Irwin Toonder - Academia.edu (original) (raw)

Papers by Irwin Toonder

Phlebology: The Journal of Venous Disease, 2005

Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment... more Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment of varicose veins. Compared with liquid sclerotherapy, foam is a much more powerful tool in the hands of an experienced practitioner. The introduction of consensus statements on foam sclerotherapy enhances its efficacy. This report will provide clinical tips and tricks during ultrasound-guided foam sclerotherapy. Methods: In general, consensus statements do not include practical tips and tricks to facilitate ultrasound-guided foam sclerotherapy itself. Experiences acquired during ultrasound-guided foam sclerotherapy sessions in our clinical practice can enhance the power of this treatment, which may be useful for colleagues in their everyday clinical practice. Conclusion: This report presents useful tips and tricks, which may contribute to effective ultrasound-guided foam sclerotherapy.

Phlebology: The Journal of Venous Disease, 2004

Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphe... more Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphenous vein (SSV) or perforating vein incompetence. This study analyses the inter-observer variability of the Trendelenburg test and the results are compared with duplex scanning - the standard for venous incompetence analysis. Methods: A total of 54 legs of 43 patients with varicose veins were investigated (36 female and seven male patients; mean age 47 years [range: 17-75]). All legs were evaluated for valvular incompetence by Trendelenburg tourniquet tests performed by three different investigators. A duplex scan was also performed in all legs. The inter-observer variability of the tourniquet test was expressed in Kappa (κ <0.5 indicated poor agreement). The sensitivity and specificity of the tourniquet tests are determined using the duplex scan as standard. Results: The inter-observer variability of the Trendelenburg test in detecting valvular incompetence of the LSV, SSV, perforati...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

The mean age of the treated PCS patients was 38 (range, 22-53) years. The mean minor diameter of ... more The mean age of the treated PCS patients was 38 (range, 22-53) years. The mean minor diameter of the compressed iliac veins in the PCS group was 3.4 (range, 1-6.2) mm. Pelvic symptoms were totally resolved or considerably improved after iliac vein stenting in the PCS group. Themean follow-up is 13 (range, 1-71) months. None of the patients are experiencing recurrent pelvic symptoms, and none of the stents have developed significant restenosis. Conclusions: Moderate to severely symptomatic nonthrombotic iliac vein obstruction is an overlooked cause of PCS and is 10 times as common in this single-center population as symptomatic left ovarian vein reflux. Venous angioplasty/stenting provides excellent midterm relief of pelvic symptoms. One patient with severe aortomesenteric compression of the left renal vein was encountered in this series. As imaging techniques and awareness of the abdominal/pelvic venous obstructive lesions improve, more patients will be relieved of their chronic undiagnosed pelvic pain.

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

s from the 2015 American Venous Forum Annual Meeting Fig. Mean pressure in common femoral vein. R... more s from the 2015 American Venous Forum Annual Meeting Fig. Mean pressure in common femoral vein. Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction F. H. Rossi, A. M. Kambara, N. M. Izukawa, P. B. Metzger, C. B. Betelli, B. L. Almeida, T. O. Rodrigues, I. P. Masciarelli, A. G. Sousa, C. B. O. Rossi. Instituto Dante Pazzanese, Sao Paulo, Brazil; Instituto Dante Pazzanese, Sao Paulo, Brazil Objectives: Post-thrombotic (PIVL) and nonthrombotic iliac vein lesions (NIVL) are frequently treated with endovascular methods. However, outcomes have never been studied by a randomized clinical trial before. The purpose of this study is to compare clinical and endovascular treatment outcomes in symptomatic chronic venous disease (CVD) patients with documented iliac vein obstruction. Methods: Patients with CVD (CEAP C3-6) and visual analog scale for pain (VAS pain) score >5 were considered eligible. We randomly assigned 50 iliac vein obstructions with >50% area reduction, per intravascular ultrasound, to undergo angioplasty and iliac vein stenting plus clinical treatment or clinical treatment alone (venoactive drug/aminaftone or warfarin [PIVL], plus compression therapy, and Unna boot for active venous ulcer). The patient and the clinical physician were blinded. Primary outcomes included (1) change from baseline in VAS pain and (2) venous ulcer healing rate at 6 months. Secondary outcomes included changes in Venous Clinical Severity Score (VCSS) and SF-36 Quality of Life Questionnaire as well as stent integrity, position, and patency at 6 months. Results: Between February 2013 andMarch 2014, 40 patients with 50 highly symptomatic iliac vein obstructions were studied. The median age was 57 years (range, 19-78 years). The female-to-male ratio was 4.7:1, and the leftright ratio was 3:1. CEAP classification was 3:36%, 4:22%, 5:12%, and 6:30%. Iliac vein stenting was 100% successful (PIVL, 42%; NIVL, 52%). The pain level on VAS scale declined from a median of 8.5 to 1.8 following stenting and from7.5 to7.0 after clinical treatment (P< .001).The rate of ulcer healing was higher after stenting (80%) vs clinical treatment group (33.3%) at 6months (95% confidence interval, 0.74-7.75; odds ratio, 2.4; P 1⁄4 .144). The VCSS scale (0-30) declined from a median of 19.2 to 11.6 after stenting and from 15.1 to 14.8 after clinical treatment (P < .001). The SF-36 Quality of Life Questionnaire (0-100) improved from a median of 53.9 to 85.0 with stenting and 48.3 to 59.8 after clinical treatment (P< .001). With a median follow-up of 10.2months, there was no stent fracture or migration. Primary and assisted primary stent patency rates were 96% and 100%, respectively. Conclusions: Angioplasty with stenting is a safe and effective treatment. The intervention promotes rapid relief of CVD symptoms and improves quality of life in highly symptomatic patients. Our results reproduce those achieved in numerous nonrandomized clinical studies. The data suggest clinical treatment alone should be limited to a very restricted number of patients who cannot undergo endovascular treatment. Author Disclosures: F. H. Rossi: FAPESP, Research Grant, Principal Investigator; A. M. Kambara: Nothing to disclose; N. M. Izukawa: Nothing to disclose; P. B. Metzger: Nothing to disclose; C. B. Betelli: Nothing to disclose; B. L. Almeida: Nothing to disclose; T. O. Rodrigues: Nothing to disclose; I. P. Masciarelli: Nothing to disclose; A. G. Sousa: Nothing to disclose; C. B. O. Rossi: Nothing to disclose. Hemodynamic Consequences of Deep Venous Obstructive Disease R. L. M. Kurstjens, M. A. F. de Wolf, I. M. Toonder, R. de Graaf, C. H. A. Wittens. Maastricht University Medical Centre, Maastricht, The Netherlands Objectives: Post-thrombotic iliofemoral venous obstruction can cause debilitating symptoms and can be treated by percutaneous angioplasty and stenting with good clinical results. However, little is known about the hemodynamic effects of iliofemoral post-thrombotic obstruction. The aim of this study was to demonstrate the hemodynamic changes in iliofemoral venous obstructive disease in the common femoral vein (CFV), compared to the dorsal foot vein, during ambulation. Methods: Sixteen patients with post-thrombotic unilateral iliofemoral deep venous obstruction were included. The dorsal foot vein and CFV were cannulated bilaterally, and patients were instructed to walk on a treadmill until a maximum walking distance was reached (3.2 km/h, slope increasing 2% every 2 minutes to a maximum of 26 minutes). Results: All patients suffered from venous claudication. Mean age was 426 14 years; 13 patients were female, and two had right-sided complaints. Pressure in the CFVwas significantly higher in diseased limbs in erect position (58.8 6 12.5 compared with 42.1 6 16.8; P 1⁄4 .008, Wilcoxon signed rank test), but this difference was not found in the dorsal foot vein (84.96 11.8 vs 87.5 6 10.5; P 1⁄4 .386). During…

Phlebology / Venous Forum of the Royal Society of Medicine, 2013

Local perivenous anaesthesia has evolved from tumescent anaesthesia which has had a huge impact o... more Local perivenous anaesthesia has evolved from tumescent anaesthesia which has had a huge impact on liposuction procedures. Perivenous anaesthesia has had a similar effect on peripheral venous surgery. Safety during its application is further enhanced when combined with skilled ultrasound guidance and astute operator awareness.

Phlebology: The Journal of Venous Disease, 2015

Introduction New developments in the treatment of complex deep venous disease have become availab... more Introduction New developments in the treatment of complex deep venous disease have become available in the last decade. Besides analysing patencies as a surrogate outcome for these treatments we analysed the Quality-of-Life (QoL) changes for successful and failed deep venous treatments. Materials and methods Patients with proven venous occlusive disease, referred to our department of Venous Surgery at the Maastricht University Medical Centre, were included. After inclusion patients were treated by percutaneous transluminal angioplasty and stenting and when indicated endophlebectomy with an arteriovenous fistula. QoL was assessed with the disease specific VEINES-QOL/Sym and the generic Short-Form (SF)-36 questionnaires preoperatively at baseline and post-operatively after 3, 12 and 24 months. Results One hundred fifty-three interventions were analysed, showing a primary, assisted primary and secondary patency of respectively 65%, 78% and 89% at 24 months. The VEINES-QOL and Sym score...

British Journal of Surgery, 2018

Background This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy ... more Background This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy (UGFS) with high ligation and surgical stripping (HL/S) of the great saphenous vein (GSV). Methods Patients were randomized to UGFS or HL/S of the GSV. The primary outcome was the recurrence of symptomatic GSV reflux. Secondary outcomes were patterns of reflux according to recurrent varices after surgery, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification, Venous Clinical Severity Score (VCSS) and EuroQol Five Dimensions (EQ-5D™) quality-of-life scores. Results Of 430 patients originally randomized (230 UGFS, 200 HL/S), 227 (52·8 per cent; 123 UGFS, 103 HL/S) were available for analysis after 8 years. The proportion of patients free from symptomatic GSV reflux at 8 years was lower after UGFS than HL/S (55·1 versus 72·1 per cent; P = 0·024). The rate of absence of GSV reflux, irrespective of venous symptoms, at 8 years was 33·1 and 49·7 per cent respectively (P = 0·009). M...

Journal of thrombosis and haemostasis : JTH, Jan 8, 2016

Little is known about the haemodynamic consequences of deep venous obstructive disease. The aim o... more Little is known about the haemodynamic consequences of deep venous obstructive disease. The aim of this study was to investigate the haemodynamic effect of post-thrombotic obstruction of the iliofemoral veins and to determine what pressure parameters differentiate best between limbs with post-thrombotic obstructive disease of the iliofemoral veins and those without obstruction. Twenty-two participants with unilateral obstruction of the iliac and common femoral veins underwent a standardised treadmill test with simultaneous bilateral invasive pressure measurements in the common femoral vein and dorsal foot vein. Mean age was 42.8±11.9 years and 86.4% of participants were female. Post-thrombotic limbs showed a mean common femoral vein pressure increase of 28.1±21.0 mmHg after walking, compared to 2.1±6.2 mmHg in control limbs (26.0 mmHg difference (95%CI: 17.1 - 34.9)). Less difference was observed in the dorsal foot vein (net drop of 36.8±22.7 mmHg in affected vs. 48.7±23.1 mmHg in n...

Journal of vascular surgery. Venous and lymphatic disorders, 2016

Journal of Vascular and Interventional Radiology, 2020

PURPOSE To report safety and efficacy of a skip stent technique using nitinol stents in patients ... more PURPOSE To report safety and efficacy of a skip stent technique using nitinol stents in patients with chronic bilateral iliocaval venous occlusions. MATERIALS AND METHODS A retrospective analysis of 48 consecutive patients (32 men; mean age, 40.7 years; age range, 18-68 years) with chronic bilateral iliocaval obstructions treated using a nonoverlapping stent technique was conducted at a single center. None of the patients had May-Thurner syndrome. Iliocaval confluence was treated by deploying a nitinol stent in inferior vena cava (IVC) and a nitinol stent in each common iliac vein close to the caval stent. Patency of stents was assessed by duplex US at 2 weeks, 3 months, and 6 months and yearly thereafter. RESULTS Recanalization and stent reconstruction was technically successful in 47 (98%) patients. The sinus-XL venous stent was used to treat IVC (95 [100%]). Common iliac and external iliac veins were treated with sinus-Venous and VENOVO stents (80 [83%] and 16 [17%] limbs, respectively). External iliac and common femoral veins were treated with sinus-Venous and VENOVO stents (83 [92%] and 7 [18%] limbs, respectively). Early thrombosis (< 30 days) of the iliac vein with stent occurred in 2 limbs. Cumulative primary, assisted primary, and secondary patency rates at 30 months were 74%, 83%, and 97%. CONCLUSIONS Findings of this study suggest that leaving a skipped lesion at the level of iliocaval confluence may not adversely affect stent patency. Patency rates were comparable with other reported techniques of stent reconstruction at the level of iliocaval confluence.

Thrombosis Journal, Sep 16, 2020

The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never b... more The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v2 and VEINES-QOL/Sy...

Journal of vascular surgery. Venous and lymphatic disorders, 2018

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2021

OBJECTIVE The impact of stent design on venous patency is not well studied. The purpose of this s... more OBJECTIVE The impact of stent design on venous patency is not well studied. The purpose of this study was to investigate the effect of stent material burden on endothelial coverage of stented venous segments, which may contribute to vessel healing and patency. METHODS Segmented self expanding bare nitinol stents (18 × 50 mm) comprising 5 mm long attached metallic rings separated by 2, 5, or 8 mm gaps were implanted in the inferior vena cava (IVC) of 10 sheep. These stents were designed and manufactured for the purposes of this study. At six, 12, and 24 weeks after implantation the animals were euthanised and the stented vessels harvested for histomorphometric analysis. Three sections from the metallic part as well as the gaps between the struts were reviewed for quantification of endothelialisation after six, 12, and 24 weeks. The intimal thickness over and between the stent struts was measured. The endothelialisation score (graded from 1 for complete luminal endothelialisation to 5...

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Less invasive contemporary endovenous techniques with improved stents have made treatment of the ... more Less invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion. Nowadays, with the evolution of less invasive endovenous techniques and the arri...

Journal of vascular surgery. Venous and lymphatic disorders, 2016

Thrombosis Journal

Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism ... more Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. Methods This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v...

Phlebologie

Less invasive contemporary endovenous techniques with improved stents have made treatment of the ... more Less invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion.

European Journal of Vascular and Endovascular Surgery

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Phlebology: The Journal of Venous Disease, 2005

Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment... more Objective: Ultrasound-guided foam sclerotherapy has become an accepted technique in the treatment of varicose veins. Compared with liquid sclerotherapy, foam is a much more powerful tool in the hands of an experienced practitioner. The introduction of consensus statements on foam sclerotherapy enhances its efficacy. This report will provide clinical tips and tricks during ultrasound-guided foam sclerotherapy. Methods: In general, consensus statements do not include practical tips and tricks to facilitate ultrasound-guided foam sclerotherapy itself. Experiences acquired during ultrasound-guided foam sclerotherapy sessions in our clinical practice can enhance the power of this treatment, which may be useful for colleagues in their everyday clinical practice. Conclusion: This report presents useful tips and tricks, which may contribute to effective ultrasound-guided foam sclerotherapy.

Phlebology: The Journal of Venous Disease, 2004

Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphe... more Objective: Trendelenburg tourniquet tests should determine long saphenous vein (LSV), short saphenous vein (SSV) or perforating vein incompetence. This study analyses the inter-observer variability of the Trendelenburg test and the results are compared with duplex scanning - the standard for venous incompetence analysis. Methods: A total of 54 legs of 43 patients with varicose veins were investigated (36 female and seven male patients; mean age 47 years [range: 17-75]). All legs were evaluated for valvular incompetence by Trendelenburg tourniquet tests performed by three different investigators. A duplex scan was also performed in all legs. The inter-observer variability of the tourniquet test was expressed in Kappa (κ <0.5 indicated poor agreement). The sensitivity and specificity of the tourniquet tests are determined using the duplex scan as standard. Results: The inter-observer variability of the Trendelenburg test in detecting valvular incompetence of the LSV, SSV, perforati...

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

The mean age of the treated PCS patients was 38 (range, 22-53) years. The mean minor diameter of ... more The mean age of the treated PCS patients was 38 (range, 22-53) years. The mean minor diameter of the compressed iliac veins in the PCS group was 3.4 (range, 1-6.2) mm. Pelvic symptoms were totally resolved or considerably improved after iliac vein stenting in the PCS group. Themean follow-up is 13 (range, 1-71) months. None of the patients are experiencing recurrent pelvic symptoms, and none of the stents have developed significant restenosis. Conclusions: Moderate to severely symptomatic nonthrombotic iliac vein obstruction is an overlooked cause of PCS and is 10 times as common in this single-center population as symptomatic left ovarian vein reflux. Venous angioplasty/stenting provides excellent midterm relief of pelvic symptoms. One patient with severe aortomesenteric compression of the left renal vein was encountered in this series. As imaging techniques and awareness of the abdominal/pelvic venous obstructive lesions improve, more patients will be relieved of their chronic undiagnosed pelvic pain.

Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2015

s from the 2015 American Venous Forum Annual Meeting Fig. Mean pressure in common femoral vein. R... more s from the 2015 American Venous Forum Annual Meeting Fig. Mean pressure in common femoral vein. Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction F. H. Rossi, A. M. Kambara, N. M. Izukawa, P. B. Metzger, C. B. Betelli, B. L. Almeida, T. O. Rodrigues, I. P. Masciarelli, A. G. Sousa, C. B. O. Rossi. Instituto Dante Pazzanese, Sao Paulo, Brazil; Instituto Dante Pazzanese, Sao Paulo, Brazil Objectives: Post-thrombotic (PIVL) and nonthrombotic iliac vein lesions (NIVL) are frequently treated with endovascular methods. However, outcomes have never been studied by a randomized clinical trial before. The purpose of this study is to compare clinical and endovascular treatment outcomes in symptomatic chronic venous disease (CVD) patients with documented iliac vein obstruction. Methods: Patients with CVD (CEAP C3-6) and visual analog scale for pain (VAS pain) score >5 were considered eligible. We randomly assigned 50 iliac vein obstructions with >50% area reduction, per intravascular ultrasound, to undergo angioplasty and iliac vein stenting plus clinical treatment or clinical treatment alone (venoactive drug/aminaftone or warfarin [PIVL], plus compression therapy, and Unna boot for active venous ulcer). The patient and the clinical physician were blinded. Primary outcomes included (1) change from baseline in VAS pain and (2) venous ulcer healing rate at 6 months. Secondary outcomes included changes in Venous Clinical Severity Score (VCSS) and SF-36 Quality of Life Questionnaire as well as stent integrity, position, and patency at 6 months. Results: Between February 2013 andMarch 2014, 40 patients with 50 highly symptomatic iliac vein obstructions were studied. The median age was 57 years (range, 19-78 years). The female-to-male ratio was 4.7:1, and the leftright ratio was 3:1. CEAP classification was 3:36%, 4:22%, 5:12%, and 6:30%. Iliac vein stenting was 100% successful (PIVL, 42%; NIVL, 52%). The pain level on VAS scale declined from a median of 8.5 to 1.8 following stenting and from7.5 to7.0 after clinical treatment (P< .001).The rate of ulcer healing was higher after stenting (80%) vs clinical treatment group (33.3%) at 6months (95% confidence interval, 0.74-7.75; odds ratio, 2.4; P 1⁄4 .144). The VCSS scale (0-30) declined from a median of 19.2 to 11.6 after stenting and from 15.1 to 14.8 after clinical treatment (P < .001). The SF-36 Quality of Life Questionnaire (0-100) improved from a median of 53.9 to 85.0 with stenting and 48.3 to 59.8 after clinical treatment (P< .001). With a median follow-up of 10.2months, there was no stent fracture or migration. Primary and assisted primary stent patency rates were 96% and 100%, respectively. Conclusions: Angioplasty with stenting is a safe and effective treatment. The intervention promotes rapid relief of CVD symptoms and improves quality of life in highly symptomatic patients. Our results reproduce those achieved in numerous nonrandomized clinical studies. The data suggest clinical treatment alone should be limited to a very restricted number of patients who cannot undergo endovascular treatment. Author Disclosures: F. H. Rossi: FAPESP, Research Grant, Principal Investigator; A. M. Kambara: Nothing to disclose; N. M. Izukawa: Nothing to disclose; P. B. Metzger: Nothing to disclose; C. B. Betelli: Nothing to disclose; B. L. Almeida: Nothing to disclose; T. O. Rodrigues: Nothing to disclose; I. P. Masciarelli: Nothing to disclose; A. G. Sousa: Nothing to disclose; C. B. O. Rossi: Nothing to disclose. Hemodynamic Consequences of Deep Venous Obstructive Disease R. L. M. Kurstjens, M. A. F. de Wolf, I. M. Toonder, R. de Graaf, C. H. A. Wittens. Maastricht University Medical Centre, Maastricht, The Netherlands Objectives: Post-thrombotic iliofemoral venous obstruction can cause debilitating symptoms and can be treated by percutaneous angioplasty and stenting with good clinical results. However, little is known about the hemodynamic effects of iliofemoral post-thrombotic obstruction. The aim of this study was to demonstrate the hemodynamic changes in iliofemoral venous obstructive disease in the common femoral vein (CFV), compared to the dorsal foot vein, during ambulation. Methods: Sixteen patients with post-thrombotic unilateral iliofemoral deep venous obstruction were included. The dorsal foot vein and CFV were cannulated bilaterally, and patients were instructed to walk on a treadmill until a maximum walking distance was reached (3.2 km/h, slope increasing 2% every 2 minutes to a maximum of 26 minutes). Results: All patients suffered from venous claudication. Mean age was 426 14 years; 13 patients were female, and two had right-sided complaints. Pressure in the CFVwas significantly higher in diseased limbs in erect position (58.8 6 12.5 compared with 42.1 6 16.8; P 1⁄4 .008, Wilcoxon signed rank test), but this difference was not found in the dorsal foot vein (84.96 11.8 vs 87.5 6 10.5; P 1⁄4 .386). During…

Phlebology / Venous Forum of the Royal Society of Medicine, 2013

Local perivenous anaesthesia has evolved from tumescent anaesthesia which has had a huge impact o... more Local perivenous anaesthesia has evolved from tumescent anaesthesia which has had a huge impact on liposuction procedures. Perivenous anaesthesia has had a similar effect on peripheral venous surgery. Safety during its application is further enhanced when combined with skilled ultrasound guidance and astute operator awareness.

Phlebology: The Journal of Venous Disease, 2015

Introduction New developments in the treatment of complex deep venous disease have become availab... more Introduction New developments in the treatment of complex deep venous disease have become available in the last decade. Besides analysing patencies as a surrogate outcome for these treatments we analysed the Quality-of-Life (QoL) changes for successful and failed deep venous treatments. Materials and methods Patients with proven venous occlusive disease, referred to our department of Venous Surgery at the Maastricht University Medical Centre, were included. After inclusion patients were treated by percutaneous transluminal angioplasty and stenting and when indicated endophlebectomy with an arteriovenous fistula. QoL was assessed with the disease specific VEINES-QOL/Sym and the generic Short-Form (SF)-36 questionnaires preoperatively at baseline and post-operatively after 3, 12 and 24 months. Results One hundred fifty-three interventions were analysed, showing a primary, assisted primary and secondary patency of respectively 65%, 78% and 89% at 24 months. The VEINES-QOL and Sym score...

British Journal of Surgery, 2018

Background This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy ... more Background This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy (UGFS) with high ligation and surgical stripping (HL/S) of the great saphenous vein (GSV). Methods Patients were randomized to UGFS or HL/S of the GSV. The primary outcome was the recurrence of symptomatic GSV reflux. Secondary outcomes were patterns of reflux according to recurrent varices after surgery, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification, Venous Clinical Severity Score (VCSS) and EuroQol Five Dimensions (EQ-5D™) quality-of-life scores. Results Of 430 patients originally randomized (230 UGFS, 200 HL/S), 227 (52·8 per cent; 123 UGFS, 103 HL/S) were available for analysis after 8 years. The proportion of patients free from symptomatic GSV reflux at 8 years was lower after UGFS than HL/S (55·1 versus 72·1 per cent; P = 0·024). The rate of absence of GSV reflux, irrespective of venous symptoms, at 8 years was 33·1 and 49·7 per cent respectively (P = 0·009). M...

Journal of thrombosis and haemostasis : JTH, Jan 8, 2016

Little is known about the haemodynamic consequences of deep venous obstructive disease. The aim o... more Little is known about the haemodynamic consequences of deep venous obstructive disease. The aim of this study was to investigate the haemodynamic effect of post-thrombotic obstruction of the iliofemoral veins and to determine what pressure parameters differentiate best between limbs with post-thrombotic obstructive disease of the iliofemoral veins and those without obstruction. Twenty-two participants with unilateral obstruction of the iliac and common femoral veins underwent a standardised treadmill test with simultaneous bilateral invasive pressure measurements in the common femoral vein and dorsal foot vein. Mean age was 42.8±11.9 years and 86.4% of participants were female. Post-thrombotic limbs showed a mean common femoral vein pressure increase of 28.1±21.0 mmHg after walking, compared to 2.1±6.2 mmHg in control limbs (26.0 mmHg difference (95%CI: 17.1 - 34.9)). Less difference was observed in the dorsal foot vein (net drop of 36.8±22.7 mmHg in affected vs. 48.7±23.1 mmHg in n...

Journal of vascular surgery. Venous and lymphatic disorders, 2016

Journal of Vascular and Interventional Radiology, 2020

PURPOSE To report safety and efficacy of a skip stent technique using nitinol stents in patients ... more PURPOSE To report safety and efficacy of a skip stent technique using nitinol stents in patients with chronic bilateral iliocaval venous occlusions. MATERIALS AND METHODS A retrospective analysis of 48 consecutive patients (32 men; mean age, 40.7 years; age range, 18-68 years) with chronic bilateral iliocaval obstructions treated using a nonoverlapping stent technique was conducted at a single center. None of the patients had May-Thurner syndrome. Iliocaval confluence was treated by deploying a nitinol stent in inferior vena cava (IVC) and a nitinol stent in each common iliac vein close to the caval stent. Patency of stents was assessed by duplex US at 2 weeks, 3 months, and 6 months and yearly thereafter. RESULTS Recanalization and stent reconstruction was technically successful in 47 (98%) patients. The sinus-XL venous stent was used to treat IVC (95 [100%]). Common iliac and external iliac veins were treated with sinus-Venous and VENOVO stents (80 [83%] and 16 [17%] limbs, respectively). External iliac and common femoral veins were treated with sinus-Venous and VENOVO stents (83 [92%] and 7 [18%] limbs, respectively). Early thrombosis (< 30 days) of the iliac vein with stent occurred in 2 limbs. Cumulative primary, assisted primary, and secondary patency rates at 30 months were 74%, 83%, and 97%. CONCLUSIONS Findings of this study suggest that leaving a skipped lesion at the level of iliocaval confluence may not adversely affect stent patency. Patency rates were comparable with other reported techniques of stent reconstruction at the level of iliocaval confluence.

Thrombosis Journal, Sep 16, 2020

The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never b... more The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v2 and VEINES-QOL/Sy...

Journal of vascular surgery. Venous and lymphatic disorders, 2018

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2021

OBJECTIVE The impact of stent design on venous patency is not well studied. The purpose of this s... more OBJECTIVE The impact of stent design on venous patency is not well studied. The purpose of this study was to investigate the effect of stent material burden on endothelial coverage of stented venous segments, which may contribute to vessel healing and patency. METHODS Segmented self expanding bare nitinol stents (18 × 50 mm) comprising 5 mm long attached metallic rings separated by 2, 5, or 8 mm gaps were implanted in the inferior vena cava (IVC) of 10 sheep. These stents were designed and manufactured for the purposes of this study. At six, 12, and 24 weeks after implantation the animals were euthanised and the stented vessels harvested for histomorphometric analysis. Three sections from the metallic part as well as the gaps between the struts were reviewed for quantification of endothelialisation after six, 12, and 24 weeks. The intimal thickness over and between the stent struts was measured. The endothelialisation score (graded from 1 for complete luminal endothelialisation to 5...

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Less invasive contemporary endovenous techniques with improved stents have made treatment of the ... more Less invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion. Nowadays, with the evolution of less invasive endovenous techniques and the arri...

Journal of vascular surgery. Venous and lymphatic disorders, 2016

Thrombosis Journal

Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism ... more Background The role of venous obstructions as a risk factor for recurrent venous thromboembolism has never been evaluated. This study aimed to determine whether there is a difference in prevalence of venous obstructions between patients with and without recurrent venous thromboembolism. Furthermore, its influence on the development of post-thrombotic syndrome and patient-reported quality of life was assessed. Methods This matched nested case-control study included 32 patients with recurrent venous thromboembolism (26 recurrent deep-vein thrombosis and 6 pulmonary embolism) from an existing prospective cohort of deep-vein thrombosis patients and compared them to 24 age and sex matched deep-vein thrombosis patients without recurrent venous thromboembolism. All participants received standard post-thrombotic management and underwent an additional extensive duplex ultrasonography. Post-thrombotic syndrome was assessed by the Villalta-scale and quality of life was measured using the SF36v...

Phlebologie

Less invasive contemporary endovenous techniques with improved stents have made treatment of the ... more Less invasive contemporary endovenous techniques with improved stents have made treatment of the May Thurner Syndrome(MTS) more accessible and safer. However, clear criteria for the accurate diagnosis remain obscure. All imaging modalities are performed with patients in a supine position were compression of the left Common Iliac Vein is seen in both asymptomatic and symptomatic patients. There is no clear threshold value. There are no validated hemodynamic criteria. This leads to the necessity of additional information such as measurements performed in an upright position as well as greater scrutiny in detecting fibrous wall thickening and spurs as well as identifying the presence of venous collaterals. Moreover, those contemplating treating MTS should not only identify specific symptoms, but also should consider that patient complaints may be related to a more complex presentation of pelvic congestion.

European Journal of Vascular and Endovascular Surgery

Journal of Vascular Surgery: Venous and Lymphatic Disorders