Follow up consisted of clinical evaluation, ankle-brachial index measure- Download full-text
ments and duplex scanning.
Results The mean follow-up time was 30.1 months. The mean length
of the endarterectomised SFAs was 29 cm (range, 15–43 cm). The five year
cumulative primary patency rate by means of life table analysis was
45.8?4.4% (SE). Percutaneous transluminal balloon angioplasty and surgi-
cal re-interventions were performed in thirty three and five patients respec-
tively resulting in a primary assisted patency rate of 57.5?4.1%. The five year
secondary patency rate was 65.6?3.8%. Limb salvage was achieved in 35 of
the 41 patients with gangrene.
Conclusions The long term results of ultrasonic SFA endarterectomy
suggest this is an effective technique.
An “All-Comers” Venous Duplex Scan Policy for Patients with Lower
Limb Varicose Veins Attending a One-stop Vascular Clinic: Is It
Makris S.A., Karkos C.D., Awad S., London N.J.M.. Eur J Vasc Endovasc
Objective To determine whether clinical assessment could predict the
correct management of patients with varicose veins (VVs), select those who
would need duplex scanning, and identify deep venous reflux (DVR).
Methods Prospective study of 342 consecutive limbs with VVs. These
were divided into 3 groups: 170 (50%) limbs with primary VVs without skin
changes (group I), 37 (11%) with recurrent VVs without skin changes
(group II), and 135 (39%) with primary or recurrent VVs with skin changes
(group III). Clinicians were asked to document whether they would nor-
mally request a duplex scan because of clinical uncertainty. Agreement
between decision-making based on clinical and on duplex findings was
Results Agreement between clinical and duplex findings for groups I,
II, and III was 82%, 59%, and 67%, respectively. In 112 cases (66%) in group
I, clinicians felt certain about the diagnosis and yet duplex scanning revealed
they were wrong in 12% of cases. In group II, clinicians would request a
duplex scan because of clinical uncertainty in 30 (81%) cases. In group III,
the sensitivity, specificity, positive and negative predictive value of clinical
assessment in detecting DVR was 32%, 77%, 24%, and 83%, respectively.
Conclusions Clinical evaluation of patients with VVs is unreliable in
planning their management. Clinicians can neither predict those who will
require duplex scanning nor correctly identify DVR. Even experienced
surgeons often “get it wrong” when assessing primary uncomplicated veins
imaging policy should be implemented if optimal management is to be
Knee versus Thigh Length Graduated Compression Stockings for
Prevention of Deep Venous Thrombosis: A Systematic Review
Sajid M.S., Tai N.R.M., Goli G., Morris R.W., Baker D.M., Hamilton G..
Eur J Vasc Endovasc Surg 2006;32:730-36.
Objective Graduated compression stockings are a valuable means of
thrombo-prophylaxis but it is unclear whether knee-length (KL) or thigh
length (TL) stockings are more effective. The aim of this review was to
ing length and efficacy of thromboprophylaxis.
Method A systematic review of the literature was undertaken. Clinical
trials on hospitalised populations and passengers on long haul flights were
selected according to specific criteria and analysed to generate summated
Results 14 randomized control trials were analysed. Thirty six of 1568
(2.3%) participants randomised to KL stockings developed a deep venous
thrombosis, compared with 79 of 1696 (5%) in the TL control/thigh length
group. Substantial heterogeneity was observed amongst trials. KL stockings
had a significant effect to reduce the incidence of DVT in long haul flight
passengers, odds ration 0.08 (95%CI 0.03–0.22). In hospitalised patients
KL stockings did not appear to be far worse than TL stockings, odds ratio
1.01 (95%CI 0.35–2.90). For combined passengers and patients, there was
a benefit in favour of KL stockings, weighted odds ratio 0.45 (95% CI
Conclusion KL graduated stockings can be as effective as TL stockings
for the prevention of DVT, whilst offering advantages in terms of patient
compliance and cost.
JOURNAL OF VASCULAR SURGERY
Volume 44, Number 6