Journal of vascular surgery. Venous and lymphatic disorders
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J Vasc Surg Venous Lymphat Disord · May 2019
Randomized Controlled Trial Multicenter Study Comparative StudyTwo-year results of a multicenter randomized controlled trial comparing Mechanochemical endovenous Ablation to RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA trial).
Endothermal techniques have proved to be effective for treatment of incompetent truncal veins. The tumescentless mechanochemical ablation (MOCA) technique has become an alternative treatment modality, but its outcome with regard to endothermal techniques is still unclear. ⋯ Unilateral treatment with MOCA in the short term resulted in less postoperative pain but more hyperpigmentation compared with RFA and a faster improvement in VCSS. More anatomic failures were reported after MOCA, mostly driven by partial recanalizations, but both techniques were associated with similar clinical outcomes at 1 year and 2 years.
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J Vasc Surg Venous Lymphat Disord · May 2019
Observational StudyEmpirical systemic anticoagulation is associated with decreased venous thromboembolism in critically ill influenza A H1N1 acute respiratory distress syndrome patients.
An association between increased venous thromboembolism (VTE) events and influenza A H1N1 (H1N1) was noted in the first 10 patients with severe acute respiratory distress syndrome (ARDS). An empirical systemic anticoagulation protocol (heparin intravenous infusion) was initiated when autopsy of patients with severe hypoxemia confirmed multiple primary pulmonary thrombi and emboli. The purpose of this study was to examine the relationship between H1N1 and VTE events and to assess the efficacy of empirical systemic heparin anticoagulation in preventing VTE and death in H1N1 severe ARDS patients. ⋯ Critically ill patients with H1N1 ARDS have increased risk of venous thrombotic complications, particularly pulmonary thromboembolism. Empirical systemic heparin anticoagulation in this cohort of patients significantly reduced VTE incidence without increased hemorrhagic complications.
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J Vasc Surg Venous Lymphat Disord · May 2019
Endobronchial forceps-assisted complex retrieval of inferior vena cava filters.
The objective of this study was to assess the safety, feasibility, and effectiveness of endobronchial forceps-assisted retrieval of inferior vena cava (IVC) filters when standard retrieval techniques fail. ⋯ Rigid endobronchial forceps can be safely and reliably used to remove embedded, fractured, or tilted retrievable IVC filters from patients in whom standard retrieval techniques are unsuccessful. There is a high success rate and minimal complications. We propose that the degree of filter tilt, caval penetration, and filter fracture are predictive of the need for the use of forceps as a first-line retrieval technique.
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J Vasc Surg Venous Lymphat Disord · Mar 2019
Statin therapy associated with improved thrombus resolution in patients with deep vein thrombosis.
Statin therapy has been associated with a decreased incidence of venous thromboembolism (VTE) in clinical trials and enhanced thrombus resolution in animal models. The effect of statins on thrombus resolution has not been reported clinically. This study investigates the association of statins with thrombus resolution or improvement in patients with deep venous thrombosis (DVT). ⋯ Statin therapy is associated with greater thrombus resolution or improvement in patients with DVT. However, statin therapy in this study was not associated with different clinical outcomes of VTE recurrence or mortality.
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J Vasc Surg Venous Lymphat Disord · Mar 2019
Case ReportsDirect contrast-enhanced magnetic resonance lymphangiography in the diagnosis of persistent occult chylous effusion leak after thoracic duct embolization.
Thoracic duct embolization (TDE) is currently the technique of choice for chylothorax refractory to medical management. Diagnosis and treatment of persistent lymphatic leakage after an initially successful TDE are complicated by inadequate imaging to localize the nidus of the lymphatic leak. Traditional imaging modalities including nuclear medicine lymphoscintigraphy, magnetic resonance lymphangiography, and fluoroscopic lymphangiography lack spatial resolution and dynamic physiologic real-time evaluation. We report a contemporary imaging technique using direct contrast-enhanced magnetic resonance lymphangiography to diagnose an occult chylous leak after TDE.