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Kresna Agung Prabowo

Pengaruh Durasi Penggunaan Stoking Kompresi Terhadap Hasil Vein Occlusion dan Venous Clinical Severity Score pada Pasien Chronic Venous Insufficiency Pasca Tindakan Endovenous Thermal Ablation = The influence of the duration of use of Compression Stockings on the results of Vein Occlusion and Venous Clinical Severity Score in Chronic Venous Insufficiency patients after Endovenous Thermal Ablation

Latar Belakang: Penyakit insufisiensi vena merupakan kondisi terganggunya aliran balik darah dari tungkai menuju ke jantung. Kondisi ini dapat terjadi secara jangka panjang atau kronik sehingga sering dikenal sebagai chronic venous insufficiency (CVI).

Tujuan: Menganalisis dan membandingkan pengaruh penggunaan stoking kompresi selama 1 minggu dan 2 minggu pada pasien CVI pasca tindakan EVTA di RSUP Nasional Dr. Cipto Mangunkusumo Jakarta dan RS jejaring pendidikan.

Metode: Penelitian ini bersifat studi kohort.

Hasil: Populasi yang diambil adalah pasien yang berobat dari bulan Maret – Mei 2024 di RSCM dan RS jejaring. Distribusi komplikasi akut pasca pemasangan stoking kompresi selama 1 minggu dan 2 minggu. Iritasi kulit dialami oleh 3 orang (9,7%) pasien pada kelompok 1 dan 11 orang (37,9%) pada kelompok 2. Nyeri dialami oleh 9 orang (31%) pasien pada kelompok 1 dan pada 9 orang (29%) pasien pada kelompok 2. Edema hanya ditemukan pada kelompok 2 yaitu sebanyak 2 kasus (6,5%). Selanjutnya, hematoma dialami oleh 4 orang (13,8%) pasien pada kelompok 1 dan 4 orang (12,9%) pada kelompok 2 Hasil analisis bivariat mendapatkan bahwa jenis intervensi berpengaruh terhadap oklusi vena dengan nilai odds ratio sebesar 1,203 (95% CI: 0,537 – 2,694) namun dengan nilai yang tidak signifikan berdasarkan uji Fischer’s Exact Test (p=0,77). Sebagai kesimpulan, penggunaan stoking kompresi selama 2 minggu tidak memiliki pengaruh yang bermakna dengan penggunaan selama 1 minggu saja. nilai korelasi sebesar -0,010 dengan nilai p=0,937. Nilai -0,01 termasuk dalam hubungan korelasi kuat (kurang dari 0,1).

Simpulan: Penggunaan stoking kompresi selama 2 minggu tidak memiliki pengaruh yang bermakna dengan penggunaan selama 1 minggu saja. nilai korelasi sebesar -0,010 dengan nilai p=0,937. Nilai -0,01 termasuk dalam hubungan korelasi kuat (kurang dari 0,1).

Kata kunci: Penyakit vena kronis,venous clinical severty score, medical compresi.

Background: Venous insufficiency is a condition where the return of blood from the legs to the heart is disrupted. This condition can occur long-term or chronically so it is often known as chronic venous insufficiency (CVI).
Objective: This study will compare vein occlusion and Venous Clinical Severity Score (VCSS) in CVI patients after the EVTA procedure who were given compression therapy with stockings for one week compared with use for two weeks.
Methods: This research is a cohort study
Results: The population taken were patients seeking treatment from March – May 2024 at RSCM and network hospitals. Distribution of acute complications after installation of compression stockings for 1 week and 2 weeks. Skin irritation was experienced by 3 (9.7%) patients in group 1 and 11 people (37.9%) in group 2. Pain was experienced by 9 (31%) patients in group 1 and 9 people (29%) patients in group 2. Edema was only found in group 2, namely 2 cases (6.5%). Furthermore, hematomas were experienced by 4 (13.8%) patients in group 1 and 4 people (12.9%) in group 2. The results of bivariate analysis showed that the type of intervention had an effect on vein occlusion with an odds ratio of 1.203 (95% CI : 0.537 – 2.694) but with a value that is not significant based on Fischer's Exact Test (p=0.77). In conclusion, the use of compression stockings for 2 weeks does not have a significant effect compared to use for just 1 week. The correlation value is -0.010 with a p value = 0.937. The value -0.01 is included in a strong correlation relationship (less than 0.1).
Conclusion: the use of compression stockings for 2 weeks does not have a significant effect compared to use for just 1 week. The correlation value is -0.010 with a p value = 0.937. The value -0.01 is included in a strong correlation relationship (less than 0.1).

Keywords: Chronic venous disease, venous clinical severity score, medical compression."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024

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Ivan Rinaldi

Hubungan Diameter dan Angka Oklusi Vena Saphena Magna Terhadap Revised Venous Clinical Severity Score (r-VCSS) Pasca Tindakan Endovenous Laser Ablation (EVLA) pada Pasien Insufisiensi Vena Kronik = Correlation between Diameter and Occlusion Rate of Great Saphenous Vein on Revised venous Clinical Severity Score (r-VCSS) After Endovenous Laser Ablation (EVLA) in Chronic Venous Insufficiency Patient

"Efektifitas EVLA terhadap diameter vena saphena magna yang besar masih banyak diperdebatkan, karena diameter vena saphena magna yang besar memiliki angka oklusi yang lebih rendah pasca EVLA dan diperkirakan mempengaruhi nilai r-VCSS. Desain penelitian ini adalah potong lintang pasien insufiensi vena kronik pada vena saphena magna yang lakukan EVLA di Rumah Sakit Cipto Mangunkusumo dan rumah sakit jejaring dari Juli 2023 – Desember 2023. 37 tungkai dari 34 pasien yang dilakukan EVLA 1470 nm dengan tip radial. Dilakukan pengukuran diameter vena saphena magna dengan usg doppler pada 4 segmen (3 femoral, 1 kruris) dan dibagi berdasarkan nilai potong, dan juga dilakukan penilaian r-VCSS pre EVLA. 1 minggu pasca EVLA dilakukan penilaian oklusi dari vena saphena magna dengan usg doppler dan nilai r-VCSS. Analisis data menggunakan SPSS versi 25.0 secara bivariat dan multivariat. 5 tungkai (13,5%) mengalami gagal oklusi 1 minggu pasca EVLA. Semua kegagalan oklusi pada segmen 1/3 proksimal femoral (diameter >10 mm) (P<0,05). Tidak ada perbedaan bermakna antara angka oklusi dengan nilai r-VCSS, baik pre dan post EVLA (P=0,490 dan P=0,102). Perbedaan diameter sesuai nilai potong tidak mempengaruhi nilai r-VCSS post tindakan. Diameter vena pre-EVLA mempengaruhi keberhasilan oklusi pasca-EVLA. Angka oklusi vena saphena magna tidak mempengaruhi nilai r-VCSS pasca EVLA.

The effectiveness of EVLA on large saphenous vein diameter is still widely debated, because large saphenous vein diameter has a lower occlusion rate after EVLA and can affect the r-VCSS value. The design of this study was a cross-sectional of patients with chronic venous insufficiency in the great saphenous vein who underwent EVLA at Cipto Mangunkusumo Hospital and a network teaching hospitals from July 2023 – December 2023. 37 extremity from 34 patients underwent 1470 nm EVLA with a radial tip. The diameter of the great saphenous vein was measured using Doppler ultrasound in 4 segments (3 femoral, 1 cruris) and divided based on the cutoff value, and pre-EVLA r-VCSS was also assessed. 1 week after EVLA, the occlusion of the great saphenous vein was assessed using Doppler ultrasound and r-VCSS values. Data analysis used SPSS version 25.0 bivariate and multivariate. cases (13.5%) failed occlusion 1 week post EVLA. All occlusion failure occurred at the 1/3 proximal of the femoral segment (diameter >10 mm) (P<0.05). There was no significant difference between occlusion rates with r-VCSS, pre and post EVLA (P=0.490 and P=0.102). The difference in diameter according to the cut value does not affect the r-VCSS after the procedure. Pre-EVLA vein diameter influences the success of post-EVLA occlusion. The degree of occlusion of the great saphenous vein does not affect the r-VCSS after EVLA."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023

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Yudi Ichsan Ramata

Perbandingan Keberhasilan Pasien Chronic Venous Insufficiency (CVI) Pasca Endovenous Laser Ablation (EVLA) yang Menggunakan Stoking Kompresi Dibandingkan dengan Stoking Kompresi Ditambah Compression Pad = Comparison of Success Rate in Chronic Venous Insufficiency (CVI) Patients Post Endovenous Laser Ablation (EVLA) Using Compression Stockings Compared to Compression Stockings with Compression Pad

"Latar belakang: Chronic venous insufficiency (CVI) menyebabkan penurunan kualitas hidup secara signifikan dan kehilangan produktivitas. Salah satu modalitas tatalaksana CVI adalah endovenous laser ablation (EVLA). Namun, EVLA dapat menyebabkan komplikasi umum seperti nyeri, lebam, trombosis vena, maupun perdarahan. Terapi kompresi dapat membantu pemulihan pasca prosedur EVLA dengan mengurangi nyeri dan mempercepat pemulihan. Namun, hingga saat ini studi yang membandingkan keberhasilan penggunaan stoking kompresi dibandingkan stoking kompresi ditambah compression pad masih belum banyak dilakukan, terutama di Indonesia. Metode: Studi potong lintang ini dilakukan di Rumah Sakit Cipto Mangunkusumo Jakarta dan rumah sakit jejaring pada bulan Januari 2023 – Juni 2023. Analisis data menggunakan SPSS 20.0 secara univariat dan bivariat. Hasil: Sebanyak 52 pasien menjadi subjek penelitian, 27 pasien (51,9%) mendapatkan stoking kompresi ditambah compression pad sedangkan 25 pasien (48,1%) hanya stoking kompresi. Tingkat oklusi vena antara penggunaan stoking kompresi ditambah pad dengan stoking kompresi tidak signifikan (p=1,00). Selisih skor VCSS antara kedua kelompok subjek tidak signifikan (p=0,707). Durasi operasi pada kelompok stoking kompresi lebih singkat secara signifikan dibandingkan stoking kompresi ditambah compression pad (p<0,001). Lama pemulihan antara kedua kelompok yang berkorelasi signifikan (p=0,075). Diameter vena saphena magna (GSV) berhubungan signifikan (p=0,030) dengan oklusi vena dimana diameter GSV yang lebih besar atau ≥10 mm memiliki risiko kegagalan terapi yang lebih tinggi. Kesimpulan: Pada penelitian ini, ditemukan bahwa durasi operasi secara signifikan lebih singkat pada kelompok pasien yang menggunakan stoking kompresi. Tidak terdapat perbedaan signifikan dalam hal keberhasilan oklusi vena, selisih skor VCSS, dan lama pemulihan antara penggunaan stoking kompresi atau ditambah compression pad.

Background: Chronic venous insufficiency (CVI) causes a significant reduction in quality of life and loss of productivity. One of the treatment modalities for CVI is endovenous laser ablation (EVLA). However, EVLA can cause general complications such as pain, bruising, venous thrombosis, or bleeding. Compression therapy can help recovery after the EVLA procedure by reducing pain and improve healing. However, until now there have not been many studies comparing the success of using compression stockings compared to compression stockings plus compression pads , especially in Indonesia. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital Jakarta and network hospitals in January 2023 – June 2023. Data analysis used SPSS 20.0 univariately and bivariately. Results: A total of 52 patients were research subjects, 27 patients (51.9%) received compression stockings plus a compression pad while 25 patients (48.1%) only received compression stockings. The occlusion rate between the use of compression stockings plus pads and compression stockings was not significant (p=1.00). The difference in VCSS scores between the two groups of subjects was not significant (p=0.707). The duration of surgery in the compression stockings group was significantly shorter than compression stockings plus compression pads (p<0.001). The recovery time between the two groups was significantly correlated (p=0.075). The diameter of the great saphenous vein (GSV) was significantly related (p=0.030) to the occlusion rate, where a larger GSV diameter or ≥10 mm had a higher risk of therapy failure. Conclusion: In this study, it was found that the duration of surgery was significantly shorter in the group of patients who used compression stockings. There was no significant difference in the success of vein occlusion, the difference in VCSS scores, and the recovery time between the use of compression stockings or adding a compression pad"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023

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Yetti Muthiah

Uji diagnostik penilaian derajat klinis penyakit insufisiensi vena kronik (IVK) dengan metode skoring venous clinical severity score (VCSS) pada pekerja wanita posisi kerja berdiri = Diagnostic test for assessment of clinical degrees of chronic vein insufficiency (CVI) by scoring method of venous clinical severity score (VCSS) on female standing workers

"American Venous Forum Commitee dari tahun 2000 ndash; 2011 terus mengembangkan sistem skoring penilaian derajat keparahan penyakit vena yang praktis bernama Venous Clinical Severity Score VCSS , namun di Indonesia, instrument VCSS hingga saat ini belum pernah dilakukan validasi. Penelitian ini adalah uji diagnostik skoring VCSS dengan membandingkan pemeriksaan penyakit vena menggunakan skoring VCSS oleh dokter umum dibandingkan dengan pemeriksaan klinis CEAP oleh dokter spesalis vaskuler sebagai baku emasnya. Penelitian dilakukan di perusahaan garmen di Jakarta Utara pada bulan Oktober dengan nilai sensivitas 87,5 , spesifitas 96,3 , nilai duga positif 83,3 dan nilai duga negatif 97,3 . Dari Hasil analisis kurva ROC nilai Area Under the Curve AUC sebesar 94,9 sangat baik. Faktor risiko paling dominan terhadap kejadian IVK pada pekerja wanita dengan posisi kerja berdiri adalah masa kerja lebih dari 1 tahun dengan.

The American Venous Forum Commitee from 2000 2011 continues to develop a practice scoring system on the severity of venous disease called Venous Clinical Severity Score VCSS , but in Indonesia, this VCSS instrument, until now has never been validated. This study is a VCSS scoring diagnostic test which compere the examination CVI using VCSS by general practitioner and using clinical class of CEAP by vascular specialist as gold standard. Based on the research, the VVTB diagnostic test by using VCSS score was 87.5 sensitivity, 96.3 specificity, 83.3 positive predictive value and 97.3 negative predictive value. From ROC curve analysis, the value of Area Under the Curve AUC is 94.9 which means very good. The most dominant risk factors for the occurrence of CVI in female workers with standing positions were more than 1 year with p "

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

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Patrianef Darwis

Relationship of venous clinical severity score with reflux and leg vein diameters based on ultrasonography in women workers with risk factors

"Introduction: In 2010, the American Venous Forum developed a Venous Clinical Severity Score (VCSS) scoring system to assess the severity of Chronic Venous Insufficiency (CVI), where this system was said to be more comprehensive than the CEAP system. However, VCSS validation was still lacking. The purpose of this study was to examine VCSS for reflux and leg vein diameter based on ultrasonography. Method: This study was a cross-sectional diagnostic test on women workers with standing work positions of 114 people (228 limbs) in Jakarta. VCSS assessment and ultrasound examinations were carried out on all subjects. The relationship between VCSS with reflux and leg vein diameter was analyzed using an odds ratio with a 95% confidence interval. Results: From 228 examined limbs, the VCSS score of 0-3 was 18.4%, and the score of ≥4 was 81.6%. Reflux was found in 21.9% of the limbs. There was a significant relationship between VCSS and reflux in leg veins. The diameter of the great saphenous vein was between 2.1-12.2 mm, the femoral vein was 7.1-17 mm, the popliteal vein as 3-11.4, and the small saphenous vein was 1.7-7mm. When VCSS was analyzed for association with venous diameter, a significant relationship was found. VCSS sensitivity compared with reflux based on USG was 78%, specificity was 98.31%, positive predictive value was 92.86%, and the negative predictive value was 93.86%.Conclusion: From the results of this study, it was concluded that the VCSS score could be used as a method for assessing chronic venous insufficiency. Although VCSS is was to assess the severity of the chronic venous disease, VCSS can also be used for screening because it shows a good relationship with the reflux and venous diameter of the limbs based on ultrasound."

Jakarta: PESBEVI, 2020

616 JINASVS 1:1 (2020)

Artikel Jurnal Universitas Indonesia Library

I Made Arya Winatha

Hubungan venous cliniical severity score dengan refluks dan diameter vena tungkai berdasarkan ultrasonografi pada pekerja wanita dengan faktor risiko = Relationship between venous clinical severity score with reflux and leg vein diameter based on ultrasonography in female workers with risk factors.

"Pada tahun 2010 American Venous Forum mengembangkan sebuah sistem skoring Venous Clinical Severity Score (VCSS) untuk menilai tingkat keparahan Insufisiensi Vena Kronik, dimana system ini dikatakan lebih lengkap daripada system CEAP. Tetapi validasi VCSS terhadap uji obyektif masih kurang. Tujuan Penelitian ini adalah untuk menguji VCSS terhadap refluks dan diameter vena tungkai berdasarkan ultrasonografi. Penelitian ini merupakan suatu uji diagnostik potong lintang pada pekerja wanita dengan posisi kerja berdiri sebnyak 114 orang (228 tungkai). Dilakukan penilaian VCSS dan pemeriksaan USG pada semua subjek. Hubungan antara VCSS dengan refluks dan diameter vena tungkai dianalisis menggunakan odd rasio dengan interval kepercayaan 95%. Dari 228 tungkai yang diperiksa didapatkan skor VCSS 0-3 sebanyak 18,4%, skor ≥4sebanyak 81,6%. Refluks didapatkan pada 21,9% tungkai. Terdapat hubungan yang signifikan antara VCSS dengan refluks pada vena tungkai. Sedangkan diameter vena safena magna antara 2,1-12,2mm, vena femoral 7,1-17mm, vena popliteal 3-11,4 dan vena safena parva 1,7-7mm. Ketika VCSS dihubungkan dengan diameter vena, didapatkan hubungan yang signifikan. Sensistivitas VCSS dibandingkan dengan refluks berdasarkan USG didapatkan 78%, spesivitas 98,31%, nilai prediksi positif 92,86% dan nilai prediksi negatif 93,86%. Dari hasil penelitian ini disimpulkan skoring VCSS dapat dipakai sebagi metode untuk menilai insufisiensi vena kronik. Meskipun VCSS dirancang untuk menilai keparahan penyakit vena kronis, VCSS dapat juga dipaki untuk melakukan skrining karena menujukkan hubungan yang baik dengan refluks dan diameter vena tungkai berdasarkan USG.

In 2010 the American Venous Forum developed a scoring system for the Venous Clinical Severity Score (VCSS) to assess the severity of chronic venous insufficiency, where the system is said to be more complete than the CEAP system. But the VCSS validation of the objective test is still lacking. The aim of this study was to test VCSS for reflux and diameter of leg veins based on ultrasonography. This study is a cross-sectional diagnostic test on female workers with a working position standing at 114 people (228 limbs). VCSS assessment and ultrasound examination were performed on all subjects. The relationship between VCSS and reflux and limb vein diameter was analyzed using odds ratios with a 95% confidence interval. From the 228 limbs examined, the VCSS score of 0-3 was 18.4%, the score ≥4 was 81.6%. Reflux is obtained at 21.9% of the legs. There is a significant relationship between VCSS and reflux in the leg veins. Whereas the diameter of the safena magna vein is between 2.1-12.2mm, 7.1-17mm femoral vein, popliteal vein 3-11.4 and safena parva vein 1.7-7mm. When VCSS is associated with vein diameter, a significant relationship is obtained. The sensitivity of VCSS compared with reflux based on USG was 78%, the specificity was 98.31%, the positive predictive value was 92.86% and the negative predictive value was 93.86%. From the results of this study concluded VCSS scoring can be used as a method to assess chronic venous insufficiency. Although VCSS is designed to assess the severity of chronic venous disease, VCSS can also be cited for screening because it shows a good relationship with reflux and diameter of leg veins based on ultrasound.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

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Karlina Nur Fitria

Analisis Asuhan Keperawatan pada Pasien dengan Chronic Venous Insufficiency dengan Penerapan Range of Motion = Analysis of Nursing Care in Patients with Chronic Venous Insufficiency with Range of Motion Application

"Chronic venous insufficiency (CVI) merupakan salah satu gangguan pada sistem vaskular Bagian dari sistem vaskular yang dipengaruhi oleh CVI yaitu sistem vena pada ekstremitas bawah. Hal ini menganggu aliran darah pada ekstremitas bawah sehingga dapat menimbulkan komplikasi luka, nyeri, dan keterbatasan rentang gerak pergelangan kaki. Masalah keperawatan yang ditegakkan yaitu nyeri akut dan gangguan integritas kulit. Karya Ilmiah Akhir Ners (KIAN) ini menguraikan analisis asuhan keperawatan dan penerapan range of motion pada pasien dengan CVI untuk meningkatkan keterbatasan rentang gerak pada pergelangan kaki dan penyembuhan luka. Hasil evaluasi dari penerapan tersebut menunjukkan peningkatan rentang gerak pergelangan kaki dari 100 menjadi 150 tetapi tidak ada peningkatan penyembuhan luka selama 6 hari perawatan. Selain itu, terdapat penurunan nyeri dari skala 6 menjadi 5. Berdasarkan hasil tersebut diharapkan latihan ROM dapat diterapkan pada pelayanan kesehatan terutama pada pasien CVI dengan keterbatasan rentang gerak pergelangan kaki.

Chronic venous insufficiency (CVI) is one of the disorders that affects vascular system. Part of the vascular system that is affected by CVI is venous system in the lower extremities. This disrupts blood flow in the lower extremities which may cause complications such as venous leg ulcer. The main nursing problem in this case is impaired skin integrity. This nursing scientific paper aims to elaborate analysis of nursing care and range of motion application in patient with CVI to increase ankle ROM limitation and wound healing. Evaluation of the ROM application shows increase in ankle ROM from 100 to 150 during 6 days of care. However, there is no increase in the healing rate after 6 days of application. According to the evaluation, ROM exercise is proposed to be applied in healthcare services particularly for CVI patients with ankle ROM limitations"

Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2022

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Dimas Putra Asmoro

Uji Diagnostik Venous Clinical Severity Score dengan Klasifikasi Clinical Etiology-Anatomy-Pathophysiology pada Varises Vena Tungkai Bawah Perawat Ruang Operasi = Venous Clinical Severity Score Diagnostic Test with Clinical-Etiology-Anatomy-Pathophysiology Classification in Varicose Veins of the Lower Limb of Operating Room Nurse

"Latar Belakang: Dalam diagnosis varises vena tungkai bawah (VVTB), venous clinical severity score (VCSS) merupakan alat bantu diagnosis VVTB yang praktis, cepat, dan dapat dikerjakan oleh semua tenaga kesehatan termasuk perawat. Hingga saat ini belum ada peneliti yang melakukan validasi eksterna penilaian VCSS yang dikerjakan oleh perawat di Indonesia.

Tujuan: Mengetahui tingkat ketepatan metode skor VCSS oleh perawat dibandingkan dengan komponen klinis (C) klasifikasi clinical-etiology-anatomy-pathophysiology (CEAP) oleh dokter spesialis bedah vaskular.

Metode: Studi cross-sectional ini mengikutsertakan 63 orang perawat instalasi bedah pusat RS Dr. Cipto Mangunkusumo tanpa varises sebelum menjadi perawat sebagai sampel yang diambil secara consecutive Penilaian VCSS dilakukan dengan komponen klinis klasifikasi CEAP sebagai pembanding. Variabel dianalisis dengan uji Chi-square, dilanjutkan dengan uji nilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), likelihood ratio dan akurasi skor diagnostik, termasuk analisis uji diagnostik menggunakan indeks Youden.

Hasil: Prevalensi VVTB pada studi ini berdasarkan skor VCSS adalah 9,5%. Korelasi antara klasifikasi CEAP dan VCSS ditemukan bermakna (p<0,05). Derajat VVTB antara klasifikasi CEAP dan VCSS berhubungan secara signifikan (p <0,05). Pada cut-offVCSS 2 didapatkan nilai sensitivitas 66,67%, spesifisitas 66,67 %, NDP 32,0%, NDN 89,47%, likelihood ratio (+) sebesar 2,00, likelihood ratio (-) sebesar 0,50, dan akurasi 66,67%.

Kesimpulan: Skor VCSS memiliki akurasi lemah terhadap komponen klinis (C) klasifikasi CEAP untuk menegakkan diagnosis VVTB.

Background: In the diagnosis of lower leg varicose veins (LLVV), the venous clinical severity score (VCSS) is practical, fast, and can be done by all health workers including nurses. Until now there has been no researcher who has conducted external validation of the VCSS assessment carried out by nurses in Indonesia.
Aim: To determine the accuracy of the VCSS scoring method by nurses compared to clinical component (C) of the clinical-etiology-anatomy-pathophysiology (CEAP) classification by vascular surgeons.
Method: This cross-sectional study included 63 nurses at the central surgical installation of Cipto Mangunkusumo Hospital without varicose veins before becoming a nurse as a consecutive sample. The VCSS assessment was carried out with the clinical component of CEAP classification as a comparison. Variables were analyzed by the Chi-square test. Followed by testing the value of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio, and accuracy of diagnostic scores, along with the ROC analysis using Youden Index.
Results and Discussion: The prevalence of LLVV in this study is 9,5%. Bivariate analysis of CEAP and VCSS has a significant correlation (p <0,05). The degree of LLVV with CEAP and VCSS is related significantly (p <0,05). With VCSS cut off at scores of 2, the sensitivity is 66.67%, the specificity is 66.67%, the PPV is 32,0%, the NPV is 89.47%, the positive and negative likelihood ratio are 2.00 and 0.50, and the accuracy value is 66.67%.
Conclusion: The VCSS score has weak level of accuracy against the clinical component (C) of CEAP classification for diagnosing VVTB."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022

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Hartika Safitri

Kadar Transforming growth factor- Beta 1 Terhadap Tingkat Keparahan Penyakit Insufisiensi Vena Kronik pada Vena Superfisial Tungkai Bawah pada Pasien yang Dilakukan Tindakan Bedah Pintas Arteri Koroner = Transforming growth factor-ð½1 Levels Concerning the Severity of Chronic Venous Insufficiency in the Superficial Veins of the Lower Limbs in Patients Undergoing Coronary

Latar Belakang : Penyakit insufisiensi vena kronik (PIVK) memiliki prevalensi yang cukup tinggi di seluruh dunia, yaitu sekitar 60-70%. Penyebab paling sering pada penyakit insufisiensi vena kronik adalah kelainan primer dari dinding vena dan katupnya mengakibatkan inkompetensi pada katup vena, reflux dan obstruksi vena. Transforming growth factor-ð½1 (TGF-ð½1) adalah sitokin dengan polipeptida kompleks yang secara signifikan ditemukan pada semua pasien penyakit insufisiensi vena kronik. Waktu refluks yang didapat dari pemeriksaan Ultrasonografi duplex (DUS) menunjukkan derajat keparahan dari insufisiensi katup vena. Akan tetapi, Hubungan kadar TGF-ð½1 terhadap tingkat keparahan dari penyakit insufisiensi vena kronik belum diketahui.

Tujuan : untuk mengetahui perbedaan kadar TGF-ð½1 terhadap tingkat keparahan dari penyakit insufisiensi vena kronik pada vena superfisial tungkai bawah.

Metode : Studi menggunakan desain potong lintang pada pasien dengan vena yang sehat dan pasien dengan penyakit insufisiensi vena kronik yang dilakukan oeprasi bedah pintas arteri koroner (BPAK) di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita pada April – Mei 2024. Tingkat keparahan penyakit insufisiensi vena kronik dinilai dengan waktu refluks dari pemeriksaan ultrasonografi duplex. TGF-ð½1 didapat dari pemeriksaan ELISA pada jaringan vena. Luaran primer adalah perbedaan kadar TGF-ð½1 berdasarkan tingkat keparahan penyakit insufisiensi vena kronik.

Hasil : Sebanyak total 56 subjek berhasil dilakukan analisis akhir. Mayoritas subjek dengan PIVK pada penelitian ini (67,7%) tergolong ke dalam PIVK derajat berat (waktu refluks >1000 ms). Tidak terdapat perbedaan nilai median yang signifikan antara derajat keparahan PIVK dengan kadar TGF-Î²1 (p>0.05). Namun dapat dilihat bahwa median kadar TGF-Î²1 lebih meningkat pada vena dengan PIVK ringan-sedang dan berat (14,27 pg/mg dan 14,04 pg/mg) jika dibandingkan dengan vena normal (10,97 pg/mg).

Kesimpulan : Tidak terdapat perbedaan signifikan antara kadar TGF-ð½1 terhadap tingkat keparahan penyakit insufisiensi vena kronik pada vena superfisial tungkai bawah pada pasien yang dilakukan tindakan bedah pintas arteri koroner.

Kata kunci: Insufisiensi vena kronik, Transforming growth factor - Beta 1, Waktu refluks

Background: Chronic venous insufficiency (PIVK) has a fairly high prevalence throughout the world, around 60-70%. The most common cause of chronic venous insufficiency is primary abnormalities of the venous wall and valve resulting in valve incompetence, reflux, and venous obstruction. Transforming Growth Factor-Î²1 (TGF-Î²1) is a complex polypeptide cytokine that is significantly found in all patients with chronic venous insufficiency. Reflux time obtained from Duplex Ultrasonography (DUS) examination indicates the severity of valve insufficiency. However, the relationship between TGF-Î²1 levels and the severity of CVI has not yet been determined.

Objective: To determine the differences in TGF-Î²1 levels concerning the severity of chronic venous insufficiency in the superficial veins of the lower limbs.

Method: The study used a cross-sectional design in patients with healthy veins and patients with chronic venous insufficiency who undergoing coronary artery bypass surgery at the Harapan Kita National Cardiovascular Center from April to May 2024. The severity of chronic venous insufficiency was assessed by reflux time from duplex ultrasonography examination. TGF-Î²1 was obtained from ELISA examination of venous tissue. The primary outcome was the difference in TGF-Î²1 levels based on the severity of chronic venous insufficiency.

Results: A total of 56 subjects underwent final analysis. The majority of subjects with CVI in this study (67.7%) were classified into severe CVI (reflux time >1000 ms). There were no significant differences in median values between the severity of CVI and TGF-Î²1 levels (p>0.05). However, it was observed that the median TGF-Î²1 levels increased in veins with mild-moderate and severe CVI (14.27 pg/mg and 14.04 pg/mg) compared to normal veins (10.97 pg/mg).

Conclusion: There is no significant differences in TGF-Î²1 levels concerning the severity of chronic venous insufficiency in the superficial veins of the lower limbs in patients undergoing coronary artery bypass graft surgery.

Keywords: Chronic venous insufficiency, Transforming Growth Factor-Î²1, Reflux time.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024

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Faktor yang Berpengaruh Terhadap Patensi 6 dan 12 Bulan Pasca Single Baloon Angioplasty Pada Stenosis Vena Sentral Pasien Gagal Ginjal Kronik = Factors Influencing 6 and 12 Months Patency after Single Balloon Angioplasty in Central Venous Stenosis in Chronic Kidney Disease Patients

"Latar Belakang: Stenosis vena sentral adalah salah satu permasalahan utama yang dihadapi dalam penggunaan akses hemodialisis FAV. Kondisi ini dapat ditangani dengan tindakan single balloon angioplasty. Namun, tatalaksana ini memiliki angka patensi yang tidak memuaskan akibat respon pembuluh darah terhadap barotrauma. Mengetahui risiko yang mempengaruhi patensi pasca tindakan single baloon angioplasty pada penderita stenosis vena sentral penting untuk memprediksi prognosis pasien. Penelitian ini bertujuan untuk mengetahui faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Metode: Sebuah penelitian kohort retrospektif multicenter pada Januari 2018 – September 2022 di empat rumah sakit dilakukan untuk menilai faktor yang berpengaruh terhadap patensi 6 dan 12 bulan pasca tindakan single baloon angioplasty pada pasien stenosis vena sentral. Faktor yang diteliti mencakup derajat stenosis, panjang stenosis, jumlah stenosis, lokasi stenosis, residual stenosis, ukuran balon, dan tekanan balon. Hasil: Terdapat total 76 pasien pada penelitian ini. Pada penelitian ditemukan faktor yang berpengaruh pada patensi 6 bulan pasca single balloon angioplasty adalah jenis kelamin laki – laki (78.4% vs 46.2%; p 0.004), panjang stenosis ≥ 2 cm (85.7% vs 56.5%; p 0.042), lokasi stenosis pada vena innominata (75% vs 39.3%; p: 0.002),derajat stenosis ≥ 80% (83.3% vs 42.5%; p : 0.001), dan residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). Tidak ditemukan faktor yang berpengaruh pada patensi 12 bulan pasca single balloon angioplasty. Kesimpulan: Terdapat hubungan antara panjang stenosis, lokasi stenosis, derajat stenosis, dan residual stenosis terhadap patensi single balloon angioplasty

Background: Central venous stenosis is one of the main problems encountered in AVF hemodialysis access. This condition can be treated with a single balloon angioplasty. However, this treatment has a low patency rates due to the response of the vessels to barotrauma. Knowing the risks that affect patency after single balloon angioplasty in patients with central venous stenosis is important to predict the patient's prognosis. This study aims to determine the factors influencing 6 and 12 months patency after single balloon angioplasty in central venous stenosis patient. Methods: A multicenter retrospective cohort study in January 2018 – September 2022 in four hospitals was conducted to assess factors that affect 6 and 12 months patency after single balloon angioplasty in patients with central venous stenosis. Factors studied included the degree of stenosis, length of stenosis, number of stenosis, location of stenosis, residual stenosis, balloon size, and balloon pressure. Results: There were a total of 76 patients in this study. In this study, it was found that the factors that affected the patency 6 months after single balloon angioplasty were male gender (78.4% vs 46.2%; p 0.004), stenosis length ≥ 2 cm (85.7% vs 56.5%; p 0.042),stenosis at the innominate vein (75% vs 39.3%; p: 0.002), stenosis degree ≥ 80% (83.3% vs 42.5%; p : 0.001), and residual stenosis ≥ 30% (85% vs 53.6%; p 0.013). There were no factors that had an effect on patency 12 months after single balloon angioplasty. Conclusion: There is a relationship between the length of the stenosis, the location of the stenosis, the degree of stenosis, and the residual stenosis on the patency of single balloon angioplasty"

Depok: Fakultas Kedokteran Universitas Indonesia, 2023

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