Sept
18
“Crystal clear” evidence that higher compression reduces ulcer recurrence
Issue
7
Athanasios Giannoukas:
Managing superficial vein thrombosis Page 12
A randomised study in Serbia has found that the use of higher pressure compression stockings is associated with a lower rate of venous leg ulcer recurrence over a fiveyear period. Speaking at the European Venous Forum annual meeting (EVF; 28–30 June, Athens, Greece), Dragan Milic, Medical Center of Nis, Serbia, said that for efficient long-term prevention of ulcer recurrence, the results of his study are “crystal clear”—the stronger the compression, the better the results.
Kathleen Gibson:
Profile
Page 10
New intravascular ultrasound-based scoring system may predict future stent failure
M
ilic upheld compression therapy as a “cornerstone” of venous disease treatment, which he argued should be the focus of all venous specialists, including surgeons. In a bid to recentralise the debate around this treatment, rather than interventional or pharmacological therapy, Milic reaffirmed his view that “good compression is the foundation of care”. Venous insufficiency and venous ulcerations are an important social and healthcare problem, with an overall incidence of venous ulcers in patients older than 45 years of 3.5 per 1,000 every year. Milic explained that, according to the Bohn Vein study, 0.1% of the adult population has an active venous ulcer and 0.6% has a healed venous ulcer. Further, 1.5% of European adults will suffer a
Dragan Milic
venous ulcer at some point in their lives and the incidence of chronic venous insufficiency according to many studies is 0.5–3% in adults, and 70% of people with venous leg ulcers experience negative emotional impact. Finally, the treatment of venous leg ulcers is very expensive, and accounts for 1% of the healthcare budget, with annual healthcare costs for venous ulcers estimated at £300 million in the UK, €250 million in Germany and US$1 billion in the USA. Milic further reported that while there is no firm data for the Balkan region in Eastern Europe, it is believed that the cumulative prevalence of chronic venous insufficiency and venous ulceration is much higher than 1% and that in Serbia alone, 40,000 were reported as having an active venous Continued on page 2
To accompany the growing importance of intravascular ultrasound (IVUS) as an adjuvant diagnostic tool when treating deep venous disease, a study sought to create an IVUS-based scoring system able to predict stent failure in the treatment of May-Thurner Syndrome. The findings were revealed at the Society for Vascular Surgery Vascular Annual Meeting (VAM; 20–23 June, Boston, USA) by Steven D Abramowitz, MedStar Washington Hospital Center, Washington DC, USA.
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he prediction of stent failure qualifies a step forward in both standardising and comparing outcomes for endovascular venous treatment. In turn, the investigators suggest the use of the IVUS scoring system allows for the objective characterisation of iliac vein lesions, and may be able to predict lesions at high risk of reintervention. The study took place within two collaborative institutions, analysing 118 patients diagnosed with May-Thurner syndrome, all of whom underwent IVUS-guided stent placement from April 2009 to May 2015. Patients included 86 (73%) females and 32 (27%) males with a mean age of 46 years (range: 17–83 years). All patients had C3–6 Continued on page 4