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Femoral vein valvuloplasty (FVV) is the operation of choice for primary valvular incompetence, but this procedure is highly operator dependent for judging the competence of the valve repair during surgery. We have reviewed our experience with FVV, focusing on the utility of angioscopic-guided valve repair and hemodynamic results. Nine limbs in six patients underwent superficial FVV. There were four men and two women; the average age was 49 years (range 32 to 62 years). All limbs were Society for Vascular Surgery/International Society for Cardiovascular Surgery clinical stage III (venous ulcer), and descending phlebography showed grade 4 reflux in six limbs, grade 3 reflux in one limb, and grade 2 reflux in two limbs. In addition to FVV, five limbs underwent subfascial ligation of incompetent perforators and three limbs underwent ligation and stripping of superficial varicosities. Two limbs underwent polytetrafluoroethylene wrapping of the valvuloplasty. The last five valvuloplasties underwent angioscopic evaluation of the repair, and the last two procedures were closed valvuloplasties (without venotomy). Follow-up averaged 20.3 months (range 2 to 51 months). In all patients ulcers healed without recurrence. There were two perioperative deep vein thromboses in the polytetrafluoroethylene wrapped repairs. All superficial femoral veins were patent by duplex scanning at the time of follow-up. Venous refill time measured by light reflection rheography did not improve after surgery. Venous filling index measured by air plethysmography showed near normalization (3.83 +/- 0.82) after angioscopically guided FVV.(ABSTRACT TRUNCATED AT 250 WORDS)
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Between 1980 and August 1991, we encountered 11 non-infected aortic pseudoaneurysms after aortic surgery. The interval between the initial operation and revision varied from 1.8 to 26.8 years (mean 15.2 years). Three were found more than 20 years after operation. Pulling off of and degrading of the silk sutures were considered to be the causes. All patients underwent operative correction without mortality. In thoracic aortic pseudoaneurysm repair, a temporary bypass between the right axillary artery and left external iliac artery was generally adopted. There was no need for heparinization with this technique.
Nowadays most issues regarding venous disorders are described as chronic venous insufficiency (CVI)-which is defined as all symptoms that manifestate as impaired blood outflow from the lower limbs or in general the result of blood stasis in the deep and superficial venous system. Due to the fact that the symptomatology of venous diseases is wide, the treatment should be multioriented and often as well multi-specialized. The treatment of CVI needs a good understanding of the etiology of the primary insufficiency of the superficial and the deep venous systems. The main purpose of the surgical therapy is to remove the reflux in the great saphenous vein and the perforating veins. Additionally, during the surgical treatment the various veins should be removed in a way that gives the best cosmetic effect. In this article we presented the analysis of different surgical treatments in patients diagnosed with CVI 2-4 grade according to CEAP scale. The patients were hospitalized in our Clinic between april 1998 and april 2003. This group consisted of 311 patients, among them were 257 patients with primary varices, 25 patients with recurrent varices and 29 with postthrombotic syndrome. The choice of surgery was based on clinical examination and the result of venous USG. The most frequent (62%) surgical therapy was removal of the great saphenous vein with miniphlebectomy. To make the treatment more efficient we used the endoscopic method of obliteration of the insufficient perforating veins in lower limbs, called subfascial endoscopic perforating surgery (SEPS).
Currently, inflammation is considered to be the central player in the pathogenesis of atherosclerosis. It leads to the formation of multiple plaques in the arterial beds including coronary vasculature. Recent studies using the latest imaging techniques have shown that in patients with acute coronary syndromes (ACS) multiple plaques are ruptured and have thrombus formation on them. Various factors make these plaques unstable, these include structural components of plaque like thin fibrous cap, high lipid content of the plaque core and inflammation, both localized and generalized. It has been shown that most of the ACS are caused by plaques causing non-critical stenosis as seen on traditional X-ray angiography. Also, the phenomenon of remodelling makes angiography a poor technique for plaque visualization. Hence newer modalities are required to identify these "vulnerable plaques". Intravascular ultrasound (IVUS), thermography and Magnetic Resonance Imaging (MRI) are a few such promising techniques. Here we review the invasive and non-invasive modalities that can be helpful in the identification of these plaques before they become unstable and cause ACS, and also the available therapies to stabilize these plaques.
BACKGROUND: Endoscopic harvesting of the greater saphenous vein is increasingly used during cardiac surgery to improve patient satisfaction and reduce the wound complications associated with traditional open techniques. Although histologic studies suggest no significant difference in vein quality between these two techniques, long-term follow-up is lacking to address whether graft patency and event-free survival are influenced by the harvest method. METHODS: A total of 112 isolated coronary artery bypass patients were prospectively randomized to have veins harvested using either an endoscopic (n = 54) or traditional (n = 58) technique. Groups were demographically similar with regard to preoperative risk stratification and coronary procedures performed. Event-free survival (freedom from death, myocardial infarction, or recurrent angina) and use of outpatient resources for resolution of wound complications were determined. Follow-up was 100% at 5 years. RESULTS: Five-year actual event-free survival was similar in patients with endoscopic versus traditionally harvested v e ins (75% versus 74%, P =.85). The number of outpatient office visits required to manage each wound complication to complete resolution was significantly less following endoscopic versus traditional vein harvest (1.5 versus 6 visits, P =.001). CONCLUSIONS: Wound complication management following endoscopic versus traditional vein harvest requires less resource utilization. Five-year follow-up of a prospective randomized trial demonstrates that use of endosco pic versus traditionally harvested saphenous veins does not influence event-free survival.
BACKGROUND: Endoscopic vessel harvest for coronary artery bypass conduit has become a routine procedure. With the advancement of endoscopic equipment, radial arteries can be safely harvested with excellent cosmetic results. METHODS: One hundred consecutive patients undergoing coronary artery bypass grafting underwent endoscopic radial artery harvest without complications requiring intervention. The vessel was accessed through a 3-cm long, longitudinal incision performed several millimeters medial to the palpated artery to avoid the lateral antebrachial cutaneous nerve. Commercially available endoscopic retractors, using ultrasonic or direct-current shears, were used to ligate side branches and mobilize the pedicled artery and satellite veins. Ligation was performed with clips at the wrist, endo-loops proximally, and endoshears for transection. RESULTS: Patient age ranged from 42 to 88 years; 70% of the patients were men, and 26% were diabetic. Le f t radial arteries were preferentially harvested. All arteries were used and no further conduit was needed because of inadequate length. In 2 patients subcutaneous hematomas formed postoperatively and resolved without exploration. Although some thenar dysthesia was present in 14 patients, no permanent neurovascular injuries occurred. There were no infections, although skin edges did get traumatized from the retractor. COMMENT: Radial arteries can be harvested in a reproducible, safe, and efficient manner wi th less morbidity and better patient satisfaction.
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The aim of this study was to evaluate microvascular assessment in patients with Behcet disease (BD) by means of an intravital videocapillaroscopic study. Sixteen BD patients were compared with an equivalent group of healthy subjects matched for age and sex. Videocapillaroscopy (VCP) was performed in peripheral areas and in conjunctiva, and morphological and quantitative parameters were assessed. In both areas VCP showed several morphological alterations (microaneurysms, megacapillaries, desertification areas) detectable in a high percentage of patients; quantitatively we found significant changes of incisuring and sludging score, of capillary loop intermediate branch length (in peripheral areas) and of arteriole/venule diameter (in conjunctiva). Therefore, vessel involvement included both the number and the whole vessel structure and was seen both in peripheral and conjunctival areas when the two different vascular beds of micro- and paramicrocirculation were examined. We conclude that an important rearrangement of microcirculation is detectable in BD and that VCP may have diagnostic and prognostic value, providing qualitative and quantitative information able to define the systemic extension of vascular damage and the degree of vessel wall alteration.