The Future of Phlebology in Europe

Background Worldwide superficial and deep venous diseases are common and associated with significant individual and socioeconomic morbidity. Increasing burden of venous disease requires Phlebology to define itself as an independent specialty representing not only patients but the multidisciplinary physicians involved in venous care. Methods & Results In this article the scope of venous disease in Europe and subsequent future governance for treatment in the region is discussed. Superficial venous disease is common with 26.9-68.6% of European populations reported to have C2-C6 disease according to the CEAP (Clinical severity, Aetiology, Anatomy and Pathophysiology) scoring system. However, a significant disparity is observed in the treatment of superficial venous disease across Europe. Post thrombotic syndrome (PTS) after deep vein thrombosis (DVT) contributes to the increasing burden of deep venous disease. Aggressive thrombus removal for acute ileofemoral DVT provides a cost-effective 14.4% risk reduction in the development of PTS. Additionally, deep venous lesions requiring endovascular intervention are being increasingly performed to prevent recurrent thrombosis. The European College of Phlebology (ECoP) has been formed to provide a responsible body for the care of the European patient with venous disease. The role of the ECoP includes unifying European member states through standardised guideline production, identification of research strategy and provision of training and accreditation of physicians. Conclusion Creation of a European venous disease specific speciality will provide a patient centred approach through understanding of the impact of disease in the region and delivery of high quality diagnostics and treatment from an appropriately certified Phlebologist.

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Treatment Of Venous Thromboembolism - Case For Thrombolytic Therapy

10.1055/s-0038-1652738 ◽

1981 ◽

Author(s):

V V Kakkar

Keyword(s):

Deep Vein Thrombosis ◽

Thrombolytic Therapy ◽

Massive Pulmonary Embolism ◽

Vein Thrombosis ◽

Physiological Processes ◽

Large Numbers ◽

Complete Lysis ◽

Thrombus Removal ◽

Deep Vein

Thrombolytic therapy has a unique advantage in the treatment of patients suffering from thrombotic disease, since it is capable of inducing the dissolution of intravascular fibrin and thus causing the reduction or elimination of thrombi. The rapidity of thrombus removal distinguishes this form of treatment from anticoagulant therapy, in which normal physiological processes are allowed to restore the obstructed circulation. By quickly removing the obstruction, it should be possible to reduce the mortality arising from acute thromboembolic episodes.The results of therapy for deep-vein thrombosis have been fairly uniform. The published studies can be broadly classified into two main groups; in uncontrolled trials, partial or complete lysis of thrombi was obtained in approximately 65-80% of the patients who received streptokinase, while only 10-25% of the patients receiving heparin showed this change.In patients suffering from acute major or massive pulmonary embolism, a number of trials have demonstrated a more rapid resolution of the embolus than would be expected by treatment with heparin alone.The role of lytic therapy in preventing the late sequelae of deep vein thrombosis at present remains uncertian. Studies involving large numbers of patients and longer periods of follow-up are required to determine the extent to which post phlebitic venous insufficiency is reduced by early thrombolytic therapy.

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Concomitant Use of Diosmin/Hesperidin and Oral Rivaroxaban Increases Deep Vein Recanalization and Reduces the Incidence of Post-Thrombotic Syndrome in Patients with Proximal Deep Vein Thrombosis

Blood ◽

10.1182/blood-2018-99-110084 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 986-986

Author(s):

Kirill Lobastov ◽

Iliya Schastlivtsev ◽

Victor Barinov

Keyword(s):

Deep Vein Thrombosis ◽

Clinical Severity ◽

Proximal Deep Vein Thrombosis ◽

Control Groups ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

And Control ◽

Deep Vein ◽

The Impact

Abstract Aim: To assess the impact of long-term Diosmin/Hesperidin use in the treatment of proximal deep vein thrombosis (DVT). Methods: This study was a pilot randomized open-label study with blinded outcome assessor - enrolled patients with their first episodes of popliteal-femoral DVT confirmed by duplex ultrasound (DUS). All participants were randomized into two groups: 1.) control that received a standard treatment with oral Rivaroxaban, and 2.) experimental that required additional treatment with Diosmin/Hesperidin 450/50 mg twice a day. Both drugs were used for six months. Patients were followed-up for the whole treatment period with series DUS every two months in order to evaluate the degree of recanalization by popliteal (PV), superficial femoral (SFV), and common femoral (CFV) veins' compressibility. Thrombi extension was assessed by modified Marder score. At the end of the follow-up period, patients were assessed with Villalta and venous clinical severity scores. Post-thrombotic syndrome (PTS) was diagnosed in those who had ≥5 Villalta score. Results: Sixty patients were randomized to the control and experimental groups (n=30 in each group). There were 40 men and 20 women with mean age of 56.3±13.4. Clinically unprovoked DVT was recognized in 65% of cases and left side localization in 45%. The median of Marder baseline scores were 15.0±4.8 and 11.1±4.3 in the experimental and control groups, respectively (p=0.002). After six months of treatment, the Marder score decreased to 0.8±1.6 and 2.8±3.5 in the main control groups, respectively (p=0.006). The generalized linear model repeated measures found a greater reduction in the Marder score (р <0.0001) and increased speed of recanalization on SFV (р <0.0001) with a non-significant tendency in the CFV (p=0.130) and PV (p=0.204) in the experimental group compared to the control one. Full recanalization of the PV at six months was observed in 24 patients (80%), who had received Diosmin/Hesperidin, and only in 17 persons (57%) of the control group (p=0.047). The median of Villalta score in the group treated with Diosmin/Hesperidin was significantly lower compared to the control one (2.9±2.7 versus 5.8±3.0 [p <0.0001]). The same difference was found for VCSS score (2.3±1.9 versus 4.9±1.9 [p <0001]). According to the Villalta score, PTS was recognized in six patients (20%) and 17 patients (57%) in the experimental and control groups, respectively (p=0.004). Conclusion: Long-term treatment with Diosmin/Hesperidin can increase the speed of deep vein recanalization and reduce the incidence of PTS diagnosed at six months in patients with proximal DVT treated with oral rivaroxaban. Disclosures Lobastov: Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Schastlivtsev:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau. Barinov:Bayer: Honoraria, Speakers Bureau; Servier: Honoraria, Speakers Bureau.

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The Era of Endovascular Treatment in Venous Disease: What Can We Do and Who Gets Benefit?

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/aci.47684 ◽

2019 ◽

Vol 5 (1 (P)) ◽

pp. 52

Author(s):

Hariadi Hariawan

Keyword(s):

Venous Insufficiency ◽

Venous System ◽

Arterial System ◽

Venous Disease ◽

Venous Obstruction ◽

Vein Thrombosis ◽

Peripheral Muscle ◽

Venous Diseases ◽

Valve Function ◽

Deep Vein

Venous system is very different and more complex than arterial system. To deliver blood against the forces of gravity, venous system rely on valve function and peripheral muscle pump. In acute venous disease, blood becomes stasis and leads to deep vein thrombosis. In chronic condition, clinical manifestation may vary from either venous obstruction or vascular incompetence. In general venous diseases are devided into venous thromboembolism and chronic venous insufficiency.

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Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis: A retrospective cohort study

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2021.01.007 ◽

2021 ◽

Author(s):

Qihong Ni ◽

Jianyun Long ◽

Xiangjiang Guo ◽

Shuofei Yang ◽

Xiaohu Meng ◽

...

Keyword(s):

Cohort Study ◽

Deep Vein Thrombosis ◽

Clinical Efficacy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Venous Access ◽

Vein Thrombosis ◽

Thrombus Removal ◽

Acute Deep Vein Thrombosis ◽

Deep Vein

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Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

Vascular Medicine ◽

10.1177/1358863x21994672 ◽

2021 ◽

pp. 1358863X2199467

Author(s):

Jean-Eudes Trihan ◽

Michael Adam ◽

Sara Jidal ◽

Isabelle Aichoun ◽

Sarah Coudray ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Risk Stratification ◽

Hospitalized Patients ◽

Operating Characteristics ◽

Vein Thrombosis ◽

Ultrasound Study ◽

Wells Score ◽

Deep Vein ◽

The Impact ◽

Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

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Post-thrombotic syndrome after deep vein thrombosis: The role of follow-up Doppler ultrasound

Medicina Clínica (English Edition) ◽

10.1016/j.medcle.2020.01.024 ◽

2021 ◽

Vol 156 (5) ◽

pp. 251-252

Author(s):

Francisco Galeano-Valle ◽

Jorge del-Toro-Cervera ◽

Pablo Demelo-Rodríguez

Keyword(s):

Deep Vein Thrombosis ◽

Doppler Ultrasound ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

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Advanced Nursing Practice in Orthogeriatrics

Journal of Research and Practice on the Musculoskeletal System ◽

10.22540/jrpms-05-029 ◽

2021 ◽

Vol 05 (01) ◽

pp. 29-34

Author(s):

Anastasia Margioula ◽

◽

Stavroula Rizou ◽

◽

Keyword(s):

Nursing Practice ◽

Hospital Setting ◽

Cost Effective ◽

Term Care ◽

Advanced Nursing Practice ◽

Vein Thrombosis ◽

Secondary Infections ◽

Regular Care ◽

Postoperative Constipation ◽

Deep Vein

In the last few decades, all the countries aim to combine the improvement of the quality of health care with the reduction of health costs. In order to harmonize the above-mentioned contradictory goals, newly enhanced roles, as in the case of Advanced Nursing Practice, have been introduced, initially in the private sector and more recently in the public hospital setting. The orthogeriatric advanced nursing practitioners’ role is valuable for providing pain relief, diagnosing and treating postoperative delirium, deep vein thrombosis, and secondary infections, preventing subsequent injuries and pressure sores, helping patients deal with postoperative constipation, and assist them in early mobilizing. After patients’ discharge from the hospital, their role is essential for ensuring the patients are adhering to their osteoporotic treatment and have the adequate skills to prevent falls. Their role is significant for older adults living in nursing homes or long-term care facilities. Their care is cost-effective compared to regular care.

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Quantitative Selection of Variation Reduction Plans

Volume 3: 10th International Conference on Design Theory and Methodology ◽

10.1115/detc98/dtm-5664 ◽

1998 ◽

Author(s):

Anna C. Thornton

Keyword(s):

Risk Mitigation ◽

Cost Effective ◽

Variation Reduction ◽

Multiple Quality Characteristics ◽

Cost Effective Approach ◽

Manufacturing Performance ◽

The Impact ◽

Manufacturing Variation ◽

Selection Of

Abstract Quality has been a rallying call in the design and manufacturing world for the last two decades. One way to improve quality is to reduce the impact of manufacturing variation. Variation risk mitigation is challenging especially when a product has multiple quality characteristics and complex production and assembly. It is common wisdom that companies should identify and mitigate the risk associated with variation throughout the design process. As yield problems are identified, they should be mitigated using the most cost effective approach. One approach to variation risk mitigation is variation reduction (VR). VR targets reduction of variation introduced by existing manufacturing processes using tools such as Design of Experiments (DOE) and robust design. Many companies have specialized groups that specialize in these methods. VR teams have the role of improving manufacturing performance; however, these teams are limited in their resources. In addition, no tools exist to quantitatively determine where a VR team’s efforts are most effectively deployed. This paper provides a mathematical and optimization model to best allocate VR resources in a complex product.

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