The predictive value of haemodynamic parameters for outcome of deep venous reconstructions in patients with chronic deep vein obstruction - A systematic review

Objective The aim of this study was to investigate the predictive value of haemodynamic parameters on success of stenting or bypass surgery in patients with non-thrombotic or post-thrombotic deep venous obstruction. Methods EMBASE, MEDLINE and trial registries were searched up to 5 February 2016. Studies needed to investigate stenting or bypass surgery in patients with post-thrombotic obstruction or stenting for non-thrombotic iliac vein compression. Haemodynamic data needed to be available with prognostic analysis for success of treatment. Two authors, independently, selected studies and extracted data with risk bias assessment using the Quality in Prognosis Studies tool. Results Two studies using stenting and two using bypass surgery were included. Three investigated plethysmography, though results varied and confounding was not properly taken into account. Dorsal foot vein pressure and venous refill times appeared to be of influence in one study, though confounding by deep vein incompetence was likely. Another investigated femoral-central pressure gradients without finding statistical significance, though sample size was small without details on statistical methodology. Reduced femoral inflow was found to be a predictor for stent stenosis or occlusion in one study, though patients also received additional surgery to improve stent inflow. Data on prediction of haemodynamic parameters for stenting of non-thrombotic iliac vein compression were not available. Conclusions Data on the predictive value of haemodynamic parameters for success of treatment in deep venous obstructive disease are scant and of poor quality. Plethysmography does not seem to be of value in predicting outcome of stenting or bypass surgery in post-thrombotic disease. The relevance of pressure-related parameters is unclear. Reduced flow into the common femoral vein seems to be predictive for in-stent stenosis or occlusion. Further research into the predictive effect of haemodynamic parameters is warranted and the possibility of developing new techniques that evaluate various haemodynamic aspects should be explored.

Effect of a new incision management system (PREVENA®) on wound healing after endophlebectomy of the common femoral vein: a case series

Background

New endovascular techniques facilitate treatment of complex deep vein obstructions in cases of post-thrombotic syndrome. In a relevant number of these patients, endophlebectomy including the implantation of an arteriovenous fistula between the common femoral artery and the femoral vein is indispensable in order to establish a good inflow. These procedures display a high risk of wound complications. Despite conservative efforts to prevent these postoperative complications, wound healing problems occur in more than 20 % of cases. The present case report is the first description of wound dressing using a PREVENA® incision management system in cases of endophlebectomy.

Case presentation

A single center’s experience with the incision management system PREVENA®, which was used after endophlebectomy and venous stenting in complex hybrid procedures in three white men aged 46 years, 53 years, and 61 years is the subject of this case report. Although the surgical procedures were performed under therapeutical anticoagulation and took a couple of hours, no wound complications occurred.

Conclusions

These encouraging results underline a potential benefit of the incision management system PREVENA® in cases of complex venous recanalization including endophlebectomy of the femoral vein as well as the implantation of an arteriovenous fistula.

Physical activity monitoring in patients with peripheral arterial disease: validation of an activity monitor

OBJECTIVES

The daily life physical activity (PA) of patients with peripheral arterial disease (PAD) may be severely hampered by intermittent claudication (IC). From a therapeutic, as well as research, point of view, it may be more relevant to determine improvement in PA as an outcome measure in IC. The aim of this study was to validate daily activities using a novel type of tri-axial accelerometer (Dynaport MoveMonitor) in patients with IC.

METHODS

Patients with IC were studied during a hospital visit. Standard activities (locomotion, lying, sitting, standing, shuffling, number of steps and "not worn" detection) were video recorded and compared with activities scored by the MoveMonitor. Inter-rater reliability (expressed in intraclass correlation coefficients [ICC]), sensitivity, specificity, and positive predictive values (PPV) were calculated for each activity.

RESULTS

Twenty-eight hours of video observation were analysed (n = 21). Our video annotation method (the gold standard method) appeared to be accurate for most postures (ICC > 0.97), except for shuffling (ICC = 0.38). The MoveMonitor showed a high sensitivity (>86%), specificity (>91%), and PPV (>88%) for locomotion, lying, sitting, and "not worn" detection. Moderate accuracy was found for standing (46%), while shuffling appeared to be undetectable (18%). A strong correlation was found between video recordings and the MoveMonitor with regard to the calculation of the "number of steps" (ICC = 0.90).

CONCLUSIONS

The MoveMonitor provides accurate information on a diverse set of postures, daily activities, and number of steps in IC patients. However, the detection of low amplitude movements, such as shuffling and "sitting to standing" transfers, is a matter of concern. This tool is useful in assessing the role of PA as a novel, clinically relevant outcome parameter in IC.

Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?

The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.

Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

Introduction

Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer treatments appear that are suitable for more complex problems.

Report

An adolescent male presented with bilateral iliofemoral thrombosis based on a hypoplastic inferior vena cava that had existed for more than two weeks. He was succesfully treated by bilateral ultrasound-accelerated catheter-directed thrombolysis using EkoSonic® (Small Vessel) Endovascular System (EKOS) and stenting of the inferior vena cava. After eight months of follow-up, the inferior vena cava is still patent.

Conclusion

EKOS thrombolysis of longer existing bilateral deep venous thrombosis in the central venous system is a succesful treatment modality in congenital inferior vena cava anomalies.

Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results

BACKGROUND

Transilluminated powered phlebectomy (TIPP) is a minimal invasive method of varicose vein surgery that is often performed with spinal or general anaesthesia following the removal of the greater saphenous vein (GSV). The use of exclusively local tumescent anaesthesia (TA) during TIPP has never been reported in the literature.

OBJECTIVE

To introduce and evaluate the use of TIPP under TA in the treatment of tributary varicose veins.

METHODS

Twenty patients with tributary varicose veins were treated with TIPP using the TriVex System. According to duplex scanning, patients had a competent or previous ligated saphenofemoral junction. All patients were clinically classified atleast as C2 according to the clinical, aetiological anatomical, pathological elements (CEAP) classification. The postoperative follow-up was at one week, one month and three months.

RESULTS

The mean operative time was 40.5 (+/- 10.8) min, associated with an average number of 3.6 (+/- 0.7) incisions. The mean pain score (10-point visual analog scale) during the procedure, at one and three months after treatment were 2.0 (+/- 1.1), 1.6 (+/- 0.9) and 1.2 (+/- 0.5), respectively. Thigh haematoma and complications such as discolouration, indurations and paraesthesia were reported. Fifteen (75%) patients were satisfied with the cosmetic result (based on a 4-point visual analog scale) after three months and 13 (65%) patients were satisfied with the performed treatment. The mean venous clinical severity (VCS) scores among the patients before treatment, one week, four weeks and three months after treatment was 2.7 (+/- 1.5), 3.9 (+/- 1.6), 2.4 (+/- 2.0) and 1.7 (+/- 1.9), respectively.

CONCLUSIONS

The use of TA resulted in adequate anaesthesia during TIPP. The pain, during and post-treatment, was minimal and acceptable for the patients. TIPP was associated with a high incidence of haematoma and reduction of the number of incisions. Patients were satisfied with the cosmetic result.