruited (51% male, Mage = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks (SE 1.63, 95% CI 33.7-40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications (p = .035), presence of haemosiderosis (p = .006), decreased mobility (longer sitting times) (p = .007) and lower social support scale scores (p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance (p = .06). CONCLUSION Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.
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Affiliation(s)
- K J Finlayson
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - C N Parker
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - C Miller
- 2080La Trobe University, Melbourne, VIC, Australia
| | - H E Edwards
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - J Campbell
- Menzies Health Institute Queensland, 97562Griffith University, Gold Coast, QLD, Australia
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Ultrasound-guided foam sclerotherapy as a therapeutic modality in venous ulceration. Surgeon 2021; 20:e206-e213. [PMID: 34629303 DOI: 10.1016/j.surge.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this systematic review and meta-analysis was to evaluate rates of ulcer healing following ultrasound-guided foam sclerotherapy (UGFS). METHODS The MEDLINE, CENTRAL and Embase databases were used to search for relevant studies using the terms ' (sclerotherapy AND ulcer) OR (vein AND ulcer) OR (sclerotherapy AND vein)'. Heterogeneity between studies was quantified using the I2 statistic. A random effects model was used to calculate risk ratios where substantial heterogeneity was found. RESULTS The initial search yielded 8266 articles. 8 studies were included in the qualitative synthesis and 3 in the meta-analysis. Superior complete ulcer healing rates were noted in patients treated with foam sclerotherapy versus compression therapy alone (pooled OR 6.41, 95% CI = 0.3-148.2, p = 0.246, random effects method). A marked degree of heterogeneity was observed between studies (I2 = 81%). CONCLUSION A prospective, trial is warranted in order to determine the true merits of UGFS in the setting of venous ulceration.
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Kocaaslan C, Bademci MS, Bayraktar FA, Oztekin A, Aydin E, Tayfur K. Treatment strategies of iliac vein stenosis. J Vasc Surg Venous Lymphat Disord 2020; 8:904-905. [PMID: 32800261 DOI: 10.1016/j.jvsv.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cemal Kocaaslan
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medicine Faculty, Istanbul, Turkey
| | - Mehmet Senel Bademci
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medicine Faculty, Istanbul, Turkey
| | - Fatih Avni Bayraktar
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medicine Faculty, Istanbul, Turkey
| | - Ahmet Oztekin
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medicine Faculty, Istanbul, Turkey
| | - Ebuzer Aydin
- Department of Cardiovascular Surgery, Istanbul Medeniyet University Medicine Faculty, Istanbul, Turkey
| | - Kaptaniderya Tayfur
- Department of Cardiovascular Surgery, Ordu University Medicine Faculty, Ordu, Turkey
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