24 results on '"T. Noppeney"'
Search Results
2. Perioperative quality assessment of varicose vein surgery
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S. Debus, T. Noppeney, Giovanni Torsello, C.-G. Schmedt, M. Storck, H. Nüllen, R. Kellersmann, Dittmar Böckler, and K. Walluscheck
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,030204 cardiovascular system & hematology ,030230 surgery ,Varicose Veins ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Germany ,Varicose veins ,medicine ,Humans ,Intraoperative Complications ,Aged ,Quality of Health Care ,Aged, 80 and over ,business.industry ,Postoperative complication ,Perioperative ,Middle Aged ,Vascular surgery ,Surgery ,Cardiac surgery ,Cardiothoracic surgery ,Catheter Ablation ,Female ,Laser Therapy ,medicine.symptom ,Complication ,business ,Vascular Surgical Procedures ,Abdominal surgery - Abstract
An estimated 350,000 varicose vein (VV) surgical procedures are performed in Germany each year, with annual treatment costs amounting to about 800 million Euro. To evaluate the outcome quality of this treatment, we examined the intraoperative and postoperative complication rates on record in the VV surgery quality assessment (QA) registry of the German Society for Vascular Surgery (GSVS). Data on 89,647 patients (27,463 men, 62,184 women; average age 52.8 years, range 15–96 years) collected in the GSVS varicose surgery QA registry between 2001 and 2009 were analyzed. In these patients, 95,214 surgical procedures were performed on 105,296 limbs. Complication rates were correlated with the type of VV surgical procedure, with whether surgery was performed on an inpatient or outpatient basis, and with the CEAP classification (C stage) and American Society of Anaesthesiologists’ (ASA) stage at the time of surgery. Statistical analyses were performed using a chi-square test, a Cochrane-Armitage test, and an odds ratio calculation. Intraoperative and postoperative complication was low (0.18 and 0.43 %, respectively), being the lowest for radiofrequency ablation (0.25 %) but not differing significantly from those for endovenous laser therapy and high ligation and stripping. General complications occurred in 0.67 % of outpatients and in 0.25 % of inpatients, a highly significant statistical difference (p more...
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- 2016
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Catalog
3. Manifestationen und Prävention der Arteriosklerose
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T. Hupp, Thomas Schmitz-Rixen, Reinhart T. Grundmann, T. Noppeney, Werner Lang, Giovanni Torsello, Alexander Oberhuber, and Eike Sebastian Debus
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Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Hintergrund Das Gewicht der Atherosklerose fur das Gesundheitssystem machen folgende Zahlen deutlich: In der Altersgruppe der ab 65-Jahrigen liegt bei uns die Erkrankungshaufigkeit der Frauen an koronarer Herzkrankheit (KHK) bei 18 %, die der Manner bei 28 %. Die Sterblichkeit wegen KHK wurde fur das Jahr 2004 mit 80,57 auf 100.000 Frauen und 149,21 auf 100.000 Manner berechnet. more...
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- 2013
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4. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)
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C, Wittens, A H, Davies, N, Bækgaard, R, Broholm, A, Cavezzi, S, Chastanet, M, de Wolf, C, Eggen, A, Giannoukas, M, Gohel, S, Kakkos, J, Lawson, T, Noppeney, S, Onida, P, Pittaluga, S, Thomis, I, Toonder, M, Vuylsteke, Esvs Guidelines Committee, P, Kolh, G J, de Borst, N, Chakfé, S, Debus, R, Hinchliffe, I, Koncar, J, Lindholt, M V, de Ceniga, F, Vermassen, F, Verzini, Document Reviewers, M G, De Maeseneer, L, Blomgren, O, Hartung, E, Kalodiki, E, Korten, M, Lugli, R, Naylor, P, Nicolini, and A, Rosales more...
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Treatment Outcome ,Venous Insufficiency ,Predictive Value of Tests ,Risk Factors ,Chronic Disease ,Humans ,Severity of Illness Index - Published
- 2015
5. Leitlinie zur Diagnostik und Therapie des Krampfaderleidens
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L. Schimmelpfennig, W. Braunbeck, Horst E. Gerlach, H. G. Kluess, C. Langer, H.-J. Hermanns, R. Fischer, U. Ehresmann, G. Salzmann, H. Nüllen, and T. Noppeney
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Cardiology and Cardiovascular Medicine - Abstract
Leitlinien sind systematisch erarbeitete Empfehlungen, um den Arzt in Klinik und Praxis bei Entscheidungen über eine angemessene Versorgung des Patienten im Rahmen spezi-fischer klinischer Umstände zu unterstützen. Leitlinien gelten für Standardsituationen und berücksichtigen die aktuellen, zu den entsprechenden Fragestellungen zur Verfügung stehenden wissenschaftlichen Erkenntnisse. Leitlinien bedürfen der ständigen Überprüfung und eventuell der Änderung auf dem Boden des wissenschaftlichen Erkenntnisstandes und der Praktikabilität in der tägli-chen Praxis. Durch die Leitlinien soll die Methodenfreiheit des Arztes nicht eingeschränkt werden. Ihre Beachtung garantiert nicht in jedem Fall den diagnostischen und therapeutischen Erfolg. Leitlinien erheben keinen Anspruch auf Vollständigkeit. Die Entscheidung über die Angemessenheit der zu ergreifenden Maßnahmen trifft der Arzt unter Berücksichtigung der individuellen Problematik. more...
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- 2004
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6. Neues bei den Venen?
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T. Noppeney
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medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Vascular surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2014
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7. Certification of vascular centers - a project of the German Society for Vascular Surgery
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T. Umscheid, H. Imig, H.-H. Eckstein, T. Noppeney, H. Wenk, and H.-P. Niedermeier
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medicine.medical_specialty ,Certification ,Quality Assurance, Health Care ,Chronic venous insufficiency ,Radiology, Interventional ,Blood Vessel Prosthesis Implantation ,Germany ,Medicine ,Humans ,Vascular Diseases ,Vascular Medicine ,Societies, Medical ,Angiology ,Medicine(all) ,Patient Care Team ,Medical Audit ,Vascular center ,business.industry ,General surgery ,Angiography ,Vascular surgery ,medicine.disease ,Diabetic foot ,Surgery ,Ambulatory Surgical Procedures ,Radiological weapon ,Phlebothrombosis ,Health Facilities ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Objectives Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center. Material and methods Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.8%), and the applications of 5 centers are still pending. This analysis is based on 57 German certified vascular centers. Results Each center treats a median of 1149 inpatients (11% of these are emergency admissions) and 2159 outpatients per year. Sixty percent of the patients treated have an arterial disease. All centers have vascular surgery and radiology departments. In 11 out of 57 centers, angiology services are offered in cooperation with affiliated physicians. Each vascular center has an average of 4.2 vascular surgeons, 3 radiologists and 1 angiologist. All centers offer radiological and ultrasound diagnostics (CT angiography in 100%, MRT in 95%, duplex sonography in 100%). Each clinic executes a median of 521 (233–1436) arterial operations and 263 (37–1055) arterial interventions. In addition, they execute varicose surgeries (n = 217), shunt applications/revisions (n = 58), minor amputations (n = 57) and major amputations (n = 42). They conduct 338 (92–3606) conservative therapies per year (POAD, diabetic foot, phlebothrombosis, chronic venous insufficiency). Conclusions The certification of interdisciplinary vascular centers is a new approach to assure the contextual and structural quality of interdisciplinary vascular centers. more...
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- 2006
8. The Relationship Between Volume and Outcome Following Elective Open Repair of Abdominal Aortic Aneurysms (AAA) in 131 German Hospitals
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H. Wenk, Oliver Wolf, T. Noppeney, M. Hanke, T. Bruckner, T. Umscheid, Hans-Henning Eckstein, H.-P. Niedermeier, and Peter Heider
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medicine.medical_specialty ,Time Factors ,Blood transfusion ,medicine.medical_treatment ,Blood Loss, Surgical ,Workload ,Outcomes ,Logistic regression ,Risk Assessment ,Severity of Illness Index ,Risk Factors ,Germany ,Odds Ratio ,medicine ,Humans ,Blood Transfusion ,Prospective Studies ,Registries ,Mortality ,Prospective cohort study ,Aged ,Quality of Health Care ,Medicine(all) ,business.industry ,Perioperative mortality ,Perioperative complications ,Mortality rate ,Age Factors ,Perioperative ,Odds ratio ,Length of Stay ,Hospitals ,Surgery ,Logistic Models ,Treatment Outcome ,Elective Surgical Procedures ,AAA repair ,Elective Surgical Procedure ,business ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
ObjectivesSeveral studies indicate that high-volume hospitals have better results in open repair of unruptured abdominal aortic aneurysms (AAA). Up to now no studies had addressed this question in German hospitals.DesignPost-hoc-analysis from a prospective physician-led registry.Material and methodsSince 1999, the German Society for Vascular Surgery has conducted a prospective registry for open and endovascular repair of AAAs. This study includes 131 hospitals who conducted n=10163 elective open repairs for unruptured AAA between 1999 to 2004. All perioperative variables including annual volume as a continuous variable were analysed in a step-wise logistic regression model. In order to define a threshold annual volume an additional logistic regression analysis was performed by use of annual volume groups (0–9, 10–19, 20–29, 30–39, 40–49, 50 or more). The relationship between annual volume and further outcome parameters (length of procedure, blood transfusion, length of stay) were also analyzed.ResultsThe overall mortality rate was 3.2%. The stepwise logistic regression model identified the following predictors of an increased perioperative mortality: age (OR 1.084, 95% CI 1.066–1.102), AAA diameter (OR 1.008, 95% CI 1.001–1.016), length of procedure (OR 1.008, 95% CI 1.006–1.009), ASA-Score (OR 2.636, 95% CI 2.129–3.264), suprarenal clamping (OR 1.447, 95% CI 1.008–2,078), blood transfusion (OR 1.786, 95% CI 1.268–2.514). Annual volume was moderately predictive (OR 1.003, 95% CI 1–1.006) but failed to reach statistical significance (p=0.07). The analysis of volume groups identified a significantly higher risk for hospitals with an annual volume of 1-9 AAA-repairs by comparison to hospitals with an annual volume of 50 or more AAA-repairs (OR 1.903, 95% CI 1.124–3.222). Operations at low volume hospitals were also longer (p more...
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9. Varicose vein surgery after acute isolated superficial vein thrombosis in daily practice: INSIGHTS-SVT study.
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Noppeney T, Rabe E, Hoffmann U, Schimke A, Heinken A, Langer F, Pittrow D, Klotsche J, Gerlach HE, and Bauersachs R
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- Humans, Female, Male, Middle Aged, Prospective Studies, Germany, Aged, Treatment Outcome, Adult, Time Factors, Vascular Surgical Procedures adverse effects, Recurrence, Risk Factors, Venous Thromboembolism etiology, Venous Thromboembolism diagnosis, Acute Disease, Hemorrhage etiology, Practice Patterns, Physicians', Conservative Treatment adverse effects, Varicose Veins surgery, Varicose Veins diagnostic imaging, Venous Thrombosis etiology, Venous Thrombosis diagnostic imaging, Venous Thrombosis surgery
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Objective: The aim of this study was to assess the utilization of surgical interventions in patients diagnosed with superficial vein thrombosis (SVT) and its potential association with the occurrence of venous thromboembolism (VTE) and bleeding events., Methods: INSIGHTS-SVT, a prospective, non-interventional, multicenter study in Germany, investigated the management and outcomes of patients with acute SVT who received conservative and/or invasive treatments at the discretion of the treating physician., Results: Among the 872 patients with 12-month data, 657 had medical therapy only, and 215 patients underwent vascular surgery (70 within 3 months of SVT diagnosis, 136 between months 4 and 12, and nine had an intervention in both periods). The most commonly performed procedures included endovenous thermal ablation, ligation of the saphenofemoral or saphenopopliteal junction, and vein stripping. The primary outcome of symptomatic VTE was observed in 5.8% of conservatively treated patients and 6.3% of those who underwent surgical intervention. Additionally, the secondary outcome of recurrent or extended SVT was documented in 4.7% of conservatively treated patients and 5.3% of invasively treated patients. Bleeding events occurred in 1.4% of conservatively treated patients and 2.1% of surgically treated patients. These differences were statistically not significant. Furthermore, our analysis indicated a potential protective effect associated with surgical treatments, such as ligation of the saphenofemoral or saphenopopliteal junction, stripping and endovenous thermal ablation, concerning the endpoint of VTE for patients when applied after 3 months from the index SVT event., Conclusions: In line with previous research, our study suggests that surgical interventions are not frequently employed in the management of SVT, although they may be warranted in select cases. Nevertheless, additional research is essential to gain a deeper understanding of the indications, criteria, and benefit of surgical interventions in the treatment of SVT., Competing Interests: Disclosures E.R. has received honoraria for lectures and advisory boards from Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Leo Pharma, and Pfizer. R.B. has received research support from AFNET, CPC, and FADOI; and honoraria from Bayer, BMS, Leo, Pfizer, and Viatris. H.G. has received honoraria for lectures and advisory boards from Aspen, Mylan, Bayer, and Boehringer-Ingelheim. D.P. has received honoraria for consultancy, advisory boards, or lectures by Actelion, Bayer, Biogen, Aspen, Amgen, MSD, Boehringer Ingelheim, Novartis, Daiichi Sankyo, Genzyme, and Zambon. F.L. has received honoraria for lectures or consultancy from Aspen, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, LEO Pharma, Pfizer, Sanofi, and Viatris. U.H. has received research support and honoraria for lectures and advisory boards from Bayer HealthCare Pharmaceuticals, Bristol-Myers-Squibb, Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Leo Pharma, and Aspen. T.N. has received honoraria for consultancy from Medi Bayreuth; and honoraria for presentations from Aspen, Bayer, Bristol-Myers Squibb, and Mylan. A.H. was, at the time of the study, a full-time employee of Aspen Pharma GmbH, Munich, and is now an employee of Amgen GmbH, Germany. A.S. is a full-time employee of Mylan Germany GmbH, Germany., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.) more...
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- 2024
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10. Compression Therapy in Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome—a Review Based on a Structured Literature Search.
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Thieme D, Linnemann B, Mühlberg K, Noppeney T, Kreutz M, and Thieme M
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- Female, Humans, Male, Acute Disease, Evidence-Based Medicine, Lower Extremity blood supply, Prevalence, Randomized Controlled Trials as Topic, Risk Factors, Treatment Outcome, Postthrombotic Syndrome prevention & control, Postthrombotic Syndrome etiology, Postthrombotic Syndrome therapy, Stockings, Compression, Venous Thrombosis therapy, Venous Thrombosis complications, Venous Thrombosis prevention & control
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Background: After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS., Methods: 12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search., Results: Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44])., Conclusion: Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment. more...
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- 2024
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11. Determinants of Late Venous Thromboembolic Events After Acute Isolated Superficial Vein Thrombosis in Daily Practice: 12 Month Results of the INSIGHTS-SVT Study.
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Rabe E, Hoffmann U, Schimke A, Heinken A, Langer F, Noppeney T, Pittrow D, Klotsche J, Gerlach HE, and Bauersachs R
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- Female, Humans, Male, Anticoagulants adverse effects, Fondaparinux adverse effects, Hemorrhage chemically induced, Hemorrhage epidemiology, Heparin, Low-Molecular-Weight adverse effects, Prospective Studies, Middle Aged, Aged, Pulmonary Embolism epidemiology, Pulmonary Embolism drug therapy, Varicose Veins, Venous Thromboembolism diagnosis, Venous Thromboembolism drug therapy, Venous Thromboembolism epidemiology, Venous Thrombosis drug therapy, Venous Thrombosis epidemiology
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Objective: Long term incidence of symptomatic venous thromboembolism (VTE) and bleeding events in patients with superficial vein thrombosis (SVT) was investigated., Methods: In this prospective, observational study, patients with acute SVT were treated at the discretion of the responsible physician. The primary efficacy outcome was symptomatic VTE including deep vein thrombosis (DVT), pulmonary embolism (PE), and recurrent or extending SVT. The primary safety outcome was clinically relevant bleeding, recorded at periodic clinic visits over a 12 month period., Results: The mean age of 872 patients with 12 month follow up was 60.6 ± 14.5 years, 64.5% were female, 80.1% had chronic venous disease (defined as chronic venous insufficiency and or varicose veins), and 41.9% had a history of VTE. They were receiving fondaparinux in 62.1% (mean duration 34.9 ± 15.7 days), low molecular weight heparin (LMWH) in 25.0% (mean duration 26.2 ± 23.2 days), any other anticoagulants in 6.2%, and no anticoagulant in 6.7%. At 12 months, 108 patients (14.3%) achieved the primary efficacy outcome. The most common VTE event was recurrent or extending SVT in 11.0%, followed by symptomatic DVT in 2.7%, symptomatic PE in 2.4%, hospitalisation due to VTE in 1.8%, and death in 1.1%. Clinically relevant bleeding events occurred in 2.1% of patients, and major bleedings in 0.3%. By drug, the rate of the primary efficacy outcome was highest in the LMWH group (22.4%) and lowest in the fondaparinux group (10.4%). In a multivariable model, patients with events between three months and 12 months were significantly more likely to have higher BMI (hazard ratio [HR] 1.06; p = .002), history of VTE (HR 2.89; p = .002), and severe systemic infections (HR 7.59; p = .006)., Conclusion: The risk of symptomatic VTE remained elevated over 12 months of follow up. Therefore, anticoagulation beyond 45 days may be considered in patients with risk factors. [ClinicalTrials.gov identifier: NCT02699151.]., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.) more...
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- 2023
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12. Radiofrequency Thermal Ablation for the Treatment of Chronic Insufficiency of the Saphenous Vein-A Comparative Retrospective Study.
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Andercou O, Stancu B, Coman HF, Cucuruz B, Noppeney T, and Marian D
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- Humans, Retrospective Studies, Treatment Outcome, Saphenous Vein surgery, Catheter Ablation, Varicose Veins etiology, Varicose Veins surgery
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Objectives: The broad spectrum of chronic venous disease encompasses varicose veins, edema, hyperpigmentation and venous ulcers. Radiofrequency thermal ablation is indicated for the treatment of superficial venous reflux of the lower limb. Our research is a comparative clinical study that aims to identify the most effective and safest therapeutic method in the management of chronic venous insufficiency of the lower limbs., Materials and Methods: Patients admitted to the Department of Surgery of the University of Medicine and Pharmacy in Cluj-Napoca, Romania, with the clinical diagnosis of varicose veins of the lower limbs, treated by thermal ablation with radiofrequency or by open surgical techniques during the year 2022, were included., Results: A percentage of 50.9% of the patients were treated by the radiofrequency thermal ablation procedure and 49.1% by surgical treatment. More than half of them were hospitalized for 2 days. The duration of hospitalization was significantly longer in patients who had postoperative complications ( p < 0.001). The chance of being treated by open surgical treatment for a small saphenous vein is 10.11 times higher than by radiofrequency thermal ablation., Conclusion: According to the applied tests, there is no statistical difference between the group treated by radiofrequency thermal ablation and the one surgically treated in terms of sex, age, origin, CEAP clinical stage at hospitalization, clinical diagnosis at hospitalization and affected lower limb. more...
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- 2023
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13. Corrigendum to "European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. [Eur J Vasc Endovasc Surg (2022) 63, 184-267]".
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, Josee van Rijn M, Stansby G, Kolh P, Goncalves FB, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ortega MR, Ulloa JH, Urbanek T, van Rij AM, and Vuylsteke ME more...
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- 2022
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14. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs.
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, and Vuylsteke ME more...
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- Europe, Humans, Lower Extremity blood supply, Vascular Surgical Procedures standards, Societies, Medical standards, Vascular Diseases surgery, Vascular Surgical Procedures methods, Veins surgery
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- 2022
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15. Management and Outcomes of Patients with Isolated Superficial Vein Thrombosis under Real Life Conditions (INSIGHTS-SVT).
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Bauersachs R, Gerlach HE, Heinken A, Hoffmann U, Langer F, Noppeney T, Pittrow D, Klotsche J, and Rabe E
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- Adult, Aged, Aged, 80 and over, Anticoagulants adverse effects, Factor Xa Inhibitors adverse effects, Female, Fondaparinux adverse effects, Hemorrhage chemically induced, Heparin, Low-Molecular-Weight adverse effects, Humans, Leg Ulcer complications, Lower Extremity blood supply, Male, Middle Aged, Prospective Studies, Pulmonary Embolism etiology, Recurrence, Risk Factors, Stockings, Compression, Treatment Outcome, Varicose Veins complications, Venous Insufficiency complications, Venous Thrombosis etiology, Anticoagulants therapeutic use, Factor Xa Inhibitors therapeutic use, Fondaparinux therapeutic use, Heparin, Low-Molecular-Weight therapeutic use, Venous Thrombosis therapy
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Objective: Management and outcomes of superficial vein thrombosis (SVT) are highly variable and not well described. Therefore, the INvestigating SIGnificant Health TrendS in the management of SVT (INSIGHTS-SVT) study collected prospective data under real life conditions., Methods: Prospective observational study of objectively confirmed acute isolated SVT. The primary outcome was a composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), and extension or recurrence of SVT at three months. The primary safety outcome was clinically relevant bleeding., Results: A total of 1 150 patients were included (mean age 60.2 ± 14.7 years; 64.9% women; mean BMI 29.4 ± 6.3 kg/m
2 ). SVT was below the knee in 54.5%, above the knee in 26.7%, above and below the knee in 18.8%. At baseline, 93.6% received pharmacological treatment (65.7% fondaparinux, 23.2% heparins, 4.3% direct oral anticoagulants [DOACs], 14.5% analgesics), 77.0% compression treatment, and 1.9% surgery; 6.4% did not receive any anticoagulation. The primary outcome occurred in 5.8%; 4.7% had recurrent or extended SVT, 1.7% DVT, and 0.8% PE. Clinically relevant non-major bleeding occurred in 1.2% and major bleeding in 0.3%. Complete clinical recovery of SVT was reported in 708 patients (62.4%). Primary outcome adjusted by propensity score and for treatment duration was lower with fondaparinux compared with low molecular weight heparin (4.4% vs. 9.6%; hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.3 - 0.9; p = .017). On multivariable analysis, associated factors for primary outcome included another SVT prior to the present SVT event (HR 2.3), age per year (HR 0.97), duration of drug treatment per week (HR 0.92), and thrombus length (HR 1.03)., Conclusion: At three month follow up, patients with isolated SVT are at risk of thromboembolic complications (mainly recurrent or extended SVT), despite anticoagulation. In this real life study, about one third had received either heparins, oral anticoagulants, or no anticoagulation., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.) more...- Published
- 2021
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16. Risk and protective factors for post-thrombotic syndrome after deep venous thrombosis.
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Cucuruz B, Kopp R, Pfister K, Noppeney J, Tripal K, Korff T, Zeman F, Koller M, and Noppeney T
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Germany epidemiology, Humans, Incidence, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Postthrombotic Syndrome diagnostic imaging, Postthrombotic Syndrome epidemiology, Prognosis, Protective Factors, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Venous Thrombosis diagnostic imaging, Venous Thrombosis epidemiology, Young Adult, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Postthrombotic Syndrome prevention & control, Venous Thrombosis therapy
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Objective: The most frequent complication of deep venous thrombosis (DVT) is post-thrombotic syndrome (PTS). We recently showed inhibition of varicose vein development by atorvastatin and rosuvastatin. The aim of this study was to test the influence of lipid-lowering therapy with statins on PTS development., Methods: All patients between January 2002 and June 2018 with diagnosed DVT were enrolled in this study and analyzed retrospectively. Documentation was performed using the standardized system M1 (CompuGroup Medical, Koblenz, Germany) throughout the observation period. Patients received therapeutic anticoagulation and compression stockings. In case of recurrent DVT, patients received lifelong therapeutic anticoagulation. All patients received clinical examination and duplex ultrasound evaluation 3 to 6 months after primary diagnosis and annually thereafter., Results: A total of 579 patients with DVT were enrolled in this study. Of these patients, 414 (71%) developed PTS (337/414 [81%] presented with the mild version; mean Villalta score, 5.79). Risk factors for PTS development were recurrent DVT (P = .001) and malignant disease (P = .001). Protective factors were therapy with platelet aggregation inhibitors (P = .049) and lipid-lowering therapy with statins (P = .001). After multivariable analysis, the only risk factor was recurrent DVT (P = .001), and the only protective factor was lipid-lowering therapy (P = .001)., Conclusions: Post-thrombotic changes might be reduced by lipid-lowering therapy., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) more...
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- 2020
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17. Corrigendum to 'Management of Chronic Venous Disease: Clinical Practice Guidelines' [European Journal of Vascular & Endovascular Surgery 49/6 (2015) 678/737].
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, and Rosales A more...
- Published
- 2020
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18. Treatment of popliteal vein aneurysms.
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Noppeney T, Kopp R, Pfister K, Schierling W, Noppeney J, and Cucuruz B
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- Adolescent, Adult, Aged, Aged, 80 and over, Aneurysm complications, Aneurysm diagnostic imaging, Aneurysm physiopathology, Anticoagulants adverse effects, Drug Administration Schedule, Female, Hemodynamics, Humans, Male, Middle Aged, Popliteal Vein diagnostic imaging, Popliteal Vein physiopathology, Pulmonary Embolism etiology, Pulmonary Embolism prevention & control, Registries, Retrospective Studies, Time Factors, Treatment Outcome, Venous Thrombosis etiology, Venous Thrombosis prevention & control, Young Adult, Aneurysm therapy, Anticoagulants administration & dosage, Popliteal Vein surgery, Vascular Surgical Procedures adverse effects, Watchful Waiting
- Abstract
Objective: Popliteal vein aneurysms are associated with high risk for deep venous thrombosis (DVT) and pulmonary embolism. The goal of this study was to report treatment strategies for popliteal vein aneurysms and their outcome after long-term follow-up., Methods: All patients between June 1993 and June 2018 with diagnosed popliteal vein aneurysm were enrolled in this study and analyzed retrospectively. They received regular surveillance alone or treatment. Patients were offered aneurysm resection or lifelong anticoagulation if they had aneurysm size of twice normal vein diameter. All patients received clinical examination and duplex ultrasound examination 3 to 6 months after operation or primary diagnosis and annually thereafter., Results: A total of 39 patients (aneurysm size, mean 23.3 mm) were treated by either operation or anticoagulation (31/39 [79%]) or surveillance alone (8/39 [21%]). Patients with an aneurysm >20 mm in diameter had a significantly higher incidence of turbulent flow on duplex ultrasound examination with higher risk for development of DVT (P = .029). Of the 31 patients with a therapeutic approach, 29 (94%) preferred resection, whereas 2 (6%) patients were treated with lifelong anticoagulation and compression. Mean follow-up was 57.9 ± 12.5 months., Conclusions: According to these results, it seems that patients with large popliteal vein aneurysms experience DVT more frequently. Therefore, popliteal vein aneurysms >20 mm should be considered for surgical treatment or lifelong anticoagulation, depending on the patient's preference., (Copyright © 2019. Published by Elsevier Inc.) more...
- Published
- 2019
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19. Complex treatment of vascular prostheses infections.
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Andercou O, Marian D, Olteanu G, Stancu B, Cucuruz B, and Noppeney T
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- Adult, Aged, Amputation, Surgical statistics & numerical data, Anti-Bacterial Agents therapeutic use, Debridement statistics & numerical data, Female, Humans, Incidence, Male, Middle Aged, Prosthesis-Related Infections therapy, Retrospective Studies, Vascular Surgical Procedures methods, Vascular Surgical Procedures statistics & numerical data, Blood Vessel Prosthesis adverse effects, Prosthesis-Related Infections epidemiology, Vascular Surgical Procedures adverse effects
- Abstract
Infections after vascular reconstructions are very rare; however, when they occur, they are associated with a high risk of morbidity. In order to obtain the best results possible, the treatment needs to be initiated as early as possible, from the very first signs of infection, and it needs to be carried out in centers specializing in vascular surgery. The aim of the present study was to assess the incidence of infections in a single university center.This retrospective analysis over a 2-year period is based on the medical reports of hospitalized patients who were diagnosed with infection following revascularization.From 2013 to 2014, a number of 151 open reconstructive surgical procedures were performed. 15 patients suffered from infection (10%) of the vascular reconstruction. Of these patients, 40% have had an aorto-bifemoral bypass, 53%-a femoro-popliteal bypass, and 7% (n = 1)-an axillo-femoral bypass. According to the Samson classification, the patients were categorized as follows: group 2: 6 cases, group 3: 2 cases, group 4: 4 cases, and group 5: 3 cases. The most frequent bacteria found were methicillin-resistant Staphylococcus aureus (MRSA) (n = 6, 40%), followed by S aureus (n = 5, 33%). The treatment options were: application of antibiotics alone without any invasive treatment in 3 patients, local irrigation and debridement in 6 patients, complete explantation of the prosthesis with a new extra-anatomic bypass in 6 cases, and partial excision of the prosthesis, which was replaced and covered with muscle flap, in 3 cases. The amputation rate in our study was 18%, which corresponds to the rates published in the literature.The treatment of infections in vascular surgery needs to be complex and adapted to each individual patient, because infections being in a permanent dynamic state. The treatment needs to be performed in specialized centers that have large experience in vascular surgery, in order for the patient to have the best chances of survival and protection from amputation. more...
- Published
- 2018
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20. Rationale, design, and methodology of the observational INSIGHTS-SVT study on the current state of care and outcomes of patients with superficial vein thrombosis.
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Bauersachs R, Gerlach HE, Heinken A, Hoffmann U, Langer F, Noppeney T, Pittrow D, Klotsche J, and Rabe E
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- Aged, Female, Germany, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Surveys and Questionnaires, Treatment Outcome, Anticoagulants administration & dosage, Quality of Life, Venous Thromboembolism drug therapy
- Abstract
Objective: Superficial vein thrombosis (SVT) is a common disease in clinical practice. In terms of pathophysiology and outcomes, the condition is related to venous thromboembolism, bearing a potential for severe thromboembolic complications if it is not treated adequately. A wide range of treatment approaches (including oral and injectable anticoagulants, pain medication, nondrug therapy including compression therapy, and no treatment at all) are applied in clinical practice, but there is sparse information about selection of patients for therapies, current treatment pathways, and drug use as well as outcomes. The INvestigating SIGnificant Health TrendS in the management of Superficial Vein Thrombosis (INSIGHTS-SVT) study aims to close this gap by collecting representative data on the current treatment of SVT., Methods: The observational prospective study of about 1200 patients is carried out by up to 120 clinical and office-based physicians who regularly treat patients with SVT and are capable of conducting appropriate compression ultrasound diagnostics, such as vascular physicians, phlebologists, internists, vascular surgeons, and general practitioners. Patients are eligible for inclusion if they have ultrasound-confirmed acute, isolated SVT of the lower extremities. Documentation about the characteristics of the patients, diagnostics, comorbidities, and medical and nonmedical treatment is collected at baseline, at 10 ± 3 days or at approximately 45 days (depending on treatment), at approximately 3 months, and at approximately 12 months. Patients are requested to fill in quality of life questionnaires (on pain, Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms [VEINES-QOL/Sym], EuroQol-5 Dimension 5-Level [EQ-5D-5L]) at baseline and at approximately 3 months. Interventions are not stipulated by the trial protocol., Results: The primary efficacy outcome is the incidence of venous thromboembolism at 3 months; the primary safety outcome is the combined incidence of major and clinically relevant bleeding events at 3 months. As quality measures, plausibility checks at data entry, queries based on statistical analyses that focus on outliers and distribution of values, monitoring visits, and adjudication procedures will be applied., Conclusions: This large study is expected to provide a comprehensive picture of patients with SVT under clinical practice conditions in Germany., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2017
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21. Varicose Remodeling of Veins Is Suppressed by 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors.
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Eschrich J, Meyer R, Kuk H, Wagner AH, Noppeney T, Debus S, Hecker M, and Korff T
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- Animals, Case-Control Studies, Cell Proliferation drug effects, Cells, Cultured, Chemokine CCL2 metabolism, Disease Models, Animal, Dose-Response Relationship, Drug, Female, Humans, Male, Mice, Middle Aged, Muscle, Smooth, Vascular metabolism, Muscle, Smooth, Vascular pathology, Myocytes, Smooth Muscle metabolism, Myocytes, Smooth Muscle pathology, Signal Transduction drug effects, Time Factors, Transcription Factor AP-1 genetics, Transcription Factor AP-1 metabolism, Varicose Veins metabolism, Varicose Veins pathology, Veins drug effects, Veins metabolism, Veins pathology, Atorvastatin pharmacology, Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacology, Muscle, Smooth, Vascular drug effects, Myocytes, Smooth Muscle drug effects, Rosuvastatin Calcium pharmacology, Varicose Veins prevention & control, Vascular Remodeling drug effects
- Abstract
Background: Despite the high prevalence of chronic venous insufficiency and varicose veins in the Western world, suitable pharmaceutical therapies for these venous diseases have not been explored to date. In this context, we recently reported that a chronic increase in venous wall stress or biomechanical stretch is sufficient to cause development of varicose veins through the activation of the transcription factor activator protein 1., Methods and Results: We investigated whether deleterious venous remodeling is suppressed by the pleiotropic effects of statins. In vitro, activator protein 1 activity was inhibited by two 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, rosuvastatin and atorvastatin, in stretch-stimulated human venous smooth muscle cells. Correspondingly, both statins inhibited venous smooth muscle cell proliferation as well as mRNA expression of the activator protein 1 target gene monocyte chemotactic protein 1 (MCP1). In isolated mouse veins exposed to an increased level of intraluminal pressure, statin treatment diminished proliferation of venous smooth muscle cells and protein abundance of MCP1 while suppressing the development of varicose veins in a corresponding animal model by almost 80%. Further analyses of human varicose vein samples from patients chronically treated with statins indicated a decrease in venous smooth muscle cell proliferation and MCP1 abundance compared with samples from untreated patients., Conclusions: Our findings imply that both atorvastatin and rosuvastatin effectively inhibit the development of varicose veins, at least partially, by interfering with wall stress-mediated activator protein 1 activity in venous smooth muscle cells. For the first time, this study reveals a potential pharmacological treatment option that may be suitable to prevent growth of varicose veins and to limit formation of recurrence after varicose vein surgery., (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.) more...
- Published
- 2016
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22. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, Document Reviewers, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, and Rosales A more...
- Subjects
- Chronic Disease, Humans, Predictive Value of Tests, Risk Factors, Severity of Illness Index, Treatment Outcome, Venous Insufficiency diagnosis, Venous Insufficiency epidemiology, Venous Insufficiency physiopathology, Venous Insufficiency surgery, Venous Insufficiency therapy
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- 2015
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23. Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities.
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Proebstle TM, Alm J, Göckeritz O, Wenzel C, Noppeney T, Lebard C, Pichot O, Sessa C, and Creton D
- Subjects
- Adolescent, Adult, Aged, Chi-Square Distribution, Europe, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pain etiology, Pain Management, Pain Measurement, Predictive Value of Tests, Prospective Studies, Regional Blood Flow, Risk Assessment, Risk Factors, Saphenous Vein diagnostic imaging, Saphenous Vein physiopathology, Severity of Illness Index, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Duplex, Varicose Veins complications, Varicose Veins diagnostic imaging, Varicose Veins physiopathology, Young Adult, Catheter Ablation adverse effects, Endovascular Procedures adverse effects, Saphenous Vein surgery, Varicose Veins surgery
- Abstract
Background: Radiofrequency segmental thermal ablation (RSTA) has become a commonly used technology for occlusion of incompetent great saphenous veins (GSVs). Midterm results and data on clinical parameters are still lacking., Methods: A prospective multicenteral trial monitored 295 RSTA-treated GSVs for 36 months. Clinical control visits included flow and reflux analysis by duplex ultrasound imaging and assessment of clinical parameters according to the CEAP classification and Venous Clinical Severity Score (VCSS)., Results: A total of 256 of 295 treated GSVs (86.4%) were available for 36 months of follow-up. At 36 months, Kaplan-Meier survival analysis showed the probability of occlusion was 92.6% and the probability of no reflux was 95.7%, and 96.9% of legs remained free of clinically relevant axial reflux. If complete occlusion was present at the 12-month follow-up, the risk of developing new flow by 24 and 36 months of follow-up was 3.7% and 4.1%, respectively. Diameters of the GSV measured 3 cm distal to the saphenofemoral junction reduced from 5.8 ± 2.1 mm at screening to 2.2 ± 1.1 mm at 36 months. The average VCSS score improved from 3.9 ± 2.1 before treatment to 0.9 ± 1.5 at 3 months (P < .0001) and stayed at an average <1.0 during the complete 36 months of follow-up. Only 41.1% of patients were free of pain before treatment; at 36 months, 251 (98.0%) reported no pain and 245 (95.7%) did not experience pain during the 24 months before. At 36 months, 189 of 255 legs (74.1%) showed an improvement in CEAP class compared with the clinical assessment before treatment (P < .001). Stages C(3) and C(4) combined to 46% before treatment and dropped constantly to a combined level of 8% at 36 months. However, the proportion of C(2) legs that dropped from 52.3% before treatment to <10% at 12 months showed a constant increase thereafter, reaching 33.3% at 36 months., Conclusion: RSTA showed a high and durable success rate in vein ablation in conjunction with sustained clinical efficacy., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.) more...
- Published
- 2011
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24. Certification of vascular centers - a project of the German Society for Vascular Surgery.
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Eckstein HH, Niedermeier HP, Noppeney T, Umscheid T, Wenk H, and Imig H
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- Ambulatory Surgical Procedures standards, Ambulatory Surgical Procedures statistics & numerical data, Angiography statistics & numerical data, Blood Vessel Prosthesis Implantation standards, Blood Vessel Prosthesis Implantation statistics & numerical data, Germany, Humans, Medical Audit, Patient Care Team, Radiology, Interventional standards, Societies, Medical, Vascular Diseases diagnosis, Vascular Diseases surgery, Vascular Diseases therapy, Vascular Surgical Procedures statistics & numerical data, Certification, Health Facilities standards, Quality Assurance, Health Care organization & administration, Vascular Surgical Procedures standards
- Abstract
Objectives: Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center., Material and Methods: Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.8%), and the applications of 5 centers are still pending. This analysis is based on 57 German certified vascular centers., Results: Each center treats a median of 1149 inpatients (11% of these are emergency admissions) and 2,159 outpatients per year. Sixty percent of the patients treated have an arterial disease. All centers have vascular surgery and radiology departments. In 11 out of 57 centers, angiology services are offered in cooperation with affiliated physicians. Each vascular center has an average of 4.2 vascular surgeons, 3 radiologists and 1 angiologist. All centers offer radiological and ultrasound diagnostics (CT angiography in 100%, MRT in 95%, duplex sonography in 100%). Each clinic executes a median of 521 (233-1436) arterial operations and 263 (37-1055) arterial interventions. In addition, they execute varicose surgeries (n=217), shunt applications/revisions (n=58), minor amputations (n=57) and major amputations (n=42). They conduct 338 (92-3606) conservative therapies per year (POAD, diabetic foot, phlebothrombosis, chronic venous insufficiency)., Conclusions: The certification of interdisciplinary vascular centers is a new approach to assure the contextual and structural quality of interdisciplinary vascular centers. more...
- Published
- 2006
- Full Text
- View/download PDF
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