scholarly journals TP5.2.6 Use of objective assessment criteria to assess symptom severity and clinical effectiveness following deep venous stenting

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mustafa Ghulam ◽  
Krishan Lodhia ◽  
Jemima Carter ◽  
Athanasios Saratzis ◽  
Prakash Saha
Keyword(s):  
Symptom Severity ◽  
Objective Assessment ◽  
Clinical Effectiveness ◽  
Clinical Severity ◽  
Venous Disease ◽  
Secondary Patency ◽  
Post Intervention ◽  
Stent Patency ◽  
Venous Stenting ◽  
Venous Clinical Severity Score

Abstract Aims This review aimed to identify measures that assess symptom severity in patients prior to deep venous intervention, and outcomes used to evaluate its clinical effectiveness. Methods MEDLINE was searched for studies of stent placement for treatment of iliofemoral venous disease using relevant key words (April 2019). Data were extracted and validated by three authors. Results 6,356 patients with venous stents were identified from 93 studies. 1,300 patients (20%) were treated for acute thrombosis and 5,056 patients for chronic venous insufficiency (CVI), due to non-thrombotic lesions (2,200 patients, 35%) or post-thrombotic disease (2,856 patients, 45%). The Clinical-Etiological-Anatomical-Physiological classification (CEAP) was reported in 3,233/5,056 CVI patients (64%) pre-intervention (C0:2%; C1:2%; C2:7%; C3:46%; C4:21%; C5:6%; C6:16%). Stent patency was reported in all studies, with variable follow-up (six months – five years). Primary patency was 81% in 3,365 patients and secondary patency 95% in 4,700 patients at one year. 655 patients had active ulceration, of which 397 (61%) healed post-intervention. Venous Clinical Severity Score (VCSS) or revised VCSS was reported in 849 patients (13%). Average VCSS/rVCSS was eight pre-intervention and three post-intervention. Villalta scores were reported in 768 patients (12%) pre-intervention vs. 1,111 patients (17%) post-intervention. Average Villalta scores were 20 pre-intervention vs. five post-intervention. Conclusions Few studies use objective measures to quantify the clinical effectiveness of deep venous stenting; consensus is lacking on which is the most appropriate tool to use. More research is needed on ideal assessment measures to identify suitable patients for these interventions and to quantify clinical effectiveness.

scholarly journals COVID-19 and Singapore: From Early Response to Circuit Breaker

2020 ◽  
Vol 49 (8) ◽  
pp. 561-572 ◽  
Author(s):  
Jacinta I-Pei Chen ◽  
Jason Chin-Huat Yap ◽  
Li Yang Hsu ◽  
Yik Ying Teo
Keyword(s):  
Patency Rate ◽  
Primary Patency ◽  
Clinical Severity ◽  
Venous Disease ◽  
Secondary Patency ◽  
Post Intervention ◽  
Stent Patency ◽  
Venous Stenting ◽  
Secondary Patency Rate ◽  
Venous Clinical Severity Score

Introduction: This paper presents our experience with deep venous stenting in a multi-ethnic Asian cohort of patients with symptomatic Non-Thrombotic Iliac Vein Lesions (NIVL) and Post-Thrombotic Syndrome (PTS). Materials and Methods: This was a multicentre retrospective cohort study of patients who had symptomatic deep venous disease. Stent patency rate was evaluated using Duplex ultrasonography immediately post-intervention and at 3, 6 and 12 months. Clinical outcomes were evaluated using the revised Venous Clinical Severity Score (rVCSS) and Visual Analogue Scale (VAS) pain score at baseline and 3 months post-procedure. Results: 87 patients (males = 47/87 (54.0%)); median age = 62 years (IQR 55 – 70)) and 115 limbs were analysed (left = 76/115 (66.1%)). Median follow-up time was 175 (IQR 57 – 257) days. 97/115 (84.3%) had NIVLs and 55/115 (47.8%) had May-Thurner-Syndrome. 43/115 (37.4%) had Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease. Primary stent patency rates were 98.2% (112/114), 97.9% (93/95), 95.7% (89/93) and 92.8% (64/69) immediately postintervention, 3, 6 and 12 months, respectively. The 6-month secondary patency rate was 99.1% (114/115). Mean rVCSS and VAS improved from 11.52 (±3.54) to 5.77 (±2.36) (P < 0.01) and 6.62 (±1.93) to 2.92 (±1.50) (P < 0.01) respectively, at 3 months. 41/43 (95.3%) venous ulcers healed over a median time of 169 days (IQR 120 – 253). Conclusions: Short term primary patency rates following deep venous stenting are excellent, with few re-interventions. Patients presented with NIVLs rather than PTS. There was excellent clinical improvement at 3 months, with a high and expedient venous ulcer healing rate. Key words: Containment, Coronavirus, Epidemic, Outbreak, Pandemic

scholarly journals Endovascular Deep Vein Stenting of Symptomatic Post-Thrombotic and Non-Thrombotic Iliac Vein Stenotic Lesions: A Multicentre Cohort Experience from Singapore

2020 ◽  
Vol 49 (8) ◽  
pp. 551-560
Author(s):  
Mervin Nathan Han Hui Lim ◽  
Karthikeyan Damodharan ◽  
Sze Ling Chan ◽  
Ming Ren Toh ◽  
Charyl Jia Qi Yap ◽  
...  
Keyword(s):  
Patency Rate ◽  
Iliac Vein ◽  
Clinical Severity ◽  
Venous Disease ◽  
Secondary Patency ◽  
Stent Patency ◽  
Venous Stenting ◽  
Post Thrombotic Syndrome ◽  
Venous Clinical Severity Score ◽  
Deep Vein

Introduction: This paper presents our experience with deep venous stenting in a multi-ethnic Asian cohort of patients with symptomatic Non-Thrombotic Iliac Vein Lesions (NIVL) and Post-Thrombotic Syndrome (PTS). Materials and Methods: This was a multicentre retrospective cohort study of patients who had symptomatic deep venous disease. Stent patency rate was evaluated using Duplex ultrasonography immediately post-intervention and at 3, 6 and 12 months. Clinical outcomes were evaluated using the revised Venous Clinical Severity Score (rVCSS) and Visual Analogue Scale (VAS) pain score at baseline and 3 months post-procedure. Results: 87 patients (males = 47/87 (54.0%)); median age = 62 years (IQR 55 – 70)) and 115 limbs were analysed (left = 76/115 (66.1%)). Median follow-up time was 175 (IQR 57 – 257) days. 97/115 (84.3%) had NIVLs and 55/115 (47.8%) had May-Thurner-Syndrome. 43/115 (37.4%) had Clinical, Etiology, Anatomy and Pathophysiology (CEAP) 6 disease. Primary stent patency rates were 98.2% (112/114), 97.9% (93/95), 95.7% (89/93) and 92.8% (64/69) immediately postintervention, 3, 6 and 12 months, respectively. The 6-month secondary patency rate was 99.1% (114/115). Mean rVCSS and VAS improved from 11.52 (±3.54) to 5.77 (±2.36) (P < 0.01) and 6.62 (±1.93) to 2.92 (±1.50) (P < 0.01) respectively, at 3 months. 41/43 (95.3%) venous ulcers healed over a median time of 169 days (IQR 120 – 253). Conclusions: Short term primary patency rates following deep venous stenting are excellent, with few re-interventions. Patients presented with NIVLs rather than PTS. There was excellent clinical improvement at 3 months, with a high and expedient venous ulcer healing rate. Key words: Deep vein stenting, May-Thurner Syndrome, Non-thrombotic iliac vein lesion, Post-thrombotic syndrome, Vascular patency

Venovo venous stent in the treatment of non-thrombotic or post-thrombotic iliac vein lesions – short-term results from the Arnsberg venous registry

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Michael K. W. Lichtenberg ◽  
Rick de Graaf ◽  
Wilhelm F. Stahlhoff ◽  
Ahmet Özkapi ◽  
Tienush Rassaf ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Symptom Relief ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Primary Patency ◽  
Clinical Severity ◽  
Secondary Patency ◽  
Stent Patency ◽  
Venous Clinical Severity Score ◽  
First Time

Abstract. Background: We sought to determine the patency and clinical symptom relief of the Venovo venous stent in the endovascular treatment of non-thrombotic (NIVL) or post-thrombotic venous obstruction (PTO) of the iliofemoral track over a period of 6 months. Patients and methods: A total of 80 patients (45 female, mean age 57 years) treated in 2016 and 2017 were included in the Arnsberg venous registry. Clinical improvement was determined by the revised venous clinical severity score (rVCSS) as well as the clinical, etiologic, anatomic and pathophysiologic (CEAP) score. Primary and secondary stent patency was evaluated using duplex ultrasound. Results: Overall 6-months patency rates were 98 % for primary and 100 % for secondary patency. For NIVL primary patency was 97 %, whereas for PTO primary patency was 96 %. Early stent re-occlusion occurred in 3 patients within 34, 59 and 156 days after intervention. Two of these patients were successfully treated by endovascular mechanical thrombectomy and stent in stent implantation. Clinical improvement with a gain of ≥ 2 rVCSS levels was observed in 51 %. CEAP scores decreased from 4.3 to 2.7. Conclusions: In this first time report the novel Venovo venous stent showed adequate patency rates associated with reasonable clinical improvement and low device-related complications throughout a 6-months-follow-up in both NIVL and PTO.

Patency rates, safety and clinical results of the sinus-Obliquus venous stent in the treatment of chronic ilio-femoral venous outflow obstruction – data from the Arnsberg venous registry

VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 270-275 ◽  
Author(s):  
Michael Lichtenberg ◽  
Rick de Graaf ◽  
Wilhelm F. Stahlhoff ◽  
Ahmet Özkapi ◽  
Maria Simon ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Symptom Relief ◽  
Vena Cava ◽  
Clinical Severity ◽  
Secondary Patency ◽  
Short Term ◽  
Stent Patency ◽  
Venous Ulceration ◽  
Venous Clinical Severity Score ◽  
The Mean

Abstract. Background: We sought to determine the patency and clinical symptom relief following the usage of the sinus-Obliquus venous stent in the endovascular treatment of venous obstruction of the ilio-femoral track in short-term. Patients and methods: 48 patients (62 % female, mean age 57 years) with chronic unilateral post-thrombotic obstruction (PTO) and non-thrombotic iliac vein obstructive lesions (NIVL) without involvement of inferior vena cava receiving a sinus-Obliquus venous stent was included in the analysis. Clinical improvement determined by the revised venous clinical severity score (rVCSS) as well as the clinical, etiologic, anatomic and pathophysiologic score (CEAP), safety, and stent patency rates were determined at baseline and at 1, 6 and 12 months after stent placement. Ten of the 48 included patients had a venous ulceration. Results: Primary patency rates were 98 % at FU1, 94 % at FU2 and 94 % at FU3, respectively. Secondary patency was 100 % at FU1, 96 % at FU2 and remained 96 % at FU3. At 12 months, the mean rVCSS dropped from 9.0 to 4.8 points (p < 0.001) whereas the mean CEAP improved from 3.45 to 2.96 (p < 0.001). A substantial healing of ulcerations was observed in 8 of 10 patients with initial venous ulceration. There were no relevant safety concerns noticed. Conclusions: Even though long-term studies are missing, the sinus-Obliquus venous stent already showed very promising patency rates at short term, associated with substantial clinical improvement and low device-related complications in both NIVL and PTS.

scholarly journals Stent extension into a single inflow vessel is a valuable option after endophlebectomy

2017 ◽  
Vol 33 (9) ◽  
pp. 610-617 ◽  
Author(s):  
Timme MAJ van Vuuren ◽  
Ralph LM Kurstjens ◽  
Mark AF de Wolf ◽  
Jorinde HH van Laanen ◽  
Cees HA Wittens ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Severity Score ◽  
Balloon Occlusion ◽  
Clinical Severity ◽  
Secondary Patency ◽  
Hybrid Procedures ◽  
Venous Flow ◽  
Venous Stenting ◽  
Venous Clinical Severity Score ◽  
Temporary Balloon Occlusion

Background Venous stenting with an endophlebectomy and arteriovenous fistula can be performed in patients with extensive post-thrombotic changes. However, these hybrid procedures can induce restenosis, sometimes requiring stent extension, into a single inflow vessel. This study investigates the effectiveness of stenting into a single inflow vessel. Methods All evaluated patients had temporary balloon occlusion of the arteriovenous fistula to evaluate venous flow into the stents. When stent inflow was deemed insufficient, AVF closure was postponed and additional stenting was performed. Patency rates and clinical outcomes were evaluated. Results Twenty-four (38%) of 64 patients had additional stenting. The primary, assisted primary and secondary patency were 60 %, 70% and 70% respectively. Villalta score reduced by 6.1 points ( p < 0.001), and venous clinical severity score by 2.7 points ( p = 0.034). Conclusion Stenting through the femoral confluence into a single inflow vessel is a feasible bailout option if primary hybrid intervention fails with relative high patency rates and clinical improvement.

scholarly journals Use of Objective Assessment Criteria to Assess Symptom Severity and Clinical Effectiveness After Deep Venous Stenting

2020 ◽  
Vol 72 (1) ◽  
pp. e59
Author(s):  
Ghulam Majeed ◽  
Krishan Lodhia ◽  
Jemima Carter ◽  
Jack Kingdon ◽  
Prakash Saha
Keyword(s):  
Symptom Severity ◽  
Objective Assessment ◽  
Clinical Effectiveness ◽  
Assessment Criteria ◽  
Venous Stenting

Change in perception of sclerotherapy results after exposure to pre–post intervention photographs

2017 ◽  
Vol 33 (4) ◽  
pp. 282-287 ◽  
Author(s):  
Fabricio R Santiago ◽  
Mario Piscoya ◽  
Yung-Wei Chi
Keyword(s):  
Varicose Veins ◽  
Statistical Significance ◽  
Wilcoxon Test ◽  
Clinical Severity ◽  
Post Intervention ◽  
Chi Square ◽  
Severity Scores ◽  
Venous Clinical Severity Score ◽  
Before And After ◽  
Chi Square Test

Objective To evaluate patients’ self-perception of cosmetic improvement before and after they were presented with pre- and postprocedure photographs after sclerotherapy with 75% dextrose. Methods Treatments included sclerotherapy of reticular and varicose veins using 75% dextrose. All treated limbs were photographed and classified according to Clinical, Etiology, Anatomy, and Pathology classification and Venous Clinical Severity Score pre- and posttreatment. The patients were queried before and after viewing the photos during these visits and indicated if they were very unsatisfied, dissatisfied, satisfied, or very satisfied. Nonparametric kappa correlation coefficient and a Chi square test were used to measure associations among agreement (p < 0.05 indicated statistical significance). The paired Wilcoxon test was used to compare statistical differences in mean Venous Clinical Severity Scores measured at different times (p < 0.05 indicated statistical significance). Data were analyzed using STATA software (version 12). Results Individuals were more satisfied with the results of sclerotherapy after exposure to images portraying their limbs two months after the procedure (p = 0.0028). This effect was maintained six months after sclerotherapy (p = 0.0027). Conclusion Patient exposure to pre- and postsurgical photographs is a simple intervention with the potential of improving patient satisfaction up to six months after treatment with sclerotherapy.

Presentation patterns in women with pelvic venous disorders differ based on age of presentation

2020 ◽  
pp. 026835552095468
Author(s):  
Levan Sulakvelidze ◽  
Maxwell Tran ◽  
Richard Kennedy ◽  
Sanjiv Lakhanpal ◽  
Peter J Pappas
Keyword(s):  
Analysis Of Variance ◽  
Age Groups ◽  
Iliac Vein ◽  
Clinical Severity ◽  
Ovarian Vein ◽  
Venous Stenting ◽  
Venous Clinical Severity Score ◽  
Vas Scores ◽  
Chi Square Analysis ◽  
Venous Disorders

Background The prevalence and presentation patterns in women with pelvic venous disorders (PeVD) secondary to pelvic venous insufficiency (PVI) at various ages are ill-defined. The purpose of this investigation was to determine if the types of symptoms, interventions, and treatment outcomes of women with PeVD varied with age progression. Methods From January 2015 to December 2019, we retrospectively reviewed prospectively collected data on 1,280 women with PeVD from our electronic medical record at the Center for Vascular Medicine (CVM). Medical and surgical comorbidities, past medical history, presenting pelvic and lower extremity symptoms, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) class, revised Venous Clinical Severity Score (rVCSS), visual analog pain score (VAS) and types of interventions were assessed. Patients were grouped into five categories based on age of initial presentation: 20–29, 30–39, 40–49, 50–59, and greater than or equal to 60. Patients were also subcategorized according to their course of treatment: Iliac venous stenting alone, ovarian vein embolization (OVE) alone, simultaneous iliac vein stenting and ovarian vein embolization, and staged iliac vein stenting and ovarian vein embolization. Differences in groups were analyzed utilizing chi square, analysis of variance and regression analysis with Graphpad Prism 8 (San Diego, CA) and SAS Studio 3.8 (Cary, NC) statistical software. Results From January 2015 through December 2019, 1,280 women were treated for PeVD. The average ages in each group were the following: 26.53 ± 2.90 (n = 57), 35.80 ± 2.84 (n = 238), 44.98 ± 2.78 (n = 345), 54.67 ± 2.90 (n = 324) and 68.39 ± 8.44 (n = 316) respectively. The prevalence of PVI by age group was 4.45%,18.59%, 26.95%, 25.31% and 24.70% respectively (p < 0.05). The prevalence of diabetes, hypertension, coronary artery disease (CAD) and hypercholesterolemia differed between age groups (p < 0.05). Significant differences in the prevalence of pelvic pain, dyspareunia, dysmenorrhea, vulvar varices, leg pain, leg edema, leg heaviness, restless legs, varicose veins, and leg ulcers were observed across treatment groups (p < 0.05). CEAP distribution differed by age with CEAP 0–2 decreasing with age, CEAP 3 progressively increasing with age and CEAP 4–6 predominantly observed in patients older than 50. Analysis of variance indicated that with each decile increase in age, the prevalence of leg symptoms increased (p < 0.05) with a reciprocal decrease in pelvic symptoms (p < 0.05). All intervention types were infrequent in twenty year old’s. There was a linear increase in stenting with each decile increase in age. The prevalence of OVE was similar across all age groups. There was an overall improvement in VAS scores for all treatment and age groups. For patients in their 20 s, an initial improvement in VAS scores was observed with moderate recurrence of pain observed after three months. Conclusion PeVD presents as a spectrum of signs and symptoms, with pelvic and leg symptoms being inversely related according to age. The prevalence of PeVD is lowest in patients in their twenties with differences in presentation observed with increasing age. Venous stenting progressively increases with each decile of age whereas the prevalence of OVE is similar regardless of age. There is overall improvement in symptoms post intervention, although women in their 20 s do not respond as well to intervention as women in other age groups. Future investigations will focus on determining which pelvic venous lesion is the predominant factor that needs correction to achieve maximal pain reduction.

A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb

2018 ◽  
Vol 34 (2) ◽  
pp. 115-127 ◽  
Author(s):  
Mohamed AH Taha ◽  
Andrew Busuttil ◽  
Roshan Bootun ◽  
Alun H Davies
Keyword(s):  
Quality Of Life ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Secondary Patency ◽  
Stent Patency ◽  
Venous Stenting ◽  
Post Thrombotic Syndrome ◽  
Thrombus Removal ◽  
Therapy Quality

Objectives The aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis. Method and results EMBASE and Medline databases were interrogated to identify studies in which acute deep venous thrombosis patients were stented. Twenty-seven studies and 542 patients were identified. Primary, assisted primary and secondary patency rates 12 months after stent placement ranged from 74 to 95, 90 to 95 and 84 to 100%, respectively. The observed post-thrombotic syndrome rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. Quality of life questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (22.67 ± 3.01 versus 39.34 ± 6.66). Conclusion Venous stenting appears to be an effective adjunct to early thrombus removal; however, further studies are needed to identify optimal anticoagulant regimen and effect on quality of life.

Segmental saphenous ablation for chronic venous disease treatment

2020 ◽  
pp. 026835552094623
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Savino Occhionorelli ◽  
Maria Grazia Sibilla ◽  
Marianna Mucignat ◽  
...  
Keyword(s):  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Procedural Pain ◽  
Venous Disease ◽  
Disease Treatment ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score ◽  
Endovenous Thermal Ablation ◽  
Occlusion Rate ◽  
Reflux Recurrence

Background Endovenous thermal ablation for chronic venous disease treatment is recommended over traditional surgery. The present investigation compares endovenous laser ablation (EVLA) with radiofrequency (RF) for segmental endovenous sapheno–femoral junction ablation. Methods This is a retrospective study in which 79 patients underwent a 6 cm great saphenous vein ablation by RF or by EVLA. Primary outcome was occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score, peri-procedural pain, aesthetic satisfaction. Results At 12 ± 1 months recanalization of shrunk tract was recorded in 5/85 (5.8%) cases (2 RF, 3 EVLA) [OR: 1.6; 95%CI: 0.2–10.4; P = 0.6689]. Two cases (1/44 RF group and 1/38 EVLA group) also showed reflux recurrence [OR: 1.0; 95%CI: 0.06–17.8; P = 1.0000]. No significant differences between groups were found in AVVQ, VCSS, peri-procedural pain, or aesthetic satisfaction. Conclusion Saphenous sparing is feasible and effective by means of both EVLA and RF, representing a possible alternative to surgery.

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