Progress in the management of venous disease during our five decades as surgeons

Peter NEGLÉN, MD, PhD1, Bo EKLÖF, MD, PhD2 1Trimiklini, Cyprus; 2Råå, Sweden Abstract The authors’ experience spans 5 decades of development in the management of venous disease. They describe their journey through the open surgery era; the transforming introduction of duplex ultrasound scanning; the establishment of consensus-driven classification, terminology, and investigatory planning, hugely important for research and patient care; and the emergence of minimally invasive endovascular procedures during the 21st century with greater acceptability by patients, minimal morbidity/ mortality, and wider application than open surgery. The management of patients with venous disease has progressed immensely since the 1960s. Introduction At…

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Update on calf vein thrombosis

Pier Luigi ANTIGNANI, MD, PhD, FIUA, MRSM, DFAVF, FESVM, EFACP; President of the International Union of Angiology; Director, Vascular Center, Nuova Villa Claudia, Rome, Italy Abstract Calf deep vein thrombosis, defined as thrombosis confined to the calf veins of the lower limbs, is a frequent finding in symptomatic outpatients and inpatients when the ultrasound examination is extended to the deep veins of the whole leg. The prevalence of the disease is between 5% and 33% of all deep vein thrombosis (DVT) cases detected by ultrasound, low in symptomatic patients and higher in asymptomatic patients at high risk of DVT. Thrombi…

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Role of anticoagulation treatment in the prevention of post-thrombotic syndrome

Christos KARATHANOS, MD, PhD1; Athanasios GIANNOUKAS,MD, PhD2; 1Consultant Vascular Surgeon; 2Professor of Vascular Surgery and Head of the Department; Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece Abstract Post-thrombotic syndrome (PTS) develops after deep vein thrombosis (DVT) of the lower limbs and may affect up to 50% of patients after proximal DVT. Prevention is of paramount importance as there is no gold standard for treatment of established PTS. Pharmacological or mechanical thromboprophylaxis is recommended to prevent PTS. Effective DVT treatment with vitamin K antagonists (VKAs), direct oral anticoagulants…

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Micronized purified flavonoid fraction in adjunction to rivaroxaban improves outcomes of popliteal-femoral deep-vein thrombosis at 12-month follow-up

Kirill LOBASTOV,1 MD, PhD; Ilya SCHASTLIVTSEV,1,2 MD, PhD; Victor BARINOV,2 MD, PhD 1Pirogov Russian National Research Medical University, Moscow, Russian Federation; 2Clinical Hospital no.1 of the President’s Administration of the Russian Federation Abstract Aim: To assess the efficacy of the long-term use of micronized purified flavonoid fraction (MPFF) in the treatment of popliteal-femoral deep-vein thrombosis (DVT). Methods: In this pilot, comparative, open-label clinical study, patients with the first episode of popliteal-femoral DVT confirmed by duplex ultrasound scan (DUS) were allocated to two groups: the control group received standard treatment with rivaroxaban for 6 months and compression stockings for 12 months,…

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What is the best method of imaging in iliofemoral venous obstruction?

Gerard J. O’SULLIVAN MB, BCh, BAO, FRCR National University of Ireland, Galway, Ireland Abstract Iliofemoral venous obstruction is increasingly recognized as a major cause of post-thrombotic syndrome. Patients can be left with significant symptoms after just one episode of iliofemoral deep-vein thrombosis; ranging from milder problems, such as varicose veins, to itching, leg swelling, and even venous ulceration. With the advent of endovascular techniques to reconstruct the iliofemoral segment has come an understanding that accurate recognition and diagnosis form a central part of the puzzle. Clinical evaluation is limited, and imaging has assumed a central role. This article looks at…

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Deep vein thrombosis and air travel: risk management in 2015

Deep vein thrombosis and air travel: risk management in 2015 Michèle CAZAUBON Vascular Unit, Vein Clinic, American Hospital of Paris, France. Abstract Long-haul flights increase the risk of venous thromboembolism (VTE) for several weeks after the flight by 3-fold among passengers compared with the general population. The risk increases with flight duration and persists for several weeks (until week 8) after landing. This risk is not the same for all passengers and should be determined before any long flight, especially among frequent travellers. The calculation of risk is based on simple clinical data, easily obtained by the treating physician. If…

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