BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such ...BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.AIM To investigate changes in physical function and the quality of life(QOL)following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.METHODS We enrolled 37 participants(those with varicose veins,n=17;healthy individuals,n=20).We performed the following measurements pre-and post-nonsurgical treatment in the varicose vein patients and healthy individuals:Calf muscle oxygenation during the two-minute step test,open eyes one-leg stance,30 s sit-to-stand test,visual analog scale(VAS)for pain,Pittsburgh sleep quality index,physical activity assessment,and QOL assessment.RESULTS Varicose veins patients and healthy individuals differ in most variables(physical function,sleep quality,and QOL).Varicose veins patients showed significant differences between pre-and post-nonsurgical treatment—results in the 30 sit-to-stand test[14.41(2.45)to 16.35(4.11),P=0.018],two-minute step test[162.29(25.98)to 170.65(23.80),P=0.037],VAS for pain[5.35(1.90)to 3.88(1.73),P=0.004],and QOL[39.34(19.98)to 26.69(17.02),P=0.005];however,no significant difference was observed for muscle oxygenation.CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients,bringing their condition close to that of healthy individuals.Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.展开更多
BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in...BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in patients with varicose veins.CASE SUMMARY The present report describes the case of a 70-year-old man with varicose veins,vitiligo,and phlebosclerosis.Venous angiography revealed blood reflux in the superficial and deep veins.The patient underwent surgery to remove the saphe-nous veins.During the operation,a calcified vein resembling a wooden stick was found,which was surprisingly extracted from the thickened venous wall.A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification,obvious thickening of the venous wall,extensive collagen deposition on the venous wall,hyaline degeneration,and venous sclerosis causing closure of the venous lumen.CONCLUSION This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers.Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes.Therefore,it is important to be aware of this condition and address it rather than overlook it.展开更多
BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)...BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.展开更多
Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-strippi...Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy(FS).Methods:A total of 64 patients(35 females,29 males;mean age,57?11 years[range,29–79 years])with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019.The maximum diameter of the vein branches was>20 mm,which appeared to be cystic dilatation and forms large-scale in the crus or the thigh.All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia.The surgical time,pain/phlebitis,number of incisions,amount of bleeding,recurrence of varicose vein,incidence of surgical site infections(SSIs),satisfaction score,and improvement in clinical symptoms were evaluated respectively with the patients in two groups:Group A,with patients who underwent treatment with the Trivex system,and Group B,patients who underwent treatment by point-form-stripping combined with FS.Results:All procedures were performed successfully.The average operative time in Group A was 56?11 min,whereas that of Group B was 90?33 min,which was a significant difference(p<0.05).Group A patients felt little pain after surgery,whereas in Group B the level of pain peaked on postoperative day 30,mostly due to thrombophlebitis after FS.There was no recurrence of varicose vein was observed in any patient,however,there were some residual effects in Group B,including the amount of bleeding volume,in-hospital stays,pain/phlebitis,and number of incisions(P<0.05).There were no significant differences with respect to SSIs,improvement in clinical symptoms,and satisfaction scores observed(p>0.05).Conclusions:This study shows that patients benefited from both treatment options.However,primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy(FS).In summary,the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy(FS)for those who demand a high level of appearance,and especially for young patients,the Trivex system is recommended.展开更多
Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences.In the recent decade,the recommendations for managing symptomatic varicose ...Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences.In the recent decade,the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques.The literature was systematically searched on Medline without language restrictions.All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed.Endovenous laser ablation(EVLA)and radiofrequency ablation(RFA)both are same safe and effective in terms of occlusion rate,and time to return to normal activity.In comparison with RFA or EVLT,Cure conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire(CHIVA)may cause more bruising and make little or no difference to rates of limb infection,superficial vein thrombosis,nerve injury,or hematoma.In terms of recurrence of varicose veins,there is little or no difference between CHIVA and stripping,RFA,or EVLT.Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy(FS)group(51%)during 1 year of follow-up.The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy.Although the mechanochemical endovenous ablation(MOCA)is a non-thermal,non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage,the overall success rate of MOCA is lower than those of other procedures such as EVLA,RFA,or high ligation and stripping.EVLA is the most cost-effective therapeutic option,with RFA being a close second for the treatment of patients with varicose veins.Endovenous thermal ablation(EVLA or RFA)is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins.Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures.MOCA and cyanoacrylate embolization appear promising,but evidence of their effectiveness is required.展开更多
Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective:...Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18;72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.展开更多
Adams disease is the consequence of overly active transient receptor potential cation channels (TRP). This case report presents a patient suffering from multiple vascular problems and may provide new insights into the...Adams disease is the consequence of overly active transient receptor potential cation channels (TRP). This case report presents a patient suffering from multiple vascular problems and may provide new insights into the causes of venous problems. Endothelial and smooth muscle cells in veins contain TRP. These channels when activated excessively result in calcium accumulation, oxygen radical formation and apoptosis of endothelial and smooth muscle cells. The death of critical cells in vein valves, may lead to varicose veins. The loss of endothelial cells in venules may lead to retinal tears. Damage to vein walls may lead to a deep vein thrombosis. Transient receptor potential cation channels may be new drug targets of interest in the treatment or prevention of these conditions.展开更多
Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.Portal vein tumor thrombus(PVTT)is among the most ominous signs ...Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.Portal vein tumor thrombus(PVTT)is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.Data sources:A systematic search of MEDLINE(PubMed),Embase,Cochrane Library and Database for Systematic Reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases until December 2022 was conducted using free text and MeSH terms:hepatocellular carcinoma,portal vein tumor thrombus,portal vein thrombosis,vascular invasion,liver and/or hepatic resection,liver transplantation,and systematic review.Results:Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy.Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus,accurate identification of the subgroups of patients who may benefit from resection,as well as meticulous surgical technique.This review addressed five specific areas:(a)formation of PVTT;(b)classifications of PVTT;(c)controversies related to clinical guidelines;(d)surgical treatments versus non-surgical approaches;and(e)characterization of surgical techniques correlated with classifications of PVTT.Conclusions:Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.展开更多
BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of patients.We sought to determine the relationship between surfac...BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of patients.We sought to determine the relationship between surface depressions and the diaphragm.AIM To use exploratory laparoscopy to determine the relationship between surface depressions and the diaphragm.METHODS An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and diaphragm.When surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during inspection.RESULTS Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the liver.There was no significant relationship between the presence of surface depressions and gender nor the presence of rib projections.However,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface depressions.Further studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.展开更多
Varicose veins are enlarged, protuberant superficial veins that are palpable beneath the skin. The causes of such a venous pathology may be primary, secondary, or congenital. The major agents leading to the developmen...Varicose veins are enlarged, protuberant superficial veins that are palpable beneath the skin. The causes of such a venous pathology may be primary, secondary, or congenital. The major agents leading to the development of varicose veins include: Hereditary, prolonged standing, Increasing age, Heavy lifting, Prior superficial or deep vein clots, Female gender and Multiple pregnancies. In this manuscript, we report a case of inguinal varicose vein in connection with femoral vein, resulted from direct intravenous injection of drug. The diagnosis was made based on Doppler sonography.展开更多
A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. A...A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography(CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein(SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that(1) direct devascularization of the main SMV trunkwithout a vein graft is possible. The presence of collateralcirculation can increase the success rate of patientsundergoing radical surgery and prevent the occurrence ofserious postoperative complications. In addition,(2) thiscase demonstrated the clinical value of 3 D reconstruction.展开更多
Objective The study aimed to compare quality of saphenous vein(SV)grafts,wound complications,and clinical outcomes between endoscopic vein harvesting(EVH)technique and open vein harvesting(OVH)technique of coronary ar...Objective The study aimed to compare quality of saphenous vein(SV)grafts,wound complications,and clinical outcomes between endoscopic vein harvesting(EVH)technique and open vein harvesting(OVH)technique of coronary artery bypass graft(CABG)surgery.Methods One hundred patients with multi-vessel coronary disease underwent elective CABG using SV grafts were prospectively recruited and randomized into two groups.展开更多
Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the ...Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.展开更多
Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections afte...Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections after pancreatobiliary surgery still represent significant clinical issues. In addition, insufficient attention is paid to the fact that severe stenosis of the PV can result in life-threatening complications. Material and Methods: At our institution, lymph node dissection within the hepatoduodenal ligament was performed for biliary or pancreatic neoplasms in 68 patients between October 2005 and April 2017. The diameter of the PV was measured on computed tomography scans obtained before and after the operation. PV stenosis was defined as a >50% reduction in the diameter of the PV. The degree of PF (Pancreatic Fistula) was defined by the International Study Group of Pancreatic Fistula after pancreaticoduodenectomy. Furthermore, the Clavien-Dindo (CD) classification was used to assess the complications that occurred in cases in which pancreatojejunostomy was not performed. The relationship between the degree of PV stenosis and the occurrence of postoperative complications was analyzed. Results: The overall frequency of PF was 56.3% (18 patients). Grade B or C PF occurred in 5 patients (15.6%). In the present small series, a correlation was detected between the degree of PV stenosis and the occurrence of postoperative complications after pancreatobiliary surgery (p Conclusions: Clinicians should keep in mind that the PV can narrow in cases in which grade B or C PF or intra-abdominal abscesses occur after pancreatobiliary surgery.展开更多
BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impac...BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impact on patient prognosis.This study aimed to investigate the incidence and risk factors of DVT in the lower limbs following craniocerebral surgery.AIM To identify independent risk factors for the development of postoperative DVT and to develop an effective risk prediction model.METHODS The demographic and clinical data of 283 patients who underwent craniocerebral surgery between December 2021 and December 2022 were retrospectively analyzed.The independent risk factors for lower extremity DVT were identified by univariate and multivariate analyses.A nomogram was created to predict the likelihood of lower extremity DVT in patients who had undergone craniocerebral surgery.The efficacy of the prediction model was determined by receiver operating characteristic curve using the probability of lower extremity DVT for each sample.RESULTS Among all patients included in the analysis,47.7%developed lower extremity DVT following craniocerebral surgery.The risk of postoperative DVT was higher in those with a longer operative time,and patients with intraoperative intermittent pneumatic compression were less likely to develop postoperative DVT.CONCLUSION The incidence of lower extremity DVT following craniocerebral surgery is significant,highlighting the importance of identifying independent risk factors.Interventions such as the use of intermittent pneumatic compression during surgery may prevent the formation of postoperative DVT.展开更多
Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the ...Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.展开更多
Laser treatment represents an attractive option to other methods of vessel diseases especially varicose veins. A long pulse (30-50ms) 532nm laser was used in our experiments, with the pulse duration matching the therm...Laser treatment represents an attractive option to other methods of vessel diseases especially varicose veins. A long pulse (30-50ms) 532nm laser was used in our experiments, with the pulse duration matching the thermal relaxation time of the vessels and the green laser matching the absorption spectrum peak of the blood.Laser irradiates nude vein vessels directly or exterior skin to finish operation faster and to acquire the practical data for upper enteron varicose vein treatment in several animal experiments performed in vivo. The 5Jenergy pulse allows us to finely occlude rabbit or dog's vein vessels up to 2 mm in diameter when irradiating them off external skin. Blood vessels are occluded at once, and later biopsy specimens show the immediate and long-term lasting occlusion effect. While vessels are irradiated directly, they are usually irradiated to perforate, detailed causes are still under investigation. Animal experiments showed that the long pulse green laser therapy is a safe and effective solution to the vein's occlusion, which promises such laser with high energy of each pulse and 30-50 ms duration is an ideal candidate for vessel diseases treatment.展开更多
基金Supported by Biomedical Research Institute,Pusan National University Hospital,202200420001.
文摘BACKGROUND Studies on varicose veins have focused its effects on physical function;however,whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear.Moreover,the differences in such functions between individuals with varicose veins and healthy individuals remain unclear.AIM To investigate changes in physical function and the quality of life(QOL)following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity.METHODS We enrolled 37 participants(those with varicose veins,n=17;healthy individuals,n=20).We performed the following measurements pre-and post-nonsurgical treatment in the varicose vein patients and healthy individuals:Calf muscle oxygenation during the two-minute step test,open eyes one-leg stance,30 s sit-to-stand test,visual analog scale(VAS)for pain,Pittsburgh sleep quality index,physical activity assessment,and QOL assessment.RESULTS Varicose veins patients and healthy individuals differ in most variables(physical function,sleep quality,and QOL).Varicose veins patients showed significant differences between pre-and post-nonsurgical treatment—results in the 30 sit-to-stand test[14.41(2.45)to 16.35(4.11),P=0.018],two-minute step test[162.29(25.98)to 170.65(23.80),P=0.037],VAS for pain[5.35(1.90)to 3.88(1.73),P=0.004],and QOL[39.34(19.98)to 26.69(17.02),P=0.005];however,no significant difference was observed for muscle oxygenation.CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients,bringing their condition close to that of healthy individuals.Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.
文摘BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in patients with varicose veins.CASE SUMMARY The present report describes the case of a 70-year-old man with varicose veins,vitiligo,and phlebosclerosis.Venous angiography revealed blood reflux in the superficial and deep veins.The patient underwent surgery to remove the saphe-nous veins.During the operation,a calcified vein resembling a wooden stick was found,which was surprisingly extracted from the thickened venous wall.A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification,obvious thickening of the venous wall,extensive collagen deposition on the venous wall,hyaline degeneration,and venous sclerosis causing closure of the venous lumen.CONCLUSION This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers.Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes.Therefore,it is important to be aware of this condition and address it rather than overlook it.
基金the Excellent Talents Fund Project of Xuzhou Medical University,No.XYFY2021019.
文摘BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
基金supported by a grant from the“Famous doctors,Famous hospital,Famous clinic”project of the SHENZHEN municipal government[SZSM201512013].
文摘Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy(FS).Methods:A total of 64 patients(35 females,29 males;mean age,57?11 years[range,29–79 years])with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019.The maximum diameter of the vein branches was>20 mm,which appeared to be cystic dilatation and forms large-scale in the crus or the thigh.All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia.The surgical time,pain/phlebitis,number of incisions,amount of bleeding,recurrence of varicose vein,incidence of surgical site infections(SSIs),satisfaction score,and improvement in clinical symptoms were evaluated respectively with the patients in two groups:Group A,with patients who underwent treatment with the Trivex system,and Group B,patients who underwent treatment by point-form-stripping combined with FS.Results:All procedures were performed successfully.The average operative time in Group A was 56?11 min,whereas that of Group B was 90?33 min,which was a significant difference(p<0.05).Group A patients felt little pain after surgery,whereas in Group B the level of pain peaked on postoperative day 30,mostly due to thrombophlebitis after FS.There was no recurrence of varicose vein was observed in any patient,however,there were some residual effects in Group B,including the amount of bleeding volume,in-hospital stays,pain/phlebitis,and number of incisions(P<0.05).There were no significant differences with respect to SSIs,improvement in clinical symptoms,and satisfaction scores observed(p>0.05).Conclusions:This study shows that patients benefited from both treatment options.However,primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy(FS).In summary,the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy(FS)for those who demand a high level of appearance,and especially for young patients,the Trivex system is recommended.
文摘Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences.In the recent decade,the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques.The literature was systematically searched on Medline without language restrictions.All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed.Endovenous laser ablation(EVLA)and radiofrequency ablation(RFA)both are same safe and effective in terms of occlusion rate,and time to return to normal activity.In comparison with RFA or EVLT,Cure conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire(CHIVA)may cause more bruising and make little or no difference to rates of limb infection,superficial vein thrombosis,nerve injury,or hematoma.In terms of recurrence of varicose veins,there is little or no difference between CHIVA and stripping,RFA,or EVLT.Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy(FS)group(51%)during 1 year of follow-up.The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy.Although the mechanochemical endovenous ablation(MOCA)is a non-thermal,non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage,the overall success rate of MOCA is lower than those of other procedures such as EVLA,RFA,or high ligation and stripping.EVLA is the most cost-effective therapeutic option,with RFA being a close second for the treatment of patients with varicose veins.Endovenous thermal ablation(EVLA or RFA)is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins.Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures.MOCA and cyanoacrylate embolization appear promising,but evidence of their effectiveness is required.
文摘Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18;72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.
文摘Adams disease is the consequence of overly active transient receptor potential cation channels (TRP). This case report presents a patient suffering from multiple vascular problems and may provide new insights into the causes of venous problems. Endothelial and smooth muscle cells in veins contain TRP. These channels when activated excessively result in calcium accumulation, oxygen radical formation and apoptosis of endothelial and smooth muscle cells. The death of critical cells in vein valves, may lead to varicose veins. The loss of endothelial cells in venules may lead to retinal tears. Damage to vein walls may lead to a deep vein thrombosis. Transient receptor potential cation channels may be new drug targets of interest in the treatment or prevention of these conditions.
文摘Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.Portal vein tumor thrombus(PVTT)is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.Data sources:A systematic search of MEDLINE(PubMed),Embase,Cochrane Library and Database for Systematic Reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases until December 2022 was conducted using free text and MeSH terms:hepatocellular carcinoma,portal vein tumor thrombus,portal vein thrombosis,vascular invasion,liver and/or hepatic resection,liver transplantation,and systematic review.Results:Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy.Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus,accurate identification of the subgroups of patients who may benefit from resection,as well as meticulous surgical technique.This review addressed five specific areas:(a)formation of PVTT;(b)classifications of PVTT;(c)controversies related to clinical guidelines;(d)surgical treatments versus non-surgical approaches;and(e)characterization of surgical techniques correlated with classifications of PVTT.Conclusions:Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.
文摘BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of patients.We sought to determine the relationship between surface depressions and the diaphragm.AIM To use exploratory laparoscopy to determine the relationship between surface depressions and the diaphragm.METHODS An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and diaphragm.When surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during inspection.RESULTS Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the liver.There was no significant relationship between the presence of surface depressions and gender nor the presence of rib projections.However,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface depressions.Further studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.
文摘Varicose veins are enlarged, protuberant superficial veins that are palpable beneath the skin. The causes of such a venous pathology may be primary, secondary, or congenital. The major agents leading to the development of varicose veins include: Hereditary, prolonged standing, Increasing age, Heavy lifting, Prior superficial or deep vein clots, Female gender and Multiple pregnancies. In this manuscript, we report a case of inguinal varicose vein in connection with femoral vein, resulted from direct intravenous injection of drug. The diagnosis was made based on Doppler sonography.
基金Supported by the National Natural Science Foundation of China,No.81773128 and No.81472247Project of provincial key basic Research,No.2017ZDJC-08 and No.2016SF-204Clinical Research Project of The First Affiliated Hospital of Xi’an Jiaotong University,No.XJTU1AF-CRF-2015-003 and No.XJTU1AF-CRF-2015-011
文摘A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography(CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein(SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that(1) direct devascularization of the main SMV trunkwithout a vein graft is possible. The presence of collateralcirculation can increase the success rate of patientsundergoing radical surgery and prevent the occurrence ofserious postoperative complications. In addition,(2) thiscase demonstrated the clinical value of 3 D reconstruction.
文摘Objective The study aimed to compare quality of saphenous vein(SV)grafts,wound complications,and clinical outcomes between endoscopic vein harvesting(EVH)technique and open vein harvesting(OVH)technique of coronary artery bypass graft(CABG)surgery.Methods One hundred patients with multi-vessel coronary disease underwent elective CABG using SV grafts were prospectively recruited and randomized into two groups.
文摘Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.
文摘Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections after pancreatobiliary surgery still represent significant clinical issues. In addition, insufficient attention is paid to the fact that severe stenosis of the PV can result in life-threatening complications. Material and Methods: At our institution, lymph node dissection within the hepatoduodenal ligament was performed for biliary or pancreatic neoplasms in 68 patients between October 2005 and April 2017. The diameter of the PV was measured on computed tomography scans obtained before and after the operation. PV stenosis was defined as a >50% reduction in the diameter of the PV. The degree of PF (Pancreatic Fistula) was defined by the International Study Group of Pancreatic Fistula after pancreaticoduodenectomy. Furthermore, the Clavien-Dindo (CD) classification was used to assess the complications that occurred in cases in which pancreatojejunostomy was not performed. The relationship between the degree of PV stenosis and the occurrence of postoperative complications was analyzed. Results: The overall frequency of PF was 56.3% (18 patients). Grade B or C PF occurred in 5 patients (15.6%). In the present small series, a correlation was detected between the degree of PV stenosis and the occurrence of postoperative complications after pancreatobiliary surgery (p Conclusions: Clinicians should keep in mind that the PV can narrow in cases in which grade B or C PF or intra-abdominal abscesses occur after pancreatobiliary surgery.
文摘BACKGROUND Deep vein thrombosis(DVT)of the lower extremity is one of the most common postoperative complications,especially after craniocerebral surgery.DVT may lead to pulmonary embolism,which has a devastating impact on patient prognosis.This study aimed to investigate the incidence and risk factors of DVT in the lower limbs following craniocerebral surgery.AIM To identify independent risk factors for the development of postoperative DVT and to develop an effective risk prediction model.METHODS The demographic and clinical data of 283 patients who underwent craniocerebral surgery between December 2021 and December 2022 were retrospectively analyzed.The independent risk factors for lower extremity DVT were identified by univariate and multivariate analyses.A nomogram was created to predict the likelihood of lower extremity DVT in patients who had undergone craniocerebral surgery.The efficacy of the prediction model was determined by receiver operating characteristic curve using the probability of lower extremity DVT for each sample.RESULTS Among all patients included in the analysis,47.7%developed lower extremity DVT following craniocerebral surgery.The risk of postoperative DVT was higher in those with a longer operative time,and patients with intraoperative intermittent pneumatic compression were less likely to develop postoperative DVT.CONCLUSION The incidence of lower extremity DVT following craniocerebral surgery is significant,highlighting the importance of identifying independent risk factors.Interventions such as the use of intermittent pneumatic compression during surgery may prevent the formation of postoperative DVT.
文摘Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.
文摘Laser treatment represents an attractive option to other methods of vessel diseases especially varicose veins. A long pulse (30-50ms) 532nm laser was used in our experiments, with the pulse duration matching the thermal relaxation time of the vessels and the green laser matching the absorption spectrum peak of the blood.Laser irradiates nude vein vessels directly or exterior skin to finish operation faster and to acquire the practical data for upper enteron varicose vein treatment in several animal experiments performed in vivo. The 5Jenergy pulse allows us to finely occlude rabbit or dog's vein vessels up to 2 mm in diameter when irradiating them off external skin. Blood vessels are occluded at once, and later biopsy specimens show the immediate and long-term lasting occlusion effect. While vessels are irradiated directly, they are usually irradiated to perforate, detailed causes are still under investigation. Animal experiments showed that the long pulse green laser therapy is a safe and effective solution to the vein's occlusion, which promises such laser with high energy of each pulse and 30-50 ms duration is an ideal candidate for vessel diseases treatment.