Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study.

OBJECTIVES: Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. METHODS: A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). 'Good' and 'very good' consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively. RESULTS: Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, 'good' and 'very good' consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, 'very good' consensus was achieved for 3/3 statements. CONCLUSIONS: The main findings from this study were that there was 'good' or 'very good' consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.

[Early and late mortality and morbidity after elective repair of infrarenal aortic aneurysm]. / Electiv infrarenalis aortaaneurysma sebészi kezelésének korai és késoi mortalitása és morbiditása.

INTRODUCTION: The open repair (OR) of infrarenal aortic aneurysm (AAA) has low mortality in tertiary care centres, however, endovascular repair (ER) could be more beneficial for some cases. The aim of our study was to compare the mortality and morbidity of the different AAA repair techniques. MATERIAL AND METHODS: In a single centre retrospective study we evaluated the postoperative complications, the early and late mortality of patients underwent open or endovascular AAA repair. RESULTS: Total of 431 patients underwent OR and 59 had ER. Early mortality was below 2% in both groups (statistically non-significant [NS] difference). Postoperative complications were found in 14.4% in the OR group and 11.9% in the ER group (NS). The intraoperative blood loss and use of blood products were higher, the operation time was significantly longer in the OR group (p < 0.001). The average follow-up time was 37 ± 22 months. Long term mortality and the prevalence of stroke and acute myocardial infarction were similar in both groups. 16% of the patients in the OR group developed incisional hernia. Patients after ER needed further vascular intervention more frequently than patients in the OR group (16.2% vs. 6.2%; p = 0.0327). CONCLUSION: The early and late mortality was similar after open and endovascular AAA repair. Postoperative complications did not show significant difference between the two groups. We found significant difference in the use of blood products, the prevalence of incisional hernias and the number of reinterventions. According to our results, stent graft implantation is mainly recommended in high risk patients and open aortic repair still has a role in the low-moderate operative risk group.

[Takayasu's arteritis; rare disease with special considerations]. / Takayasu arteritis; ritka kókép, különleges megfontolások.

Takayasu's arteritis is a chronic, non-specific inflammation of unknown aetiology, involving the aorta and its main branches. The authors describe the aetiology, pathomechanism, characteristic symptoms and a series of diagnostic criteria. Classifications used in previous decades and nowadays are listed. The therapy--considering the main principles--is individual, and it can be a combination of medical and surgical treatment or percutaneous angioplasty. Takayasu's arteritis is a rare disease in the western countries. There can not be found a specific examination to diagnose it. Mainly in the case of young female patients with inflammation of unknown origin for early diagnosis, it is essential to consider this particular disease.

[Congenital arteriovenous malformation complicated with brachial artery false aneurysm]. / Congenitalis arterio-venosus fistula talaján kialakult artéria brachialis álaneurysma esete.

Congenital arteriovenous malformations in the upper extremity, mainly in the hand are rare. In this patient an arteriovenous fistula of the hand caused arterial dilatation of the upper limb, and blunt injury of brachial artery resulted in an extreme large false aneurysm. This situation, which threatened with rupture and peripheral embolisation was treated by resection of the false aneurysm with end-to-end direct anastomosis. Complication of a congenital arteriovenous malformation so late, in the ninth decade is almost exceptional. We think that the successful surgical treatment of an infrequent lesion's rare late complication is worth presenting.

[Fournier's gangrene: early diagnosis is the best remedy]. / A Fournier-gangrénáról; a korai diagnózis a legjobb ellenszer.

Despite the broadening knowledge about Fournier's gangrene, its mortality rate is still considered very high. The authors describe the etiology, pathomechanism, the possible pathways of progression, and the causes and predisposing factors of the disease. Besides the traditional--surgical and antibiotic--therapy, complementary ways of treatment are described. Between 1994 and 2000, ten patients were treated for Fournier's gangrene in our department. We present our experience, the early signs and the way clinical symptoms develop. It is important to observe the early severe general condition and initially minimal local changes for early diagnosis in improved survival.