RESUMO
BACKGROUND: Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. METHODS: We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. RESULTS: We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). CONCLUSION: Day of surgery appears to impact on patients' length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.
Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Artéria Femoral/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Alta do Paciente/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricosRESUMO
INTRODUCTION: This prospective study of foam sclerotherapy for varicose veins aimed to determine the outcomes of treatment including ulcer healing and complication rates in our unit. Data were collected prospectively over a 10-year period and maintained on a database by our vascular sciences unit, which performed the planning and post-treatment venous duplex scans. Patients undergoing treatment due to venous ulceration were identified from this database. An initial cohort of patients underwent a follow-up scan and assessment at one year. MATERIALS AND METHODS: Patients were treated with foam sclerotherapy, in multiple sessions if required, to occlude all incompetent superficial veins greater than 3 mm in size. We used 3% sodium tetradecyl sulphate as our sclerosing agent, according to our departmental protocol, followed by a period of compression therapy. Patients underwent pre- and post-treatment scans to assess venous competence, the effects of treatment and any complications that arose. RESULTS: We identified 336 patients treated for clinical, aetiological, anatomical and pathophysiological stage 5/6 venous ulceration. At six weeks post-treatment, 21% had fully healed ulcers and a further 46.1% were clinically improving with no further venous incompetence. The remainder continued treatment. An initial cohort of 162 patients was assessed at one year and 77.1% ulcers remained healed. The remainder demonstrated some venous incompetence and ultimately 12.5% required further treatment. Our complication rates were similar to those quoted in published meta-analyses including a deep vein thrombosis rate of 1.16%. CONCLUSIONS: Foam sclerotherapy remains a useful treatment option for venous ulceration with a low morbidity rate.
Assuntos
Escleroterapia , Úlcera Varicosa/terapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Cicatrização/efeitos dos fármacosRESUMO
OBJECTIVES: Evaluation of the prognostic ability of the APACHE-AAA model in an independent group of post-operative (open) Abdominal Aortic Aneurysm (AAA) patients. METHODS: The model was applied to predict in-hospital mortality in 541 patients (325 elective and 216 emergencies; 489 from Oxford; 52 from Lewisham). Multi-level modelling was used to adjust for both the local structure and process of care and patient case-mix. Model performance was assessed using goodness-of-fit and subgroup analyses. RESULTS: The model's predictive ability to discriminate between dead and alive patients was very good (ROC area=0.84). The model achieved a good fit across all strata of risk (Hosmer-Lemeshow C-test (8, N=476)=7.777, p=0.456) and in all subgroups. The model was able to rank the ICUs according to their performance independently of the patient case-mix. CONCLUSION: The APACHE-AAA model accurately predicted in-hospital mortality in a population of patients independent of the one used to develop it, confirming its validity. The multi-level methodology employed has shown that patient outcome is not only a function of the patient case-mix but instead predictive models should also adjust for the individual hospital-related factors (structure and process of care).
Assuntos
APACHE , Aneurisma da Aorta Abdominal/mortalidade , Mortalidade Hospitalar , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Análise Discriminante , Inglaterra/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Modelos Estatísticos , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Curva ROC , Medição de RiscoRESUMO
BACKGROUND: Sympathetic activation may limit exercise performance by restraining muscle blood flow or by negatively affecting skeletal muscle metabolic behavior. To test this hypothesis, we studied the effect of thoracoscopic sympathetic trunkotomy (TST) on forearm exercise duration, blood flow, and muscle bioenergetics in 13 patients with idiopathic palmar hyperhidrosis. METHODS AND RESULTS: Heart rate and beat-by-beat mean arterial pressure were recorded at rest and during right and left rhythmic handgrip before and 4 to 7 weeks after right TST. Forearm blood flow was measured bilaterally at rest and on the right during exercise. Right forearm muscle phosphocreatine content and intracellular pH were assessed by (31)phosphorus magnetic resonance spectroscopy. After right TST, exercise duration increased from 8.9+/-1.4 to 13.4+/-1.8 minutes (P<0.0001) with the right forearm and from 5.7+/-0.4 to 7.6+/-0.9 minutes (P<0.05) with the left (P<0.05 for the interaction between treatment and side). Right forearm blood flow at rest was 66% higher (P<0.01) after right TST, but this difference decreased as the exercise progressed. After right TST, a significant reduction occurred in muscle acidification and phosphocreatine depletion during ipsilateral forearm exercise. This was associated with a significantly reduced mean arterial pressure response to right handgrip, whereas the pressor response to left handgrip did not change. CONCLUSIONS: Sympathetic denervation of the upper limb significantly improves forearm skeletal muscle bioenergetics and exercise performance in patients with idiopathic palmar hyperhidrosis.
Assuntos
Metabolismo Energético , Contração Muscular/fisiologia , Músculo Esquelético/inervação , Músculo Esquelético/metabolismo , Simpatectomia , Adulto , Feminino , Antebraço/irrigação sanguínea , Antebraço/fisiologia , Força da Mão/fisiologia , Insuficiência Cardíaca/metabolismo , Humanos , Hiperidrose/cirurgia , Espectroscopia de Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Isótopos de Fósforo , Esforço Físico/fisiologia , Fluxo Sanguíneo Regional , Descanso/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Sistema Nervoso Simpático/cirurgiaRESUMO
BACKGROUND: Carotid angiographic plaque surface morphology is a powerful risk factor for stroke and systemic vascular risk. However, the underlying pathology is unclear, and a better understanding is required both to evaluate other forms of carotid imaging and to develop new treatments. Previous studies comparing angiographic plaque surface morphology with pathology have been small and unblinded, and the vast majority assessed only the crude macroscopic appearance of the plaque. We performed the first large study comparing angiographic surface morphology with detailed histology. METHODS AND RESULTS: Carotid plaque surface morphology was classified as ulcerated, irregular, or smooth on 128 conventional selective carotid artery angiograms from consecutive patients undergoing endarterectomy for severe symptomatic stenosis. Blinded angiographic assessments were compared with 10 histological features recorded on detailed microscopy of the plaque using reproducible semiquantitative scales. Angiographic ulceration was associated with plaque rupture (P=0.001), intraplaque hemorrhage (P=0.001), large lipid core (P=0.005), less fibrous tissue (P=0.003), and increased instability overall (P=0.001). For example, angiographically ulcerated plaques were much more likely than smooth plaques to be ruptured (OR=15.4, 95% CI=2.7 to 87.3, P<0.001), show a large lipid core (OR=26.7, 95% CI=2.6 to 270, P<0.001) or a large hemorrhage (OR=17.0, 95% CI=2.0 to 147, P=0.02). The equivalent odds ratios for angiographically irregular versus smooth plaque were 6.3 (1.3 to 31, P=0.02), 6.7 (1.5 to 30, P=0.008), and 9.2 (1.1 to 77, P=0.02), respectively. CONCLUSIONS: In contrast to previous studies based on macroscopic assessment, we found very strong associations between detailed histology and carotid angiographic plaque surface morphology. Plaque surface morphology on carotid angiography is a highly sensitive marker of plaque instability. Studies of the predictive value of MR- and CT-based lumen contrast plaque surface imaging are required.
Assuntos
Angiografia/métodos , Doenças das Artérias Carótidas/patologia , Radiografia Intervencionista , Idoso , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/metabolismo , Doenças das Artérias Carótidas/cirurgia , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/metabolismo , Complicações do Diabetes/patologia , Complicações do Diabetes/cirurgia , Endarterectomia das Carótidas , Feminino , Fibrose , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Método Simples-Cego , Fumar/epidemiologia , Propriedades de SuperfícieRESUMO
BACKGROUND: A randomized controlled study was undertaken to compare heparin with heparin plus graduated compression stockings (Brevet Tx, Seton Healthcare) in the prophylaxis of deep vein thrombosis (DVT) following abdominal surgery. METHODS: Sixty high-risk patients were recruited if they met at least two of the following criteria identified as predisposing to DVT: age greater than 39 years, malignancy, varicose veins, cardiac disease or hypertension, diabetes mellitus, obesity or previous thromboembolic episode. All patients received subcutaneous heparin and were randomized to receive Brevet Tx to either the right or left leg before surgery. The stocking was worn for 2 weeks after surgery. The patients underwent duplex imaging before surgery, and at 3, 6 and 14 days after operation. All scans were performed by one sonographer. The policy was to perform a venogram where a positive result was indicated by duplex scanning. RESULTS: Fifty-six patients completed the study. Six patients (11 per cent) suffered a DVT in the non-stockinged leg, but none in the stockinged leg (P = 0.016, McNemar's test). The DVTs occurred on days 3, 6, 7, 8, 9 and 12 following surgery. CONCLUSION: Brevet Tx in addition to low-dose subcutaneous heparin significantly reduced the incidence of DVT in high-risk patients undergoing abdominal surgery.
RESUMO
BACKGROUND: Carotid endarterectomy (CEA) has been an evidence-based treatment for symptomatic severe carotid stenosis since 1991. Surgical techniques and patient selection have changed over the years. The results of CEA in a single centre over a 23-year period were reviewed. METHODS: Prospectively gathered preoperative, operative, postoperative and long-term follow-up data were analysed. Routine intraoperative shunting and patch closure has been used since 1988. Data were analysed using the chi2 test or by logistic regression, adjusting for age at operation and date of operation. RESULTS: Five hundred and seventy-three CEAs (37 bilateral and three repeat procedures) were carried out on 533 patients. Trainees performed an increasing proportion of CEAs from 1996 to 1998 (15, 50 and 56 per cent respectively). The perioperative death rate was 0.8 per cent and the rate of any perioperative neurological deficit was 6.9 per cent. Other causes of morbidity included nerve injury (5.1 per cent) of which the commonest was to the hypoglossal nerve (2.7 per cent). During follow-up (median 4 (range 0-22) years) there were 81 neurological events (15.9 per cent) which included 35 ipsilateral (6.6 per cent) and 18 contralateral (3.4 per cent) strokes. There was no significant difference in outcome for grade of surgeon, intraoperative shunting or patch closure. Major causes of death were cardiac death (74; 14.6 per cent) followed by stroke (23; 4.5 per cent) and cancer (20; 3.9 per cent). CONCLUSION: The introduction of routine intraoperative shunting and patch closure, as well as allowing surgical trainees to perform supervised CEAs, has not affected perioperative morbidity and mortality rates or long-term outcome.
RESUMO
Conventional long chain triglyceride (LCT) was compared with a new emulsion containing 50% medium chain triglyceride (5% MCT/5% LCT) in a randomized cross-over trial of 10 days duration. Plasma concentrations of albumin, prealbumin, the complement components C3 and C4, and prothrombin times measured daily at 8 am, before lipid infusion, showed no progressive change during the 10 days of the trial, nor in each separate 5-day period when LCT or MCT/LCT was infused. Aspartate transaminase and alkaline phosphatase activities were similar over the two periods. There was a significant increase (compared with preinfusion levels) in C3 and C4 levels after 5 hr of either lipid infusion. Nitrogen balance was improved, and plasma bilirubin levels were lower on the regimen containing MCT/LCT.
Assuntos
Complemento C3/análise , Complemento C4/análise , Emulsões Gordurosas Intravenosas/farmacologia , Fígado/fisiopatologia , Nitrogênio/metabolismo , Nutrição Parenteral Total/métodos , Triglicerídeos/farmacologia , Adulto , Idoso , Bilirrubina/sangue , Combinação de Medicamentos/farmacologia , Emulsões Gordurosas Intravenosas/administração & dosagem , Feminino , Glicerol/farmacologia , Humanos , Fígado/efeitos dos fármacos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Peso Molecular , Fosfolipídeos/farmacologia , Estudos Prospectivos , Óleo de Soja/farmacologia , Triglicerídeos/administração & dosagem , Triglicerídeos/metabolismoRESUMO
In a retrospective study of tracheoesophageal fistula repairs in the Oxford Region, 1968 to 1982, 64 consecutive cases were classified according to Waterston group and gap length (less than 2 cm or greater than 2 cm); where possible their current status was assessed by interview or questionnaire. Waterston group and gap length varied independently. Both affected the course of the first admission but thereafter, Waterston classification was a poor prognostic guide. However, those with a long gap were significantly more likely to have respiratory and swallowing difficulties and stunted growth.
Assuntos
Atresia Esofágica/classificação , Fístula Traqueoesofágica/classificação , Atresia Esofágica/mortalidade , Atresia Esofágica/cirurgia , Seguimentos , Humanos , Lactente , Recém-Nascido , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Fístula Traqueoesofágica/mortalidade , Fístula Traqueoesofágica/cirurgiaRESUMO
Simple Doppler was compared with routine arteriography in assessing patency of the arteries at the ankle and the pedal arch. Fifty-six limbs were evaluated--29 with rest pain or trophic lesions, 20 with claudication, and 7 without symptoms. On Doppler examination 177 of 220 (80%) vessels were assessed patent, compared with 127 of 220 (58%) on arteriography. Of the 49 judged occluded on arteriograms, 59% were patent by Doppler and of 44 in which arteriograms were inadequate 82% had Doppler signals. Doppler signals could be heard in 20 of 177 (11%) vessels only with the feet dependant. This prospective, double-blind study provides numerical data to support the observation that a simple Doppler probe can detect patent distal vessels which may not be demonstrated by routine arteriography. This allows selection of patients for further more detailed arteriograms or for operative exploration with a view to distal bypass grafting.
Assuntos
Tornozelo/irrigação sanguínea , Arteriosclerose/diagnóstico , Pé/irrigação sanguínea , Ultrassonografia , Idoso , Angiografia , Artérias/patologia , Arteriosclerose/diagnóstico por imagem , Arteriosclerose/patologia , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The aim of the study was to assess the impact of the introduction of femorodistal arterial bypass grafting on the patterns of lower limb amputation and reconstructive surgery, in particular the success rates of distal, conservative, amputations. Two 2-year cohorts of patients 7 years apart were analysed by a retrospective analysis of departmental audit and patient records. Significantly more patients undergoing distal amputation were considered to have reconstructible arterial disease in the later cohort. This was paralleled by an increase in the rate of suprapopliteal/popliteal and distal arterial bypass and a fall in below-knee amputation rate in this group of patients. The overall healing rate and rate of conversion of distal amputations were not adversely affected by the introduction of femorodistal bypass grafting, despite the fact that more distal amputees were non-diabetic in this second group. There was a high rate of success for distal amputations combined with femorodistal bypass, but the subgroup was too small for statistical analysis. We conclude that the use of distal amputation, with or without distal arterial bypass, offers a promising, although unproven, prospect for lower limb conservation even in non-diabetics.
Assuntos
Amputação Cirúrgica/métodos , Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular/métodos , Artéria Femoral/cirurgia , Perna (Membro)/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Fourty-six patients with a clinical diagnosis of acute appendicitis were laparoscoped before exploration. As a result the diagnosis was revised in 10 patients (22%). With experience the laparoscopic features of appendicitis can be recognised confidently so reducing the number of normal appendices removed.
Assuntos
Apendicite/diagnóstico , Laparoscopia , Abdome , Doença Aguda , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologiaRESUMO
A total of 195 patients with benign peptic oesophageal strictures treated by endoscopic dilatation and antireflux medication between July 1977 and July 1986 were studied prospectively to determine the effect of such treatment on the subsequent course of this disease. Of the patients, 58% were female and they were significantly older than the males at the time of initial presentation (75 years vs 68 years, P less than 0.0001). 46% of both sexes required only one dilatation but the men required more dilatations over a longer period: 31% males vs 19% females required more than 3 dilatations (P less than 0.05) and 40% males vs 27% females were being dilated 2 years or more after the initial dilatation (P less than 0.05). Dilatation combined with antireflux medication is clearly an effective method of management for most patients with peptic oesophageal strictures. The value of antireflux surgery requires evaluation for that subset of patients, predominantly males, who require long-term and repeated dilatation.
Assuntos
Alginatos/uso terapêutico , Antiácidos/uso terapêutico , Dilatação , Estenose Esofágica/terapia , Esofagite Péptica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose Esofágica/tratamento farmacológico , Estenose Esofágica/etiologia , Esofagite Péptica/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
In a 1-year period, 13 patients underwent duplex-guided compression (DGC) of femoral artery false aneurysms. Of the 13 false aneurysms, 11 arose after cardiac catheterisation, and DGC was successful in 10 (77%) cases. The number of percutaneous cardiological procedures has risen over the past 5 years, and with time a greater proportion of these procedures have become more complex, involving coronary angioplasty or coronary stenting. The rate of vascular complications has risen from 0.2% in 1991-1992 to 0.61% in 1994-1995. Duplex-guided compression has reduced the number of operations performed for the vascular complications of percutaneous cardiological procedures by 50%. No complications have arisen from DGC, and it is recommended as the first line of management for femoral artery false aneurysms after percutaneous cardiological procedures.
Assuntos
Falso Aneurisma/terapia , Artéria Femoral/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PressãoRESUMO
In order to test the hypothesis that medium chain triglycerides (MCT's) are a safe and potentially superior energy source during parenteral nutrition 13 patients were entered into a randomised cross over trial. They received either a long chain triglyceride emulsion (LCT) or a 50% medium chain (MCT)/50% LCT mixture as part of their energy supply. Nitrogen balance was significantly better when MCT/LCT was infused and the greater levels of plasma ketones and lower plasma triglyceride levels suggested that MCT was more readily metabolised in these patients. Routine haematology, biochemistry and liver function tests gave no indication of harmful side effects from MCT.
Assuntos
Emulsões Gordurosas Intravenosas/uso terapêutico , Nutrição Parenteral , Triglicerídeos/uso terapêutico , Adulto , Idoso , Ensaios Clínicos como Assunto , Humanos , Lipídeos/uso terapêutico , Testes de Função Hepática , Pessoa de Meia-Idade , Nitrogênio/metabolismo , Distribuição AleatóriaRESUMO
We have performed a feasibility study of telemedicine as an alternative to conventional outpatient appointments for the making of diagnostic and management decisions for patients referred for vascular surgery. Twenty-two sequential patients referred by a single general practice to a vascular centre were offered a telemedicine clinic appointment as an alternative to a conventional hospital outpatient appointment. A referral pro forma and digital photograph (where appropriate) were transmitted in advance of the videoconference. The videoconference involved patient, practice nurse and vascular consultant. All patients opted for the teleconsultation. The majority had leg ulceration or leg pain. Six patients required only the initial teleconsultation and were managed thereafter in the community. Thirteen were referred to the vascular laboratory for investigation. Three proceeded to angioplasty and four to surgery. Two patients had a conventional outpatient appointment for follow-up but all others were followed up via telemedicine. Overall 27 conventional outpatient appointments were replaced by a teleconsultation.
Assuntos
Medicina de Família e Comunidade/organização & administração , Encaminhamento e Consulta , Consulta Remota/métodos , Doenças Vasculares/diagnóstico , Comunicação por Videoconferência , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Humanos , Pessoa de Meia-Idade , Doenças Vasculares/cirurgiaRESUMO
INTRODUCTION: Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative. PATIENTS AND METHODS: The study retrospectively examined all patients who had undergone any form of embolectomy during 2006 and 2007 by review of their medical records, an electronic laboratory database, and the patients' drug charts. RESULTS: Overall, 45 patients were studied. A total of 389 activated partial thromboplastin time (APTT) tests were performed of which 146 (37.6%) were in the therapeutic range (50-90 s), 40.4% were < 50 s and 22.1% were > 90 s. Five patients (11.1%) had further surgical procedures. Significant bleeding occurred in two patients. CONCLUSIONS: The results indicate that many patients are not appropriately anticoagulated. Whilst a new UFH protocol is being developed by our hospital trust, the authors believe the use of LMWH could provide a more effective and user-friendly alternative to UFH.
Assuntos
Anticoagulantes/uso terapêutico , Embolectomia/métodos , Embolia/tratamento farmacológico , Heparina de Baixo Peso Molecular/uso terapêutico , Tempo de Tromboplastina Parcial , Doença Aguda , Anticoagulantes/efeitos adversos , Hemorragia/tratamento farmacológico , Humanos , Infusões Subcutâneas , Estudos RetrospectivosRESUMO
Venous leg ulcers are common, chronic, debilitating, and expensive. Evidence supports use of compression bandaging, with superficial venous surgery in selected cases, but these interventions frequently fail to achieve healing. We describe a series of 152 consecutive referrals from a nurse-led specialist dermatology clinic to a vascular surgical service; a group posing particularly challenging problems. This observational study, with median follow-up of 18 months, describes outcomes in a number of important clinically identifiable subgroups. Its findings may assist service planning and discussion of the surgical role within multidisciplinary ulcer management.
Assuntos
Encaminhamento e Consulta , Escleroterapia , Meias de Compressão , Úlcera Varicosa/terapia , Procedimentos Cirúrgicos Vasculares , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Reoperação , Fatores de Tempo , Falha de Tratamento , Resultado do Tratamento , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/fisiopatologia , Úlcera Varicosa/cirurgiaRESUMO
OBJECTIVES: Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting. METHODS: Thirty-nine patients with varicose veins underwent cannulation of varicosities. The pressure and the blood oxygen content within varicosities were measured in different positions and during exercise. Similar measurements were made in the long saphenous veins of 10 control subjects without venous disease. RESULTS: Mean pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6 mmHg). Control subjects had similar pressures measured in the long saphenous vein. No pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66 mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity from the heart. Pressure reduction in varicosities after exercise was significantly less than that in control subjects. Recovery time (RT 90) was also significantly shorter than in the control group. Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa (SD 0.9) on standing; these values were not significantly different to samples from control subjects. CONCLUSIONS: AV shunting is unlikely to be a causative factor in the development of primary varicose veins.