On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
ObjectiveTo summarize the progress of perioperative pain management in patients with lower limb vascular diseases. MethodRetrieved the literature about pain management in patients with lower limb vascular diseases both at home and abroad in recent years and reviewed the literature. ResultsLower limb vascular diseases were very common in elderly patients. Whether it was limb ischemic pain or surgery-related pain, it often increased the stress response and activation of the autonomic system, which was not conducive to the recovery of the disease. Good analgesic management was important for these patients. Perioperative pain management could be performed by intravenous analgesics, oral analgesics, local anesthesia, neuraxial anesthesia and peripheral nerve block. Acute and chronic pain should be actively managed during perioperative period. Pre-emptive analgesic strategies could be implemented in patients with severe peripheral vascular disease. ConclusionsGood perioperative analgesia management is necessary. Pain management which employes one or more analgesic methods is important in maximizing pain relief, function, and quality of life for this patient group.
Objective To explore the feasibility and the security of one-day stay ward in stripping surgery of saphenous vein varicosity. Methods Two hundred and eighty two patients treated in our hospital in 2011 were enrolled in this study， according to the operation mode， these patients were divided into 2 groups， ninety patients in one-day stay ward group and one hundred and ninety two patients in in-patient group. Their clinical features and medical operation indexs（included preoperative waiting time， duration of hospital stay， and medical cost）were retrospectively analyzed. Results There was no statistical differences on clinical features between the two groups. But compared with in-patient group， the preoperative waiting time， duration of hospital stay， and medical cost were shorter or lower in one-day stay ward group （P＜0.05）. Conclusions The one-day stay ward operation mode can decrease preoperative waiting time， duration of hospital stay and medical cost significantly， and it also can ensure the safety of clinical treatment. So it’s worthy in the clinical promotion.
Objective To analyze the feasibility, possible problems and application of bilingual teaching rounds in vascular surgery teaching. Methods Ninety participants included internship, interns and residents of standardized training from 2015 to 2016 in vascular department of West China Hospital of Sichuan University were included. The questionnaire named the feasibility of bilingual rounds in surgery teaching was done and analyzed in all of these students. The results of the evaluation score from different teachers on their teaching process were also analyzed. Results Three groups could accept bilingual teaching rounds of this teaching form, and all of them were willing to be involved in, but their English levels and acceptance participate times were different. The CET4 levels of three groups did not have any difference; however, the CET6 levels had significant difference. There were significant differences in the preparation times and the review times (all P values <0.05), and there were no difference in acceptance, value and promote degree (all P values >0.1). In different teaching teachers' self assessment on the same objective, there was significant differences (all P values <0.05). Conclusion Bilingual rounds in surgery teaching have certain feasibility. Different adjustments are needed according to the English level and the grade, and higher request of the teacher is necessary.
ObjectiveTo understand progress of gene research for chronic venous ulcer (CVU) so as to seek for the best treatment strategy for it.MethodThe literatures about studies on gene polymorphism and variability that leaded to the occurrence and development of CVU in recent years were reviewed and analyzed.ResultsThe CVU was mainly caused by the chronic venous insufficiency (CVI). Many changes in the gene expression had been found in the curable CVU and incurable CVU. The expressions of regulated inflammatory genes, encoding extracellular peptide genes, and encoding different cellular pathways genes in the incurable CVU patients had remarkable differences as compared with the healthy individuals. Although there were more studies on incurable CVU than curable CVU, it was still unable to accurately predict the healing time of CVU. At the same time, genome-wide associations study had not been performed to find single nucleotide polymorphism related to the risk of CVU.ConclusionsAlthough CVU is mainly caused by CVI, not all patients with CVI have ulcer. At present, parts of risk factors of CVU have been known, such as age, iliofemoral vein embolism, deep vein insufficiency, hypertension, obesity, and so on. However, there are fewer studies on heredity, so it is necessary to strengthen its research. Gene expression and gene polymorphism have increasingly become focus of research on causes of chronic inflammation. Genome-wide association study is a gold standard of complex disease genetics, so it is neccessary to further search so as to better understand genetic basis and genetic background of CVU and find the best treatment strategy for improving ulcer healing.
Inpatients after COVID-19 infection, especially those admitted to intensive care unit (ICU), may encounter a series of coagulation dysfunction, which may lead to thrombosis, such as pulmonary embolism (PE), deep vein thrombosis (DVT) or arterial thrombosis (AT). Although there are many literatures on the incidence rate, prevention and treatment of venous thromboembolism (VTE) in hospitalized patients with COVID-19 infection, there are few data on the symptomatic and subclinical incidence rate of VTE after COVID-19 infection discharge. Therefore, there are no specific recommendations or guidelines for the prevention of VTE after discharge from hospital due to COVID-19 infection, and the current guidelines are controversial. In this study, we reviewed and summarized the existing literature on the incidence rate, prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19 infection, in order to provide guidance for VTE prevention in patients with COVID-19 infection after discharge.
Objective To identify and analyze all medical injury liability disputes lawsuits pertaining to inferior vena cava filters (IVCF) in “Lexis®China” database, the causes and outcomes of litigation of the cases were clarified with a view, and to provide suggestions for preventing potential medical patient dispute lawsuits and improving the clinical diagnosis and treatment level of doctors. Method The term “inferior vena cava filter” was searched in Lexis®China, and spanning from 2011-01-01 to 2022-12-31. Results A total of 221 cases of medical injury liability disputes were found, after screening and exclusion, a total of 179 relevant cases were included in this study for analysis. All first instance lawsuits were brought by patients against hospitals and had a high rate of compensation awarded (91.6%). Forty four cases were entered second instance litigation, and the proportion of maintaining the original judgment was high (68.2%). The main content involving the modification of the judgment was to increase the compensation amount (85.7%). In the 14 lawsuits related to the failure to place IVCF by the medical authority, the litigation points were all disputes arising from the hospital’s improper diagnosis and treatment of VTE patients, which led to the failure to place IVCF, with the highest proportion (92.3%) of improper diagnosis and treatment of pulmonary embolism (PE). For PE and deep vein thrombosis patients with clear indications for IVCF implantation but not placed, leading to litigation, the hospital bore different liability for compensation (18%–100%) depending on the fault factors of the hospital’s negligence in diagnosis and treatment. The hospital could also be held responsible for inadequate informed disclosure to affect patient judgment (23.1%). In 165 lawsuits related to the placement of IVCF, the vast majority of IVCF implants were for the diagnosis and treatment of VTE in patients (73.9%). However, such unplanned operations caused additional injuries and expenses to patients, and VTE occurred most frequently during hospitalization (76.2%). This type of embolism was most commonly secondary to fracture incision and fixation surgery (31.2%), and the average liability of hospitals for compensation varied due to different secondary factors. The occurrence of intraoperative and postoperative complications related to IVCF implantation could also lead to litigation (18.8%), and the proportion of dead patients in litigation was relatively high (32.3%). The most common complication leading to litigation was PE recurrence or exacerbation (22.5%), while intraoperative complications were vascular injury during interventional procedures (2/3). The overall trend of IVCF-related lawsuits reserves between 2011 and 2020 showed an overall upward trend, reaching a peak of 37 cases in 2020; the average amount of damages exceeded 100 000 yuan per case in 10 of the 12 years included in the statistics. Conclusions In China’s IVCF-related medical liability lawsuits, patients most often sue their doctors, who are often sued for failure to insert a filter due to untimely diagnosis and treatment of VTE, inadequate notification of informed consent for IVCF insertion, unplanned IVCF insertion due to the presence of VTE and IVCF-related complications, and the outcome is often unfavourable to the doctors. In addition, the number of IVCF related lawsuits and hospital compensation amounts have remained high in recent years.
Objective To discuss the surgical management in resection of primary peritoneal tumors involving iliac vessels. Methods The clinical data of 124 patients with primary peritoneal tumors involving iliac vessels， that underwent surgical procedures from December 2006 to December 2011 were analyzed retrospectively. There were 68 menand 56 women with an age raging from 16-72 years old （mean 44 years old）. Results All patients underwent operative treatment. Fifty-two patients with tumors infiltrating or surrounding the major illiac vessels， 72 patients with tumors compressing the iliac vessels. Primary peritoneal tumors involving iliac vessels were completely resected in 90 patients， were incompletely resected in 31 patients， and were palliatively resected in 3 patients. Resectoin of primary peritoneal tumors and iliac vessel reconstruction were performed in 42 patients with tumors infiltrating or surrounding the major illiac vessels. There was no death during perioperative period. There were complications in 2 patients， that including urinary fistula in 1 patient and fat liquefaction of incision in 1 patient. Complications were not found in the rest of the patients. All patients were followed-up from 12-24 months （mean 16 months）. Thirty-eight patients relapsed locally in 90 patients with tumor completely resected. Nine patients died in those tumor incompletely resected（6 patients died because of recurrence， 3 patients died because of cadiovasuclar and cerebrovascular accidents）. Three patients follwing palliative resected were dead during the follow-up period （3 patients died because of recurrence）. Among the 42 patients underwent the procedure of iliac vessels， recurrence occured in 3 patients without involving iliac vessels， 1 patient relapsed involving inferior vena cava （IVC） which resulted in IVC obstruction and deep venous thrombosis following 7 months after operation. Recurrence occured in 2 patients involving common iliac veins following 8 months after operation. Venous thrombus of common iliac vein graft occured in 1 patientin in 10 months after operation. Conclusion Resection completely and involved iliac vessel reconstruction would reduce recurrence of tumor and promote long term survival in patients with primary peritoneal tumors involving iliac vessels
Objective To summarize the present research progress of venous thromboembolism in the elderly. Methods Reviewed the literatures in recent years about the epidemiology, risk factors, diagnosis, prevention, and prognosis of venous thromboembolism in the elderly. Results Venous thromboembolism was a more common cardiovascular system diseases for the elderly, the incidence was higher, but the elderly didn’t pay much attention on it. The clinical manifestations of venous thromboembolism in elderly were different from young people, and all kinds of inspection methods had advantages and disadvantages. It gave priority to anticoagulation therapy, but we should pay attention to the risk of bleeding. Conclusions High incidence of venous thromboembolism was observed in the elderly, and diagnostic measures for venous thromboembolism were various. In the process of treatment, classification, the pros and cons were especially needed to pay attention to, and its special researches were necessary.
ObjectiveTo explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).MethodsThe patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. ResultsA total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].ConclusionsUGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.