scholarly journals Artificial Intelligence Evidence-Based Current Status and Potential for Lower Limb Vascular Management

2021 ◽  
Vol 11 (12) ◽  
pp. 1280
Author(s):  
Xenia Butova ◽  
Sergey Shayakhmetov ◽  
Maxim Fedin ◽  
Igor Zolotukhin ◽  
Sergio Gianesini
Keyword(s):  
Artificial Intelligence ◽  
Healthcare Management ◽  
Chronic Venous Disease ◽  
Current Status ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Digital Medicine ◽  
Automatic Methods ◽  
Artery Disease ◽  
Deep Vein

Consultation prioritization is fundamental in optimal healthcare management and its performance can be helped by artificial intelligence (AI)-dedicated software and by digital medicine in general. The need for remote consultation has been demonstrated not only in the pandemic-induced lock-down but also in rurality conditions for which access to health centers is constantly limited. The term “AI” indicates the use of a computer to simulate human intellectual behavior with minimal human intervention. AI is based on a “machine learning” process or on an artificial neural network. AI provides accurate diagnostic algorithms and personalized treatments in many fields, including oncology, ophthalmology, traumatology, and dermatology. AI can help vascular specialists in diagnostics of peripheral artery disease, cerebrovascular disease, and deep vein thrombosis by analyzing contrast-enhanced magnetic resonance imaging or ultrasound data and in diagnostics of pulmonary embolism on multi-slice computed angiograms. Automatic methods based on AI may be applied to detect the presence and determine the clinical class of chronic venous disease. Nevertheless, data on using AI in this field are still scarce. In this narrative review, the authors discuss available data on AI implementation in arterial and venous disease diagnostics and care.

Anatomy of the Hunter’s canal and its role in the venous outlet syndrome of the lower limb

2014 ◽  
Vol 30 (9) ◽  
pp. 604-611 ◽  
Author(s):  
JF Uhl ◽  
C Gillot
Keyword(s):  
Femoral Condyle ◽  
Femoral Vein ◽  
Arterial Occlusion ◽  
Anatomical Study ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Adductor Canal ◽  
Compressive Neuropathy ◽  
Deep Vein

Background The “Adductor canal syndrome” has been described as an unusual cause of acute arterial occlusion inside the Hunter’s canal in young sportsmen. It may also produce a compressive neuropathy of the saphenous nerve. To our knowledge, femoral vein compression in the canal has never been reported. Objective To describe the anatomy, to propose a physiology of this canal, and to show that the femoral vein is much more exposed than the artery to compression inside this adductor hiatus, particularly at the outlet. Material and methods The whole adductor canal was exposed in 100 limbs for anatomical study following latex injection. A series of 200 phlebographies and 100 CT venograms were also analyzed. Results Anatomically, we found a musculotendinous band called the “vastoadductor membrane,” which jointed the adductor tendon to the vastus medialis in all the cases. The femoral vein, located more posteriorly, was frequently narrowed at this level. This band can create a notch with a venous stenosis at the outlet of the Hunter’s canal, usually located 12–14 cm above the femoral condyle. Two femoral valves constitute the landmark of the canal on the venograms: the lower is just below the outlet, 9 cm above the condyle. The second valve is 3 cm higher inside the canal. Functionally, the cadaveric simulations showed that the contraction of the adductor longus closes the hiatus, while the adductor magnus opens it. Our hypothesis is that Hunter’s canal prevents femoropopliteal axis reflux by synchronizing with calf pump ejection during ambulation. Conclusion Compression of the femoral vein inside the adductor’s canal is an underestimated and misdiagnosed cause of postural stenosis of the femoral vein. Ultrasound investigation of both limbs in patients with chronic venous disease (CVD) should be systematically carried out at this precise level in order to prevent future occlusion and onset of acute deep vein thrombosis.

The post-thrombotic syndrome

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 220-223 ◽  
Author(s):  
F. Pannier ◽  
E. Rabe
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Compression Therapy ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Common Complication ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Prevention And Treatment ◽  
Deep Vein

SummaryPost-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) in the legs. Risk factors include recurrent ipsilateral DVT, proximal vein involvement, persistent occlusion of the deep venous system, obesity, and pre-existing chronic venous disease. Compression therapy, exercise, and weight loss, as well as effective anticoagulation of the initial DVT and secondary thromboprophylaxis, are all important aspects in the prevention and treatment of post-thrombotic syndrome.

Underlying deep venous abnormalities in patients with unilateral chronic venous disease

2013 ◽  
Vol 28 (8) ◽  
pp. 426-431 ◽  
Author(s):  
A S Gaweesh ◽  
M H Kayed ◽  
T Y Gaweesh ◽  
J Shalhoub ◽  
A H Davies ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Venous Obstruction ◽  
Cross Sectional ◽  
Vein Thrombosis ◽  
Clinically Significant ◽  
Deep Vein ◽  
Computed Tomography Venography

Objectives To report our initial experience using direct multidetector computed tomography venography (MDCT-V) for imaging lower limb deep veins. CT findings in limbs with chronic venous disease (CVD) were compared with contralateral healthy limbs. Methods MDCT-V with bilateral direct pedal injection of contrast was used to image the deep veins in both lower limbs. Eight patients with unilateral lower limb CVD of varying severity (according to the Clinico-Etiological-Anatomical and Pathological classification [CEAP] class 2-6) were studied. Five patients had primary CVD, while three patients had CVD secondary to previous deep vein thrombosis. Results Deep venous obstruction (>50%) or occlusion was identified in all CVD limbs and was not seen in contralateral healthy limbs. These lesions were not only iliac, were not exclusively present in advanced CVD and were independent of the presence or absence of deep venous reflux. Conclusion Morphologically significant lesions could be underlying in patients with clinically significant CVD. Direct MDCT-V provides clear reconstructable cross-sectional images of the whole deep venous tree, including infrainguinal areas, beyond the reach of intravascular ultrasound. Utilization of new venous imaging modalities may uncover previously undiagnosed and potentially treatable venous pathology in patients with CVD.

Natural history of deep vein thrombosis in children

2014 ◽  
Vol 30 (6) ◽  
pp. 412-417 ◽  
Author(s):  
G Spentzouris ◽  
A Gasparis ◽  
RJ Scriven ◽  
TK Lee ◽  
N Labropoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Objective To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins. Methods Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded. Results There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1–16 years. The median follow-up was 23 months, range 8–62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis ( p = 0.012) and failure to recanalize ( p = 0.036) increased significantly the risk for developing signs and symptoms. Conclusions Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.

Superficial venous interventions: assessing the risk of DVT

2008 ◽  
Vol 23 (2) ◽  
pp. 53-57 ◽  
Author(s):  
S Vedantham
Keyword(s):  
Chronic Venous Disease ◽  
Risk Level ◽  
Venous Disease ◽  
Contributing Factors ◽  
Moderate Risk ◽  
Vein Thrombosis ◽  
Venous Interventions ◽  
Long Term Consequences ◽  
Deep Vein

Objectives Understand the potential consequences of deep vein thrombosis (DVT) in patients undergoing superficial venous interventions, the proper way to assess DVT risk in patients with superficial venous disease and the appropriate management of patients stratified by risk level. Methods Review of published literature Results Because DVT can have major long-term consequences, DVT risk should be assessed as a routine part of the preprocedure evaluation of venous disease. Chronic venous disease may have multiple contributing factors amenable to treatment in both the superficial and deep venous systems. Conclusion Superficial venous interventions should be deferred in patients at particularly high risk for DVT, but may be performed with appropriate countermeasures for DVT prophylaxis in patients at moderate risk.

The Future of Phlebology in Europe

2014 ◽  
Vol 29 (1_suppl) ◽  
pp. 181-185 ◽  
Author(s):  
Brahman Dharmarajah ◽  
Tristan RA Lane ◽  
Hayley M Moore ◽  
HA Martino Neumann ◽  
Eberhard Rabe ◽  
...  
Keyword(s):  
Cost Effective ◽  
Research Strategy ◽  
Clinical Severity ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
Venous Diseases ◽  
Thrombus Removal ◽  
Deep Vein ◽  
The Impact

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.

scholarly journals Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic – The Venous and Lymphatic Triage and Acuity Scale (VELTAS)

2020 ◽  
Vol 35 (8) ◽  
pp. 550-555
Author(s):  
Kurosh Parsi ◽  
Andre M van Rij ◽  
Mark H Meissner ◽  
Alun H Davies ◽  
Marianne De Maeseneer ◽  
...  
Keyword(s):  
Massive Pulmonary Embolism ◽  
Vascular Anomalies ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
International Consensus ◽  
Vein Thrombosis ◽  
Venous Compression ◽  
Global Pandemic ◽  
Lymphatic Diseases ◽  
Clinical Conditions

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

scholarly journals Post-thrombotic syndrome prevention – do we really know the predictive factors?

Phlebologie ◽  
2019 ◽  
Vol 48 (04) ◽  
pp. 245-250
Author(s):  
Tomasz Urbanek
Keyword(s):  
Predictive Factors ◽  
Current Knowledge ◽  
Late Complication ◽  
Early Mobilization ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stocking ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
The Individual

AbstractDespite an increasing knowledge and experience regarding deep vein thrombosis (DVT) treatment, the rate of post-thrombotic syndrome (PTS) remains still relatively high. According to the current knowledge it is still difficult to predict on the individual basis, who of the DVT patients will develop PTS as late complication of the vein thrombosis. Among the factors influencing the higher prevalence of PTS, the ipsilateral DVT recurrence is of the highest importance. The other factors which should be mentioned are age, obesity, previous chronic venous disease as well as a proximal DVT location or lack of symptoms’ resolution in the early treatment. Looking for the most effective PTS prevention method several clinical trials were performed regarding pharmacological DVT treatment, use of early mobilization and medical compression stocking as well as an implementation of the thrombectomy and thrombolysis. This paper presents a review of the current knowledge regarding the PTS predictive factors and prevention.

scholarly journals Position of the European College of Phlebology

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 111-115
Author(s):  
S Onida ◽  
J Shalhoub ◽  
AH Davies
Keyword(s):  
International Perspective ◽  
Chronic Venous Disease ◽  
Current Status ◽  
Venous Disease ◽  
European Perspective ◽  
The European Union ◽  
Common Condition ◽  
Significant Morbidity ◽  
High Quality ◽  
European College

Chronic venous disease is a common condition, bearing significant morbidity to patients. It is predicted that the population suffering from this disease will significantly increase in the coming years, with a growing demand for specialists in the field of phlebology. Training and delivery of services are highly heterogeneous in the European Union. The establishment of the European College of Phlebology marks the opportunity to address these differences from a European perspective, with the aim of providing all patients with standardised, high-quality, accessible medical care. In this paper, we review the current status of phlebology from a European and an international perspective, as well as highlighting the current and future roles of the European College of Phlebology.

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