1 – Highlights
The following highlights from the Asian Chapter of the Union Internationale de Phlébologie, June 18-20, 2007, Kyoto, Japan were published in International Venous Digest in July 2007. This document was produced by the members of the Medical Reporters’ Academy (see picture on page 144 of the present issue).
Flow in the popliteal vein is markedly reduced (-40%) during sleep in the sitting position. This is partially ameliorated by standard foot exercises recommended by airlines. Blood flow is actually increased over and above baseline readings (+20%) with foot exercises against severe resistance. According to Fletcher’s study, the effect is short-lived and exercise needs to be repeated every 15 to 30 minutes.
Following an earthquake, Japanese people tend to sleep in their cars for several days as a precaution against subsequent tremors. The incidence of duplex detected calf deep vein thrombosis (DVT) in these individuals is 30% and decreases with increasing distance from the epicenter of the earthquake.
An outstanding review by A. Skyropoulos (USA) of thromboprophylaxis with LWMH emphasized the high prevalence of VTE in hospital patients, emphasizing the fact that recent studies have shown that the prevalence in Asia is similar to that found in Western countries. Evidence-based medicine has established the efficacy of LMWH and its superiority over vitamin K antagonists. However, despite the availability of guidelines , recent registries highlight the fact that many surgical patients continue to receive suboptimal thromboprophylaxis (what is needed is education not only of doctors but also the public – Editors’ comments).
The value of the D-dimer test in modern practice was highlighted by 2 presentations (M. Dalsing, USA, and G. Palareti, Italy). A negative D-dimer result as a screening tool in symptomatic low- to moderate-risk patients (Wells assessment method) suspected of having DVT reduces the need for duplex scanning in 30% of patients. In patients with established DVT, the finding of a high D-dimer value one month after stopping vitamin K antagonists is associated with a high DVT recurrence rate (OR 2.27; 95% CI 1.15 to 4.46). These patients should be considered for more prolonged therapy.
Iliac vein stenting with or without recanalization performed for outflow obstruction or restenosis in a series of 982 limbs by S. Raju, USA, has been shown to have a primary and secondary patency rate of 79% and 100% at 6 years. Relief of pain and swelling at 6 years (cumulative) was 62% and 32%, respectively. 58% of the ulcers remained healed at 6 years despite the residual reflux.
Data from the Bonn epidemiological study (Presentation by E. Rabe) including 3072 participants, aged 18-79, have provided information on the prevalence of chronic venous disease according to the CEAP classification: telangiectasias 87%, varicose veins 23%, chronic venous insufficiency (C3- C6) 17%. The prevalence of venous leg ulcers (C5-C6) was 0.7%. The risk factors for varicose veins (age over 60, female gender, number of pregnancies, and family history of varicose veins) were different from the risk factors for chronic venous insufficiency (age over 50, obesity, urban residence).
B. Eklof, Sweden, presented the 14 projects the members of the American Venous Forum have volunteered to lead during the 5th Pacific Vascular Symposium (January 2004, Hawaii, USA). These projects are a vision for the future: what we know, what we do not know, and what we dream could be done over the next 10 years. A committee was created to support and encourage completion of the projects. The next step for the committee is to produce a supplement for J Vasc Surg.