A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions

Objective Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). Methods The MEDLINE database was searched using the term “iliac vein stent.” Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. Results 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Conclusion Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.

Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization

Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.

A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency

Objective To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. Methods A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications. Results The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur. Conclusion Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.

Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study

Aim To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. Methods A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. Design Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. Results A sample of 143 participants was recruited (51% male, M age = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks ( SE 1.63, 95% CI 33.7–40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications ( p = .035), presence of haemosiderosis ( p = .006), decreased mobility (longer sitting times) ( p = .007) and lower social support scale scores ( p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance ( p = .06). Conclusion Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.

Impact of statin treatment on patients diagnosed with chronic venous disease. Morphological analysis of the venous wall and clinical implications

Objectives The study evaluates the potential morphological changes that may occur in the venous wall in the case of the patients with chronic venous disease which associates treatment with statins for at least 2 years. Methods Operated patients with chronic venous disease in the CEAP C2-C3 stage were included in the study. 215 venous fragments, collected from 50 patients within the study group and 179 venous fragments collected from 52 patients within the control group were microscopically analysed, evaluating a series of morpho-anatomical parameters. Results In the study group, it was found that, venous reflux predominantly affects small veins, and also, a significant increase in collagen deposits in the adventitia and media tunics, proportional to the thickening of the venous wall. Conclusion Our results indicate possible effects of statins upon the venous morphology. Further studies are needed to determine the impact of these results on daily practice.

Association between obesity and the aggravation of limited range of ankle mobility in chronic venous disease

Aim The aim of the present study was to show that an increase in weight leads to the aggravation of limited joint mobility. Method One hundred sixteen patients with varicose veins of the lower limbs and body mass index (BMI) higher than 30 kg/m2 were evaluated at the Belczak Clinic in Maringá, Brazil. All patients were evaluated by the same physician, and the goniometric readings were performed on all patients by a physiotherapist. The participants were then divided into three groups based on BMI: Group I—BMI between 30 and 40. Group II—BMI between 40 and 50, and Group III—BMI > 50. Results There is a significant difference between the groups detected. Conclusion The present findings show that an increased BMI in obese individuals with chronic venous disease is associated with a progressive limitation of ankle mobility.