Pub Date : 2017-08-29DOI: 10.4172/2329-6925.1000334
S. Rustum, B. Meyer, J. Hinrichs, T. Aper, A. Haverich, M. Wilhelmi
We report on a 62-year old male patient with complicated surgical history and actual covered ruptures of an aortic allograft. Considering the hostile abdomen we decided for an interventional/endovascular treatment. We implanted an aortic-(EVAS; Nellix®) as well as two renal stentgrafts in „chimney “technique. Following an uneventful perioperative course the patient was discharged on 14th postoperative day. This unusual case demonstrates that endovascular aneurysm sealing especially in combination with the chimney technique may be a feasible and reasonable alternative approach for the urgent/emergent treatment of aortic (prosthesis) associated complications where traditional surgical approaches are not applicable.
{"title":"Endovascular Aneurysm Sealing (EVAS) in Combination with the Chimney Technique for the Treatment of Aortic Allograft Rupture","authors":"S. Rustum, B. Meyer, J. Hinrichs, T. Aper, A. Haverich, M. Wilhelmi","doi":"10.4172/2329-6925.1000334","DOIUrl":"https://doi.org/10.4172/2329-6925.1000334","url":null,"abstract":"We report on a 62-year old male patient with complicated surgical history and actual covered ruptures of an aortic allograft. Considering the hostile abdomen we decided for an interventional/endovascular treatment. We implanted an aortic-(EVAS; Nellix®) as well as two renal stentgrafts in „chimney “technique. Following an uneventful perioperative course the patient was discharged on 14th postoperative day. This unusual case demonstrates that endovascular aneurysm sealing especially in combination with the chimney technique may be a feasible and reasonable alternative approach for the urgent/emergent treatment of aortic (prosthesis) associated complications where traditional surgical approaches are not applicable.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79117080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-29DOI: 10.4172/2329-6925.1000333
Rustum S, Schmitto J, Dogan G, Umminger J, Haverich A, Wilhelmi M
Peudoaneurysms are rare complications related to left ventricular assist device (LVAD) implantation and mostly occur at the left ventricular apex, as well as the anastomosis of the outflow graft to the ascending aorta. Beside anastomosis related complications and an erosion of the graft with a sternal wire they can occur due to an infection. Nevertheless pseudoaneurysms represent a major complication potentially leading to significant morbidity and mortality and in most cases necessitating open-surgical management. Here we report on a case of an infectioninduced pseudoaneurysm in close proximity to the LAVD’s outflow cannula which was treated successfully with an endovascular stentgraft.
{"title":"Successful Treatment of LVAD Patient with Infection-Induced Pseudoaneurysm using Endovascular Stent Graft","authors":"Rustum S, Schmitto J, Dogan G, Umminger J, Haverich A, Wilhelmi M","doi":"10.4172/2329-6925.1000333","DOIUrl":"https://doi.org/10.4172/2329-6925.1000333","url":null,"abstract":"Peudoaneurysms are rare complications related to left ventricular assist device (LVAD) implantation and mostly occur at the left ventricular apex, as well as the anastomosis of the outflow graft to the ascending aorta. Beside anastomosis related complications and an erosion of the graft with a sternal wire they can occur due to an infection. Nevertheless pseudoaneurysms represent a major complication potentially leading to significant morbidity and mortality and in most cases necessitating open-surgical management. Here we report on a case of an infectioninduced pseudoaneurysm in close proximity to the LAVD’s outflow cannula which was treated successfully with an endovascular stentgraft.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78133752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-24DOI: 10.4172/2329-6925.1000329
Ngo Nonga Bernadette, Ze Jj, D. Messomo, Handy De, A. Pondy, Mballa Jc
Pulmonary embolism is a well-recognized clinical entity with significant morbidity and mortality. It is called massive when it extends over more than half of the vascular bed. In the past, surgical treatment was the last therapeutic option but more and more surgical treatments are performed in several centers with few side effects and a lower mortality rate. Pulmonary embolectomy has never been attempted in Cameroon. We are reporting herein the first case of massive pulmonary embolism in a 30 years old man complicated by lung gangrene treated by thrombectomy and lung resection.
{"title":"Thrombectomy and Lung Resection for Massive Left Pulmonary Embolism in a 30 Years Old Man in Yaounde, Cameroon","authors":"Ngo Nonga Bernadette, Ze Jj, D. Messomo, Handy De, A. Pondy, Mballa Jc","doi":"10.4172/2329-6925.1000329","DOIUrl":"https://doi.org/10.4172/2329-6925.1000329","url":null,"abstract":"Pulmonary embolism is a well-recognized clinical entity with significant morbidity and mortality. It is called massive when it extends over more than half of the vascular bed. In the past, surgical treatment was the last therapeutic option but more and more surgical treatments are performed in several centers with few side effects and a lower mortality rate. Pulmonary embolectomy has never been attempted in Cameroon. We are reporting herein the first case of massive pulmonary embolism in a 30 years old man complicated by lung gangrene treated by thrombectomy and lung resection.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88626380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-24DOI: 10.4172/2329-6925.1000328
T. Ando, Daichi Akiyama, H. Okada, M. Takeda
The patient was diagnosed with anuloaortic ectasia with localized dissection in the right Valsalva sinus. He underwent aortic root replacement with mechanical valve. But, he was re-admitted for mediastinitis. Although his serum (CRP) level was normalized for one month, his body temperature suddenly rose to 40°C. An emergency operation was performed including re-sternotomy, drainage, and irrigation. However, a proximal anastomotic site ruptured and he went into shock. Following cardiopulmonary bypass, we performed a second aortic root replacement. Therefore, the patient was operated for sternum debridement and to wrap the prosthetic vessel into an omental pedicle. Nine days after the last intervention, bleeding from the chest wound suddenly appeared and he went into shock. He was transported to the operating room to initiate cardiopulmonary bypass. During circulatory arrest, laceration was detected at the same annular position. Deep into the left ventricle, we made interrupted sutures in the left cardiac muscle. Next, we implanted a Freestyle aortic root bioprosthesis using the full root technique. After removing all former implants, another prosthetic vessel was anastomosed between the Freestyle conduit and the distal aorta, and wrapped with omental pedicle. After three weeks, his serum CRP level was normal. He remained free of infection for at least three years.
{"title":"Successful Management of Refractory Prosthetic Vessel Infection, Prosthetic Valve Endocarditis and Mediastinitis: Report of a Case-Late Timing Caused Repeated Surgery","authors":"T. Ando, Daichi Akiyama, H. Okada, M. Takeda","doi":"10.4172/2329-6925.1000328","DOIUrl":"https://doi.org/10.4172/2329-6925.1000328","url":null,"abstract":"The patient was diagnosed with anuloaortic ectasia with localized dissection in the right Valsalva sinus. He underwent aortic root replacement with mechanical valve. But, he was re-admitted for mediastinitis. Although his serum (CRP) level was normalized for one month, his body temperature suddenly rose to 40°C. An emergency operation was performed including re-sternotomy, drainage, and irrigation. However, a proximal anastomotic site ruptured and he went into shock. Following cardiopulmonary bypass, we performed a second aortic root replacement. Therefore, the patient was operated for sternum debridement and to wrap the prosthetic vessel into an omental pedicle. Nine days after the last intervention, bleeding from the chest wound suddenly appeared and he went into shock. He was transported to the operating room to initiate cardiopulmonary bypass. During circulatory arrest, laceration was detected at the same annular position. Deep into the left ventricle, we made interrupted sutures in the left cardiac muscle. Next, we implanted a Freestyle aortic root bioprosthesis using the full root technique. After removing all former implants, another prosthetic vessel was anastomosed between the Freestyle conduit and the distal aorta, and wrapped with omental pedicle. After three weeks, his serum CRP level was normal. He remained free of infection for at least three years.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87526947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-16DOI: 10.4172/2329-6925.1000327
Anh Vo-Thi-Kim, Bai Nguyen-Xuan, D. Dao-Van, S. Duong-Quy
Introduction: Obstructive sleep apnea is very common in patients with high blood pressure (HBP), especially in whom with refractory HBP (R-HBP). It has been suggested treatment with continuous positive airway pressure (CPAP) might ameliorate the blood pressure in these patients. This study was planned to evaluate the effect of CPAP for treatment of R-HBP patients with severe OSA. Methods: It was a cross-sectional and descriptive study. All patients with R-HBP associated with clinical symptoms of OSA were included in this study. They underwent polysomnography (PSG) for diagnosis severe OSA. The patients with severe OSA (apnea-hypopnea index (AHI) >30/hour) were treated with CPAP. They had been followed-up during 3 months. Result: There was 48 patients with R-HBP and symptoms of OSA had PSG. Thirty-nine patients had severe OSA (81.2%) and 32/39 (82.1%) accepted to treat with CPAP. The mean age was 54 ± 8 years (45-64 years) with male-female ratio was 1.6; mean BMI was 27.5 ± 4.6 kg/m2 (23.2-32.5 kg/m2); mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 160 ± 15 mmHg and 105 ± 10 mmHg, respectively. Epworth score was 16 ± 4 with AHI was 37 ± 5/hour. There were a significant reduction of SBP and DBP before and after 3 months treated with CPAP (P<0.01 and P<0.01; respectively). Epworth score was significant lower after 3 months with CPAP than at inclusion (P<0.01). Fasting glucose and total and LDL cholesterol were significantly reduced after treatment with CPAP (P<0.05 and P<0.05). Conclusion: The prevalence of severe OSA is high in patients with R-HBP having clinical symptoms of OSA. This high prevalence is usually associated with overweight, a high risk factor for R-HBP and OSA. The treatment with CPAP might help to control of blood pressure in patients with R-HBP associated with severe OSA.
{"title":"The Effect of Continuous Positive Airway Pressure (CPAP) in Treatment of Patients with Refractory High Blood Pressure Associated with Severe Obstructive Sleep Apnea (OSA)","authors":"Anh Vo-Thi-Kim, Bai Nguyen-Xuan, D. Dao-Van, S. Duong-Quy","doi":"10.4172/2329-6925.1000327","DOIUrl":"https://doi.org/10.4172/2329-6925.1000327","url":null,"abstract":"Introduction: Obstructive sleep apnea is very common in patients with high blood pressure (HBP), especially in whom with refractory HBP (R-HBP). It has been suggested treatment with continuous positive airway pressure (CPAP) might ameliorate the blood pressure in these patients. This study was planned to evaluate the effect of CPAP for treatment of R-HBP patients with severe OSA. Methods: It was a cross-sectional and descriptive study. All patients with R-HBP associated with clinical symptoms of OSA were included in this study. They underwent polysomnography (PSG) for diagnosis severe OSA. The patients with severe OSA (apnea-hypopnea index (AHI) >30/hour) were treated with CPAP. They had been followed-up during 3 months. Result: There was 48 patients with R-HBP and symptoms of OSA had PSG. Thirty-nine patients had severe OSA (81.2%) and 32/39 (82.1%) accepted to treat with CPAP. The mean age was 54 ± 8 years (45-64 years) with male-female ratio was 1.6; mean BMI was 27.5 ± 4.6 kg/m2 (23.2-32.5 kg/m2); mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 160 ± 15 mmHg and 105 ± 10 mmHg, respectively. Epworth score was 16 ± 4 with AHI was 37 ± 5/hour. There were a significant reduction of SBP and DBP before and after 3 months treated with CPAP (P<0.01 and P<0.01; respectively). Epworth score was significant lower after 3 months with CPAP than at inclusion (P<0.01). Fasting glucose and total and LDL cholesterol were significantly reduced after treatment with CPAP (P<0.05 and P<0.05). Conclusion: The prevalence of severe OSA is high in patients with R-HBP having clinical symptoms of OSA. This high prevalence is usually associated with overweight, a high risk factor for R-HBP and OSA. The treatment with CPAP might help to control of blood pressure in patients with R-HBP associated with severe OSA.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80666553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-10DOI: 10.4172/2329-6925.1000326
S. Belczak, D. Szejnfeld, Nathalia Almeida Cardoso da Silva, R. Klajner, L. Ogawa, Marcos Vinícius Maia da Mata
Background: Management of uterine myomas aims at improving symptoms that can be a problem and interfere in the patient’s quality of life. Less invasive approaches, such as uterine artery embolization (UAE), for selected patients is supposed to be a safer choice. Methods: Thirty-one women (mean age 38.5 ± 5.9) with symptomatic uterine myomas underwent UAE. All them scored 0 (mildest) to 10 (worst) for discomforting symptoms (abdominal pain (cramping) during and out of menstrual periods; bleeding during and out of menstrual periods; discomforting abdominal swelling; pain during sexual intercourse; general discomfort in diary activities and in social activities) before and 90 days after UAE. Results: Mean scores before and 90 days after UAE were significantly different for all symptoms, except for pain in sexual intercourse. Scores for bleeding out of menstrual periods increased after UAE, and decreased for all the other symptoms. Total scores before management (43.8 ± 25.4) decreased significantly (p<0.001) three months after UAE (16.1 ± 22.6). Conclusion: Clinical outcomes from UAE were very positive for this group of women, especially those presenting higher mean scores for abdominal pain and bleeding during menstrual periods.
{"title":"Symptoms Improvement after Uterine Artery Embolization for Myomas Management","authors":"S. Belczak, D. Szejnfeld, Nathalia Almeida Cardoso da Silva, R. Klajner, L. Ogawa, Marcos Vinícius Maia da Mata","doi":"10.4172/2329-6925.1000326","DOIUrl":"https://doi.org/10.4172/2329-6925.1000326","url":null,"abstract":"Background: Management of uterine myomas aims at improving symptoms that can be a problem and interfere in the patient’s quality of life. Less invasive approaches, such as uterine artery embolization (UAE), for selected patients is supposed to be a safer choice. Methods: Thirty-one women (mean age 38.5 ± 5.9) with symptomatic uterine myomas underwent UAE. All them scored 0 (mildest) to 10 (worst) for discomforting symptoms (abdominal pain (cramping) during and out of menstrual periods; bleeding during and out of menstrual periods; discomforting abdominal swelling; pain during sexual intercourse; general discomfort in diary activities and in social activities) before and 90 days after UAE. Results: Mean scores before and 90 days after UAE were significantly different for all symptoms, except for pain in sexual intercourse. Scores for bleeding out of menstrual periods increased after UAE, and decreased for all the other symptoms. Total scores before management (43.8 ± 25.4) decreased significantly (p<0.001) three months after UAE (16.1 ± 22.6). Conclusion: Clinical outcomes from UAE were very positive for this group of women, especially those presenting higher mean scores for abdominal pain and bleeding during menstrual periods.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89521332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-20DOI: 10.4172/2329-6925.1000324
H. Tran-Van, Anh Vo-Thi-Kim, T. Tran-Ngoc, S. Duong-Quy
Background: Pulmonary arterial hypertension is frequent in patients with severe chronic obstructive pulmonary disease (COPD). It increases the morbidity and mortality of patients with advanced stage of COPD. The use of long-term oxygen therapy (LTOT) and some other vasodilators seems necessary to prevent pulmonary arterial hypertension (PAH) and right heart failure in these patients. Objective: This study was planned to compare the effect of LTOT alone and LTOT combined with sildenafil (PDE-5 inhibitor) and simvastatin (HMG CoA reductase inhibitor) on pulmonary arterial pressure of patients with severe COPD having hypoxia at rest. Methods: It was a cross-sectional and comparative study. All patients with severe COPD having hypoxia at rest (SpO2<88%) had been classified in three groups: Group 1 (treated with LTOT), Group 2 (treated with LTOT+sildenafil), and Group 3 (treated with LTOT+sildenafil+simvastatin). All study patients had been treated with conventional therapy (long-acting beta2-agonists+inhaled corticosteroids+long-acting muscarinic antagonists) and followed up during 6 months with one visit every three months. The mean systolic pulmonary arterial pressures (PAP) had been measured by transthoracic echocardiography (TTE). Results: Ninety-eight patients with severe COPD and hypoxia at rest were included in this study (Group 1:32 patients, Group 2:35 patients, and Group 3:31 patients). The systolic PAPs and diffusing capacity of the lungs for carbon monoxide (DLCO) were significantly ameliorated after 3 to 6 months. The mean systolic PAP in patients from Group 2 and Group 3 were significantly lower than that in Group 1 at 3 months (41 ± 9 mmHg and 39 ± 7 mmHg vs. 46 ± 10 mmHg; P<0.05 and P<0.05; respectively). After 6 months, oxygen consumption (VO2 max) and 6 minutes walking distances were significantly increased in patients from Group 2 and Group 3 (P<0.05 and P<0.05; respectively). Conclusion: LTOT is an efficacy treatment for severe COPD patients with hypoxia at rest and PAH. Sildenafil and simvastatin have some additional effect on the reduction of PAP and physical exercise capacity.
{"title":"Comparison of Long Term Oxygen-Therapy (LTOT) and LTOT Combined with Sildenafil and Simvastatin in the Treatment of Severe Chronic Obstructive Pulmonary (COPD) with Hypoxia at Rest and Severe Pulmonary Arterial Hypertension","authors":"H. Tran-Van, Anh Vo-Thi-Kim, T. Tran-Ngoc, S. Duong-Quy","doi":"10.4172/2329-6925.1000324","DOIUrl":"https://doi.org/10.4172/2329-6925.1000324","url":null,"abstract":"Background: Pulmonary arterial hypertension is frequent in patients with severe chronic obstructive pulmonary disease (COPD). It increases the morbidity and mortality of patients with advanced stage of COPD. The use of long-term oxygen therapy (LTOT) and some other vasodilators seems necessary to prevent pulmonary arterial hypertension (PAH) and right heart failure in these patients. Objective: This study was planned to compare the effect of LTOT alone and LTOT combined with sildenafil (PDE-5 inhibitor) and simvastatin (HMG CoA reductase inhibitor) on pulmonary arterial pressure of patients with severe COPD having hypoxia at rest. Methods: It was a cross-sectional and comparative study. All patients with severe COPD having hypoxia at rest (SpO2<88%) had been classified in three groups: Group 1 (treated with LTOT), Group 2 (treated with LTOT+sildenafil), and Group 3 (treated with LTOT+sildenafil+simvastatin). All study patients had been treated with conventional therapy (long-acting beta2-agonists+inhaled corticosteroids+long-acting muscarinic antagonists) and followed up during 6 months with one visit every three months. The mean systolic pulmonary arterial pressures (PAP) had been measured by transthoracic echocardiography (TTE). Results: Ninety-eight patients with severe COPD and hypoxia at rest were included in this study (Group 1:32 patients, Group 2:35 patients, and Group 3:31 patients). The systolic PAPs and diffusing capacity of the lungs for carbon monoxide (DLCO) were significantly ameliorated after 3 to 6 months. The mean systolic PAP in patients from Group 2 and Group 3 were significantly lower than that in Group 1 at 3 months (41 ± 9 mmHg and 39 ± 7 mmHg vs. 46 ± 10 mmHg; P<0.05 and P<0.05; respectively). After 6 months, oxygen consumption (VO2 max) and 6 minutes walking distances were significantly increased in patients from Group 2 and Group 3 (P<0.05 and P<0.05; respectively). Conclusion: LTOT is an efficacy treatment for severe COPD patients with hypoxia at rest and PAH. Sildenafil and simvastatin have some additional effect on the reduction of PAP and physical exercise capacity.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81539659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-20DOI: 10.4172/2329-6925.1000325
W. M. Gamal, Elammary Mk, A. Mohamed
Background: Varicose veins is a major problem among adult population. It has a major effect on life quality as well as healthcare system resources, we aim in this study to compare ultrasound guided foam sclerotherapy (UGFS) with surgery in management of primary varicose veins patients and to measure patients’ satisfaction with either modalities. Methods: 100 lower limbs of 100 patients with great saphenous vein (GSV) incompetence were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Clinical, etiological, anatomical and pathophysiological (CEAP) Classification and the Venous Clinical Severity Score (VCSS) were completed and investigated with a follow-up period of 1 year. Results: Total occlusion of great saphenous vein (GSV) was 88% in foam group as well as in the surgery group, recurrence rate in the foam group was 6% as well as in surgery group. Patient satisfaction at 1 year was 94% in foam group while in surgery group it was 90%. There were no statistical significant differences in follow up regarding VCSS, recurrence, patient satisfaction between both groups at 1 month, 6 months and 1 year (p value>0.001). Conclusion: Surgical treatment and UGFS achieved elevated rates of total occlusion of GSV incompetence with no significant difference. Both treatments led to significant improvements in VCSS, demonstrating improvements in clinical outcomes. UGFS is a valid noninvasive modality in management of great saphenous vein incompetence and is comparable to surgery.
{"title":"Duplex Guided Foam Sclerotherapy Versus Surgery in Management of Primary Varicose Veins","authors":"W. M. Gamal, Elammary Mk, A. Mohamed","doi":"10.4172/2329-6925.1000325","DOIUrl":"https://doi.org/10.4172/2329-6925.1000325","url":null,"abstract":"Background: Varicose veins is a major problem among adult population. It has a major effect on life quality as well as healthcare system resources, we aim in this study to compare ultrasound guided foam sclerotherapy (UGFS) with surgery in management of primary varicose veins patients and to measure patients’ satisfaction with either modalities. \u0000Methods: 100 lower limbs of 100 patients with great saphenous vein (GSV) incompetence were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Clinical, etiological, anatomical and pathophysiological (CEAP) Classification and the Venous Clinical Severity Score (VCSS) were completed and investigated with a follow-up period of 1 year. \u0000Results: Total occlusion of great saphenous vein (GSV) was 88% in foam group as well as in the surgery group, recurrence rate in the foam group was 6% as well as in surgery group. Patient satisfaction at 1 year was 94% in foam group while in surgery group it was 90%. There were no statistical significant differences in follow up regarding VCSS, recurrence, patient satisfaction between both groups at 1 month, 6 months and 1 year (p value>0.001). \u0000Conclusion: Surgical treatment and UGFS achieved elevated rates of total occlusion of GSV incompetence with no significant difference. Both treatments led to significant improvements in VCSS, demonstrating improvements in clinical outcomes. UGFS is a valid noninvasive modality in management of great saphenous vein incompetence and is comparable to surgery.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83124438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-29DOI: 10.4172/2329-6925.1000323
J. Rosenblum, Gazes Mi, S. Rosenblum, A. Karpf, N. Greenberg
Chronic wound care is a growing medical problem, reaching epidemic proportions worldwide. Even after the wound has healed, wound recurrence remains a significant issue, with rates approximating 40% in 6 months after healing. The authors evaluate a retrospective analysis of their wound care clinics healing and recurrence rates. The authors evaluate the efficacy of varying physical modalities on preventing recurrence of wounds after their healing. The authors take their evaluation out to one year.
{"title":"A Multicenter Evaluation of Chronic Ulcer Recurrence with the Use of Varying Mechanical Wound Healing Modalities","authors":"J. Rosenblum, Gazes Mi, S. Rosenblum, A. Karpf, N. Greenberg","doi":"10.4172/2329-6925.1000323","DOIUrl":"https://doi.org/10.4172/2329-6925.1000323","url":null,"abstract":"Chronic wound care is a growing medical problem, reaching epidemic proportions worldwide. Even after the wound has healed, wound recurrence remains a significant issue, with rates approximating 40% in 6 months after healing. The authors evaluate a retrospective analysis of their wound care clinics healing and recurrence rates. The authors evaluate the efficacy of varying physical modalities on preventing recurrence of wounds after their healing. The authors take their evaluation out to one year.","PeriodicalId":17397,"journal":{"name":"Journal of Vascular Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87474894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-29DOI: 10.4172/2329-6925.1000321
N. Schahab, A. Aksoy, Schamim Schahab, M. Steinmetz, Christian Berg, C. Schaefer, G. Nickenig, V. Tiyerili
`Aim: The aim of our study was to determine the effectiveness and safety of remote ischaemic conditioning (RIC) in combination with i.v. prostavasin as a method of treatment for patients with peripheral acral vasculopathy, presenting as critical ischemia of the digitals of upper and lower limbs at the time of presentation with either surgical nor interventional treatment option Method: 33 patients were included in this non-randomized, prospective pilot-study with compassionate use. Primary endpoints were healing of ulcerations and amputation free time, secondary endpoint was safety of RIC. For the RIC, a blood flow reduction in the extremities was held in 2 cycles for over 5 minutes (20 mmHg over the systolic blood pressure) with 5 minutes reperfusion. During this time the medical agents were infused through a superficial vein into index extremity transvenously. The medication included: 2500 i.e., Heparin bolus, 5 μg PGE-1 in a 50 mL syringe with an isotonic solution. In cases where a vascular occlusion was seen in angiography additionally to PGE-1, 20 mg rt-PA was infused. Results: In 33 cases, transcutaneous oxygen partial pressure (TcPO2) levels increased significantly from 33 ± 16 mmHg to 48 ± 13 mmHg (p=0.0005) after the therapy compared to baseline. In 33 cases there was an improvement from 55 ± 27 mmHg to 73 ± 27 mmHg (p ≤ 0.004) in the acral arterial pressure measurement. 31 patients showed significantly better perfusion and vascularisation of the ischemic extremity after the therapy demonstrated in acral oscillography (31/94%) and angiography (6/18%). In 16 cases ulcerations (n=20) healed after 15 sessions of RIC. There was no need of any major or minor amputation in all patients. Conclusion: The presented RIC therapy proved to be an effective and safe treatment in addition to best medical treatment for patients with acute acral vascular disorder, especially in acute digital ischaemia, without a surgical or an interventional option.
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