RESUMO
The authors present the case report of effective conservative treatment in a patient with spontaneous, self-limiting, non-atherosclerotic dissection of the superior mesenteric artery (SMA) without fixed obstruction of the vessel lumen and signs of intestinal ischemia. Treatment with both anti-coagulant and anti-hypertensive agents succeeded in limiting the progression of intimal dissection and in preventing the potential dramatic sequelae of this rare clinical condition. Conservative treatment of spontaneous SMA dissection may be an alternative to surgery, if residual blood flow is maintained.
Assuntos
Artéria Mesentérica Superior , Doenças Vasculares/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de PacientesRESUMO
OBJECTIVES: To evaluate the incidence and the time of onset of early micro-embolism after CAS (carotid artery stenting) with two different mesh-covered stents and to assess the role of DW-MRI (Diffusion-weighted magnetic resonance imaging) in their prediction. METHODS: Single-institution prospective study including 50 patients (33 male, median age 74 years) who underwent CAS with Roadsaver® or CGuard™. All patients with primary stenosis (37/50, 74%) had carotid plaque DW-MRI pre-procedure, with both qualitative evaluation of the hyperintensity and ADC (apparent diffusion coefficient) measurement of the plaque. All patients had brain DW-MRI pre-procedure, at 1 h, 24 h and 30 days post-procedure to evaluate the appearance of hyperintense lesions over time. Imaging analysis was performed in a double-blinded fashion by two radiologists. RESULTS: There were no statistically significant differences between the two stents both in the incidence at 1 h (P = 0.23) and 24 h (P = 0.36) and in the volume of new DWI hyperintense brain lesions at 24 h (P = 0.27). Thirty-four new asymptomatic lesions in 19 patients (38%) were reported: 4 (11.8%) at 1 h, 30 (88.2%) at 24 h. The 30-day DWI-MR showed complete resolution of all lesions and no evidence of new lesion. The incidence of new lesions at 24 h resulted significantly higher in patients with DWI hyperintense carotid plaques (12/16, 75% vs. 0/21, 0%, P < 0.0001). This result was paralleled by the difference in ADC value (0.83 ± 0.21 vs. 1.42 ± 0.52). CONCLUSION: The majority of early asymptomatic brain lesion occurred during the first 24 h after CAS. Pre-procedure high DWI signal of the plaque was associated with an increased incidence of post-procedure microembolizations.
Assuntos
Estenose das Carótidas/terapia , Imagem de Difusão por Ressonância Magnética/métodos , Embolização Terapêutica/métodos , Embolia Intracraniana/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Stents/efeitos adversos , Idoso , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Embolia Intracraniana/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
AIM: This article describes four cases of leiomyosarcoma treated in the University Hospital of Turin and reviews current understanding of the biological behavior of the tumor, together with essential diagnostic procedures and established approaches to treatment. METHODS: Between February 2004 and December 2005, four patients (two men and two women; mean age 57.5 years) with leiomyosarcoma of the interior vena cava (IVC) were treated at the Vascular Surgery Unit. Resection and excision of the tumor were carried out (4/4 patients), with resection of the IVC above and below the mass (2/4) and reconstruction of the vein with a Dacron prosthesis with termino-lateral reimplantation of the renal vein in one and placement of a polytetrafluorethylene graft in the other. RESULTS: The postoperative course was unremarkable; the patients were discharged between postoperative days VIII and XI. Oral anticoagulant therapy with dicumarol (3/4) was given to maintain venous or prosthesis patency during the follow-up period. The mean length of follow-up was 23 months (range, 16-28). All patients recovered without local recurrence of disease. CONCLUSION: This malignant slow-growing tumor produces late clinical manifestations, making the study of its natural history clinically important. Currently, surgical excision is the only therapy that can alter disease progression and improve survival. The utility of adjuvant chemo- and radiotherapy remains controversial.
Assuntos
Leiomiossarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Veia Cava Inferior , Prótese Vascular , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Cuidados Pós-Operatórios , Procedimentos de Cirurgia Plástica , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/cirurgiaRESUMO
Activated C protein resistance is a common coagulation defect caused by factor V Leiden mutation and is associated with an augmented risk of predominantly venous thrombosis. Augmented tendency to arterial thrombosis is sporadically reported. This case report describes femoropopliteal thrombosis in a young patient with heterozygous V Leiden factor mutation. Progressive thrombotic occlusion required amputation of the forefoot which resulted in stump dehiscence. Poor blood supply to the perilesional substrate delayed wound healing. An optimal though not yet definitive result was achieved after months of accurate medication. The criticality of lower limb ischemia in an otherwise healthy young patient underscores the grave impact this condition can have on the patient's quality of life and on health care costs.
Assuntos
Fator V/genética , Artéria Femoral , Mutação , Artéria Poplítea , Trombose/genética , Resistência à Proteína C Ativada/genética , Adulto , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/métodos , Heterozigoto , Humanos , Masculino , Trombose/complicações , Trombose/cirurgia , CicatrizaçãoRESUMO
An increasing body of health care regulations and the growing concern of physicians and patients about health care services have sharpened the debate surrounding the concept of quality in medicine. Once unknown terms such as audit, peer review, accreditation, ISO 9000, quality assurance (QA), continuous quality improvement (CQI) and risk management have become more familiar but also less clear. Following recent reports, medical error has been cited as a result of a health care system that has not yet fully embraced the tenets of quality management. A clearer explanation of definitions, knowledge and procedures is therefore needed. In Italy, the general debate on surgical risk led to a proposal to implement control systems that would monitor the work of each team member in the operating room, from the patient's arrival to transfer to the floor. But to understand the dynamics of doubtful cases, we need to start from new concepts that release the surgeon from the role of ''high priest in the surgery temple.'' Such concepts would underpin a process analysis of how much is effectively done and by whom. This means, on one hand, developing a greater awareness of one's role and competences, and on the other, delineating the stages within which each health care professional is expected to operate. Entering into the debate are the guidelines scientific societies have drawn up to rationalise and improve health care delivery through recommendations directed at optimizing the efficacy and efficiency of surgical intervention as the result of scientific evaluation and clinical observation. However, the critics in question do not always allow the surgeon to work under a medico-legal ''guarantee'' that covers his medical conduct. Further-more, they can be a double-edged sword in court if not adequately considered and critically evaluated with regard to a specific case, the object of censure and charge. In fact, they can be ''exploited'' as an instrument of accusation or defence in an arena where the mass media rush to blame the surgeon but later forget to duly report the acquittal of charges held against the surgeon. The present article examines the light and dark sides of guidelines, taking as an example those profiled by the Italian Society of Vascular and Endovascular Surgery and based on international guidelines for the treatment of symptomatic carotid stenosis.
Assuntos
Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Guias de Prática Clínica como Assunto , Endarterectomia das Carótidas/legislação & jurisprudência , Humanos , Itália , Imperícia/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Médicas , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
AIM: Varicose veins of the legs are a common condition affecting 10-15% of men and 20-25% of women in the western world. This high prevalence is responsible of high medical and social costs. Most primary varices are associated with greater saphenous vein (GSV) incompetence. A new method, radiofrequency (RF) endovenous obliteration (VNUS-Closure'' procedure), recently has been described as a less invasive and cost-saving alternative to stripping for the treatment of refluxing GSV. METHODS: Twenty-four patients with varicose veins underwent endovenous obliteration of the above knee GSV by VNUS Closure'' procedure. The vein diameters were from 5 to 10 mm. The RF catheter was inserted via percutaneous puncture or through a small skin incision. All operations were performed in local, tumescent anesthesia, under ultrasound guidance. All patients were discharged 2 h after operation. Clinical and ultrasound follow-up was performed at 1 week, and at 1, 6, 12, 24 months. RESULTS: The complete or partial occlusion of the treated segment of the GSV has been achieved in 23 cases. In only one patient persisting patency of the GSV was immediately detected after the procedure. That was successfully treated by ultrasound guided foam sclerotherapy. All patients could resume all normal activities within 3-5 days. Every patient had reduction of varicosities, leg pain, fatigue and oedema. Adverse sequelae were minimal: 2 patients had transient thigh paresthesias. We didn't report deep venous thrombosis or pulmonary embolism (mean follow-up 26.7 months, range 15-33 months). CONCLUSION: A literature review and the authors'experience reveal that, in absence of significant complications, such as deep vein thrombosis and pulmonary embolism, there are significant advantages in the RF endovascular obliteration of the GSV. In effect, the Closure'' procedure, in selected patients, offers reduced postoperative pain, shorter sick leaves, faster return to normal activities compared with vein stripping, and it appears to be cost-saving for society. The mid-term (36 months) recurrence rates after RF obliteration seem to be similar to the results of the conventional surgical management.
Assuntos
Ablação por Cateter , Extremidade Inferior/irrigação sanguínea , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Ablação por Cateter/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Escleroterapia/economia , Escleroterapia/métodos , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/economia , Varizes/terapiaRESUMO
In Italy the diagnostic and therapeutic radiology practice is regulated by special laws, which are changed acting in accordance with EURATOM directive so that other specialists can use radiological instrument, such as orthopedic surgeons and cardilogists do. Medical and technological progress enables vascular surgeons to choose other treatments alternative to conventional surgery in the treatment of some vascular diseases by the use of radiological instruments. In our country there are special laws for the practice of radiology, so we verify if vascular surgeons can legally perform endovascular procedures using radiological techniques.
RESUMO
The authors report their experience in the management of a rare case of bilateral popliteal artery entrapment syndrome occurred to their observation. This unusual pathological entity, arising mostly in young subjects and unilaterally, in this case was bilateral and developed in a 51 years old patient. The clinical case is fully documented by multiple Echo-Doppler and arteriographic examinations which clearly demonstrate the peculiar characteristics of the disease. Finally the patient received a two stage surgical treatment with a good global result. The Authors stress the importance of a correct diagnostic approach to this unusual disease to avoid the possibility to misdiagnose it.
Assuntos
Arteriopatias Oclusivas/diagnóstico , Artéria Poplítea , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
The authors report a case of acute superior mesenteric and right renal artery embolism that occurred during an interventional radiological procedure on the abdominal aorta of a young diabetic woman. The onset of a severe abdominal pain during the procedure evoked the clinical suspicion of intestinal ischemia related to the dislodgement of atheroembolic material into the mesenteric artery; the event was correctly diagnosed, but the surgical therapy was delayed by many hours because of the fact that the patient was in a peripheral hospital of the region and had to be transferred to our institution. Fortunately in spite of the considerable delay, the operation was fully successful, probably because of the favourable location of the embolus, which allowed collateral splanchnic circulation to maintain a good metabolic balance.
Assuntos
Angioplastia com Balão/efeitos adversos , Aorta Abdominal/patologia , Arteriosclerose/complicações , Embolia/etiologia , Oclusão Vascular Mesentérica/etiologia , Obstrução da Artéria Renal/etiologia , Angiopatias Diabéticas/complicações , Embolia/diagnóstico por imagem , Feminino , Humanos , Intestinos/irrigação sanguínea , Complicações Intraoperatórias , Isquemia/etiologia , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia Intervencionista , Obstrução da Artéria Renal/diagnóstico por imagem , StentsRESUMO
We present a case of left-sided inferior vena cava unexpectedly observed during an operation of aorto bifemoral bypass in a patient with severe Leriche syndrome and almost complete obstruction of the infrarenal aorta. This very rare congenital malformation (0.2-0.5%) was not recognized by the duplex scanner performed preoperatively, probably because of the low level of suspicion carried on by an experienced operator. AngioCT or angioMR, which would have surely shown us the anomaly, were not done because, in the lack of an aneurysmal disease or other abdominal pathological situations, these investigations were not required before operation. The possible hazards of such an unrecognized malformation are great, mostly in terms of incontrollable intraoperative hemorrhages, but the final outcome of this case was positive.
Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Artéria Ilíaca/cirurgia , Veia Cava Inferior/anormalidades , Idoso , Humanos , Síndrome de Leriche/complicações , Síndrome de Leriche/cirurgia , Masculino , Radiografia , Veia Cava Inferior/diagnóstico por imagemRESUMO
We present two cases of left sided inferior vena cava, one unexpectedly observed during an operation of aorto bifemoral bypass in a patient with severe Leriche syndrome and almost complete obstruction of the infrarenal aorta, the second in a patient with an aneurysm of the abdominal aorta, in whom the anomaly was recognized before the operation. This very rare congenital malformation (0.2-0.5%) was not recognized in the first patient by the duplex scanner performed preoperatively, probably because of the low level of suspicion carried on by an experienced operator. Computer tomography angiography or magnetic resonance angiography, which would have surely shown us the anomaly, were not done in the first patient because, in the lack of an aneurysmal disease or other abdominal pathological situations, these investigations were not required before operation. The possible hazards of such an unrecognized malformation are great, mostly in terms of uncontrollable intraoperative hemorrhages, but the final outcome of this case was positive.
Assuntos
Veia Cava Inferior/anormalidades , Idoso , Angiografia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Síndrome de Leriche/complicações , Síndrome de Leriche/cirurgia , Angiografia por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler DuplaRESUMO
The authors report the observation of one case of vagal paraganglioma occurred in a young woman. The tumor manifested itself as a left sub-mandibular tumescence; the very first diagnostic approach was achieved through echography, which showed a mass behind the internal carotid artery and compressing the internal jugular vein. The following examinations, represented by neck CT, NMR, angiography and fine needle aspiration initially directed towards the suspicion of chemodectoma. Only at operation, the anatomical situation of the tumor, which encapsulated the vagus nerve and the subsequent results of the hystological examination revealed the correct diagnosis of vagal paraganglioma.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Paraganglioma/cirurgia , Doenças do Nervo Vago/cirurgia , Nervo Vago/cirurgia , Adulto , Angiografia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Embolização Terapêutica , Feminino , Humanos , Paraganglioma/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Nervo Vago/diagnóstico por imagem , Doenças do Nervo Vago/diagnóstico por imagemRESUMO
Isolated aneurysms of the hypogastric artery are very rare and account for between 0.04% and 0.4% of all intra-abdominal aneurysms. In 85% of cases they are monolateral and are present in association with an aneurysm of the infrarenal abdominal aorta and of the common and external iliac arteries, they make up part of a poly-aneurysmal disease. Unless the patient is an extremely poor condition, surgical treatment is generally indicated for aneurysms greater than 3 cm; close monitoring of those with smaller aneurysms is recommended. Two patients presented with isolated aneurysm of an internal iliac artery which had developed several years after aortoiliac surgery. The one received surgical treatment; the other, who was in poor general conditions and at high risk for surgery, underwent endovascular embolization. Both procedures were successful, with a current follow-up between 15 and 18 months. Endovascular embolization, as performed in the 2(nd) patient, provided an alternative to the surgical procedure. After injection in the aneurysmal sac of the Gianturco spirals, a covered stent was placed in the iliac axis to exclude the inflow of the hypogastric artery. According to our experience of 2 patients, the one treated surgically and the other submitted to a less invasive endovascular procedure, we can state that both methods are practicable. The final choice lies with the vascular surgeon, after weighing the multiple factors that each case involves.
Assuntos
Aorta Abdominal/cirurgia , Embolização Terapêutica/métodos , Aneurisma Ilíaco/etiologia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Angiografia , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/terapia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
In a patient already operated for abdominal aortic aneurysm fifteen months previously, because of the onset of aspecific vertigo, instrumental investigations of the supra aortic vessels showed us the presence of a non palpable mass, in the left side of the neck. Duplex Scanner, angio-CT and Angiography let us suspect the presence of an aneurysm located somewhere in the course of the thyrocervical trunk. At the operation the aneurysm, which we originally suspected to be a false and a possibly iatrogenic one, in the reality was a true aneurysm and was located at the termination of the thyrocervical trunk, just in the first segment of the inferior thyroid artery. The case is reported because of its rarity and the difficulties in the preoperative diagnosis.
Assuntos
Aneurisma , Glândula Tireoide/irrigação sanguínea , Idoso , Aneurisma/diagnóstico , Aneurisma/cirurgia , Humanos , MasculinoRESUMO
A case of post stenotic aneurysm of the inferior mesenteric artery (IMA) is reported. This case underlines the importance of a correct diagnosis by instrumental methods such as Duplex Scanner, CT and Arteriography, mainly when the first diagnosis is aneurysm of the abdominal aorta (AAA). Our patient showed, furthermore, the occlusion of the celic axis, of the superior mesenteric artery and of both hypogastric arteries; thus his intestinal vascularization was represented, from the gastric fundus until the rectum, only by the inferior mesenteric artery and its collateral network. The operation consisted in the resection and reimplantation of the vessel on the left side of the terminal abdominal aorta, after removal of the dilated segment. This location was chosen because of the coexistence of a mild dilatation of the aorta of 2.8 cm and considering possible aortic surgery for AAA in the future.
Assuntos
Aneurisma/complicações , Artéria Mesentérica Inferior , Oclusão Vascular Mesentérica/complicações , Aneurisma/diagnóstico , Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico , Constrição Patológica , Diagnóstico Diferencial , Humanos , Masculino , Artéria Mesentérica Inferior/cirurgia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/cirurgia , Pessoa de Meia-IdadeRESUMO
The Authors report their experience in the treatment of venous and arteriovenous malformations, which in this paper are divided into two subgroups, pure venous malformations (VMs) and arteriovenous malformations (AVMs). A pure surgical indication was evident in less than 50% of cases (48.1%), while more conservative treatments were performed in remaining patients. Considering the particular characteristics of the disease, a complete surgical radicality isn't always possible, so surgery must be considered in selected cases.
Assuntos
Angiodisplasia/terapia , Malformações Arteriovenosas/terapia , Veias/anormalidades , Adolescente , Adulto , Angiodisplasia/cirurgia , Malformações Arteriovenosas/cirurgia , Criança , Pré-Escolar , Embolização Terapêutica , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Escleroterapia , Resultado do Tratamento , Veias/cirurgiaRESUMO
Cystic adventitial disease (CAD) of the popliteal artery is a rare but well-known cause of intermittent claudication, especially in young patients. The etiology of the disease is still controversial and the literature reports various hypotheses for its origin. Diagnosis starts with thorough history taking and physical examination; non invasive diagnostic studies comprise color duplex scanner (ECD), computed tomography (CT), better if elicoidal (3D CT) and magnetic resonance imaging (MRI), which can aid in establishing correct recognition of the disease in most cases. A 48-year-old man presented with intermittent right calf claudication that had begun 4 months earlier; the symptom-free interval was about 100 m. MRI and MR angiography of right popliteal fossa revealed the presence of an oval cystic (maximum diameter 45 mm). The caudal aspect of the cyst showed pedicles protruding between the popliteal vein and the popliteal artery that compressed the artery, causing complete occlusion of its lumen. Surgery was performed through the posterior approach using an S-shaped incision; the affected segment of the popliteal artery was successfully excised and replaced with an autogenous external saphenous vein graft. A follow-up is underway, both clinical and with; no cyst recurrence has so far been detected either clinically or by duplex scanner during the 15-month postoperative follow-up period; the graft is patent and the patient is completely symptom free. Severe claudication in young patients, possibly without significant vascular risk factors, should prompt the clinical suspicion of adventitial cystic disease of the popliteal artery. Medical history, clinical examination and non invasive instrumental investigations, such as duplex scanner, elicoidal CT and/or MRI, may aid in establishing the correct diagnosis.
Assuntos
Claudicação Intermitente/cirurgia , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea , Humanos , Claudicação Intermitente/etiologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/diagnóstico , Artéria Poplítea/diagnóstico por imagem , RadiografiaRESUMO
Safe surgical repair of an abdominal aortic aneurysm in conjunction both with nephrectomy (for monolateral or bilateral kidney carcinoma) or with radical cystectomy and orthotopic urinary diversion (for bladder carcinoma) can be performed. These combined surgical procedures can be performed without morbidity due to excessive blood loss, increased operative time or vascular graft infection. A nephrectomy associated with abdominal aortic aneurysm repair can be performed both by a median single surgical approach or by a double one during the same intervention. The authors describe and discuss 4 case reports and the techniques required for these combined procedures.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/métodos , Carcinoma/cirurgia , Aneurisma Ilíaco/cirurgia , Neoplasias Renais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Idoso , Angiografia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Carcinoma/complicações , Carcinoma/diagnóstico , Cistectomia , Humanos , Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrectomia , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Derivação Urinária , UrografiaRESUMO
The objective of this article is the presentation of a new device, simple, easy to use, at low cost, for the prevention of postoperative haematoma following surgery of varicose veins of the lower limbs. It consists in a two-part device that functions as an elastic and pneumatic bandage, that wraps thigh and leg, with the knee articulation free and that is placed immediately before the stripping of the saphenous vein when all the surgical wounds are closed, except the supramalleolar one. While the head of the stripper is pulled, the device is inflated by air with a compression of 40-50 mmHg and the last surgical wound is sutured. Pneumatic compression is held for 24-36 hours, allowing the patients to walk and, in the meantime, to control the colour and the temperature of the foot. The advantages of this device are: easy use and low costs; compression on the area of the saphenous vein and of the main collaterals; uniform but moderate pressure on all the limb circumference.