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Cheng Z, Wu X, Xie N. Prediction of compressive comfort of graded compression sleeves based on calf feature classification. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:319-329. [PMID: 38146715 DOI: 10.1080/10803548.2023.2298132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
This study explored the relationship between the design of calf compression sleeves and the comfort of young women in long sitting and standing work environments. By studying the relationship between material elongation and comfort pressure, a prediction model was obtained. The characteristics of the calf models of 94 women were classified, and the influence of different calf characteristics on the pressure distribution and tensile value design was objectively analyzed through simulation tests. The samples were then produced based on the simulation results, and subjective and objective try-on tests and evaluations were carried out. The results show that the difference in the shape of the calf has a certain impact on the pressure distribution and comfort. The predicted value of the theoretical model is in good agreement with the actual test value. The sample can bring a suitable gradient pressure and meet the comfort requirements and safety standards.
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Affiliation(s)
- Zhe Cheng
- School of Fashion, Wuhan Textile University, Wuhan, China
- Wuhan Textile and Clothing Digital Engineering Technology Research Center, Wuhan Textile University, Wuhan, China
| | - Xinzhou Wu
- School of Fashion, Wuhan Textile University, Wuhan, China
- Wuhan Textile and Clothing Digital Engineering Technology Research Center, Wuhan Textile University, Wuhan, China
| | - Nana Xie
- School of Fashion, Wuhan Textile University, Wuhan, China
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Joassard O, Kerveillant AL, Sellal C, Coatantiec E, Jabbour V, Desjeux G, Braithwaite B, Elias A, Fauconnier A. Evaluation of Elastic Venous Compression Device dispensation in pregnant and post-partum women using the French National Health Insurance Claims Database: The ProFIL retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 296:342-348. [PMID: 38531180 DOI: 10.1016/j.ejogrb.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES To describe the real-world use of Elastic Venous Compression Devices (EVCDs) during pregnancy and post-partum using data from a representative subset of the French National Health Insurance Claims Database (the Echantillon Généraliste des Bénéficiaires, EGB). STUDY DESIGN Women aged 15-49 who were pregnant between 1st July 2017 and 15th June 2018 were identified in the EGB using pregnancy-specific acts (certain prenatal examinations or deliveries). Subgroups were defined by age, presence of Venous Thrombo-Embolism (VTE) risk factors, history of VTE, delivery type and time period. EVCD dispensations (format, prescriber, and date) were identified among those for "standard orthotics" using their unique reimbursement tariffs. Dispensation rates were computed for all subgroups, overall and by format and were compared. RESULTS 15,528 pregnant women were included: 7,252 [46.7 %] deliveries (5,796 vaginal [79.9 %], 482 planned cesarean sections (C-sections) [6.7 %] and 974 unplanned C-Sections [13.4 %]), 2,734 (17.6 %) terminations and 5,542 (35.7 %) unknown outcomes. Overall, 4,919 (31.7 %) women were dispensed at least one EVCD. Ante-partum dispensation occurred in 43.1 % (n = 3,122) of women whose pregnancy led to a delivery. Dispensation rates were 17.3 % (n = 1,005), 46.7 % (n = 225) and 44.1 % (n = 430) after vaginal delivery, planned C-sections or unplanned C-sections, respectively. Overall, dispensation rates significantly increased with age, the presence of VTE risk factors, and a history of VTE (p < 0.01). EVCD dispensation was most frequent (17.0 %) during the 5th month of pregnancy. Among pregnant women who were dispensed at least one EVCD during ante- or post-partum, 69.0 % had one or two units of compression (27.1 % [one unit], 41.9 % [two units]). Stockings (48.6 %, n = 6,038) were dispensed significantly more frequently than socks (36.9 %, n = 4,586) and tights (14.5 %, n = 1,806) (p < 0.01). The main contributors to mechanical VTE prophylaxis were gynecologists (26.3 % of dispensations, n = 2,280), general practitioners (20.2 %, n = 1,749) and midwives (15.1 %, n = 1,314). CONCLUSIONS Low observed dispensation rates highlight a discrepancy between the French National Authority for Health (Haute Autorité de Santé, HAS), recommending EVCDs use during pregnancy and after delivery, and the real-life use of EVCD. Prescription sensitization combined with targeted information campaigns for pregnant women would be beneficial to contribute to the prevention of VTE, a health problem for pregnant women.
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Affiliation(s)
- Olivier Joassard
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | | | - Claire Sellal
- Midwife practice, 14 Rue du Chapeau Rouge, 44000 Nantes, France.
| | - Erwana Coatantiec
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Violaine Jabbour
- Laboratoires Innothera, 22 Avenue Aristide Briand, 94110 Arcueil, France.
| | - Guillaume Desjeux
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Ben Braithwaite
- e-Health Services Sanoïa, 70 Impasse Allegriat, 13400 Aubagne, France.
| | - Antoine Elias
- Department of Vascular Medicine, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France; Clinical research department, Hôpital Sainte Musse, Centre Hospitalier Toulon La Seyne-sur-Mer, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France.
| | - Arnaud Fauconnier
- Obstetrics and Gynecology department, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, BP 3082, 78303 Poissy CEDEX, France; Paris-Saclay university, UVSQ, research unit 7285 "Risk and safety in clinical medicine for women and perinatal health (RISCQ), 2 Avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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Stevenson EM, Coda A, Bourke MDJ. Investigating low rates of compliance to graduated compression therapy for chronic venous insufficiency: A systematic review. Int Wound J 2024; 21:e14833. [PMID: 38522455 PMCID: PMC10961173 DOI: 10.1111/iwj.14833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.
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Affiliation(s)
- Elise M. Stevenson
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and WellbeingThe University of NewcastleOurimbahNew South WalesAustralia
| | - Michael D. J. Bourke
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
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Shi Y, Liu R, Lv J, Ye C. Biomedical therapeutic compression textiles: Physical-mechanical property analysis to precise pressure management. J Mech Behav Biomed Mater 2024; 151:106392. [PMID: 38228035 DOI: 10.1016/j.jmbbm.2024.106392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/18/2024]
Abstract
Biomedical therapeutic compression textiles (TCTs) have been extensively applied in the prevention and treatment of chronic venous insufficiency of lower extremities. An efficiency and operable development strategy to achieve the morphologic control and pressure fitness of TCTs needs to be proposed to improve the medical precision and patient adherence. Therefore, the present study qualitatively explored the influencing mechanisms of each knitting variable on physical-mechanical properties and pressure behaviors of TCTs. Then constructed the quantitative models to digitalize the knitting variables for determination of yarn-machinery setting design values. The results revealed that the feeding velocity of elastic inlay yarn materials and loop size settings impacted the pressure values owing to the diversities of fabric dimensions and mechanical tensile properties, respectively. Simultaneously, the derivation ratios of proposed circumferential and pressure models evaluated by experimental validated trials were approximately 1.1% and 10.8%, respectively. This study provided the fundamental references for the design, manufacturing, and property controlling of compression textiles to improve the biomedical therapeutic effectiveness for targeted users.
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Affiliation(s)
- Yu Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region (SAR), China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong SAR, China
| | - Rong Liu
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region (SAR), China; Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong SAR, China.
| | - Jingyun Lv
- School of Fundamental Education, Beijing Polytechnic College, Beijing, China
| | - Chongyang Ye
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region (SAR), China
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Mosti G, Wittens C, Caggiati A. Black holes in compression therapy: A quest for data. J Vasc Surg Venous Lymphat Disord 2024; 12:101733. [PMID: 38092227 DOI: 10.1016/j.jvsv.2023.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Although compression therapy (CT) is considered a crucial conservative treatment in chronic venous disease, strong evidence is missing for many clinical indications. This literature review aims to point out what strong evidence we have for CT and all the clinical scenarios where strong evidence still needs to be included. METHODS The research was conducted on MEDLINE with PubMed, Scopus and Web of Science. The time range was set between January 1980 and October 2022. Only articles in English were included. RESULTS The main problem with CT is the low scientific quality of many studies on compression. Consequently, we have robust data on the effectiveness of CT only for advanced venous insufficiency (C3-C6), deep vein thrombosis and lymphedema. We have data on the efficacy of compression for venous symptoms control and in sports recovery, but the low quality of studies cannot result in a strong recommendation. For compression in postvenous procedures, superficial venous thrombosis, thromboprophylaxis, post-thrombotic syndrome prevention and treatment, and sports performance, we have either no data or very debated data not allowing any recommendation. CONCLUSIONS We need high-level scientific studies to assess if CT can be effective or definitely ineffective in the clinical indications where we still have a paucity of or contrasting data.
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Affiliation(s)
- Giovanni Mosti
- Clinica MD Barbantini, Angiology Department, Lucca, Italy.
| | - Cees Wittens
- Department of Venous Surgery, Rotterdam, the Netherlands
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Jacinto MAG, Oliveira ACDS, Martínez CSG, Schlosser TCM, Dantas BADS, Torres GDV. Healing of Venous Leg Ulcers Influenced by Individual Aspects: Cluster Analysis in a Specialist Wound Management Clinic. J Prim Care Community Health 2024; 15:21501319231223458. [PMID: 38288560 PMCID: PMC10826402 DOI: 10.1177/21501319231223458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic. METHODS Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period. RESULTS The sample comprised 103 participants, with some still under treatment (Treatment Group-TG/ n = 60) and others having achieved VLU healing (Healing Group-HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors. CONCLUSIONS These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment.
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Mirakhmedova S, Amirkhanov A, Seliverstov E, Efremova O, Zolotukhin I. Daily Duration of Compression Treatment in Chronic Venous Disease Patients: A Systematic Review. J Pers Med 2023; 13:1316. [PMID: 37763085 PMCID: PMC10533179 DOI: 10.3390/jpm13091316] [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: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: There are no data on the daily regimen of compression therapy in patients with chronic venous disease. This systematic review aimed to establish the optimal daily duration of compression treatment. Methods: A systematic search of CENTRAL and MEDLINE was performed to identify RCTs, non-RCTs, reviews, systematic reviews, meta-analyses, and guidelines evaluating the use of compression regimens in the treatment of varicose veins. Results: Thirty-two RCTs, three non-RCTs, four observational studies, and two crossover trials reporting the duration and regimes of compression treatment fulfilled the inclusion criteria. The daily duration of compression was reported in patients after invasive treatment, for venous ulcer treatment, in patients with venous symptoms. The quality of the studies varied. We could not conduct a meta-analysis due to the heterogeneity of the research data and their quality. Twenty-three studies reported results of compression usage after invasive procedures. Eight studies reported daily duration regimens in patients with venous ulcers. Nine studies reported the impact of compression on venous symptoms and/or edema or limb volume change. One study was conducted to assess if compression improves QoL in venous patients. While there was a clear difference found in the daily duration depending on the clinical scenario, no data in support of exact regimens were found. Conclusions: There are no reliable data supporting exact daily regimens of compression treatment in various cohorts of CVD patients.
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Affiliation(s)
| | | | | | | | - Igor Zolotukhin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow 117997, Russia; (S.M.); (A.A.); (E.S.); (O.E.)
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Rezaei-Kalantari K, Fahrni G, Rotzinger DC, Qanadli SD. Insights into pelvic venous disorders. Front Cardiovasc Med 2023; 10:1102063. [PMID: 36742076 PMCID: PMC9892065 DOI: 10.3389/fcvm.2023.1102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Pelvic venous disorders (PeVD), sometimes referred to as pelvic congestion syndrome (PCS), widely impact affected patients-mainly young women's quality of life, causing puzzling, uncomfortable symptoms sometimes requiring months or years to get an explanation, while simply remaining undiagnosed in other cases. Because pelvic pain is a non-specific symptom, an appropriate diagnosis requires a careful patient workup, including a correlation between history and non-invasive imaging. Invasive imaging is frequently required to confirm the diagnosis and plan treatment. Current therapeutic approaches principally rely on minimally invasive techniques delivered through endovascular access. However, while comprehensive descriptive classifications such as the symptoms-varices-pathophysiology (SVP) classification exist, universally accepted guidelines regarding therapy to apply for each SVP category are still lacking. This review strongly focuses on PeVD imaging and discusses available therapeutic approaches with regard to pathophysiological mechanisms. It proposes a new classification scheme assisting clinical decision-making about endovascular management to help standardize the link between imaging findings and treatment.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular, Medical and Research Center, Cardio-Oncology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,*Correspondence: Guillaume Fahrni,
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Abstract
Pelvic venous disorders (PeVD) also known as Pelvic Congestion Syndrome (PCS) affect a great number of women worldwide and often remain undiagnosed. Gynecological symptoms caused by vascular background demand a holistic approach for appropriate diagnosis. This is a relevant cause of chronic pelvic pain and atypical varicose veins. The diagnosis is based on imaging studies and their correlation with clinical presentation. Although the aetiology of PCS still remains unclear, it may result from a combination of factors including genetic predisposition, anatomical abnormalities, hormonal factors, damage to the vein wall, valve dysfunction, reverse blood flow, hypertension and dilatation. The following paper describes an in-depth overview of anatomy, pathophysiology, symptoms, diagnosis and treatment of PCS. In recent years, minimally invasive interventions have become the method of first choice for the treatment of this condition. The efficacy of a percutaneous approach is high and it is rarely associated with serious complications.Key MessagesPelvic venous disorders demand a holistic approach for appropriate diagnosis.This article takes an in-depth look at existing therapies of Pelvic Congestion Syndrome and pathophysiology of this condition.Embolisation is an effective and safe treatment option.
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Affiliation(s)
- Kamil Bałabuszek
- Department of Radiography, Medical University of Lublin, Lublin, Poland
| | - Michał Toborek
- Department of Radiography, Medical University of Lublin, Lublin, Poland
| | - Radosław Pietura
- Department of Radiography, Medical University of Lublin, Lublin, Poland
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Dialsingh I, Mohammed SR, Medford RS, Budhoo E, White-Gittens I, Maharaj D. Conservative therapy significantly reduces patients' chronic venous disease symptoms: A Caribbean insight into the VEIN Act Program. Phlebology 2022; 37:651-661. [PMID: 35848710 DOI: 10.1177/02683555221114542] [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
OBJECTIVES We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients' compliance to conservative therapy and the effectiveness of such therapy in reducing patients' CVD symptoms. METHOD Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit. RESULTS We enrolled 193 patients into the study, most of which (76%) were female, between 39-78 years (80%) and within the C2-C4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatment. CONCLUSIONS Patient compliance to conservative therapy for management of CVD is high across the Caribbean, and such therapy is effective in reducing intensity of CVD symptoms.
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Affiliation(s)
- Isaac Dialsingh
- Department of Mathematics and Statistics, Faculty of Science and Technology, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Saeed Rashaad Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Rei Sebastian Medford
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, 37612The University of the West Indies, St Augustine Campus, St Augustine, Trinidad
| | - Emerson Budhoo
- Caribbean Orthopaedic Foot and Ankle Institute, Medical Associates Hospital, St Joseph, Trinidad
| | | | - Dale Maharaj
- Caribbean Vascular and Vein Clinic, St Clair Medical Center, Port of Spain, Trinidad
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Cooke PV, Bai H, Cho LD, Kang Y, Kim J, Dionne E, Gonzalez C, Vasan V, Tadros RO, Ting W. Compression stocking compliance does not impact reintervention or symptom change after iliac vein stenting in patients with moderate to severe lower extremity edema. Ann Vasc Surg 2022; 85:262-267. [PMID: 35271963 DOI: 10.1016/j.avsg.2022.02.024] [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: 01/17/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Medical compression stocking (MCS) therapy remains a core treatment for chronic venous disease, particularly in patients with lower extremity edema. This study investigated the impact of postoperative MCS adherence in patients with moderate to severe edema who underwent iliac vein stenting. METHODS Patients at a large tertiary care center who underwent iliac vein stenting from August 2011 to June 2021 were analyzed. Symptoms were quantified using the venous clinical severity score (VCSS) and clinical assessment score (CAS). The criterium for inclusion was moderate or severe lower extremity edema at the time of iliac vein stenting. Patients were stratified into two cohorts: complete postoperative compression therapy compliance (MCS+) and no postoperative compression therapy use (MCS-). RESULTS Among 376 patients fitting our study criteria, we identified 168 MCS+ and 208 MCS- patients. Preoperatively, the VCSS composite score was higher for the MCS+ group (11.7 vs. 9.5, p < 0.001), but the VCSS edema score did not significantly differ between groups (p = 0.179). Postoperatively, the mean changes in VCSS edema at the first postoperative visit, the one-year follow-up, and the two-year follow-up were not significantly different between the MCS+ and MCS- cohorts (p = 0.123, 0.296, 0.534, respectively). Analysis of CAS for edema revealed that the MCS+ cohort had modestly better improvement in edema at the 90-day follow-up visit vs. the MCS- cohort (p = 0.018), but this difference was not observed in the 30-day (p = 0.834) or 6-month follow up visit (p = 0.755). Multivariate analysis revealed no difference in the need for major intervention (OR 0.93 [95% CI 0.44 - 1.50], p = 0.504). Kaplan Meier analysis via log-rank test revealed no difference in reintervention-free survival between groups (p = 0.77). CONCLUSION Many patients with moderate to severe lower extremity edema experience reduction in their edema after iliac vein stenting. In our study, compression stocking compliance after surgery had little impact on edema relief in this population.
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Affiliation(s)
| | | | | | - Yeju Kang
- Icahn School of Medicine at Mount Sinai
| | | | | | | | | | - Rami O Tadros
- Division of Vascular Surgery- Department of Surgery, Icahn School of Medicine at Mount Sinai
| | - Windsor Ting
- Division of Vascular Surgery- Department of Surgery, Icahn School of Medicine at Mount Sinai
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Ma F, Xu H, Zhang J, Premaratne S, Gao H, Guo X, Yang T. Compression Therapy Following Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 80:302-312. [PMID: 34774690 DOI: 10.1016/j.avsg.2021.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis were performed to evaluate the necessity for compression therapy with elastic stockings following endovenous thermal ablation (EVTA) for chronic venous insufficiency. METHODS MedLine, ScienceDirect and the Cochrane Library were searched for the relevant literature according to the inclusion and exclusion criteria. Two researchers independently extracted data and assessed the quality of the literature. Randomized controlled trials comparing the use of elastic stockings for compression therapy versus no compression therapy following RFA or EVLA for varicose veins were included in this study. The primary outcome of postoperative pain was assessed using the visual analogue pain scale. Secondary outcomes included the bruising score, quality of life, venous clinical severity score, time to return to normal activities, complications, and the rate of saphenous vein occlusion. The mixed effect model or random effect model was used to calculate relative risk (RR), mean difference (MD) or standardized mean difference following the heterogeneity test. Sensitivity analysis was performed for outcomes with high heterogeneity (I2 >50%). Outcomes were described qualitatively for studies that could not be pooled. RESULTS Six RCTs with 1,045 subjects were included. Overall, postoperative compression therapy significantly reduced the mean pain in the first 10 days post-EVTA (MD = - 4.98,95% CI: -8.71 to -1.24), and the time to return to normal activities (MD = -1.01, 95% CI: -1.97 to -0.06). In terms of the bruising score, the venous clinical severity score, complications (RR = 1.05,95% CI: 0.55-2.00), quality of life at 2 weeks (MD = -0.71,95% CI: -2.09 to 0.67) and 6 months (MD = 0.26,95% CI: -1.22 to 1.74), and the saphenous vein occlusion rate (RR=1.00,95% CI: 0.95-1.04), there were no significant differences between the compression and control groups. CONCLUSION Our study recommends the routine use of compression therapy with elastic stockings following EVTA of varicose veins to reduce postoperative pain and the time to return to normal activities. However, further multi-center and high-quality randomized clinical trials are needed for the unified treatment for varicose veins, the target population as well as the duration of compression therapy on whether elastic stockings is beneficial following EVTA.
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Affiliation(s)
- Fan Ma
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Huimin Xu
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Jiantao Zhang
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Shyamal Premaratne
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA
| | - Hongxia Gao
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Xiaorong Guo
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Tao Yang
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China.
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Schreurs RHP, Joore MA, Ten Cate H, Ten Cate-Hoek AJ. Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective. BMJ Open 2021; 11:e048331. [PMID: 34642192 PMCID: PMC8513256 DOI: 10.1136/bmjopen-2020-048331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Elastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective. DESIGN Thirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes. SETTING Two regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region. PARTICIPANTS The interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor's assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI. RESULTS Two FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT. CONCLUSIONS This study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.
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Affiliation(s)
- Rachel Hellen Petra Schreurs
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Center and Thrombosis Expertise Center, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Center and Thrombosis Expertise Center, Maastricht University Medical Centre+, Maastricht, The Netherlands
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