BRAVISSIMO: 12-month results from a large scale prospective trial.

The BRAVISSIMO study is a prospective, non-randomized, multi-center, multi-national, monitored trial, conducted at 12 hospitals in Belgium and 11 hospitals in Italy. This manuscript reports the findings up to the 12-month follow-up time point for both the TASC A&B cohort and the TASC C&D cohort. The primary endpoint of the study is primary patency at 12 months, defined as a target lesion without a hemodynamically significant stenosis on Duplex ultrasound (>50%, systolic velocity ratio no greater than 2.0) and without target lesion revascularization (TLR) within 12 months. Between July 2009 and September 2010, 190 patients with TASC A or TASC B aortoiliac lesions and 135 patients with TASC C or TASC D aortoiliac lesions were included. The demographic data were comparable for the TASC A/B cohort and the TASC C/D cohort. The number of claudicants was significantly higher in the TASC A/B cohort, The TASC C/D cohort contains more CLI patients. The primary patency rate for the total patient population was 93.1%. The primary patency rates at 12 months for the TASC A, B, C and D lesions were 94.0%, 96.5%, 91.3% and 90.2% respectively. No statistical significant difference was shown when comparing these groups. Our findings confirm that endovascular therapy, and more specifically primary stenting, is the preferred treatment for patients with TASC A, B, C and D aortoiliac lesions. We notice similar endovascular results compared to surgery, however without the invasive character of surgery.

[Infrared coagulation as an aide in proctology]. / Infraroodkoagulatie een aanwinst in de proktologie.

The infrared coagulation has being described as a method of treatment for haemorrhoids first and second degree, with results almost as effective as rubber band ligation and sclerosing injection therapy, but with fewer complications. More frequent applications of infrared coagulation may improve results and are often in a six month interval necessary. A major indication exist in bleeding haemorrhoids where the infrared coagulation gives a quick result.

[Postoperative syndromes and recurrence in highly selective vagotomy]. / Postoperatieve syndromen en recidieven na een hoogselectieve vagotomie.

In a prospective multicenter trial the clinical results and recurrences after proximal gastric vagotomy (PGV) in different gastroduodenal ulcer types have been investigated. Pyloric and prepyloric ulcers showed a significantly higher recurrence rate after PGV without drainage than duodenal and gastric ulcers. The secretory pattern could not explain the failure of PGV in these two ulcer types, which exhibit an alteration of the muscular layer at the pylorus and the distal antrum, a so called antropyloric dystrophy. About 60% of the recurrent ulcers after PGV stay asymptomatically. A refined concept for surgical treatment of peptic ulcer is proposed.

[Antithrombin III deficiency as a risk factor in postoperative thrombosis]. / Antitrombine III tekort als postoperatieve tromboserisikofaktor.

Hypercoagulation caused by decreased antithrombin III level leads to thrombosis inspite of postoperative prophylactic heparin therapy. Induced low level of antithrombin III is recognised in particular diseases which lead to a reduced ATIII synthesis, high breakdown or loss. Induced forms should be substituted with ATIII transfusions. Congenital forms should be treated lifelong with coumarin derivates. One should always suspect an ATIII deficiency when in spite of full heparin dosage a prolonged plasma thrombin time is not attained. A case history of recurrent thrombosis may also point to such deficiency.