Prospective randomized controlled trial: conventional versus powered phlebectomy.

Objectives: Transilluminated powered phlebectomy (TriVex) is a new surgical technique that uses tumescent dissection, transillumination, and powered phlebectomy. The purpose of this study was to compare TriVex with conventional varicose vein surgery in terms of pain, cosmesis, recurrence, complications, and operating time.

Methods: One hundred eighty-eight limbs in 141 patients (33 men, 108 women; mean age, 42.

Endovascular approach to abdominal aortic aneurysms limits the postoperative systemic immune response.

Objectives: endovascular repair of abdominal aortic aneurysms (E-AAA) has in recent years developed as an alternative to the conventional open repair (C-AAA). Adverse outcomes following the open approach may relate to immune cell activation and the systemic inflammatory response syndrome (SIRS) and organ failure but the benefits in this respect of the endovascular approach are unclear. This study evaluated this question and focused on T-cell activation and function.

Tibial and peroneal artery bypasses using polytetrafluoroethylene (PTFE) with an interposition vein cuff.

Unlabelled: The combined results of femoro-distal bypasses using prosthetic material with vein cuffs from two separate vascular units is presented.

Method: Over the last five years, 89 infrainguinal bypasses using polytetrafluoroethylene (PTFE) with a distal interposition vein cuff to a tibial artery have been performed in two centres. All operations were for critical limb ischaemia.

Contralateral stenosis and stump pressures: parameters to identify the high risk patient undergoing carotid endarterectomy under local anaesthesia.

Carotid endarterectomy (CEA) under local anaesthesia (LA) enables the assessment of the two parameters of stump pressure and contralateral stenosis as predictors of neurological complications both intra- and postoperatively. Over a 7 year period, 175 carotid endarterectomies were performed under LA and of these, stump pressure measurements and angiographic findings were recorded on 99 patients. There were no deaths, two patients (2.

New approaches in the medical management of venous ulceration.

This literature survey of the medical treatment of venous ulcers of the lower extremities discusses five classes of agents: (1) fibrinolytics, (2) hydroxyrutosides, (3) prostaglandins, (4) methylxanthines, and (5) others. The authors conclude that all these agents require further research.

Lipoprotein [Lp(a)] and peripheral vascular disease.

Lipoprotein(a) [Lp(a)], which combines structural elements of the lipid and fibrinolytic systems, is a major independent risk factor for the development of coronary heart disease. Eighty-four consecutive patients with peripheral vascular disease (of whom 42 had concomitant ischaemic heart disease) and 43 healthy controls were enrolled in a case-control study. We found that the mean Lp(a) concentration in male patients with peripheral vascular disease (PVD) was almost threefold higher than that of controls, while in female patients the Lp(a) concentration was more than twice that of controls.

The profunda femoris: a durable outflow vessel in aortofemoral surgery.

Aorta-common femoral artery bypass is the standard operation for relief of aortoiliac occlusive disease. When extensive superficial femoral artery disease coexists, the profunda femoris, even in its distal portion, may be used as the outflow vessel. To test this assumption we compared cumulative patency, limb salvage, and the need for distal bypass of 134 aorta-profunda femoris and 151 aorta-common femoral artery bypasses performed consecutively for aortoiliac occlusive disease over a 12-year period.

Foreign body complications of central venous catheterisation in critically ill patients.

In three critically ill patients, central venous catheter--associated foreign bodies were identified while the patients were in the intensive care unit. Two patients had fragments of retained catheter; in the third patient a guide-wire was lost within the vascular tree. The catheter fragments were associated with clinical symptoms while side effects were not observed with loss of the guide-wire.

A new technique for bilateral iliac vein and inferior vena cava reconstruction using reinforced polytetrafluoroethylene.

We report on the management of a patient with intractable venous claudication and ulceration due to bilateral iliac vein and inferior vena cava occlusion. An inverted V graft was constructed from two 8 mm diameter reinforced PTFE grafts. The upper end was anastomosed to the inferior infrarenal vena cava and the lower ends anastomosed to the common femoral veins.

Oxpentifylline treatment of venous ulcers of the leg.

Objective: To determine the effect of oxpentifylline on the healing of venous ulcers of the leg.

Design: Double blind, randomised, prospective, placebo controlled, parallel group study.

Setting: Four outpatient clinics treating leg ulcers in England and the Republic of Ireland.

Congenital arteriovenous malformation of the scalp with high output cardiac failure: a case report.

A 19-year-old man was diagnosed with a rapidly enlarging arteriovenous malformation of the scalp and a mild degree of cardiomegaly. Operation to excise the large fistula took place under general anesthesia. Both external carotid arteries and their branches were controlled to prevent intraoperative hemorrhage, and dissection took place down to the periosteum.

Intravenous pentoxifylline in the treatment of rest pain: a preliminary report.

Twenty patients with ischemic rest pain were treated with intravenous pentoxifylline, 1,200 mg daily, for up to three weeks. Ten patients obtained sufficient relief to avoid surgical intervention. Seven of these had complete or near complete relief of rest pain, but the other three required continuing analgesia.

Can pre-operative duplex scanning replace pre-operative short saphenous venography as an aid to localizing the sapheno-popliteal junction?

The accuracy of Duplex ultrasound scanning in locating the sepheno-popliteal junction (SPJ) was assessed by comparison with clinical examination and short saphenous venography. Twenty-three legs with varicosities of the short saphenous system had their SPJ located by Duplex scanning and marked pre-operatively. Varicography was performed on all patients.

Indium-111 labeled platelet deposition following transfemoral angiography.

The incidence of thromboembolitic events in patients undergoing transfemoral angiography was examined using indium-111 labeled platelets. Twenty-seven patients received approximately 300 muCi of autologous labeled platelets at least 3 hours before angiography and were scanned with a gamma camera immediately before and after angiography. All patients were free of clinically obvious complications in the 1-2 day period after angiography.

Stenosis following carotid endarterectomy.

Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation but the incidence of restenosis is unknown. During a four year period 80 endarterectomies of the internal carotid artery were performed in 73 patients. Post-operatively we studied our patients prospectively by means of Doppler ultrasound in combination with real time spectral analysis and where indicated digital venous angiography to determine the incidence of restenosis.

Asymptomatic carotid stenosis: is prophylactic endarterectomy justifiable?

Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation; however, its role in the management of asymptomatic stenosis of the internal carotid artery remains controversial. Over a 4 year period 190 patients with 209 asymptomatic stenoses of the internal carotid artery were prospectively studied by means of Doppler ultrasound in combination with real time spectral analysis to determine the natural history of asymptomatic carotid stenosis. We report a cumulative stroke-free survival of 97 per cent at 3 years and we therefore question the merit of prophylactic endarterectomy in the management of asymptomatic carotid disease.

Carotid ultrasonic arteriography combined with real time spectral analysis: a comparison with angiography.

In a one year period, 400 patients were examined by carotid ultrasonic arteriography combined with real time sound spectral analysis. Contrast arteriography was performed on 112 patients. The noninvasive examinations and contrast arteriograms of these patients were reviewed by two independent observers, who were unaware of the findings of the other diagnostic modality.