Efficacy and tolerability of liposomal heparin spraygel as an add-on treatment in the management of superficial venous thrombosis.

Superficial venous thrombosis usually resolves spontaneously in a few weeks. In most cases, treatment includes peroral analgesics or nonsteroidal anti-inflammatory drugs accompanied by the recommendation to wear elastic stockings and perform regular mild ambulation. In contrast to this "standard treatment," a recent ACCP guideline has recommended that patients affected by spontaneous superficial thrombophlebitis be treated with intermediate doses of unfractionated or low-molecular-weight heparin. This study was designed to assess the efficacy of topically applied heparin spraygel in terms of reduction of local symptoms and signs of superficial venous thrombosis.

Liposomal heparin spray: a new formula in adjunctive treatment of superficial venous thrombosis.

The objective of this study was to assess the efficacy and safety of liposomal heparin spray-a new formula of topical heparin delivery. This was a randomized, multicenter, controlled open clinical trial with 2 parallel groups. Forty-six outpatients with clinical signs of superficial venous thrombosis (SVT) were treated with either topical liposomal heparin spraygel (LHSG) (Lipohep Forte Spraygel, 4 puffs of 458 IU tid (n = 22) or with low-molecular-weight heparin (LMWH) (Clexane 40 mg once a day (n = 24), administered subcutaneously (sc). Main outcome measures were efficacy parameters (improvement of local symptoms-pain control and planimetric evaluation of erythema size, duplex Doppler assessment of thrombus regression) and safety parameters (documentation of adverse events, with particular reference to deep vein thrombosis [DVT] by duplex sonography, and patients' and investigators' assessment of drug tolerance). Patients' and investigators' subjective assessment of efficacy of treatment and change in basic biochemical parameters were defined as secondary outcome measures. Statistical analysis was performed with use of Wilcoxon test, Mann-Whitney U-test and Chi-square test. Regression of SVT-related symptoms, including pain, erythema, and thrombus presence, was shown as comparable in LHSG and LMWH groups. These results were corroborated by efficacy assessment by investigators and patients. Three cases of deep venous thrombosis in heparin spraygel and 1 in heparin sc group were reported. No significant adverse reactions were observed in the spraygel group, but 1 serious allergic reaction was observed in the LMWH group. Tolerance of new formula heparin was assessed as good. Heparin spraygel-a new topical mode of heparin application, seems a promising method of heparin delivery. This initial study has demonstrated comparable efficacy and safety of LHSG and LMWH in local treatment of SVT. These findings should be confirmed by further extensive study that will reach appropriate statistical power to support such conclusion, for despite heparin treatment, significant risk of DVT was demonstrated in both groups.

[Effectiveness of treatment of varicose veins assessed by epidemiological comparative studies]. / Efektywnosc leczenia zylaków w swietle porównawczych badan epidemiologicznych.

Effectiveness of varicose veins (VV) management, due to high prevalence of this condition, is an important medical, social and economical issue. The aim of the study was to compare cost effectiveness of VV treatment by comparison of the results of two epidemiological surveys performed in Warsaw Bródno population, in 1982-1984 (group I, n=4997) and 1998-2000 (group 11, n=3556). Analysis compared prevalence of varicose veins, venous ulcers, deep vein thrombosis (DVT) in relation to number of VV procedures performed, and cost of conservative and surgical treatment, subjective patients' assessment of treatment results. Varicose veins prevalence has not changed significantly in group I was 15.7% (men 9.3%, women 20.1%) vs. 13.7% (men 8.7%, women 15.9%) in group II. Similarly, prevalence of venous ulcers (0.76% vs 0.73%), and previous DVT among VV patients (8.9% vs 8.9%) have not changed in both groups. Percentage of patients treated surgically in relation to all VV patients (19.7% vs 26.1%), as well as treated conservatively (45.2% vs 48.8%) increased, the latter mainly due to significant increase of ratio of patients treated with phlebotropic drugs. Patients'assessment of conservative and surgical treatment has improved dramatically, cost of treatment remained similar. Despite significant surgical and conservative treatment efforts, prevalence of essential venous diseases in hospital catchment area remained unchanged. Amount of patients satisfied both with surgical and conservative treatment increased, perhaps mainly due to better efficacy of phlebotropic drugs and better access to specialist care. On the other hand, significant amount of patients doesn't start any treatment at all. We conclude that preventive varicose veins surgery during early stage of disease may not diminish prevalence of serious venous complications.

Percutaneous thrombin injection to complete SMA pseudoaneurysm exclusion after failing of endograft placement.

Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.

Ten years experience with subfascial endoscopic perforator vein surgery.

We report here results from our 10-year experience of performing subfascial endoscopic perforator vein surgery (SEPS). Between 1989 and 1999 we performed 254 SEPS in 224 patients. SEPS results were evaluated 1 month after surgery and every 6 months during observation. In the year 2000, all patients who underwent the procedure were called in for a final follow-up examination. Analysis covered all documented data of 130 patients and 146 limbs (58% and 57.5%, respectively, of those that underwent surgery). The study group comprised 51 men and 79 women, between 26 and 72 years of age. The chronic venous insufficient clinical condition of patients prior to surgery was as follows: class 3, 3.1%; class 4, 40%; class 5, 29.2%; class 6, 27.7%. Post-thrombotic syndrome was diagnosed in 85 patients (65.3%). The observation period ranged from 6 months to 10 years (4 years and 8 months on average). Long-term SEPS results demonstrated the efficacy and safety of this surgical technique. SEPS is a new treatment method, especially for patients with ulcerations. Unfortunately, it dose not completely solve the problem of treating chronic venous insufficiency.