-
Fedor Lurie,
Anthony Comerota, Bo Eklof,
Robert L Kistner,
Nicos Labropoulos,
Joann Lohr,
William Marston,
Mark Meissner,
Gregory Moneta,
Peter Neglén,
Diana Neuhardt,
Frank Padberg,
Harold J Welsh
[show abstract]
[hide abstract]
ABSTRACT: This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test.
Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression-decompression).
The study enrolled 17 healthy volunteers and 57 patients with primary chronic venous disease. Repeatability of reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable (P < .05) when performed in the morning with the patient standing. The agreement between the clinical interpretations significantly depended on a selected cut point (Spearman's ρ, -0.4; P < .01). Interpretations agreed in 93.4% of the replicated measurements when a 0.5-second cut point was selected. The training intervention improved the frequency of agreement to 94.4% (κ = 0.9). Alternations of the time of the duplex scan, the patient's position, and the reflux-provoking maneuver significantly decreased reliability.
This study provides evidence to develop a new standard for duplex ultrasound detection of venous reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic reflux can significantly improve the reliability of reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2011; 55(2):437-45. · 3.52 Impact Factor
-
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2010; 52(5 Suppl):37S-38S. · 3.52 Impact Factor
-
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2010; 52(5 Suppl):3S-7S.e4. · 3.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Non-uniform terminology in the world's venous literature has continued to pose a significant hindrance to the dissemination of knowledge regarding the management of chronic venous disorders. This VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology, focusing on terms that were identified as creating interpretive problems, with the intent of promoting the use of a common scientific language in the investigation and management of chronic venous disorders. The VEIN-TERM consensus document is intended to augment previous transatlantic/international interdisciplinary efforts in standardizing venous nomenclature which are referenced in this article.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 03/2009; 49(2):498-501. · 3.52 Impact Factor
-
Journal of Vascular Surgery 01/2008; 46 Suppl S:84S-93S. · 3.21 Impact Factor
-
Journal of Vascular Surgery 01/2008; 46 Suppl S:1S-3S. · 3.21 Impact Factor
-
Mark H Meissner,
Thomas W Wakefield,
Enrico Ascher,
Joseph A Caprini,
Anthony J Comerota, Bo Eklof,
David L Gillespie,
Lazar J Greenfield,
Aiwu Ruth He,
Peter K Henke,
Anil Hingorani,
Russell D Hull,
Craig M Kessler,
Robert D McBane,
Robert McLafferty
[show abstract]
[hide abstract]
ABSTRACT: Acute venous disorders include deep venous thrombosis, superficial venous thrombophlebitis, and venous trauma. Deep venous thrombosis (DVT) most often arises from the convergence of multiple genetic and acquired risk factors, with a variable estimated incidence of 56 to 160 cases per 100,000 population per year. Acute thrombosis is followed by an inflammatory response in the thrombus and vein wall leading to thrombus amplification, organization, and recanalization. Clinically, there is an exponential decrease in thrombus load over the first 6 months, with most recanalization occurring over the first 6 weeks after thrombosis. Pulmonary embolism (PE) and the post-thrombotic syndrome (PTS) are the most important acute and chronic complications of DVT. Despite the effectiveness of thromboembolism prophylaxis, appropriate measures are utilized in as few as one-third of at-risk patients. Once established, the treatment of venous thromboembolism (VTE) has been defined by randomized clinical trials, with appropriate anticoagulation constituting the mainstay of management. Despite its effectiveness in preventing recurrent VTE, anticoagulation alone imperfectly protects against PTS. Although randomized trials are currently lacking, at least some data suggests that catheter-directed thrombolysis or combined pharmaco-mechanical thrombectomy can reduce post-thrombotic symptoms and improve quality of life after acute ileofemoral DVT. Inferior vena caval filters continue to have a role among patients with contra-indications to, complications of, or failure of anticoagulation. However, an expanded role for retrievable filters for relative indications has yet to be clearly established. The incidence of superficial venous thrombophlebitis is likely under-reported, but it occurs in approximately 125,000 patients per year in the United States. Although the appropriate treatment remains controversial, recent investigations suggest that anticoagulation may be more effective than ligation in preventing DVT and PE. Venous injuries are similarly under-reported and the true incidence is unknown. Current recommendations include repair of injuries to the major proximal veins. If repair not safe or possible, ligation should be performed.
Journal of Vascular Surgery 01/2008; 46 Suppl S:25S-53S. · 3.21 Impact Factor
-
Mark H Meissner, Bo Eklof,
Phillip Coleridge Smith,
Michael C Dalsing,
Ralph G DePalma,
Peter Gloviczki,
Gregory Moneta,
Peter Neglén,
Thomas O' Donnell,
Hugo Partsch,
Seshadri Raju
[show abstract]
[hide abstract]
ABSTRACT: Secondary chronic venous disorders (CVD) usually follow an episode of acute deep venous thrombosis (DVT). Most occluded venous segments recanalize over the first 6 to 12 months after an episode of acute DVT, leading to chronic luminal changes and a combination of partial obstruction and reflux. Such morphological changes produce venous hypertension with the highest levels of ambulatory venous pressure occurring in patients with combined outflow obstruction and distal reflux. The clinical manifestations of secondary CVD, including pain, venous claudication, edema, skin changes, and ulceration are commonly referred to as the post-thrombotic syndrome. Such sequelae are best avoided by early and aggressive treatment of proximal DVT. The diagnostic evaluation of secondary CVD is similar to primary CVD and is based upon duplex ultrasound. However, the definition of hemodynamically significant venous stenosis remains obscure and there are no reliable tests to confirm the presence of such lesions. Diagnosis depends more on anatomic rather than hemodynamic criteria, and IVUS is superior to venography in estimating the morphological degree and extent of iliac vein stenosis. The fundamental role of compression in the treatment of CVD is well recognized. Compliance with compression is essential to heal ulcers and minimize recurrence. The efficacy of various adjuncts to ulcer treatment, including complex wound dressings and medications have been variable. Although superficial venous surgery has not been demonstrated to improve ulcer healing rates, it does decrease ulcer recurrence. Deep venous valve reconstruction is performed in only a few specialized centers, and the results are better for primary than for secondary CVD. Treatment of incompetent perforating veins remains controversial. Although artificial venous valves are promising, most early experimental models have failed. With respect to venous obstruction, iliocaval angioplasty and stenting has emerged as the primary treatment for proximal iliofemoral venous obstruction with surgical bypass assuming a secondary role.
Journal of Vascular Surgery 01/2008; 46 Suppl S:68S-83S. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Endovenous laser (EVL) ablation of the great saphenous vein (GSV) is thought to minimize postoperative morbidity and reduce work loss compared with high ligation and stripping (HL/S). However, the procedures have not previously been compared in a randomized trial with parallel groups where both treatments were performed in tumescent anesthesia on an out-patient basis.
Patients with varicose veins due to GSV insufficiency were randomized to either EVL (980 nm) or HL/S in tumescent anesthesia. Miniphlebectomies were also performed. Patients were examined preoperatively and at 12 days, and 1, 3, and 6 months postoperatively. Sick leave, time to normal physical activity, pain score, use of analgesics, Aberdeen score, Medical Outcomes Study Short Form-36 quality-of-life score, Venous Clinical Severity Score (VCSS), and complication rates were investigated. The total cost of the procedures, including lost wages and equipment, was calculated. Cost calculations were based on the standard fee for HL/S with the addition of laser equipment and the standard salary and productivity level in Denmark.
A follow-up of 6 months was achieved in 121 patients (137 legs). The groups were well matched for patient and GSV characteristics. Two HL/S procedures failed, and three GSVs recanalized in the EVL group. The groups experienced similar improvement in quality-of-life scores and VCSS score at 3 months. Only one patient in the HL/S group had a major complication, a wound infection that was treated successfully with antibiotics. The HL/S and EVL groups did not differ in mean time to resume normal physical activity (7.7 vs 6.9 calendar days) and work (7.6 vs 7.0 calendar days). Postoperative pain and bruising was higher in the HL/S group, but no difference in the use of analgesics was recorded. The total cost of the procedures, including lost wages, was euro 3084 ($3948 US) in the HL/S and euro 3396 ($4347 US) in the EVL group.
This study suggests that the short-term efficacy and safety of EVL and HL/S are similar. Except for slightly increased postoperative pain and bruising in the HL/S group, no differences were found between the two treatment modalities. The treatments were equally safe and efficient in eliminating GSV reflux, alleviating symptoms and signs of GSV varicosities, and improving quality of life. Long-term outcomes, particularly with respect to recurrence rates, shall be investigated in future studies, including the continuation of the present.
Journal of Vascular Surgery 09/2007; 46(2):308-15. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared the hemodynamic effects of different mechanical devices aimed for prevention of travel-related deep venous thrombosis with active foot movements.
Two battery-operated intermittent pneumatic compression (IPC) devices and three foot and calf muscle pump facilitating devices (PFD) that claimed to prevent travel-related deep venous thrombosis were tested in 17 healthy volunteers on the ground and in 8 of same volunteers during flight. Flow changes during active foot movements were compared with the effects of each of the tested devices.
There was no significant difference in hemodynamic effect between PFDs and active foot movements. The hemodynamic effects of IPC devices were significantly less compared with active foot movements. Values obtained during air flights were not significantly different from those obtained on the ground.
Whereas IPC use for prevention of venous stasis during flight can be justified for immobile patients or during sleep, PFDs do not provide additional hemodynamic benefits compared with simple movements of the foot.
Journal of Vascular Surgery 11/2006; 44(4):889-91. · 3.21 Impact Factor
-
New England Journal of Medicine 09/2006; 355(5):488-98. · 53.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Current techniques to treat venous ulcerations and patients with severe lipodermatosclerosis include the elimination of incompetent perforator veins by open surgical ligation and division or by subfascial endoscopic perforator surgery. An alternative and less invasive means to obliterate perforator veins is ultrasound-guided sclerotherapy (UGS). We hypothesize that UGS is a clinically effective means of eliminating perforator veins and results in improvement of the clinical state (scores) without the complications associated with other more invasive methods.
Between January 2000 and March 2004, UGS was used to treat chronic venous insufficiency in 80 limbs of 68 patients. This was a clinical series of patients who had perforator incompetence and no previous surgery for venous disease < or = 2 years of their UGS procedure. Most had perforator disease without coexisting axial reflux of the saphenous or deep venous systems. Color flow duplex scanning was used to identify incompetent perforator veins in the calf, and duplex guidance was used to inject each perforator with the liquid sclerosant sodium morrhuate (5%). Patients were restudied by duplex scanning up to 5 years after treatment. Clinical results were determined by Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS) before and after treatment.
Of the 80 limbs treated with UGS, 98% of incompetent perforators were successfully obliterated at the time of treatment, and 75% of limbs showed persistent occlusion of perforators and remained clinically improved with a mean follow-up of 20.1 months. According to the CEAP classification, there were 46.2% with limb ulceration or C6, 1.2% C5, 28.7% C4, 17.5% C3, and 6.2% C2 with pain isolated to the site of the perforator(s). Of those who returned for follow-up, the VCSSs changed from a median of 8 before treatment (95% confidence interval [CI], 3 to 15) to a median of 2 after treatment (95% CI, 0 to 7) (P < .01). Likewise, VDSs dropped from a median of 4 before treatment (95% CI, 1 to 3) to 1 after treatment (95% CI, 0 to 2) (P < .01). There were no cases of deep vein thrombosis involving the deep vein adjacent to the perforator injected. One patient had skin complications with skin necrosis. Perforator recurrence was found more frequently in those with ulcerations than those without.
UGS is an effective and durable method of eliminating incompetent perforator veins and results in significant reduction of symptoms and signs as determined by venous clinical scores. As an alternative to open interruption or subfascial endoscopic perforator surgery, UGS may lead to fewer skin and wound healing complications. Perforator recurrence occurs particularly in those with ulcerations, and therefore, surveillance duplex scanning after UGS and repeat injections may be needed.
Journal of Vascular Surgery 03/2006; 43(3):551-6; discussion 556-7. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The relative deficiency of the official Terminologia Anatomica with regard to the veins of the lower limbs was responsible for a nonuniform anatomic nomenclature in the clinical literature. In 2001, an International Interdisciplinary Committee updated and refined the official Terminologia Anatomica regarding the veins of the lower limbs. Recommendations for terminology were included in an updating document that appeared in the Journal of Vascular Surgery (2002;36:416-22). To enhance further the use of a common scientific language, the committee worked on the present document, which includes (1) extensions and refinements regarding the veins of the lower limbs; (2) the nomenclature of the venous system of the pelvis; (3) the use of eponyms; and (4) the use of terms and adjectives of particular importance in clinical vascular anatomy.
Journal of Vascular Surgery 05/2005; 41(4):719-24. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There are no published reports on the association between ethnicity and outcome after aortoiliac stent grafting to treat aneurismal disease. Because Hawaii is a state with an ethnically diverse population, we conducted a retrospective study to examine this potential association. We hypothesized that individuals of Asian ancestry may have higher complication rates after endovascular repair compared with non-Asians.
All endovascular devices placed to treat aneurysm disease from 1996 to 2003 were evaluated in two institutions. The association between ethnicity and access-related and device-related complications, both periprocedural and delayed, was examined with logistic regression analysis.
Ninety-two aortoiliac endografts were placed during the study period, including 87 in patients with abdominal aortic aneurysms with or without iliac aneurysm disease, and five patients with isolated iliac artery aneurysms. Forty-four percent of patients were categorized as Asian, 39% as white, 16% as Pacific Islander, and 1% as African American. Access-related and device-related complications (ADRCs) occurred in 11 of 92 (12%) of these patients. The following parameters were significantly associated with ADRCs: Asian ethnicity (P =.015), age greater than 80 years (P =.02), and external iliac diameter smaller than 7.5 mm (P =.01). Asian patients were more likely to have experienced ADRCs than were non-Asian patients (odds ratio, 7.3; 95% confidence interval, 1.5-35.8; P =.015). Asians also had smaller external iliac artery diameters (P =.0003) and more tortuous iliac arteries (P =.03) compared with non-Asians. After adjusting for iliac artery diameter and tortuosity, the association between Asian ethnicity and ARDCs became nonsignificant (P =.074), which suggests that the association between race and complications may be at least in part due to small and tortuous iliac arteries. There was no association between age, gender, or ethnicity and postoperative detection of endoleak.
Our data indicate that individuals of Asian ancestry are far more likely to experience adverse access-related and device-related complications after aortoiliac stent grafting than are non-Asians. We found that this association is at least partly attributable to the smaller and more tortuous iliac arteries in persons of Asian ancestry.
Journal of Vascular Surgery 08/2004; 40(1):24-9. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Partial obstruction of postthrombotic veins is caused by endovenous scar tissue, which creates synechiae and septae that narrow and sometimes block the lumen. We have performed surgical disobliteration, or endophlebectomy, of chronically obstructed venous segments during various kinds of deep venous reconstructions to increase the flow through previously obstructed segments. In this article we describe the endophlebectomy technique, and report the availability of this procedure as an adjunct to deep venous reconstructions for the treatment of postthrombotic chronic venous insufficiency. Patients and methods Between July 1996 and February 2003, surgical disobstruction of 23 deep venous segments was performed in 13 patients in association with 14 deep venous reconstructions to treat advanced postthrombotic chronic venous insufficiency. Postthrombotic veins were surgically exposed, and a longitudinal venotomy was carried out at a variable length. The synechiae and masses attached to the intimal layer were carefully excised. Mean duplex scanning follow-up was 10.8 +/- 8.2 months (median, 8 months; range, 1-28 months).
In 10 patients (77%) the treated segments remained primarily patent at median follow-up of 8 months (range, 1-28 months). Early thrombosis near the endophlebectomy site occurred in 3 patients, at 2, 5, and 12 days, respectively, after surgery. In 2 patients with early thrombosis further interventions were carried out with success. In a third patient with early postoperative thrombosis the final outcome was recanalization and reflux. These results yielded an overall secondary patency rate of 93%. No perioperative pulmonary embolism was observed.
This series demonstrates that surgical disobliteration of postthrombotic deep veins is technically feasible, and led to patency of the segments for the duration of follow-up for up to 28 months (mean, 10.8 +/- 8.2 months). We used this technique with the objective of disobstructing postthrombotic veins, to increase flow through a previously narrowed lumen. Postoperative thrombosis at the site of endophlebectomy occurred in 23% of patients. Although this early experience is encouraging, further studies and longer follow-up are necessary to assess the durability of the procedure.
Journal of Vascular Surgery 06/2004; 39(5):1048-52; discussion 52. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We undertook this cross-sectional study to investigate the distribution of venous reflux and effect of axial reflux in superficial and deep veins and to determine the clinical value of quantifying peak reverse flow velocity and reflux time in limbs with chronic venous disease.
Four hundred one legs (127 with skin changes, 274 without skin changes) in 272 patients were examined with duplex ultrasound scanning, and peak reverse flow velocity and reflux time were measured. Both parameters were graded on a scale of 0 to 4. The sum of reverse flow scores was calculated from seven venous segments, three in superficial veins (great saphenous vein at saphenofemoral junction, great saphenous vein below knee, small saphenous vein) and four in deep veins (common femoral vein, femoral vein, deep femoral vein, popliteal vein). Axial reflux was defined as reflux in the great saphenous vein above and below the knee or in the femoral vein to the popliteal vein below the knee. Reflux parameters and presence or absence of axial reflux in superficial or deep veins were correlated with prevalence of skin changes or ulcer (CEAP class 4-6).
The most common anatomic presentation was incompetence in all three systems (superficial, deep, perforator; 46%) or in superficial or perforator veins (28%). Isolated reflux in one system only was rare (15%; superficial, 28 legs; deep, 14 legs; perforator, 18 legs). Deep venous incompetence was present in 244 legs (61%). If common femoral vein reflux was excluded, prevalence of deep venous incompetence was 52%. The cause, according to findings at duplex ultrasound scanning, was primary in 302 legs (75%) and secondary in 99 legs (25%). Presence of axial deep venous reflux increased significantly with prevalence of skin changes or ulcer (C4-C6; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.56-4.67). Of 110 extremities with incompetent popliteal vein, 81 legs had even femoral vein reflux, with significantly more skin changes or ulcer, compared with 29 legs with popliteal reflux alone (P =.025). Legs with skin changes or ulcer had significantly higher total peak reverse flow velocity (P =.006), but the difference for total reflux time did not reach significance (P =.084) compared with legs without skin changes. In contrast, presence of axial reflux in superficial veins did not increase prevalence of skin changes (OR, 0.73; 95% CI, 0.44-1.2). Incompetent perforator veins were observed as often in patients with no skin changes (C0-C3, 215 of 274, 78%) as in patients with skin changes (C4-C6, 106 of 127, 83%; P =.25).
Continuous axial deep venous reflux is a major contributor to increased prevalence of skin changes or ulcer in patients with chronic venous disease compared with segmental deep venous reflux above or below the knee only. The total peak reverse flow velocity score is significantly higher in patients with skin changes or ulcer. It is questionable whether peak reverse flow velocity and reflux time can be used to quantify venous reflux; however, if they are used, peak reverse flow velocity seems to reflect venous malfunction more appropriately.
Journal of Vascular Surgery 01/2004; 38(6):1336-41. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to investigate the blood flow changes and venous wall movements that occur in the perivalvular area during venous flow, to learn how these physiologic events influence the movements of the valve cusps, and to learn how the movements of the valve cusps influence the venous flow.
Twenty healthy volunteers (10 male, 10 female, age 18 to 52) were subjects of this study. Each volunteer was examined in semi-recumbent and standing positions at rest and during active foot movements. Ultrasound examinations were performed in the B-flow mode supplemented by B-mode and pulsed-wave Doppler scanning.
Four phases of the valve cycle are described. During the opening phase (0.27 +/- 0.05 s), the cusps move from the closed position toward the sinus wall. After reaching a certain point, the valves cease opening and enter the equilibrium phase. During this phase (0.65 +/- 0.08 s), the leading edges remain suspended in the flowing stream and undergo self-excited oscillations with an amplitude of 0.01 to 0.16 cm. During the closing phase (0.41 +/- 0.07 sec), the leaflets move synchronously toward the center of the vein. The subsequent closed phase has a duration of 0.45 +/- 0.05 seconds when the cusps remain closed. During the equilibrium phase, flow separation occurs at the leading edge of the cusp with reattachment at the wall of sinus. At this point, flow splits into two streams at each valve cusp. Part of the flow is directed into the sinus pocket behind the valve cusp, forming a vortex along the valve cusp before re-emerging in the main stream in the vein. When the valve is maximally open, the two cusps create a narrowing of the lumen about 35% smaller than the vein distal to the valve. In this narrowed area flow accelerates, forming a proximally directed jet.
The valve cusps undergo the four phases constituting the valve cycle. The local hemodynamic events, such as flow separation and reattachment, and vortical flow in the sinus play important roles in the valve operation. In addition to prevention of retrograde flow, the valve acts as a venous flow modulator. The vortical stream behind the valve cusps participates in the operation of the valve, and prevents stasis inside the valve pocket. The central jet possibly facilitates outflow.
Journal of Vascular Surgery 12/2003; 38(5):955-61. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Deep venous reflux resolution after great saphenous vein surgery has been reported, but the studies evaluated mainly patients with deep segmental reflux. We prospectively analyzed the effects of greater saphenous vein ablation on coexisting primary deep axial venous reflux compared with segmental venous reflux. Patients and methods Between February 1997 and June 2001, patients with primary deep venous reflux scheduled for greater saphenous vein surgery were included in the study. Limbs of patients with a history of deep venous thrombosis, thrombophlebitis, trauma, and orthopedic or venous surgery were excluded. After surgery, duplex scanning was repeated and patients were examined for persistent deep venous reflux.
Thirty-three patients (38 limbs) were followed up with duplex scanning. Follow-up ranged from 2 weeks to 38 months. Preoperative axial deep reflux was present in 17 extremities, and segmental reflux was present in 21. The total number of incompetent segments was 59. Overall reflux abolishment rate was similar in extremities with axial and segmental reflux (30% vs 36%; P >.05). When segments were analyzed individually, abolishment of superficial femoral vein reflux was observed more often in extremities with segmental reflux than those with axial reflux (odds ratio, 4). In the extremities where deep reflux was not abolished with greater saphenous vein ablation, degree of reflux did not change significantly (P >.1). Duplex scanning was performed more than once during follow-up in 9 patients. In 3 of these patients reflux resolved by the second follow-up evaluation, and in 2 reflux was decreased at the second and third follow-up evaluations.
In patients with concomitant deep and superficial venous reflux, saphenous vein ablation results in resolution of deep reflux in about a third of patients. Superficial femoral vein reflux is seldom corrected in limbs with axial reflux compared with those limbs with segmental reflux. To appreciate the effects of greater saphenous vein ablation, longer follow-up may be needed.
Journal of Vascular Surgery 09/2003; 38(3):517-21. · 3.21 Impact Factor
-
Claudio Allegra,
Pier-Luigi Antignani,
John J Bergan,
Patrick H Carpentier,
Philip Coleridge-Smith,
André Cornu-Thénard, Bo Eklof,
Hugo Partsch,
Eberhard Rabe,
Jean-François Uhl,
Marie-Therese Widmer
Journal of Vascular Surgery 02/2003; 37(1):129-31. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to investigate the three likely mechanisms of intermittent pneumatic compression (IPC) in deep vein thrombosis prophylaxis (increased volume flow, increased flow velocity, and acceleration of flow) and to do this in a variety of positions, in different venous segments, and with the stimulus of three different compression garments.
In 12 healthy volunteers, three types of compression cuffs were used: foot, calf, and calf + thigh. The foot was compressed with 80 mm Hg, and the calf and thigh with 40 mm Hg. Duplex ultrasound scan was performed before and during the compression in the horizontal, 15-degree head-down, and 15-degree head-up positions. The common femoral, greater saphenous, profunda femoral, superficial femoral, and popliteal veins were examined.
In comparison with the horizontal position, the 15-degree head-down position was associated with an increase of volume flow and velocities and the head-up position was associated with decreased flow and velocities in the deep veins. The application of IPC caused significant increases in velocities and volume flow in all venous segments. The lowest increase in velocities and volume flow in the deep veins was observed with the subjects in the head-down position, and in the two other positions, the increases were greater and similar to each other. IPC caused a much more prominent increase in flow velocities and volume flow in deep veins compared with simple elevation of the legs.
IPC produces significant increases of venous flow volume and flow velocity and acceleration of flow. This is true whether the limbs are elevated, horizontal, or dependent. Segmental flow changes vary with the position of the patient and the compression garment used. Foot compression increases volume flow and velocity primarily in the popliteal vein. Calf compression provides maximal increases of volume flow and flow velocity through the deep veins.
Journal of Vascular Surgery 02/2003; 37(1):137-42. · 3.21 Impact Factor
