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  • Review ArticleJune 30, 2022

    250 2529

    Surgical Embolectomy of Acute Pulmonary Embolism

    Tae Sik Kim, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 15-18
    Treatment for acute pulmonary embolism includes anticoagulation, thrombolysis, catheter-directed therapy, and surgical pulmonary embolectomy. Surgical embolectomy is indicated in select patients based on a risk/benefit assessment and when other treatment options are contraindicated. A multidisciplinary approach along with a meticulous surgical technique might significantly lower the mortality associated with surgical embolectomy.
  • Review ArticleJune 30, 2022

    162 1804

    The 2020 Update of the CEAP Classification: Updated Contents and Background

    Ki-Pyo Hong, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 19-23
    Abstract
    The following are included in the 2020 update of the CEAP classification: addition of the modifier “r” to the C2 and C6 recurrent disease, addition of corona phlebectatica to the C4 class as a separate subclass (C4c,) subcategorization of ES (secondary etiology) into ESi (intravenous secondary etiology) and Ese (extravenous secondary etiology), and the use of anatomic abbreviations instead of numbering the venous segments in the anatomical classification. Researchers should understand the definition of the recurrence of varicose veins and the diagnostic criteria of corona phlebectatica.
  • Review ArticleJune 30, 2022

    105 516

    Ultrasound Examination of Venous Malformation

    Hyangkyoung Kim, M.D., Ph.D. and Nicos Labropoulos, Ph.D.

    Ann Phlebology 2022; 20(1): 24-29
    Venous malformations (VM) are the most common congenital vascular malformations (CVM). Varicose veins (VVs) and VM of the lower extremities can present as dilated veins and accompanying chronic venous disease symptoms, including pain and heaviness in the legs. VM can be distinguished from VVs by accurate clinical history taking, physical examination, and, most importantly, imaging. Discrimination between both diseases is critical for devising management. This review focuses on ultrasound imaging of VMs.
  • Review ArticleJune 30, 2022

    188 453

    Practical Use of Venoactive Drugs for Chronic Venous Disease in Korea

    Sangchul Yun, M.D., Ph.D., R.P.V.I., R.V.T.

    Ann Phlebology 2022; 20(1): 1-5
    Abstract
    Venoactive drugs can be used as a first-line treatment in all stages of chronic venous disease. In a more advanced stage, drugs can be used together with surgery or endovascular procedures. However, there is a lack of correlation between these clinical symptoms and varicose veins, so surgical treatment is recommended for patients with C2 or higher who are accompanied by symptoms and reflux. In other patients, with non-varicose pain in mind, first, conservative treatment should be provided to control symptoms. Currently used drugs are flavonoids including diosmin, micronized purified flavonoid fraction, rutin and troxerutin, and saponins including horse chestnut seed extract and Ruscus extract such as butcher’s broom, anthocyans, and synthetic drugs. There is a difference in the mechanism of action of each drug, and these drugs seem to be selectively used according to the symptoms mentioned by patients. The drug indications according to the guidelines and research and precautions are summarized in this review.
  • Review ArticleDecember 31, 2022

    321 417

    Patterns of Saphenous Vein Reflux and Treatment Plan

    Nicos Labropoulos, Ph.D. and Hyangkyoung Kim, M.D., Ph.D.

    Ann Phlebology 2022; 20(2): 52-57
    Abstract
    Varicose vein is a prevalent disease and a cause of substantial morbidity. Venous reflux often originates from saphenous trunks and their tributaries. The great saphenous vein and small saphenous vein have major anatomical variations due to their embryological origin. Understanding of anatomic variation and reflux pattern is important to decide the target lesions for treatment and treatment modalities for symptom relief effectively and to prevent the future complications and recurrence. In this review, we purposed to review the reflux pattern of the saphenous origin and the corresponding treatment methods.
  • Review ArticleJune 30, 2022

    83 375

    Direct Oral Anticoagulants for Anticoagulation after Initial Management of Venous Thromboembolism

    Se Min Ryu, M.D., Ph.D., Sung-Min Park, M.D., Ph.D., Se-Ran Yang, D.V.M., Ph.D., Seong-Joon Cho, M.D., Ph.D., Sook Won Ryu, M.D., Ph.D. and Seung-Hwan Lee, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 9-14
    Direct oral anticoagulants for the long-term treatment of venous thromboembolisms including deep vein thrombosis and pulmonary embolism are preferred for most hemodynamically stable, non-pregnant patients who do not have severe renal insufficiency or active cancer. This preference for these medications is based on their comparable efficacy, reduced need for monitoring, and safety profile, especially when compared to warfarin in terms of major bleeding. Recent studies suggest that certain direct oral anticoagulants may be advantageous over others.
  • Review ArticleDecember 31, 2022

    122 318

    Image Optimization in Venous Ultrasound Examination

    Hyangkyoung Kim, M.D., Ph.D. and Nicos Labropoulos, Ph.D.

    Ann Phlebology 2022; 20(2): 64-67
    Abstract
    Ultrasound is a diagnostic tool of choice for venous disease. As treatment is based on ultrasound results, accurate examination is essential and image optimization is necessary to provide objective information. Understanding the physical properties and knobology of ultrasound helps to obtain good images. To begin with, comfortable placement of the ultrasound for the examiner to use and the appropriate positioning of the patient is also important. The next step for an optimal ultrasound image is to attain good resolution to a given depth. It is also essential to appropriately utilize the provocation maneuvers when diagnosing a suspected disease, especially for the chronic venous disease.
  • Review ArticleJune 30, 2022

    45 266

    Usefulness of D-Dimer for DVT Diagnosis in COVID-19 Patients

    Chung Won Lee, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 6-8
    COVID-19, a pandemic currently, is known to cause hypercoagulability, but may cause deep vein thrombosis (DVT). Generally, D-dimer is useful for diagnosing DVT, but in COVID-19 patients, there is a high possibility of false positives due to the accompanying infection. A literature review revealed that D-dimer levels are elevated in patients with COVID-19. Therefore, a new D-dimer cutoff value for DVT in COVID-19 is needed. Higher D-dimer levels in COVID-19 patients are significantly associated with disease progression.
  • Review ArticleDecember 31, 2023

    208 263

    Guideline Development - The 2023 Korean Society for Phlebology Clinical Practice Guidelines for the Ultrasonographic Evaluation of Varicose Veins of the Lower Extremities

    Tae Sik Kim, M.D., Sangchul Yun, M.D., Wooshik Kim, M.D., Heangjin Ohe, M.D., Seung Cheol Lee, M.D., Sung Ho Lee, M.D. and Sang Seob Yun, M.D.

    Ann Phlebology 2023; 21(2): 53-59
    Abstract
    Varicose vein is a disease with a high prevalence that is commonly seen in everyday life. Accurate diagnosis using ultrasound is essential for venous diseases, but due to the nature of the disease and ultrasonographic techniques, there are a lot of intervention in subjective judgment. Therefore, it is necessary to establish clear standards for the diagnosis methods and standardize procedures of varicose veins. Recently, the diagnosis and treatment of venous diseases has increased rapidly, and the resulting social costs have become a problem. In celebration of its 20th anniversary, the Korean Society for Phlebology published this guideline, ‘The 2023 Korean Society for Phlebology clinical practice guidelines for the ultrasonographic evaluation of varicose veins of the lower extremities’ because it was determined that the establishment of accurate diagnostic standards using ultrasonography was urgently needed.
  • Original ArticleJune 30, 2022

    118 253

    Prophylactic Antibiotics for Combined Endovenous Ablation and Phlebectomy, Necessary or Not?: A Propensity Score Matching Case-Control Study

    Kilsoo Yie, M.D., A-Rom Shin, R.A. and Eun-Hee Jeong, R.A.

    Ann Phlebology 2022; 20(1): 30-36
    Abstract
    Objective: Current guidelines recommend that prophylactic antibiotics should not be used in endovenous surgery. However, it remains unclear whether prophylactic antibiotics are necessary for the combined endovenous procedure with concomitant phlebectomy.
    Methods: We conducted a propensity score-matched case-control study to assess post-procedural infection rates based on the use or non-use of prophylactic antibiotics. Initially, the study included 587 patients (mean age of 55.8 ±14.2 and 296 (50.4%) women) undergoing combined endovenous surgery with concomitant phlebectomy from 2018 to 2022. All procedures were performed under local anesthesia without any sedation. The primary outcome was to compare the incidence of surgical site wound infection (SSWI) after the combined procedure between the prophylactic antibiotic use (PA group) and non-use group (nPA group). The secondary outcomes were to analyze requirement of antibiotics due to any cause three months postoperatively and determine the incidence of thrombophlebitis requiring antibiotic treatment. After propensity score matching, 201 patients who received prophylactic antibiotics (PA group) and 201 who did not (nPA group) were selected, and the present study analyzed 402 participants.
    Results: The mean number of concomitant phlebectomies was 3.54±2.3 in the nPA group and 3.68±2.40 in the PA group (p=ns). The type of endovenous treatment (p=0.79 for VenaSeal, p=0.42 for radiofrequency ablation, p=0.52 for endovenous laser ablation, and p=0.38 for ultrasonographic foam sclerotherapy) and number of phlebectomies (3.61±2.3 in no SSWI group vs. 4.40±5.0 in SSWI group) were not associated with postoperative SSWI incidence. In the logistic regression test, the preoperative great saphenous vein size was a unique risk factor for postoperative SSWI (odds ratio 1.442, 95% confidence interval 1.12∼1.80, p=0.004).
    Conclusion: Both nPA and PA strategies had a very low and comparable incidence of SSWI after combined endovenous surgery and concomitant phlebectomy for chronic venous disease treatment. The nPA strategy did not increase post-procedural SSWI. An optimized and individualized protocol for the use of antibiotics is needed.
AP
Vol.21 No.2 Dec 31, 2023, pp. 53~101

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