1
|
Scheerders ERY, van Klaveren D, Malskat WSJ, van Rijn MJE, van der Velden SK, Nijsten T, van den Bos RR. Development and External Validation of a Prediction Model for Patients with Varicose Veins Suitable for Isolated Ambulatory Phlebectomy. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00378-2. [PMID: 38710320 DOI: 10.1016/j.ejvs.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Isolated ambulatory phlebectomy is a potential treatment option for patients with an incompetent great saphenous vein (GSV) or anterior accessory saphenous vein and one or more incompetent tributaries. Being able to determine which patients will most likely benefit from isolated phlebectomy is important. This study aimed to identify predictors for avoidance of secondary axial ablation after isolated phlebectomy and to develop and externally validate a multivariable model for predicting this outcome. METHODS For model development, data for patients included in the SAPTAP trial were used. The investigated outcome was avoidance of ablation of the saphenous trunk one year after isolated ambulatory phlebectomy. Pre-defined candidate predictors were analysed with multivariable logistic regression. Predictors were selected using Akaike information criterion backward selection. Discriminative ability was assessed by the concordance index. Bootstrapping was used to correct regression coefficients, and the c-index for overfitting. The model was externally validated using a population of 94 patients with an incompetent GSV and one or more incompetent tributaries who underwent isolated phlebectomy. RESULTS For model development, 225 patients were used, of which 167 (74.2%) did not undergo additional ablation of the saphenous trunk one year after isolated phlebectomy. The final model consists of three predictors for avoidance of axial ablation: tributary length (< 15 cm vs. > 30 cm: odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02 - 0.40; 15 - 30 cm vs. > 30 cm: OR 0.18, 95% CI 0.09 - 0.38); saphenofemoral junction (SFJ) reflux (absent vs. present: OR 2.53, 95% CI 0.81 - 7.87); and diameter of the saphenous trunk (per millimetre change: OR 0.63, 95% CI 0.41 - 0.96). The discriminative ability of the model was moderate (0.72 at internal validation; 0.73 at external validation). CONCLUSION A model was developed for predicting avoidance of secondary ablation of the saphenous trunk one year after isolated ambulatory phlebectomy, which can be helpful in daily practice to determine the suitable treatment strategy in patients with an incompetent saphenous trunk and one or more incompetent tributaries. Patients having a longer tributary, smaller diameter of the saphenous trunk, and absence of terminal valve reflux in the SFJ are more likely to benefit from isolated phlebectomy.
Collapse
Affiliation(s)
- Eveline R Y Scheerders
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wendy S J Malskat
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marie Josee E van Rijn
- Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Simone K van der Velden
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; MohsA Clinic, Eindhoven, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Renate R van den Bos
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
2
|
Sohn SH, Kang Y, Kim JS, Choi JW, Hwang HY. The impact of perivascular tissue preservation on 5-year patency of saphenous vein composite grafts. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae069. [PMID: 38637939 PMCID: PMC11076921 DOI: 10.1093/icvts/ivae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES This retrospective study was conducted to evaluate the impact of saphenous vein (SV) harvesting with versus without perivascular tissue on the 5-year angiographic patency in coronary artery bypass grafting. METHODS Among the 944 patients who received coronary artery bypass grafting between 2010 and 2015, 579 patients who received off-pump coronary artery bypass grafting using 1 SV as a Y-composite graft based on the in situ left internal thoracic artery were enrolled. SV harvesting was performed using no-touch technique without perivascular tissue (the NoPVT group) in 342 patients and with perivascular tissue (the PVT group) in 237 patients. Follow-up duration was 84.0 months (interquartile range 66.5-105.4). Propensity score matching was performed, and long-term clinical outcomes and angiographic patency were compared. RESULTS The average number of distal anastomoses per patient was comparable between the groups, although more SV grafts were anastomosed to left anterior descending territory in the PVT group than in the NoPVT group. Overall survival and cumulative incidence of cardiac death were comparable between the groups, whereas cumulative incidence of target vessel revascularization (1.3% vs 4.3% at 5 year, P = 0.009) and that of major adverse cardiac events (7.3% vs 9.9% at 5 year, P = 0.035) were lower in the PVT group than in the NoPVT group. One-year and 5-year angiographic patency rates of the SV grafts were higher in the PVT group than in the NoPVT group [97.0% vs 91.7% (P = 0.004) and 96.3% vs 89.9% (P = 0.007), respectively]. CONCLUSIONS SV grafts harvested using no-touch technique with perivascular tissue further improved the 5-year patency of SV composite grafts compared with those without perivascular tissue.
Collapse
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Sakugawa LS, Portela FSO, Louzada ACS, Portugal MFC, Teivelis MP, Mendes CDA, Pinheiro LL, Silva MFAD, Fioranelli A, Wolosker N. Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery. Clinics (Sao Paulo) 2024; 79:100346. [PMID: 38574572 PMCID: PMC11004700 DOI: 10.1016/j.clinsp.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. METHODS This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). RESULTS Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. CONCLUSION Both polidocanol foam sclerotherapy and conventional surgery positively impact patients' quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.
Collapse
Affiliation(s)
| | | | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | - Lucas Lembrança Pinheiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Siderakis C, Royse C, Ren J, Tian DH, Clarke-Errey S, Srivastav N, Royse A. From a Position of Known Angiographic Perfect Patency: What Happens Next? Heart Lung Circ 2024:S1443-9506(24)00062-3. [PMID: 38508986 DOI: 10.1016/j.hlc.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND AIM The biological behaviour of coronary graft conduits over time may be considered by serial angiography. METHODS A single institution retrospective cohort received mostly clinically indicated angiography between 1997 and 2020, following coronary bypass surgery. Only perfectly patent grafts (absence of any lumen irregularity) for each conduit type at the first postoperative angiogram were selected for a later comparison. The latest angiograms were at least 5 years postoperatively, and at least 1 year after first postoperative angiogram. Analysis was done according to each graft (anastomosis). Comparisons used generalised estimating equations, adjusted for binary logistic regression. RESULTS Of 143 patients, there were 410 of 468 (87.6%) perfectly patent grafts at the first angiogram, analysed at 6.8±4.0 years postoperative, of which 157 were internal mammary arteries, 228 were radial arteries, and 25 were saphenous veins. At the latest angiogram (12.2±3.8 years postoperative), comparison with the first angiogram for each individual graft found preserved perfect patency for internal mammary arteries 156 of 157 (99.4%), and for radial arteries, 227 of 228 (99.6%) but saphenous veins deteriorated considerably 13 of 25 (52.0%). The two arterial grafts (internal mammary and radial) were superior to vein grafts (odds ratio 163; 95% confidence interval [CI] 22-1,211; p<0.001), but not different from each other (odds ratio 0.95; 95% CI 0.78-1.16; p=0.584). CONCLUSIONS From a position of known angiographic perfect patency post-CABG, internal mammary artery and radial artery grafts retained their perfect patency in the longer term, but saphenous vein grafts did not.
Collapse
Affiliation(s)
| | - Colin Royse
- Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia; Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Ren
- Department of Surgery, University of Melbourne, Melbourne, Vic, Australia
| | - David H Tian
- Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia and Perioperative Management, Westmead Hospital, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, University of Melbourne, Melbourne, Vic, Australia
| | - Nilesh Srivastav
- Department of Surgery, University of Melbourne, Melbourne, Vic, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia.
| |
Collapse
|
5
|
Szpytma MM, Baker RA, Gimpel D, Newland RF, Lance DG, Rice GD, Crouch G, Bennetts JS. Optimal Conduit Diameter Selection in Coronary Bypass Grafting Using Saphenous Vein. Heart Lung Circ 2024:S1443-9506(24)00075-1. [PMID: 38458931 DOI: 10.1016/j.hlc.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/27/2023] [Accepted: 01/30/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Predictors of long-term saphenous vein graft (SVG) patency following coronary artery bypass grafting (CABG) include harvesting technique, degree of proximal coronary stenosis, and target vessel diameter and runoff. The objective of this study was to evaluate the association between vein graft diameter and long-term survival. METHODS Patients undergoing primary CABG (2000-2017) at Flinders Medical Centre, Adelaide, Australia, were categorised into three groups according to average SVG diameter (<3.5 mm [small], 3.5-4 mm [medium], >4 mm [large]). Survival data was obtained from the Australian Institute of Health and Welfare National Death Index. To determine the association of SVG diameter with long-term survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables associated with survival. RESULTS Vein graft diameter was collected in 3,797 patients. Median follow-up time was 7.6 years (interquartile range, 3.9-11.8) with 1,377 deaths. SVG size >4 mm was associated with lower rates of adjusted survival up to 4 years postoperatively (hazard ratio 1.48; 95% confidence interval 1.05-2.1; p=0.026). CONCLUSIONS Vein graft diameter >4mm was found to be associated with lower rates of survival following CABG.
Collapse
Affiliation(s)
- Malgorzata Maggie Szpytma
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Robert A Baker
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Perfusion and Cardiothoracic Surgery Quality and Outcomes Unit, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Damian Gimpel
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Richard F Newland
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Perfusion and Cardiothoracic Surgery Quality and Outcomes Unit, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - David G Lance
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gregory D Rice
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Gareth Crouch
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Jayme S Bennetts
- Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Adelaide, SA, Australia; Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
| |
Collapse
|
6
|
Chu H, Qin Y, Qiu T, Zhou S, Na Z, Sun Y, Xu Y, Zhong Y. Phenotype and function of smooth muscle cells derived from the human normal great saphenous vein in response to hypoxia. Phlebology 2024; 39:96-107. [PMID: 37921696 DOI: 10.1177/02683555231211990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The contribution of hypoxia to the pathophysiology of vascular smooth muscle cells (VSMCs) has not yet been fully elucidated. This study evaluated the effect of hypoxia on the phenotype and function of SMCs derived from the human normal great saphenous veins (NGSVs). METHODS Fifteen NGSV tissue samples were collected. SMCs were isolated and cultured. Proliferation, migration, adhesion, senescence, and the structure of cytoskeletal filaments in SMCs were observed. mRNA and protein expression of Bax, Bcl-2, caspase-3, matrix metalloproteinases (MMP)-2, MMP-9, tissue inhibitor of metalloproteinases (TIMP)-1, and TIMP-2 was detected by fluorescent quantitative polymerase chain reaction and immunoblotting in the cobalt chloride (CoCl2) and the control groups. RESULTS A decrease in the number of cytoskeletal filaments was observed. mRNA and protein expression of Bas and caspase-3 was significantly decreased, while the quantity of proliferation, migration, adhesion, senescence, and mRNA and protein expression of Bcl-2, MMP-2, MMP-9, TIMP-1, and TIMP-2 in SMCs in the CoCl2 group were significantly increased compared with the control group. CONCLUSION Under hypoxic conditions, the phenotype and function of SMCs derived from the human NGSVs were dysregulated, suggesting that VSMCs switch from the contractile phenotype to the secretory or synthetic phenotype, and more dedifferentiate, resulting in extracellular matrix deposition and apoptotic decrease through the intrinsic pathway.
Collapse
Affiliation(s)
- Haibo Chu
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China
| | - Yanyan Qin
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Tianzhen Qiu
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China
| | - Shunchang Zhou
- Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China
| | - Zhang Na
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China
| | - Yanping Sun
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China
| | - Yongbo Xu
- Center of General Surgery, The 80th Group Army Hospital of People's Liberation Army, Weifang, China
| | - Yuxu Zhong
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| |
Collapse
|
7
|
Sedovy MW, Leng X, Iqbal F, Renton MC, Leaf M, Roberts K, Malek A, Arnold WS, Wyatt DA, Choate CW, Rowe JF, Baker JW, Johnstone SR, Joseph M. Preserving Endothelial Integrity in Human Saphenous Veins during Preparation for Coronary Bypass Surgery. J Vasc Res 2024; 61:68-76. [PMID: 38219725 DOI: 10.1159/000535843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION While multiple factors influence coronary artery bypass graft (CABG) success rates, preserving saphenous vein endothelium during surgery may improve patency. Standard preparations include saphenous vein preparation in heparinized saline (saline) which can result in endothelial loss and damage. Here, we investigated the impact of preparing saphenous graft vessels in heparinized patient blood (blood) versus saline. METHODS Saphenous vein tissues from a total of 23 patients undergoing CABG were split into 2 groups (1) saline and (2) heparinized patient blood. Excess tissue was fixed for analysis immediately following surgery. Level of endothelial coverage, oxidative stress marker 4-hydroxynonenal (4HNE), and oxidative stress protective marker nuclear factor erythroid 2-related factor 2 (NRF2) were evaluated. RESULTS In saline patient veins, histological analysis revealed a limited luminal layer, suggesting a loss of endothelial cells (ECs). Immunofluorescent staining of EC markers vascular endothelial cadherin (VE-cadherin) and endothelial nitric oxide identified a significant improvement in EC coverage in the blood versus saline groups. Although both treatment groups expressed 4HNE to similar levels, EC blood samples expressed higher levels of NRF2. CONCLUSION Our data indicate that use of heparinized patient blood helps preserve the endothelium and promotes vein graft health. This has the potential to improve long-term outcomes in patients.
Collapse
Affiliation(s)
- Meghan W Sedovy
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
- Translational Biology, Medicine, and Health Graduate Program, Virginia Tech, Blacksburg, Virginia, USA
| | - Xinyan Leng
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
| | - Farwah Iqbal
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Mark C Renton
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
| | - Melissa Leaf
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Kailynn Roberts
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
| | - Arya Malek
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
| | - W Scott Arnold
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| | - David A Wyatt
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| | - Cynthia W Choate
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| | - Joseph F Rowe
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| | - Joseph W Baker
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| | - Scott R Johnstone
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
- Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia, USA
| | - Mark Joseph
- The Fralin Biomedical Research Institute at Virginia Tech Carilion, Center for Vascular and Heart Research, Roanoke, Virginia, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Carilion Cardiothoracic Surgery, Cardiovascular Institute, Carilion Clinic, Roanoke, Virginia, USA
| |
Collapse
|
8
|
Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 2024; 12:101670. [PMID: 37652254 DOI: 10.1016/j.jvsv.2023.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually noncontroversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Parts I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose veins.
Collapse
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, Rex Vascular Specialists, UNC Health, Raleigh, NC
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Jose Almeida
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ruth L Bush
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | - Monika L Gloviczki
- Department of Internal Medicine and Gonda Vascular Center, Rochester, MN
| | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | | | | | | |
Collapse
|
9
|
Hong KP. Clinical Efficacy of a Modified Surgical Procedure in the Treatment of Incompetent Great Saphenous Veins. J Chest Surg 2023; 56:387-393. [PMID: 37817432 PMCID: PMC10625963 DOI: 10.5090/jcs.23.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Background The aim of this study was to evaluate the clinical efficacy of a modified surgical procedure for the treatment of varicose veins. Methods This retrospective analysis was conducted on lower extremities with symptomatic great saphenous vein (GSV) incompetence that underwent stripping from the groin to the knee, with preservation of the superficial epigastric vein (SEV), between January 2015 and April 2022. Follow-up assessments were performed using Doppler ultrasound, Venous Clinical Severity Score (VCSS), and the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6 and 12 months after surgery. Results The study included 179 limbs from 120 patients (47 men and 73 women). The mean patient age was 56.5 years (range, 20-78 years), and the distribution of preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical classes was 8% C0-C1, 88% C2, and 4% C3-C6. The preoperative diameter of the saphenofemoral confluence averaged 6.9 mm (range, 2.7-15.8 mm). After a mean postoperative follow-up period of 24 months, evidence of neovascularization around the stump of the saphenofemoral junction (SFJ) was observed in 2 limbs (1.1%). Additionally, varicose vein recurrence was found in 1 limb (0.6%) and was associated with an incompetent thigh perforator. At postoperative follow- up, both VCSS and AVVQ scores were significantly lower than the preoperative scores. Conclusion Modified surgical treatment of GSV incompetence, involving preservation of the SEV and stripping of a short segment up to the knee, demonstrated favorable clinical results in terms of postoperative complication rate, neovascularization rate around the SFJ stump, varicose vein recurrence rate, and improvement in lower extremity symptoms.
Collapse
Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
10
|
Lobo Filho JG, Pimentel MD, Lobo Filho HG. Physiopathology and improvement of the saphenous vein graft in coronary artery bypass graft. Eur J Cardiothorac Surg 2023; 64:ezad347. [PMID: 37862247 DOI: 10.1093/ejcts/ezad347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
|
11
|
Nezic D. No randomized trial has confirmed significantly better long-term survival for either radial artery or saphenous vein graft recipients in coronary artery bypass grafting surgery. Eur J Cardiothorac Surg 2023; 64:ezad326. [PMID: 37792490 DOI: 10.1093/ejcts/ezad326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Dusko Nezic
- Department of Cardiac Surgery, "Dedinje" Cardiovascular Institute, Belgrade, Serbia
| |
Collapse
|
12
|
Kim J, Sohn SH, Choi JS, Oh SJ, Hwang HY. Graft Patency of No-Touch Saphenous Veins Used as Aortocoronary Bypass Grafts. J Chest Surg 2023; 56:313-321. [PMID: 37574877 PMCID: PMC10480399 DOI: 10.5090/jcs.23.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/24/2023] [Accepted: 07/02/2023] [Indexed: 08/15/2023] Open
Abstract
Background This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG). Methods In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated. Results The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively. Conclusion The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.
Collapse
Affiliation(s)
- Jeongwon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Benet A, Noda K, Tanikawa R. High-Flow Bypass and Trapping of a Ruptured Internal Carotid Artery Blister Aneurysm: Operative Principles and Key Lessons. World Neurosurg 2023; 176:81. [PMID: 37116787 DOI: 10.1016/j.wneu.2023.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
Blood blister-like aneurysms (BBAs) are infrequent but challenging small aneurysms with fragile domes consisting of a thin adventitia layer.1 Flow diversion and microsurgical trapping are acceptable treatment options. While endovascular treatment is becoming the first choice in developed countries, it is prohibitive in most developing countries, where microsurgical treatment is the only feasible option. Microsurgical treatment offers superior obliteration rates at similar neurologic outcomes than endovascular treatment.1-3 Mastering high-flow revascularization and pressure monitoring is necessary to improve outcomes of BBA, especially in the developing world. We present our operative principles, which involve pressure monitoring and a high-flow bypass to ensure sufficient post-trapping cerebral pressure.4 A 53-year-old lady was found to have a modified Fisher 4 subarachnoid hemorrhage after the worst headache of her life. Endovascular flow diversion and trapping and bypass were discussed with the patient and family. A right internal carotid artery BBA was trapped (Video 1). A right superficial temporal artery to M4 middle cerebral artery (MCA) bypass was used to both maintain perfusion during a high-flow bypass and to measure cerebral blood pressure. An external carotid artery to MCA bypass using a saphenous vein graft provided >80% of baseline MCA arterial pressure, which prevents delayed ischemic strokes.4 The patient tolerated the procedure well and was discharged home without deficits on postoperative day 15 after vasospasm watch. The patient consented to the procedure and provided consent to the publication of her images.
Collapse
Affiliation(s)
- Arnau Benet
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kosumo Noda
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
| |
Collapse
|
14
|
Raoufi M, Mohammadi Tofigh A, Kouchak Hosseini SP, Haghbin Toutounchi A, Bagherian Lemraski S, Nematihonar B. Bariatric Surgery and Femoral Vein Diameter in Morbidly Obese Patients: a Cohort Study in Iran. Obes Surg 2023; 33:2463-2467. [PMID: 37368063 DOI: 10.1007/s11695-023-06693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Considering the importance of health, the effect of obesity on the quality of life, the person's self-image, and the effect of obesity on various organs, especially the vessels, and the absence or presence of a study in Iran that investigated the effect of gastric bariatric surgery on the diameter of the femoral vein, in the present study, we investigated the effect of bariatric surgery on femoral vein diameter in morbidly obese patients referred to Imam Hossein hospital. MATERIALS AND METHODS The present study was a prospective cohort study on morbidly obese patients referred to the center in 2022-2023. In this study, 31 morbidly obese patients with BMI above 30 kg/m2 who were candidates for bariatric surgery were examined. Demographic data were collected using a demographic profile checklist. BMI, the diameter of common femoral veins, and the great saphenous vein were measured and recorded before and 6 months after surgery. Ultimately, the data was collected and analyzed using SPSS V.24 software. RESULTS In the current study, 31 patients (62 extremities) were examined. The mean age of the patients was 34.45, with a standard deviation of 8.86. Fourteen patients (45.2%) were male, and 17 (54.8%) were female. The mean diameter of the common femoral vein in the 6 months after surgery was significantly less than before surgery (11.58 (1.64) compared to 12.95 (1.84), P = 0.0001). The mean diameter of the great saphenous vein in the 6 months after surgery was significantly less than before surgery (7.30 (1.45) compared to 7.75 (1.45), P = 0.0001). CONCLUSION It seems that bariatric surgery causes a significant decrease in the diameter of lower limb veins (common femoral vein and great saphenous vein) compared to before surgery. However, further studies in this field are recommended.
Collapse
Affiliation(s)
- Masoomeh Raoufi
- Department of Radiology, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mohammadi Tofigh
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Pedram Kouchak Hosseini
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Behzad Nematihonar
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
15
|
Ho CERH, So WZ, Wong J, Tiong HY. Successful repair of transplant renal artery aneurysm (TRAA). BMC Urol 2023; 23:129. [PMID: 37525164 PMCID: PMC10391898 DOI: 10.1186/s12894-023-01280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Transplant renal artery aneurysm (TRAA) is rare. TRAA that develops post transplantation consists of 0.10% of the vascular complications post renal transplant (Transplant Proc 41:1609-1614, 2009; Indian J Urol 29:42-47, 2013). CASE PRESENTATION We report a case of TRAA in an asymptomatic young female. CT angiogram with detailed 3D reconstruction showed a 2.6 × 2.2 cm wide neck saccular TRAA arising from the anterior segmental branch of the graft renal artery (Figs. 2 and 3). A multidisciplinary team of interventional radiologists, vascular and urologist was involved for preoperative surgical planning and unique repair methods. Endovascular and percutaneous approaches were deemed not feasible, and an open in vivo approach with a saphenous vein graft was taken. CONCLUSION TRAA, albeit rare, is a complication that can occur post renal transplant. In-vivo surgical repair of TRAA is feasible with a multidisciplinary approach and careful preoperative planning. Saphenous vein graft is still a versatile graft and can be used as a conduit successfully.
Collapse
Affiliation(s)
| | - Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Julian Wong
- National University Hospital, Singapore, Singapore
| | - Ho Yee Tiong
- National University Hospital, Singapore, Singapore.
| |
Collapse
|
16
|
Kwon G, Park KH, Kwak SG, Lee J. The Results of Femorofemoral Bypass Using a Saphenous Vein Graft as an Alternative to PTFE Grafts. Vasc Specialist Int 2023; 39:7. [PMID: 36999355 PMCID: PMC10064113 DOI: 10.5758/vsi.220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose This study aimed to report the results of femorofemoral bypass (FFB) using a great saphenous vein (GSV) graft as an alternative to polytetrafluoroethylene (PTFE) grafts. Materials and Methods From January 2012 to December 2021, 168 patients who underwent FFB (PTFE, 143; GSV, 25) were included. The patients' demographic features and surgical intervention results were retrospectively reviewed. Results There were no intergroup differences in patients' demographic features. In GSV vs. PTFE grafts, the superficial femoral artery provided statistically significant inflow and outflow (P<0.001 for both), and redo bypass was more common (P=0.021). The mean follow-up duration was 24.7±2.3 months. The primary patency rates at 3 and 5 years were 84% and 74% for PTFE grafts and 82% and 70% for GSV grafts, respectively. There was no significant intergroup difference in primary patency (P=0.661) or clinically driven target lesion revascularization (CD-TLR)-free survival (P=0.758). Clinical characteristics, disease details, and procedures were analyzed as risk factors for graft occlusion. Multivariate analysis revealed that none of the factors was associated with an increased risk of FFB graft occlusion. Conclusion FFB using PTFE or GSV grafts is a useful method with an approximately 70% 5-year primary patency rate. The GSV and PTFE grafts showed no difference in primary patency or CD-TLR-free survival during follow-up; however, FFB using GSV may be an option in selective situations.
Collapse
Affiliation(s)
- Gibeom Kwon
- Departments of Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Ki Hyuk Park
- Departments of Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Sang Gyu Kwak
- Departments of Medical Statistics, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Jaehoon Lee
- Departments of Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| |
Collapse
|
17
|
Mikami T, Furuhashi M, Numaguchi R, Hosaka I, Sakai A, Tanaka M, Ito T, Maeda T, Sakurada T, Muraki S, Yanase Y, Sato H, Fukada J, Tamiya Y, Iba Y, Kawaharada N. Comparison of Phenotypes in Subcutaneous Fat and Perivascular Adipose Tissue Surrounding the Saphenous Vein in Coronary Artery Bypass Grafting. Circ J 2023; 87:791-798. [PMID: 36740256 DOI: 10.1253/circj.cj-22-0740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The saphenous vein (SV) is used as an essential conduit in coronary artery bypass grafting (CABG), but the long-term patency of SV grafts is a crucial issue. The use of the novel "no-touch" technique of harvesting the SV together with its surrounding tissue has been reported to result in good long-term graft patency of SV grafts. We recently showed that perivascular adipose tissue (PVAT) surrounding the SV (SV-PVAT) had lower levels of metaflammation and consecutive adipose tissue remodeling than did PVAT surrounding the coronary artery. However, the difference between SV-PVAT and subcutaneous adipose tissue (SCAT) remains unclear.Methods and Results: Fat pads were sampled from 55 patients (38 men, 17 women; mean [±SD] age 71±8 years) with coronary artery disease who underwent elective CABG. Adipocyte size was significantly larger in SV-PVAT than SCAT. The extent of fibrosis was smaller in SV-PVAT than SCAT. There were no significant differences between SCAT and SV-PVAT in macrophage infiltration area, quantified by antibodies for CD68, CD11c, and CD206, or in gene expression levels of metaflammation-related markers. Expression patterns of adipocyte developmental and pattern-forming genes differed between SCAT and SV-PVAT. CONCLUSIONS The properties of SV-PVAT are close to, but not the same as, those of SCAT, possibly resulting from inherent differences in adipocytes. SV-PVAT has healthy expansion with less fibrosis in fat than SCAT.
Collapse
Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine.,Department of Cardiovascular Surgery, National Hospital Organization, Obihiro Hospital
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Ryosuke Numaguchi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | - Itaru Hosaka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | - Akiko Sakai
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital
| | - Toshiyuki Maeda
- Department of Cardiovascular Surgery, Sapporo Central Hospital
| | - Taku Sakurada
- Department of Cardiovascular Surgery, Sapporo Central Hospital
| | - Satoshi Muraki
- Department of Cardiovascular Surgery, Sapporo Central Hospital
| | - Yousuke Yanase
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital
| | - Hiroshi Sato
- Department of Cardiovascular Surgery, Otaru City General Hospital
| | - Joji Fukada
- Department of Cardiovascular Surgery, Otaru City General Hospital
| | - Yukihiko Tamiya
- Department of Cardiovascular Surgery, Otaru City General Hospital
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| |
Collapse
|
18
|
Hong KP. Mid-term results of radiofrequency ablation with multiple heat cycles for incompetent saphenous veins. J Vasc Surg Venous Lymphat Disord 2022; 11:483-487. [PMID: 36581000 DOI: 10.1016/j.jvsv.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/29/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Recent reports suggest that the number of radiofrequency ablation (RFA) cycles impacts the depth of vein wall damage. This study evaluates the mid-term occlusion rate after delivering increased energy during RFA of incompetent saphenous veins. METHODS Between 2016 and 2019, consecutive patients who underwent RFA with multiple heat cycles were enrolled in the study. The exclusion criterion was previous treatment history for chronic venous disease. Duplex ultrasound data and medical records were reviewed retrospectively. RESULTS This study enrolled 217 patients (345 veins). Follow-up examinations were performed for 65% of treated veins after 6 months, 31% after 12 months, and 26% after more than 24 months with a mean follow-up period of 23 ± 18.9 months. The numbers of great saphenous and small saphenous veins were 178 and 62, respectively. According to the Kaplan-Meier method, the occlusion rate of saphenous veins was 100% at 3 years and 95.4% at 5 years. Except for one case (0.3%) of endovenous heat-induced thrombosis class 2, no significant side effects were noted. CONCLUSIONS Routine use of RFA with multiple heat cycles for incompetent saphenous veins exhibits good clinical outcomes considering mid-term occlusion rate without an increase in side effects.
Collapse
Affiliation(s)
- Ki-Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea.
| |
Collapse
|
19
|
Nezic D. Radial artery versus saphenous vein graft for coronary artery bypass grafting-long-term outcomes. Eur J Cardiothorac Surg 2022; 62:6619561. [PMID: 35766823 DOI: 10.1093/ejcts/ezac371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Dusko Nezic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| |
Collapse
|
20
|
Hoenicka M, Sabau M, Liebold A, Hofmann HS, Ried M. Preservation of Adrenoceptor and Endothelin Receptor Mediated Vasoconstriction and of Endothelium-Dependent Relaxation after Cold Storage of Explanted Blood Vessels for ex vivo Analyses. J Vasc Res 2022; 59:303-313. [PMID: 35728582 DOI: 10.1159/000524922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adrenoceptor and endothelin (ET) receptor-mediated vasoconstriction as well as endothelium-dependent vasodilation of human saphenous veins were compared before and after 20 h of cold storage. METHODS Contractile responses to potassium chloride (KCl), norepinephrine (NE), and ET-1 as well as vasodilator responses to acetylcholine (ACh) were evaluated. RESULTS Storage in HEPES-supplemented Dulbecco's modified Eagle's medium (HDMEM) diminished KCl induced contractile forces to 71% (p = 0.002) and NE induced contractions to 80% (p = 0.037), in contrast to HEPES-supplemented Krebs-Henseleit solution (HKH) and TiProtec solution. KCl-normalized NE contractions were not affected by storage. NE EC50 values were slightly lower (7.1E-8 vs. 7.5E-8, p = 0.019) after storage in HKH, with no changes after storage in the other solutions. Endothelium-dependent responses to ACh were not affected by storage. ET-1 induced contractions were attenuated after storage in HDMEM (77%, p = 0.002), HKH (75%, p = 0.020), and TiProtec (73%, p = 0.010) with no changes in normalized constrictions. ET-1 EC50 values were not affected by storage. CONCLUSION Loss of contractility after storage in HDMEM may reflect the lower content of dextrose. There was no specific attenuation of adrenoceptor, ET-receptor, or ACh receptor mediated signal transduction after storage in any of the media. HKH or TiProtec are equally suitable cold storage solutions for ex vivo measurements.
Collapse
Affiliation(s)
- Markus Hoenicka
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Marius Sabau
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
21
|
Dashwood MR, Samano N, Souza DS. Saphenous vein harvesting for CABG: wear a VEST or keep the fat? Eur J Cardiothorac Surg 2022; 62:6608695. [PMID: 35703951 DOI: 10.1093/ejcts/ezac349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Michael R Dashwood
- Surgical and Interventional Sciences, Royal Free Hospital Campus, University College Medical School, London, UK
| | - Ninos Samano
- Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Domingos S Souza
- Department of Cardiothoracic and Vascular Surgery and University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
22
|
Hong KP. Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease. J Chest Surg 2022; 55:233-238. [PMID: 35478179 PMCID: PMC9178300 DOI: 10.5090/jcs.22.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/20/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification. Methods In total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020. Results There were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11). Conclusion Duplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.
Collapse
Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
23
|
Palanisamy V, Ravikumar MS, Shree S, Sathiaraj AL, Mohanraj A, Kurian VM. Double cobra head technique of distal coronary anastomosis. Indian J Thorac Cardiovasc Surg 2022; 38:235-7. [PMID: 35221567 DOI: 10.1007/s12055-021-01247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022] Open
Abstract
In 1967, Dr. René Favaloro introduced the use of reversed greater saphenous vein graft for coronary artery bypass grafting, since then a lot of efforts were made to improve the venous graft patency rate. We introduce a novel double cobra head technique of distal coronary anastomosis for better distal runoff. We expect our technique will help in difficult situations such as limited conduit availability and target vessel with bifurcation lesions. Refining our surgical techniques is essential to keep ourselves well equipped to compete with the rapidly evolving stent culture.
Collapse
|
24
|
Ozen G, Aljesri K, Abdelazeem H, Norel X, Turkyılmaz G, Turkyılmaz S, Topal G. Comparative study on the effect of aspirin, TP receptor antagonist and TxA 2 synthase inhibitor on the vascular tone of human saphenous vein and internal mammary artery. Life Sci 2021; 286:120073. [PMID: 34688694 DOI: 10.1016/j.lfs.2021.120073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Abstract
AIMS Thromboxane (TxA2) is synthesized from arachidonic acid (AA) via thromboxane synthase (TxS) enzyme and induces vasoconstriction via TP receptor. Our aim is to compare the effects of aspirin, TxS inhibitor and TP receptor antagonist on vascular reactivity of bypass grafts (saphenous vein and internal mammary artery). MAIN METHODS Using isolated organ bath, saphenous vein and internal mammary artery preparations were incubated with TP receptor antagonist, TxS inhibitor, aspirin, IP or EP4 receptor antagonist. Then prostaglandin (PG)E2, PGF2α, phenylephrine and AA were administered in concentration-dependent manner. The expression of prostanoid receptor and PGI2 synthase (PGIS) enzyme was determined by Western Blot. KEY FINDINGS TP receptor antagonist inhibited the contraction induced by PGE2, PGF2α, and AA but not that induced by phenylephrine in both types of vessels. Aspirin increased phenylephrine-induced contraction only in internal mammary artery and decreased AA-induced contraction in saphenous vein. TxS inhibitor decreased both PGE2 and AA-induced contraction in both types of vessels. This decrease was reversed by co-incubation of TxS inhibitor and IP/EP4 receptor antagonists. The expressions of EP3 receptor and PGIS enzyme were greater in internal mammary artery compared to saphenous vein while IP and TP receptors expressed at similar levels. SIGNIFICANCE TP receptor antagonist and TxS inhibitor are more effective to reduce contraction induced by different spasmogens in comparison to aspirin. Our results suggest that TP receptor antagonist and TxS inhibitor might have an advantage over aspirin due to their preventive effect on increased vascular reactivity observed in post-operative period of coronary artery bypass grafting.
Collapse
Affiliation(s)
- Gulsev Ozen
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey.
| | - Khadija Aljesri
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Heba Abdelazeem
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Egypt
| | - Xavier Norel
- Université de Paris, INSERM, UMR-S 1148, CHU X. Bichat, 75018 Paris, France; Université Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Gulsum Turkyılmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Education and Research Hospital Bakırkoy, Istanbul, Turkey
| | - Saygın Turkyılmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Education and Research Hospital Bakırkoy, Istanbul, Turkey
| | - Gokce Topal
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| |
Collapse
|
25
|
Palanisamy V, Kurian VM, Sethuratnam R. In the VEST trial: are we missed to address the pathology incurred by the external stent? J Cardiothorac Surg 2021; 16:257. [PMID: 34496907 DOI: 10.1186/s13019-021-01640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
In the VEST IV trial, the author concluded that external stenting of saphenous vein graft mitigates its remodeling and also significantly reduces the diffuse intimal hyperplasia and development of lumen irregularities at 4.5 years after coronary artery bypass grafting surgery. We also have valuable a suggestion in addition to external stenting that might nullify the pathology caused by the stent and might enhances graft patency.
Collapse
|
26
|
Cho S, Joh JH. Changes of stump length depending on starting position of glue injection related to venous diameter during cyanoacrylate closure for incompetent saphenous veins. J Vasc Surg Venous Lymphat Disord 2021; 10:376-381. [PMID: 34438086 DOI: 10.1016/j.jvsv.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES A common pattern of recurrence after cyanoacrylate treatment of incompetent saphenous veins has been associated with reflux from the residual stump. The purpose of this study was to analyze the starting point of cyanoacrylate glue injection from the junction to decrease stump length. METHODS A retrospective review was performed using prospectively collected data of patients with cyanoacrylate closure (CAC). Preoperatively, the diameter of the saphenous vein was measured. CAC was performed according to the manufacturer's instructions. After the procedure, clinical outcomes including pain, venous clinical severity score (VCSS), and quality of life (QoL) using the Aberdeen Varicose Vein Questionnaire (AVVQ) were evaluated. Postoperative duplex scanning was performed to evaluate the occlusion rate of the target vein, stump length, and presence of endovenous glue-induced thrombosis (EGIT). The stump length was analyzed according to the preoperative venous diameter to determine the proper point of glue injection to decrease the stump length. RESULTS During the study period, CAC was performed in 408 patients. Mean age was 56.2±11.5 years (range, 19 to 84 years). A total of 279 patients (68.4%) were women. Occlusion of the target vein was achieved in all patients. After the procedure, pain, VCSS, and QoL were improved (P<.001). EGIT developed in 5.8% of patients. There was a 1.53-fold linear increase in the stump length by for every 1-mm increment of the preoperative venous diameter. In 20 patients with a venous diameter ≥5 mm, glue injection was performed safely 4 cm distal to the junction to decrease the stump length. CONCLUSION The stump length linearly increased with an increase in the saphenous vein diameter. If the diameter of the saphenous vein is more than 5 mm, cyanoacrylate glue may be injected 4 cm distal to the junction to decrease stump length.
Collapse
Affiliation(s)
- Sungsin Cho
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| |
Collapse
|
27
|
Zhang J, Feng Y, Zhao W, Liu K, Chen J. Safety and effectiveness of high flow extracranial to intracranial saphenous vein bypass grafting in the treatment of complex intracranial aneurysms: a single-centre long-term retrospective study. BMC Neurol 2021; 21:307. [PMID: 34372815 PMCID: PMC8351334 DOI: 10.1186/s12883-021-02339-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background To summarize the safety and effectiveness of high flow extracranial to intracranial saphenous vein bypass grafting in the treatment of complex intracranial aneurysms. Methods The data of complex intracranial aneurysms patients for high flow extracranial to intracranial saphenous vein bypass grafting from January 2008 to January 2020 were retrospectively collected and analyzed. Eighty-two patients (31 men and 51 women) with 89 aneurysms underwent 82 saphenous vein bypass grafts followed by immediate parent vessel occlusion. The aneurysm was located at the internal carotid artery, middle cerebral artery, and basilar artery in 75, 11, and 3 cases, respectively. Results The patency rate of bypass grafting was 100, 100, 96.3 and 92.4% on intraoperation, on the first postoperative day, at discharge and 6 months follow-up, respectively. At discharge and 6 months follow-up, 3 and 6 patients had graft occlusions. The main postoperative complications were transient hemiparesis and hemianopsia. 3 patients died due to bypass complications and poor physical condition. Conclusions High flow extracranial to intracranial saphenous vein bypass grafting is safe and effective in the treatment of complex intracranial aneurysms and the saphenous vein can meet the requirements of brain blood supply. A high rate of graft patency and adequate cerebral blood flow can be achieved. Highlights A single-centre long-term retrospective study was conducted to assess the safety and effectiveness of high flow EC-IC saphenous vein bypass grafting in the treatment of complex intracranial aneurysms. The data of 82 patients from January 2008 to January 2020 were retrospectively collected and analysed. We found the patency rate of bypass grafting was 100, 100, 96.3 and 92.4% on intraoperation, on the first postoperative day, at discharge and 6 months follow-up, respectively. At discharge and 6 months follow-up, 3 and 6 patients had graft occlusions. Finally, we conclude that high flow extracranial to intracranial saphenous vein bypass grafting is safe and effective in the treatment of complex intracranial aneurysms and the selected blood supply vessels can meet the requirements of blood supply. As far as we know, this study is one of the maximum number of cases in the treatment of complex intracranial aneurysms with saphenous vein bypass.
Collapse
Affiliation(s)
- Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yu Feng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China
| | - Kui Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, China.
| |
Collapse
|
28
|
Kwon Y, Park CB, Kang PJ, Cho WC. Eighteen Years of Follow-up after Resection of a Giant Coronary Artery Aneurysm and Reconstruction with a Vein Graft. Korean J Thorac Cardiovasc Surg 2021; 54:221-223. [PMID: 33173019 PMCID: PMC8181689 DOI: 10.5090/jcs.20.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
Giant coronary artery aneurysms are rare and challenging to treat because of variation in the presenting symptoms and the lack of established management guidelines. We report the case of a patient with a 6-cm-wide giant coronary artery aneurysm that was resected, followed by reconstruction using a saphenous vein graft and 18 years of follow-up.
Collapse
Affiliation(s)
- Yelee Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Bin Park
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Pil Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| |
Collapse
|
29
|
Hata Y, Iida O, Takahara M, Asai M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujumura T, Matsuda Y, Yanaka K, Mano T. Saphenous vein size as a surrogate marker for mortality of patients with chronic limb-threatening ischemia undergoing endovascular therapy. J Cardiol 2021; 78:341-346. [PMID: 34039466 DOI: 10.1016/j.jjcc.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The size of the autologous vein graft is an important determinant of prognosis in patients with chronic limb-threatening ischemia (CLTI) undergoing bypass surgery. However, it is unclear whether reconstruction using a small vein graft would directly affect prognosis, or a subgroup having small veins would be subject to a poor prognosis. If the latter is true, having small veins would work as a marker for a poor prognosis even in patients with CLTI undergoing endovascular therapy (EVT). Therefore, we investigated the association between the size of saphenous veins and prognosis in patients with CLTI undergoing EVT. METHODS This study included 209 consecutive patients with CLTI who primarily underwent EVT between January 2017 and December 2018. The diameter of the saphenous vein was measured at three locations (saphenous-femoral junction, knee, and ankle joint) per limb before EVT by ultrasonography. A small saphenous vein was defined as the mean diameter <3.0 mm. RESULTS All-cause mortality rate was significantly higher in patients with a small saphenous vein than in those with non-small one (46.3% versus 10.7% at 2 years, p<0.001). The multivariate Cox regression analysis revealed that a small saphenous vein was independently associated with an increased risk of all-cause mortality. CONCLUSIONS Having a small saphenous vein was an independent marker for all-cause mortality in patients with CLTI undergoing EVT.
Collapse
Affiliation(s)
- Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan.
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsutoshi Asai
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takuya Tsujumura
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Koji Yanaka
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Inabaso, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| |
Collapse
|
30
|
Samano N, Loesch A, Dashwood MR. What is the impact of preserving the endothelium on saphenous vein graft performance? Comments on the 'NO' touch harvesting technique. J Cardiothorac Surg 2021; 16:21. [PMID: 33726786 DOI: 10.1186/s13019-021-01397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Saphenous veins used for coronary artery bypass surgery are subjected to considerable vascular trauma when harvested by conventional methods. This vascular damage is responsible, at least in part, for the inferior patency of the saphenous vein when compared with the internal thoracic artery. The performance of saphenous vein grafts is improved when this conduit is harvested atraumatically using the no-touch technique. There is growing evidence that the success of the no-touch technique is due to the preservation of a number of vascular structures including the endothelium, vasa vasorum and perivascular fat. There is conflicting evidence regarding the degree of endothelial damage to the endothelium of conventional versus no-touch saphenous vein grafts. In general, it has been shown that this single layer of cells lining the lumen exhibits considerable damage associated with a combination of vascular trauma and high pressure intraluminal distension. Increased platelet aggregation and thrombus formation at the exposed subendothelial membrane is due to a local reduction of endothelium-derived factors including nitric oxide. In addition, damage to the vasa vasorum of conventionally-harvested veins will reduce transmural blood flow, a condition shown to promote neointimal hyperplasia and atheroma formation. By stripping off the perivascular fat during conventional harvesting, mechanical support of the graft is reduced and the source of adipocyte-derived factors potentially beneficial for graft patency removed. While most agree that endothelial damage to the saphenous vein affects graft patency, the contribution of other tissue-derived factors affected by vascular damage at harvesting need to be considered.
Collapse
|
31
|
Akcay M. Successful Treatment of a Huge Thrombotic Saphenous Vein Graft Occlusion with Aspiration Thrombectomy: A Case Report. J Tehran Heart Cent 2021; 15:69-72. [PMID: 33552197 PMCID: PMC7825471 DOI: 10.18502/jthc.v15i2.4186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Saphenous vein grafts (SVGs) are widely used conduits for the surgical revascularization of coronary arteries, but they are associated with poor long-term patency rates. Acute SVG thromboses often present as acute coronary syndrome and have an extensive atherosclerotic and thrombotic burden. Percutaneous coronary intervention (PCI) is the first treatment option; however, it carries a high risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Reducing the thrombus burden and preventing distal embolization during PCI can be achieved by using some pharmacological strategies (e.g., glycoprotein IIb/IIIa antagonists) and devices (e.g., thrombectomy and filter devices). There are yet no better therapeutic options for patients undergoing PCI of SVG occlusions. Here, we introduce a 52-year-old male patient admitted with a typical acute chest pain of 1 hour’s duration. Electrocardiography showed signs of acute inferoposterior myocardial infarction. A thrombotic SVG occlusion was detected in primary PCI, and a huge thrombus content was aspirated. After the thrombus aspiration with stent implantation, the chest pain was relieved and the ST-segment elevation was improved. The patient has been followed without any symptoms for 10 months.
Collapse
Affiliation(s)
- Murat Akcay
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| |
Collapse
|
32
|
Santos RFD, Niclauss L. First Results of the Single Heartstring Aortotomy for Multiple Off-Pump Vein Grafts: A Case Series. Korean J Thorac Cardiovasc Surg 2020; 53:403-407. [PMID: 33046668 PMCID: PMC7721526 DOI: 10.5090/kjtcs.20.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
To validate the technique of the single Heartstring aortotomy for multiple off-pump venous bypass grafts (described in 2015), the results of a 38-month follow-up study of 18 patients, including high-risk patients, are presented. No early deaths or cardiac or cerebral complications occurred. During the follow-up period, 2 patients died of non-cardiac causes, and 3 developed coronary ischemia. Ischemia occurred due to late graft occlusion in 2 patients, both of whom had normal postoperative courses and correct graft flow. The presence of acute symptoms 24 months after surgery in these patients indicated that technical graft failure was unlikely. This safe technique combines the advantages of simple and reproducible revascularization, the off-pump approach, and minimal aortic manipulation.
Collapse
Affiliation(s)
| | - Lars Niclauss
- Faculty of Medicine and Biology, Lausanne University, Lausanne, Switzerland.,Division of Cardiovascular Surgery, Cardiovascular Department, University Hospital Lausanne, Lausanne, Switzerland
| |
Collapse
|
33
|
Kitagawa A, Yamada Y, Nagao T. The proximity of the superficial epigastric vein to the saphenofemoral junction is associated with endovenous heat-induced thrombosis after radiofrequency ablation for varicose veins. J Vasc Surg Venous Lymphat Disord 2021; 9:669-75. [PMID: 32827735 DOI: 10.1016/j.jvsv.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To elucidate the risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins in association with the superficial epigastric vein (SEV) position to the saphenofemoral junction (SFJ). METHODS We examined 125 legs from 218 patients (mean age, 67 years; 80 female legs) with great saphenous veins (GSVs) in association with the SEV proximity to the SFJ using the duplex ultrasound test. According to the Clinical, Etiology, Anatomy and Pathophysiology classification (CEAP; C1-C6), there were 62, 38, and 25 legs in the C2, C3, and C4-C6 categories, respectively. The postoperative duplex ultrasound tests, focused on EHIT, were conducted on days 1, 7, 30, and 90 after RFA. The EHIT analysis was based on Kabnick's classification (class 1-4). We compared the GSV diameter and the SEV-SFJ distance between the EHIT positive (n = 32) and negative groups (n = 93) using the Student t-test. The risk factors (age >75, male sex, ≥C3 classification, adjunctive phlebectomy, prior venous surgery history, GSV diameter of >7.5 mm, and short SEV-SFJ distance [<4 mm]) were examined using univariate and multiple logistic regression analyses. RESULTS The EHIT ratio after RFA was 25.6% (24, five, three, and no legs in classes 1, 2, 3, and 4, respectively). In the EHIT positive group, the mean GSV diameter and the SEV-SFJ distance were larger (8.0 ± 2.3 vs 6.4 ± 2.0 mm; P < .001) and shorter (5.2 ± 4.0 vs 6.8 ± 3.7 mm; P = .05) than the negative group. Using univariate analysis, the risk factors of EHIT after RFA were as follows: ≥C3 classification (odds ratio [OR], 4.15; P = .002), GSV diameter >7.5 mm (OR, 3.50; P = .003), and short SEV-SFJ distance (OR, 2.92; P = .01). Multiple logistic regression analysis showed that a classification of ≥C3 (OR, 3.39; 95% confidence interval [CI], 1.30-8.86; P = .013), GSV of >7.5 mm (OR, 3.32; 95% CI, 1.33-8.25; P = .010), and short SEV-SFJ distance (OR, 2.71; 95% CI, 1.09-6.71; P = .032) were also significant risk factors. CONCLUSIONS RFA treatment for patients with varicose veins should be considered postoperatively in combination with a classification of ≥C3, GSV diameter of >7.5 mm, and a history of deep venous thrombosis and concomitant procedures, because it is related with greater chances of EHIT development.
Collapse
|
34
|
Maruyama Y, Imura H, Nitta T. Saphenous vein characteristics evaluated using three-dimensional contrastless computed tomography before coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2021; 69:444-50. [PMID: 32776165 DOI: 10.1007/s11748-020-01457-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Saphenous vein (SV) grafts are occasionally unsuitable for grafting owing to anatomic variants. However, there is some concern regarding preoperative SV evaluation. We used contrastless 3D-CT to investigate the anatomical SV characteristics before CABG. METHODS Contrastless 3D-CT was used to preoperatively evaluate the SV anatomy in 102 consecutive patients undergoing elective first-time CABG. The external diameter of the SV was measured at the mid-level of the thigh and calf segments on both sides. Abnormal branches of the SV were classified into three categories; (1) partial duplication, which was defined as double SVs; (2) large accessory SVs, which were larger than the great SV; and (3) complicated branches of the SV, which resulted in the great SV being undetected. The existence of varicose veins was assessed. RESULTS The size distribution of the SV (< 3 mm/3-5 mm/5 mm <) was 9/142/53 and 17/154/33 in the thigh and calf segments, respectively. Abnormal branches of the SV were found in 47 patients (46%): (1) partial duplication was noted in 40 patients; (2) large accessory SV was observed in eight patients; and (3) complicated branches were identified in five patients. Varicose veins were detected in 15 patients. SV was harvested in 74 patients, and no additional skin incision was required. CONCLUSIONS Contrastless 3D-CT is an objective, less time-consuming modality to preoperatively evaluate the SV, and may be less invasive in terms of avoiding unnecessary skin incision. This technique is useful for defining atypical anatomical variations, such as partial duplications, large accessory SVs, and varicose veins.
Collapse
|
35
|
Proebstle T, Alm J, Dimitri S, Rasmussen L, Whiteley M, Lawson J, Davies AH. Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 9:329-334. [PMID: 32599306 DOI: 10.1016/j.jvsv.2020.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cyanoacrylate closure of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of a prospective, multicenter, nonrandomized cohort study. METHODS A total of 70 patients were enrolled in a prospective, multicenter study conducted at seven centers in four European countries and underwent treatment of a solitary refluxing great saphenous vein with endovenous cyanoacrylate embolization without the use of tumescent anesthesia or postprocedure compression stockings. The primary effectiveness end point was freedom from recanalization (closure rate) of the great saphenous vein at 6 months. Safety was assessed by occurrence of adverse events after the procedure and during the 6-month follow-up period. Quality of life and clinical improvement parameters were measured before and after the procedure and through a 12-month follow-up period. Anatomic success and clinical improvement were assessed through 36 months after the procedure. RESULTS Of 70 treated patients, 64 (91%) were available for the 3-year follow-up. The closure rates by Kaplan-Meier life table methods at 6-, 12-, 24-, and 36-month time points were 91.4%, 90.0%, 88.5%, and 88.5%, respectively. Through 36 months, the improvement in change of the mean venous clinical severity score over time was statistically significant by dropping from 4.3 at baseline to 0.9 at the 36-month follow-up (P < .001). CONCLUSIONS The 3-year follow-up results of the prospective, multicenter eSCOPE study demonstrated the continued anatomic and clinical effectiveness of cyanoacrylate embolization over an extended follow-up period.
Collapse
Affiliation(s)
| | - Jens Alm
- Dermatologikum, Hamburg, Germany
| | | | | | | | | | | |
Collapse
|
36
|
Ziliotto N, Meneghetti S, Menegatti E, Baroni M, Lunghi B, Salvi F, Ferracin M, Branchini A, Gemmati D, Mascoli F, Zamboni P, Bernardi F, Marchetti G. Expression profiles of the internal jugular and saphenous veins: Focus on hemostasis genes. Thromb Res 2020; 191:113-24. [PMID: 32438216 DOI: 10.1016/j.thromres.2020.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/15/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Venous bed specificity could contribute to differential vulnerability to thrombus formation, and is potentially reflected in mRNA profiles. MATERIALS AND METHODS Microarray-based transcriptome analysis in wall and valve specimens from internal jugular (IJV) and saphenous (SV) veins collected during IJV surgical reconstruction in patients with impaired brain outflow. Multiplex antigenic assay in paired jugular and peripheral plasma samples. RESULTS Most of the top differentially expressed transcripts have been previously associated with both vascular and neurological disorders. Large expression differences of HOX genes, organ patterning regulators, pinpointed the vein positional identity. The "complement and coagulation cascade" emerged among enriched pathways. In IJV, upregulation of genes for coagulation inhibitors (TFPI, PROS1), activated protein C pathway receptors (THBD, PROCR), fibrinolysis activators (PLAT, PLAUR), and downregulation of the fibrinolysis inhibitor (SERPINE1) and of contact/amplification pathway genes (F11, F12), would be compatible with a thromboprotective profile in respect to SV. Further, in SV valve the prothrombinase complex genes (F5, F2) were up-regulated and the VWF showed the highest expression. Differential expression of several VWF regulators (ABO, ST3GAL4, SCARA5, CLEC4M) was also observed. Among other differentially expressed hemostasis-related genes, heparanase (HPSE)/heparanase inhibitor (HPSE2) were up-/down-regulated in IJV, which might support procoagulant features and disease conditions. The jugular plasma levels of several proteins, encoded by differentially expressed genes, were lower and highly correlated with peripheral levels. CONCLUSIONS The IJV and SV rely on differential expression of many hemostasis and hemostasis-related genes to balance local hemostasis, potentially related to differences in vulnerability to thrombosis.
Collapse
|
37
|
Kim PS, Elias S, Gasparis A, Labropoulos N. Results of polidocanol endovenous microfoam in clinical practice. J Vasc Surg Venous Lymphat Disord 2020; 9:122-127. [PMID: 32353594 DOI: 10.1016/j.jvsv.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Initial phase III clinical studies with polidocanol endovenous microfoam (PEM) demonstrated its safety and efficacy in the treatment of superficial venous reflux. In those studies, the primary outcome requirement was to assess the improvement in symptoms related to superficial venous disease. The goal of the present study was to evaluate the efficacy of PEM technology in routine clinical practice-specifically, the closure rates after treatment. METHODS We performed an observational study during which data were prospectively collected from 2 vein centers using an electronic database. Patients with CEAP (clinical, etiologic, anatomic, pathophysiologic) class ≥2 and symptomatic superficial axial reflux (great saphenous vein, anterior accessory saphenous vein, and small saphenous vein) were included and followed up prospectively. PEM was used to treat the saphenous vein and varicosities. The CEAP classification was used to classify chronic venous disease, and the venous clinical severity score (VCSS) was applied to measure the disease severity. Pain and discomfort were assessed using a visual analog scale, and the residual veins were assessed by physical examination. RESULTS PEM was used to treat superficial reflux in 60 patients. The CEAP classification was C2 for 32 patients, C3 for 14, C4 for 10, and C5 for 4 patients. The average pretreatment VCSS was 7.3. The saphenous vein diameter was 6.5 mm, and the average length was 31 cm. The average volume of PEM used to treat the saphenous veins was 9.3 mL. The closure rate at 3 and 6 months was 93% (54 of 58) and 93% (51 of 55), respectively. The VCSS had improved from 7.3 to 1.4. Complications included 1 case of deep vein thrombosis (1.7%), 5 patients (8.3%) with thrombophlebitis, and 4 patients (6.6%) with skin pigmentation. CONCLUSIONS PEM is safe and effective for the treatment of saphenous reflux and varicosities. The early closure rates using PEM were maintained at 6 months and are comparable to the results reported with nonthermal, nontumescent technologies and thermal tumescent technologies.
Collapse
Affiliation(s)
- Pamela S Kim
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY
| | | | | | | |
Collapse
|
38
|
Royse A, Pamment W, Pawanis Z, Clarke-Errey S, Eccleston D, Ajani A, Wilson W, Canty D, Royse C. Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts. BMC Cardiovasc Disord 2020; 20:148. [PMID: 32204693 PMCID: PMC7092416 DOI: 10.1186/s12872-020-01433-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Methods Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Results Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. Conclusions All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
Collapse
Affiliation(s)
- Alistair Royse
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia. .,Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, PO Box 2135, Melbourne, Victoria, 3050, Australia.
| | - William Pamment
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia
| | - Zulfayandi Pawanis
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Universitas Airlangga Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Sandy Clarke-Errey
- Statistical Consulting Centre, The University of Melbourne, 139 Barry St, Parkville, 3010, Australia
| | - David Eccleston
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Andrew Ajani
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - William Wilson
- Department of Medicine and Cardiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - David Canty
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - Colin Royse
- Department of Surgery, The University of Melbourne, PO Box 2135 RMH, Melbourne, 3050, Australia.,Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
| |
Collapse
|
39
|
Lobo Filho JG, Lobo Filho HG, Pimentel MD. Bilateral internal thoracic artery versus left internal thoracic artery and saphenous vein grafting in coronary artery bypass surgery. Eur J Cardiothorac Surg 2020; 57:615. [PMID: 31584658 DOI: 10.1093/ejcts/ezz263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
|
40
|
Ji Q, Song K, Shen J, Wang Y, Yang Y, Ding W, Xia L, Wang C. Long-Term Patency Rate of Radial Artery Conduits in Chinese Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. Int Heart J 2019; 60:1276-1283. [PMID: 31735768 DOI: 10.1536/ihj.18-305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure.Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified.A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26).The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%. (Trial registration: ChiCTR-OCH-1200212).
Collapse
Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Kai Song
- Shanghai Institute of Cardiovascular Disease
| | - JinQiang Shen
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - YuLin Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - WenJun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - LiMin Xia
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | | |
Collapse
|
41
|
Frappé P, Haller DM, Roméas A, Bertoletti L, François M, Robert-Ebadi H, Righini M. Avoiding disease mongering: A checklist for vascular physicians and researchers. Thromb Res 2019; 181:120-123. [PMID: 31400622 DOI: 10.1016/j.thromres.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Disease mongering is an expression created in 1992 by a medical journalist, Lynn Payer, to qualify the "selling of sickness that widens the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments". This interesting concept led us to question whether, as researchers with publication and career interests in superficial vein thrombosis, we were not shaping a benign condition into a disease. Since the publication of the CALISTO trial in 2010, anticoagulant management of superficial vein thrombosis remains debated. Issues raised, such as the cost-effectiveness of the treatment strategy, the use of a composite endpoint including death, the low event rate without mortality reduction and conflict of interest due to industrial funding. We searched Embase, Medline, Web of science, and Opengrey databases to review all aspects about disease mongering raised in the literature and created a checklist with seventeen items. We used this checklist as support for a narrative review, questioning known literature on superficial vein thrombosis. The main issues pointing towards disease mongering concerned definition and promotion; whereas management seemed rather spared. Many arguments could be counterbalanced, but researchers should pay particular attention to three major points: exaggeration of the severity of the disease and potential adverse outcomes without treatment, promotion by opinion leaders, and an openly declared, yet undoubtedly present, conflict of interest situation.
Collapse
Affiliation(s)
- Paul Frappé
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France; INSERM U 1059 Sainbiose DVH and INSERM CIC-EC 1408, University of Saint-Etienne, Saint-Etienne, France; Primary Care Unit, University of Geneva, Geneva, Switzerland.
| | - Dagmar M Haller
- Primary Care Unit, University of Geneva, Geneva, Switzerland
| | - Andrea Roméas
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM U 1059 Sainbiose DVH and INSERM CIC-EC 1408, University of Saint-Etienne, Saint-Etienne, France; Department of Vascular Medicine and Therapeutics, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mathilde François
- Department of General Practice, University of Versailles-Saint-Quentin, Versailles, France; INSERM, Center for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
42
|
Hamann SAS, van der Velden SK, De Maeseneer MGR. Safety and Effectiveness of Endovenous Thermal Ablation for Incompetent Saphenous Veins with an Aneurysm Close to the Junction. Eur J Vasc Endovasc Surg 2019; 58:244-248. [PMID: 31153734 DOI: 10.1016/j.ejvs.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/05/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim was to evaluate the safety and effectiveness of endovenous thermal ablation (EVTA) with or without adding high ligation (HL) for the treatment of incompetent saphenous veins with an aneurysm (>20 mm for the great saphenous vein, >15 mm for the small saphenous vein) close to the junction. METHODS This was a prospective observational cohort study in a single centre. All patients presenting with saphenous aneurysms close to the junction were included. Those with a venous aneurysm more distally, at >2 cm from the junction, or with associated deep venous aneurysms were excluded. Patients were treated with EVTA alone or combined with HL in cases of an aneurysm with a diameter >30 mm. Phlebectomies were performed during the same treatment session. Patients were followed up one and six weeks, and one year after treatment. Duplex ultrasound (DUS) was performed to evaluate occlusion of the vein and aneurysm as well as possible complications such as endovenous heat induced thrombosis (EHIT) or deep vein thrombosis (DVT). Venous clinical severity scores (VCSS) were registered before and one year after treatment. RESULTS Thirteen patients (15 limbs) were included between February 2012 and January 2015. Eleven limbs were treated with EVTA alone, the remaining four limbs with EVTA and HL. No severe adverse events occurred (no EHIT, no DVT). After one year none of the aneurysms was still visible on DUS and the truncal obliteration rate was 80% (two partial, one segmental recanalisation). Both treatment strategies showed significant improvement of the VCSS at the one year follow up, from a median score of 6 (interquartile range [IQR] 5-7) to 2 (IQR 1-3) (p = .001). CONCLUSION EVTA with or without HL appeared to be a safe and effective treatment for patients presenting with incompetent saphenous veins with an aneurysm close to the junction.
Collapse
Affiliation(s)
- Sterre A S Hamann
- Department of Dermatology, Erasmus MC, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Simone K van der Velden
- Department of Dermatology, Erasmus MC, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | |
Collapse
|
43
|
Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res 2019; 96:313-318. [PMID: 31183336 PMCID: PMC6543052 DOI: 10.4174/astr.2019.96.6.313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/15/2019] [Accepted: 04/01/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. Methods From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3–5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. Results Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. Conclusion For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.
Collapse
Affiliation(s)
- Hye Young Woo
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Suh Min Kim
- Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Daehwan Kim
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
44
|
Mawhinney JA, Mounsey CA, Taggart DP. Reply to Dashwood. Eur J Cardiothorac Surg 2019; 55:1022. [PMID: 30535071 DOI: 10.1093/ejcts/ezy413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamie A Mawhinney
- Cardiovascular Division, Academic Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | | | - David P Taggart
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| |
Collapse
|
45
|
Dashwood MR. Why 'EXTENT' for coronary artery bypass surgery when the saphenous vein should need no support? Eur J Cardiothorac Surg 2019; 55:1021. [PMID: 30534985 DOI: 10.1093/ejcts/ezy412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael R Dashwood
- Division of Surgery and Interventional Science, University College London Medical School, London, UK
| |
Collapse
|
46
|
Yun S. Ultrasound-based topographic analysis of tributary vein connection with the saphenous vein during ambulatory conservative hemodynamic correction of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2019; 7:356-63. [PMID: 30777672 DOI: 10.1016/j.jvsv.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
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. METHODS Ultrasound assessment of VVs was performed from March 4, 2016, to July 15, 2016, specifically focusing on the locations of escape points from the saphenous vein to TVs. The collected data were reviewed retrospectively. The topographic distribution of escape points was as follows: from inguinal ligament to midthigh; from midthigh to knee; from knee to midcalf; and from midcalf to heel. RESULTS Thirty patients (41 legs) with VVs underwent ultrasound examination. All VVs were characterized by reflux at the GSV. Topographic analysis revealed a total of 79 escape points in all patients. The most common location for escape points was the third part of the leg (from knee to midcalf), where 65.8% of escape points were located; 82.3% of all escape points were located below the knee. The mean diameter of the GSV at 3 cm and 15 cm from the saphenofemoral junction was 6.8 ± 1.6 cm and 5.5 ± 1.5 cm, respectively. Mean diameter of TVs was 5.1 ± 1.9 cm. The diameter was not significantly different between saphenous veins and TVs. The mean number of escape points in each leg was 1.9 ± 1.0. CONCLUSIONS Most escape points (65.8%) are located from knee to midcalf (third part of the leg), and 82.3% of all escape points are located below the knee. The diameter of TVs near the escape point is about 90% of that of the GSV. Thermal ablations of below-knee saphenous vein have potential nerve damage. Ablation of saphenous veins above the knee alone may result in residual shunting and formation of persistent reservoirs in TVs. These persistent reservoirs may be removed effectively with sclerotherapy or miniphlebectomy, especially trying to remove TVs near the escape point. Direct ligation of a TV near the escape point from the saphenous vein, just like saphenofemoral junction ligation, could be performed. These approaches may be able to prevent residual shunting and may reduce recurrence rates and nerve injury.
Collapse
|
47
|
Liu Y, Cui Z, Wang YY, Sun B, Xiao JY, Gao MD, Wang JX, Gong XW, Feng SY, Gao J. [Plaque features in saphenous vein graft evaluated by virtual histology intravascular ultrasound]. Zhonghua Xin Xue Guan Bing Za Zhi 2019; 47:26-33. [PMID: 30669807 DOI: 10.3760/cma.j.issn.0253-3758.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the features of plaques of saphenous venous graft (SVG) with virtual histology intravascular ultrasound (VH-IVUS) in patients underwent coronary artery bypass graft surgery. Methods: From March 2016 to March 2018, a total of 45 patients ((64.4±7.9) years old, 88.9% male (40 cases)) with ischemic symptoms after coronary artery bypass graft surgery and with coronary artery angiography evidenced SVG stenosis greater than or equal to 50%, who received percutaneous coronary intervention in Tianjin chest hospital were continuously included in this study, and the clinical data were retrospectively analyzed. VH-IVUS was performed before PCI to analyze plaque composition. The patients were divided into no smoking group (21 cases) and smoking group (24 cases), no diabetes group (30 cases) and diabetes group (15 cases), normal very low density lipoprotein cholesterin (VLDL-C) group (24 cases) and elevated VLDL-C group (21 cases), stable angina pectoris group (5 cases) and acute coronary syndrome group (40 cases), plaque burden (PB) < 70% group (11 cases) and PB ≥ 70% group (34 cases), without thin-cap fibroatheroma group (35 cases) and thin-cap fibroatheroma group (10 cases), and plaque features were compared between different groups. Results: The graft age was (8.9±3.7) years.The stenosis degree of SVG lesions was 90 (90, 98) %. The minimum lumen diameter was 1.6 (1.5, 1.8) mm. The vessel cross-sectional area was (12.1±4.0) mm(2). The plaque area was 8.6 (5.7,12.0) mm(2). The minimum lumen area was 2.5 (2.1,3.3) mm(2). The plaque burden was (75.3±8.3)%. The fibrotic tissue (FI) ratio was (65.1±10.1)%, fibrofatty plaque (FF) ratio was 13.8 (5.4,25.3) %, necrotic core tissue (NC) ratio was 12.0 (5.4,24.0)%, and dense calcium tissue (DC) ratio was1.0 (0.2,3.8)% in SVG lesions. There were no significant differences in SVG plaque area, FI area,FF area,NC area,and DC area between no smoking group and smoking group, no diabetes group and diabetes group, and normal VLDL-C group and elevated VLDL-C group. SVG plaque volume was significantly higher in acute coronary syndrome group than in stable angina pectoris group (262.2 (148.5,401.2) mm(3) vs. 93.1 (50.6,155.9) mm(3),P=0.006), and plaque area (10.1 (6.6,13.3) mm(2) vs. 5.0 (3.6,6.9) mm(2), P<0.001), FI area(4.8 (3.2,6.8) mm(2) vs. 2.8 (1.9,3.0) mm(2), P<0.001),and FF area (1.15 (0.60, 2.07) mm(2) vs. 0.30 (0.10,0.90) mm(2), P=0.009) were significantly larger in PB ≥ 70% group than in PB < 70% group.The NC area (1.75(0.40,2.78) mm(2) vs. 0.60 (0.20,1.30) mm(2), P=0.030) and DC area (0.35 (0.10,0.50) mm(2) vs. 0.00 (0.00,0.10) mm(2), P=0.006) were significantly larger in thin-cap fibroatheroma group than that in without thin-cap fibroatheroma group. Spearman correlation analysis showed that the plaque area of SVG lesion was positively correlated with FF area (r=0.64, P<0.001) and NC area (r=0.43, P=0.003). PB was positively correlated with FF area (r=0.50, P<0.001) and NC area (r=0.33, P=0.028). Graft age was positively correlated with FF area (r=0.30, P=0.047). Conclusions: The main components of SVG plaque are fibrotic tissue, conversely, calcified tissue is rare in patients with SVG stenosis after coronary artery bypass graft surgery. Fibrofatty tissue is increased in the plaque in patients with PB ≥ 70%. The necrotic component is also increased in patients with thin-cap fibroatheroma. The fibrofatty component increases and the plaque tends to be unstable in proportion with increaing age of the graft in this patient cohort.
Collapse
Affiliation(s)
- Y Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - Z Cui
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Y Y Wang
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - B Sun
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - J Y Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - M D Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - J X Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - X W Gong
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - S Y Feng
- Graduate School, Tianjin Medical University, Tianjin 300070, China
| | - J Gao
- Tianjin Cardiovascular Institute, Tianjin 300222, China
| |
Collapse
|
48
|
Kim KB, Hwang HY, de Souza DSR, Taggart DP. Saphenous vein: advances. Indian J Thorac Cardiovasc Surg 2018; 34:251-7. [PMID: 33060946 DOI: 10.1007/s12055-018-0753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022] Open
Abstract
Although the saphenous vein (SV) is a widely used conduit for coronary artery bypass graft surgery (CABG), lower long-term graft patency rates and worse clinical outcomes have been reported after CABG performed with SV grafts compared with CABG performed with internal thoracic artery (ITA) grafts. Of various efforts to overcome the limitations of SV that are resulting from structural and functional differences from arterial conduit, recent improvement in harvesting techniques including no-touch technique, surgical strategy of using the SV as part of a composite graft over an aortocoronary bypass graft, and external stenting of the SV will be discussed in this topic.
Collapse
|
49
|
Hong KP, Kim DK. The Effect of Saphenous Vein Ablation on Combined Segmental Popliteal Vein Reflux. Korean J Thorac Cardiovasc Surg 2018; 51:338-343. [PMID: 30402394 PMCID: PMC6200168 DOI: 10.5090/kjtcs.2018.51.5.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 11/23/2022]
Abstract
Background This study examined the role of superficial vein surgery in patients with combined superficial venous reflux and segmental popliteal vein reflux. Methods We retrospectively reviewed 42 limbs in 38 patients with combined superficial venous reflux and segmental popliteal vein reflux who underwent saphenous vein ablation between January 2014 and February 2017. Patients underwent outpatient follow-up duplex ultrasonography at 3, 6, and 12 months postoperatively. Resolution of deep vein reflux was defined as reversed blood flow in a popliteal segment for less than 1.0 second and a decrease in the reflux time of more than 20% of the preoperative reflux time. Results The mean follow-up period was 9 months (range, 3–23 months). Saphenous vein ablations were performed by stripping in 24 limbs and radiofrequency ablation in 18 limbs. Preoperative segmental popliteal vein reflux resolved in 21 of the 42 limbs (50%). Conclusion This study demonstrated that superficial venous surgery corrected segmental popliteal vein reflux in 50% of limbs with combined superficial venous reflux and segmental popliteal vein reflux. Other prospective studies are necessary to elucidate the etiology of the non-reversible cases.
Collapse
Affiliation(s)
- Ki-Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
| | - Do-Kyun Kim
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
| |
Collapse
|
50
|
de Oliveira RG, de Morais Filho D, Engelhorn CA, Kessler IM, Coelho Neto F. Foam sclerotherapy for lower-limb varicose veins: impact on saphenous vein diameter. Radiol Bras 2018; 51:372-376. [PMID: 30559554 PMCID: PMC6290741 DOI: 10.1590/0100-3984.2017.0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To assess changes in the great saphenous vein (GSV) after foam sclerotherapy
for varicose veins. Materials and Methods This was a prospective study of 33 patients who were treated with polidocanol
foam sclerotherapy after having had varicose veins with a clinical
severity-etiology-anatomy-pathophysiology classification of C4-C6 for three
months. The patients were evaluated by ultrasound before, during, and after
the procedure (on post-procedure days 7, 15, 30, 60, and 90). The GSV
diameter, the rate of venous occlusion, and the rate of reflux elimination
were determined. Two patients were excluded for having a history of deep
vein thrombosis history, and one was excluded for having bronchial
asthma. Results Thirty patients (26 females and 4 males, with mean age of 62 years) completed
the protocol. The mean pre-procedure GSV diameter was 6.0 ± 0.32 mm
(range, 3.6-11.2 mm). During the sclerotherapy, the mean GSV diameter was
reduced to 1.9 ± 0.15 mm (range, 0.6-3.8 mm). On post-procedure day
7, the mean GSV diameter increased to 6.3 ± 0.28 mm (range, 3.9-9.7
mm). On post-procedure day 90, the mean GSV diameter was 4.0 ± 0.22
mm (range, 1.9-8.2 mm). The rate of GSV reflux was significantly lower in
the assessment performed on post-procedure day 90 than in the pre-procedure
assessment (p < 0.0028). Conclusion On the basis of our ultrasound analysis, we can conclude that foam
sclerotherapy for varicose veins results in a significant reduction in GSV
diameter, as well as in the elimination of GSV reflux.
Collapse
Affiliation(s)
| | | | | | | | - Felipe Coelho Neto
- Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brazil
| |
Collapse
|