31 research outputs found
Appendices -Supplemental material for A systematic review of paediatric deep venous thrombolysis
No full textSupplemental material, Appendices for A systematic review of paediatric deep venous thrombolysis by Mohamed AH Taha, Andrew Busuttil, Roshan Bootun and Alun H Davies in Phlebology</p
Appendix 1 and 2 -Supplemental material for A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb
No full textSupplemental material, Appendix 1 and 2 for A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb by Mohamed AH Taha, Andrew Busuttil, Roshan Bootun and Alun H Davies in Phlebology</p
Supplemental Material - The risk of harm whilst waiting for varicose veins proceduresj-pdf-1-phl-10.1177_02683555221141824
No full textSupplemental Material for The risk of harm whilst waiting for varicose veins procedure by Roshan Bootun, Mandy Burrows, Mohammed M Chowdhury, Philip W Stather, and Wissam Al-Jundi in Phlebology</p
Outcomes of patients with varicose veins
No full textIntroduction
Varicose vein disease is a common ailment affecting the population. It is associated with causing an adverse effect on the quality of life of patients, with treatment of the condition known to improve it. The introduction of endovenous ablation has enabled the cost-effective treatment of the condition with procedures being carried out as day cases with an earlier return to normal activities. However, with healthcare expenditure increasingly under scrutiny, newer pathways are needed to continue the evolution of varicose vein management.
Aim
1. To explore and compare the current and newer endovenous methods of treatment
2. To assess patients’ views of the current management of the condition
3. To evaluate a new referral and treatment pathway of varicose vein disease
4. To assess possible improvement in the post-procedural management of varicose veins
Methods
1. A randomised controlled trial was conducted to compare radiofrequency ablation to mechanochemical ablation as well as a pilot study evaluating the use of a new cyanoacrylate adhesive sealing system. In addition, a systematic review and cost-effectiveness analysis was undertaken to evaluate the newer endovenous ablation methods.
2. A patient survey was carried out to understand the reasons for their referral as well as exploring a new management pathway.
3. A pilot study was undertaken to evaluate the feasibility of a One Stop Vein Clinic, offering same day diagnosis and treatment.
4. A randomised controlled trial comparing the use of compression stockings following endovenous ablation.
Results
1. (a) With 170 patients recruited, the randomised controlled trial comparing radiofrequency and mechanochemical ablation shows that pain score during the procedure was less with the latter method, and that there were no other major differences between the two techniques.
(b) This pilot study of 20 patients in the use of the new cyanoacrylate demonstrates that it is a safe and effective method, though a larger study would be able to provide further evidence of efficacy.
(c) The systematic review shows that surgery and the endothermal methods seem to have lower re-intervention rates compared to foam sclerotherapy. However, a lack of comparative studies involving the non-thermal techniques meant that this analysis was unable to provide sufficient evidence as to their re-intervention rates and cost-effectiveness.
2. The patient survey of 106 patients revealed that they favoured less waiting time between appointments and their treatment. A high proportion of patients were also keen on attending a One Stop Clinic.
3. The early results of this pilot study of One Stop Vein Clinic shows that patients waited on average 4 weeks from being referred by their GP, but this study was hampered by unavailability of the treatment room for long periods and reduced possibility to add patients to the veins lists.
4. One hundred and nine patients have been recruited to the randomised controlled trial of the use of compression stockings. This shows that patients in the compression group had significantly less discomfort in the first few days following treatment, but there were no major differences by 2 weeks.
Conclusions
This work illustrates that varicose vein treatment is fast evolving. The newer technologies show promise, but currently, there is insufficient evidence to demonstrate their superiority over conventional endothermal methods. The One Stop Vein Clinic also shows potential, but may be difficult to incorporate into current practice without clear protocols between the different departments. The use of compression stockings following endothermal ablation indicates that it might be advantageous in the first few days, but may not necessarily have a long-term benefit.Open Acces
Varicose veins
No full textVaricose veins affect a third of the general population and are found in the superficial fascia of the lower limbs. There is controversy as to their actual cause with the debate still ongoing as to whether it is primarily an ascending or descending condition. Several potential risk factors have been identified and the most likely risks are increasing age, family history, and pregnancy. They cause a variety of physical symptoms, the most severe of which is ulceration, and also have an adverse effect on the quality of life of patients. Treatment of varicose veins, in turn, has been shown to improve patients’ quality of life.</p
A systematic review of paediatric deep venous thrombolysis
No full textObjectives:
The aim was to assess the effectiveness and safety of Catheter Directed Thrombolysis (CDT) in children with deep venous thrombosis (DVTs) and to evaluate its long-term effect.
Method and Results:
EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute DVT patients received thrombolysis. Following title and abstract screening, 7cohort studies with total of 183 patients were identified. Technical success was 82%, and superior in regional rather than systemic thrombolysis (p< .00001). One cohort study identified significant difference in thrombus resolution at 1 year between thrombolytic and anticoagulant groups (p=0.01). The complication rate was low, with incidence rates of major bleeding, pulmonary embolism (PE) and others at 2.8%, 1.8% and 8.4%, respectively. The overall PTS rate was 12.7%. The incidence of re-thrombosis ranged from 12.3%-27%.
Conclusion:
Thrombolysis for paediatric DVT is an effective and relatively safe therapeutic option, lowering the incidence of PTS and DVT recurrence
A systematic review on the use of deep venous stenting for acute venous thrombosis of the lower limb
No full textObjectives:
The aim is to evaluate venous stent patency, the development of post thrombotic syndrome (PTS), recurrence, quality of life(QOL) and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis (DVT).
Method and Results: EMBASE and Medline databases were interrogated to identify studies in which acute DVT 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 74-95%,90-95% and 84-100% respectively. The observed PTS rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. QOL questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (CIVIQ) (22.67±3.01 vs. 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 QOL
Endovenous management of varicose veins
No full textVaricose veins are a very common condition and have been the subject of a recent proliferation of treatment modalities. The advent of the endovenous treatment era has led to a confusing array of different techniques that can be daunting when making the transition from traditional surgery. All modalities offer excellent results in the right situation, and each has its own treatment profile. Thermal ablation techniques have matured and have a reassuring and reliable outcome, but the arrival of nonthermal techniques has delivered further options for both patient and surgeon. This article provides an overview of the different treatment devices and modalities available to the modern superficial vein surgeon and details the currently available evidence and summation analysis to help surgeons to make an appropriate treatment choice for their patients
Foam sclerotherapy versus ambulatory phlebectomy for the treatment of varicose vein tributaries: study protocol for a randomised controlled trial
No full textBackground
Ambulatory phlebectomies and foam sclerotherapy are two of the most common treatments for varicose vein tributaries. Many studies have been published on these treatments, but few comparative studies have attempted to determine their relative effectiveness.
Methods/design
This is a prospective single-centre randomised clinical trial. Patients with primary truncal vein incompetence and varicose vein tributaries requiring treatment will be assigned randomly to either ambulatory phlebectomies or foam sclerotherapy. The primary outcome measure is the re-intervention rate for the varicose vein tributaries during the study period. The secondary outcomes include the degree of pain during the first two post-operative weeks and the time to return to usual activities or work. Improvements in clinical scores, quality of life scores, occlusion rates and cost-effectiveness for each intervention are other secondary outcomes. The re-intervention rate will be considered from the third month.
Discussion
This study compares ambulatory phlebectomies and foam sclerotherapy in the treatment of varicose vein tributaries. The re-intervention rates, safety, patient experience and the cost-effectiveness of each intervention will be assessed. This study aims to recruit 160 patients and is expected to be completed by the end of 2019.
Trial registration
ClinicalTrials.gov, NCT03416413. Registered on 31 January 2018
