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Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome
JOURNAL OF VASCULAR SURGERY Volume 64, Number 1
Results: Two randomized control trials and 11 observational studies were included in the analysis. Overall, 786 and 318 subjects underwent UGC and UGTI respectively. The latter modality resulted in a significantly higher success rate (97.4% vs 69.3%, OR 0.06, 95% CI 0.03-0.11) while the complication rate for both techniques was very low (0.69% vs 0.78%, OR 1.77, 95% CI 0.40-7.88). Data regarding procedural duration and length of hospitalization were very scarce, favoring UGTI (procedural time: MD 35.53 min, 9.11-63.95, length of hospitalization MD 1.99 days, 0.31 to 4.29). Scarcity of data did not allow proper cost analysis, but two studies suggested that UGTI may offer reduced treatment costs. Conclusion: Available evidence suggests that UGTI is superior in terms of efficacy and as safe as UGC and thus should be used as the primary modality for the treatment of post-catheterization femoral pseudoaneurysms. Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome Skervin A.L., Thapar A., Franchini A.J., Prandoni P., Shalhoub J., Davies A.H. Eur J Vasc Endovasc Surg 2016;51:838-45. Background: Up to 50% of patients develop post-thrombotic syndrome (PTS) following their first proximal deep vein thrombosis (DVT). This meta-analysis aims to evaluate the effectiveness of graduated compression stockings (GCS) in preventing PTS. Method: Medline, Embase, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were electronically searched from inception to January 2015 for studies investigating the effect of GCS in preventing PTS. All randomised control trials were considered for inclusion if they compared the efficacy of GCS (30-40 mmHg at the ankle) with either placebo or no stockings in adults with new proximal lower limb DVT. Methodological assessment, using the Cochrane Risk of Bias Tool, and data extraction was performed by two independent reviewers. The effect of GCS was expressed as the risk difference (RD). Results: A total of 686 articles were screened. Three randomised controlled trials inclusive of 1177 patients were eligible for inclusion. PTS developed in 49%-70% of control patients at 5 years. High statistical heterogeneity was observed between trials (all PTS: I2 ¼ 0.94; severe PTS: I2 ¼ 0.79). The risk difference in PTS incidence between control and GCS arms varied from 0% to 39% between trials. In trials with a higher baseline prevalence of PTS, a visual trend towards more benefit with GCS was noted.
Abstracts 263
Conclusion: Uncertainty because of sampling variability and heterogeneity was too high to conclude in favour or against an effect of wearing compression stockings in preventing PTS. An effect may be present for higher values of baseline risk. Further evidence is needed. Ex vivo Renal Artery Repair with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Long-term Results of Sixty-seven Procedures Duprey A., Chavent B., Meyer-Bisch V., Varin T., Albertini J.-N., Favre J.-P., Barral X., Ricco J.-B. Eur J Vasc Endovasc Surg 2016;51:872-9. Objective/Background: To evaluate the long-term outcome of renal revascularization by ex vivo renal artery reconstruction and autotransplantation for renal artery branch aneurysms (RABAs). Methods: Between 1991 and 2015, 67 ex vivo renal artery reconstructions with kidney autotransplantation were performed in 55 adults (mean age 47 years) and 10 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia in 34 patients. Other etiologies were systemic congenital disease in eight patients, spontaneous dissecting aneurysms in five, iatrogenic aneurysms in three, atheromatous aneurysms in two and unknown etiology in 13. Median RABA diameter was 20.5 mm. Fifty-three patients (82%) were hypertensive, 60 had normal renal function and no patient was on hemodialysis. Seven patients (11%) were operated on after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 14 patients (22%). The hypogastric artery was used in 41 patients, the saphenous vein in 18, the superficial femoral artery in five and a combination of different materials in three. Results: No deaths occurred during the first 30 days. Primary patency at 30 days was 90.8% following to six early thromboses. Three patients (5%) were lost to follow up. No other thrombosis occurred. At 8 years, the primary and primary-assisted patency were 88% and 91%, respectively. Survival was 95% at 9 years. Among the 53 hypertensive patients, two were lost to follow up. At 9 years, 22 (43%) were cured and nine (18%) were improved with a significant reduction of antihypertensive medication (P < .05). The pre-operative modification of the diet in renal disease (MDRD) clearance was 93 6 29 mL/minute, the immediate post-operative MDRD was 94 6 33 mL/minute, and at the end of follow up it was 86 6 26 mL/minute (P > .05). Conclusion: Ex vivo renal artery reconstruction for complex RABAs eliminates the risk of rupture, confers a benefit to hypertension, and preserves renal function with a satisfactory long-term patency.
Results: Two randomized control trials and 11 observational studies were included in the analysis. Overall, 786 and 318 subjects underwent UGC and UGTI respectively. The latter modality resulted in a significantly higher success rate (97.4% vs 69.3%, OR 0.06, 95% CI 0.03-0.11) while the complication rate for both techniques was very low (0.69% vs 0.78%, OR 1.77, 95% CI 0.40-7.88). Data regarding procedural duration and length of hospitalization were very scarce, favoring UGTI (procedural time: MD 35.53 min, 9.11-63.95, length of hospitalization MD 1.99 days, 0.31 to 4.29). Scarcity of data did not allow proper cost analysis, but two studies suggested that UGTI may offer reduced treatment costs. Conclusion: Available evidence suggests that UGTI is superior in terms of efficacy and as safe as UGC and thus should be used as the primary modality for the treatment of post-catheterization femoral pseudoaneurysms. Systematic Review and Meta-Analysis of Utility of Graduated Compression Stockings in Prevention of Post-Thrombotic Syndrome Skervin A.L., Thapar A., Franchini A.J., Prandoni P., Shalhoub J., Davies A.H. Eur J Vasc Endovasc Surg 2016;51:838-45. Background: Up to 50% of patients develop post-thrombotic syndrome (PTS) following their first proximal deep vein thrombosis (DVT). This meta-analysis aims to evaluate the effectiveness of graduated compression stockings (GCS) in preventing PTS. Method: Medline, Embase, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were electronically searched from inception to January 2015 for studies investigating the effect of GCS in preventing PTS. All randomised control trials were considered for inclusion if they compared the efficacy of GCS (30-40 mmHg at the ankle) with either placebo or no stockings in adults with new proximal lower limb DVT. Methodological assessment, using the Cochrane Risk of Bias Tool, and data extraction was performed by two independent reviewers. The effect of GCS was expressed as the risk difference (RD). Results: A total of 686 articles were screened. Three randomised controlled trials inclusive of 1177 patients were eligible for inclusion. PTS developed in 49%-70% of control patients at 5 years. High statistical heterogeneity was observed between trials (all PTS: I2 ¼ 0.94; severe PTS: I2 ¼ 0.79). The risk difference in PTS incidence between control and GCS arms varied from 0% to 39% between trials. In trials with a higher baseline prevalence of PTS, a visual trend towards more benefit with GCS was noted.
Abstracts 263
Conclusion: Uncertainty because of sampling variability and heterogeneity was too high to conclude in favour or against an effect of wearing compression stockings in preventing PTS. An effect may be present for higher values of baseline risk. Further evidence is needed. Ex vivo Renal Artery Repair with Kidney Autotransplantation for Renal Artery Branch Aneurysms: Long-term Results of Sixty-seven Procedures Duprey A., Chavent B., Meyer-Bisch V., Varin T., Albertini J.-N., Favre J.-P., Barral X., Ricco J.-B. Eur J Vasc Endovasc Surg 2016;51:872-9. Objective/Background: To evaluate the long-term outcome of renal revascularization by ex vivo renal artery reconstruction and autotransplantation for renal artery branch aneurysms (RABAs). Methods: Between 1991 and 2015, 67 ex vivo renal artery reconstructions with kidney autotransplantation were performed in 55 adults (mean age 47 years) and 10 children to repair 87 RABAs. The main underlying disease was fibromuscular dysplasia in 34 patients. Other etiologies were systemic congenital disease in eight patients, spontaneous dissecting aneurysms in five, iatrogenic aneurysms in three, atheromatous aneurysms in two and unknown etiology in 13. Median RABA diameter was 20.5 mm. Fifty-three patients (82%) were hypertensive, 60 had normal renal function and no patient was on hemodialysis. Seven patients (11%) were operated on after failure of an endovascular procedure. The mean number of renal artery branches repaired per patient was 3.5 and multiple aneurysms were treated in 14 patients (22%). The hypogastric artery was used in 41 patients, the saphenous vein in 18, the superficial femoral artery in five and a combination of different materials in three. Results: No deaths occurred during the first 30 days. Primary patency at 30 days was 90.8% following to six early thromboses. Three patients (5%) were lost to follow up. No other thrombosis occurred. At 8 years, the primary and primary-assisted patency were 88% and 91%, respectively. Survival was 95% at 9 years. Among the 53 hypertensive patients, two were lost to follow up. At 9 years, 22 (43%) were cured and nine (18%) were improved with a significant reduction of antihypertensive medication (P < .05). The pre-operative modification of the diet in renal disease (MDRD) clearance was 93 6 29 mL/minute, the immediate post-operative MDRD was 94 6 33 mL/minute, and at the end of follow up it was 86 6 26 mL/minute (P > .05). Conclusion: Ex vivo renal artery reconstruction for complex RABAs eliminates the risk of rupture, confers a benefit to hypertension, and preserves renal function with a satisfactory long-term patency.