Veins and Lymphatics

Factors affecting the evolution of type III shunts of the greater saphenous vein after the first step of the CHIVA 2 strategy

Massimo Cappelli — 2024-11-11

The CHIVA 2 strategy is a two-step surgical procedure for treating type III venous-venous shunts in the territory of the Greater Saphenous Vein (GSV). The first step consists of disconnecting the incompetent GSV tributary, either N3 or N4. Once a new N2 re-entry perforator vein has developed, or the GSV incompetence has reached the pre-existing N2 re-entry perforator vein, both documented by the re-appearance of GSV reflux during the follow-up, the second step of the CHIVA 2 strategy, i.e. the closure of the saphenous-femoral junction, can be performed.

In this paper we addressed the intriguing question of whether it was possible to identify the pre-operative factors able to favourably affect the hemodynamic stability of type III shunts of the GSVs treated by the only first step of the CHIVA 2 strategy.

Our data show that the pre-operative GSV anterograde flow, detectable all along the GSV course even soon after the first step of the procedure, plays a pivotal role in ensuring the hemodynamic stability of the treated GSV, which may not need the second step up to 45% of cases.

Adjustable compression wraps: back to the future

Jean-Patrick Benigni — 2024-11-12

Adjustable Compression Wraps (ACWs) are used to treat a variety of conditions, in particular venous leg ulcers, edema and lymphedema. Publications on the use of these devices are ultimately few and far between, with limitations or biases (small sample sizes, methodological weaknesses, non-comparative studies, lack of interface pressures).

A development model like that used in the study of a drug could be more rational. We propose five phases: phase 1) discovery and development, phase 2) in vitro testing, phase 3) clinical trials, phase 4) real-life data analysis, medico-economic investigation using Artificial Intelligence (AI), and phase 5) preparation of regulatory dossiers.

This lack of coherence in development could be an obstacle to widespread clinical use. Using AI to analyse large quantities of data could reduce the cost and number of clinical trials needed to generate more robust evidence.

This would make it possible to better define the clinical effects of ACWs in specific situations (e.g., leg wounds in the elderly, diabetic wounds, mixed leg ulcers, secondary lymphedema of the upper limb, efficacy, and comfort...) and to compare treatment costs between bandages and ACWs.

If we don't explore the future with AI, we'll never know what will be useful for the present - hence the title “Back to the Future”.

Pelvic congestion syndrome: increasing awareness is the key to facilitating proper diagnosis and appropriate treatment

Giulia Maria Piermarini — 2024-11-11

Pelvic Congestion Syndrome (PCS) represents a complex and frequently misdiagnosed disease that may greatly impact on quality of life of affected patients.

An understanding of its complex nature is crucial for both an accurate diagnosis and effective management.

In the present paper, a comprehensive overview of the clinical presentation, diagnostic strategies, and the latest advancements in the treatment of PCS is provided. Our aim is to raise awareness of treating physicians, improve proper diagnosis, and promote appropriate treatment.