A simplified BRADEN scale for the risk of developing pressure injuries.

BACKGROUND: Pressure injuries (PIs) are a major problem for healthcare providers, impacting both care costs and patients' quality of life, although they are predominately preventable. These injuries are especially present in Intensive Care Units (ICUs) as a result of the severity of the clinical conditions of patients in this unit. AIM: To develop a simplified version of the Braden scale by removing two of the most subjective subscores-Nutrition and Sensory Perception-in an attempt to reduce the chance of errors by the nursing team during the application of the scale. STUDY DESIGN: A cross-sectional study was conducted on data collected from patients admitted to the ICU of a private Brazilian tertiary hospital. The resulting data consisted of 5194 patients, 6353 hospital admissions, and 6974 ICU stays. The overall prevalence of PI was 1.09%. RESULTS: The T-test showed that both the Braden and the simplified Braden scores were significantly different between patients with and without PI (p < .001). Patients who developed PIs scored lower than those who did not. The area under the Receiver Operating Characteristic curve of the Braden Scale was 74.21% (95% CI: 68.61%-79.8%) and of the simplified scale was 72.54% (95% CI: 66.87%-78.22%). The Positive Predictive Value of the Braden Scale was 3.17% when interpolated at the same sensitivity as the simplified scale (47.37%), which achieved 3.26%. CONCLUSIONS: By removing two of the six subscores of the Braden scale we propose a new tool for identifying patients at risk of developing PI in a more objective and fast way. Our results show that classification performance had little negative impact. RELEVANCE TO CLINICAL PRACTICE: A simplified, less subjective scale allows for more precise and less time-consuming risk classification.

Brazilian Society of Angiology and Vascular Surgery 2023 guidelines on the diabetic foot.

The diabetic foot interacts with anatomical, vascular, and neurological factors that challenge clinical practice. This study aimed to compile the primary scientific evidence based on a review of the main guidelines, in addition to articles published on the Embase, Lilacs, and PubMed platforms. The European Society of Cardiology system was used to develop recommendation classes and levels of evidence. The themes were divided into six chapters (Chapter 1 - Prevention of foot ulcers in people with diabetes; Chapter 2 - Pressure relief from foot ulcers in people with diabetes; Chapter 3 -Classifications of diabetic foot ulcers; Chapter 4 - Foot and peripheral artery disease; Chapter 5 - Infection and the diabetic foot; Chapter 6 - Charcot's neuroarthropathy). This version of the Diabetic Foot Guidelines presents essential recommendations for the prevention, diagnosis, treatment, and follow-up of patients with diabetic foot, offering an objective guide for medical practice.

Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification.

INTRODUCTION: Evaluation of limb hemodynamics using the ankle-brachial index (ABI) may be difficult due to skin lesions, extensive necrosis, and obesity, such as commonly present in patients with diabetes with chronic limb-threatening ischemia (CLTI). We hypothesized that the pedal acceleration time (PAT) correlates with ABI and Wound, Ischemia, and foot Infection (WIfI) scores in patients with diabetes to serve as a new modality to accurately stage CLTI. METHODS: A single-center, cross-sectional study included patients with and without diabetes > 18 years with CLTI. Limbs were categorized in three grades of ischemia based on the ABI (ABI < 0.8, < 0.6, and < 0.4) and in two classes based on WIfI stages of amputation risk. Receiver operator characteristic (ROC) curves were used to determine PAT sensitivity, specificity, and accuracy to predict lower-limb ischemia. RESULTS: A total of 141 patients (67 nondiabetic and 74 diabetic) and 198 lower limbs (94 nondiabetic and 104 diabetic) met the inclusion criteria. In patients without diabetes, the accuracy of PAT for detecting an ABI < 0.8 was 85%; for detecting an ABI < 0.6 was 85%; and for detecting an ABI < 0.4 was 87%. In patients with diabetes, the accuracy of PAT in detecting an ABI < 0.8 was 91%; for detecting an ABI < 0.6 was 79%; and for detecting an ABI < 0.4 was 88%. In patients without diabetes, the accuracy for detecting WIfI stages of moderate and high amputation risk was 77% and for patients with diabetes was also 77%. CONCLUSIONS: PAT shows high correlation with the ABI as well as with the WIfI stages of amputation risk and the grades of ischemia, with high accuracy.

Sclerotherapy Improves Symptoms in Patients with Small and Moderate Diameter Low-Flow Vascular Malformations: A Prospective Cohort Study.

BACKGROUND: Vascular malformations are rare diseases and treatment remains controversial. Sclerotherapy is accepted as a minimally invasive treatment with good results; however, some patients do not report good response to sclerotherapy, and it is not clear which variables influence treatment outcome, preventing optimal patient selection. We hypothesized that large diameter lesions have reduced efficacy and satisfaction with sclerotherapy. Therefore, we prospectively evaluated the clinical response of low-flow vascular malformations treated with 1% polidocanol foam sclerotherapy and determined the correlation of symptom improvement with clinical variables. METHODS: Prospective cohort study of patients with symptomatic low flow vascular malformations treated at the Hospital das Clínicas between December 2016 and November 2018. Lesions were classified according to location, extension, diameter, type of vessels, margins, and symptoms. Sclerotherapy was performed by direct injection of 1% polidocanol foam, with a maximum volume of 10 ml per session. Symptom improvement was evaluated using the visual analog scale and patient-reported quality of life was assessed by the Short-form 6 dimensions (SF-6D) questionnaire. Follow-up was performed every 3 months after treatment. RESULTS: Forty lesions were treated in 38 patients, with 19 women and 19 men; median age was 20.5 years (range 4 months to 63 years). Most lesions (80%) were venous, and most commonly in the lower limbs (47.5%); 27.5% were superficial, 35% were deep, and 37.5% affected both compartments. The most common clinical presentations were deformity (95%), pain (78%), and functional limitation (58%); deep compartment lesions were more associated with functional limitation (69% vs. 27%; P = 0.030). Fifty-three per cent of lesions were >10 cm and were associated with increased numbers of psychosocial symptoms (P = 0.038). Two-hundred and forty-two sessions of sclerotherapy were performed, with 6 mean treatments per lesion (range 1-15). The mean follow-up time was 23 months (range 2-23 months). The most common complications were pain and local edema, without any major complications; some patients reported symptom recurrence (15% pain, 10% deformity, and 12% functional limitation). Sclerotherapy was associated with significant improvement of all symptoms (P < 0.001). However, lesions >10 cm were associated with poor improvement in deformity (P = 0.003). Quality of life improved for most patients (60%) and treatment satisfaction was high (82%). CONCLUSIONS: Treatment of low-flow vascular malformations with 1% polidocanol foam is safe and effective; sclerotherapy improves symptoms and quality of life. Large diameter lesions (>10 cm) are associated with increased treatment failure. A small percentage of patients reported recurrent symptoms and require other modalities for successful treatment.

Angiographic characteristics of the intermesenteric artery.

PURPOSE: The literature reports the presence of the intermesenteric artery (IA), an anastomosis connecting the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA) in 9-18% of human cadaver dissections. This is the first study describing the morphological and demographic characteristics of the IA based on in vivo imaging. METHODS: A total of 150 consecutive abdominal computed tomography (CT) angiographies of adult patients identified by sex and age were analyzed. The IA was assessed for its presence, point of origin, pathway, point of insertion, and diameter at its origin. The diameters of the SMA, IMA, and other arteries from which the IA originated and into which it inserted were measured by CT angiography using Radiant™ and Osirix MD™ software. RESULTS: The IA was found in 17 (51.5%) of the females and 60 (51.3%) of the males. The diameters of the SMA and IMA were larger in the males than in the females, but there was no sex difference in the diameter of the IA. The diameter of the SMA was larger than that of the IMA, and the diameter of the IA was smaller than that of the other arteries evaluated. An IA connecting the SMA and IMA trunks was found in 25.9% of the cases, while other connections between the branches of those trunks through an IA occurred less frequently. CONCLUSIONS: The intermesenteric artery is more frequently found than the literature refers and in most of cases directly connects the upper and lower arterial mesenteric circulations.

Arterial stiffness predicts amputation and death in patients with chronic limb-threatening ischemia.

OBJECTIVE: Arterial stiffness indices predict cardiovascular outcomes in patients with coronary or kidney disease; however, there is little data on the prognostic value of arterial stiffness in patients with advanced peripheral arterial disease. We determined whether arterial stiffness indices predict the outcomes of major amputation or death in patients with chronic limb-threatening ischemia (CLTI). METHODS: Arterial stiffness was prospectively measured using brachial oscillometry in patients with CLTI. After measuring arterial stiffness, patients were followed in 6-month intervals for up to 3 years and evaluated for limb preservation, occurrence of major amputation, or death. Hemodynamic variables and arterial stiffness indices were used to define predictors of amputation or death. RESULTS: A total of 136 patients presented with CLTI, and 134 (99%) of these patients required limb revascularization. At the end of follow-up (mean, 14 months), 24 patients (18%) were alive with a major amputation, and mortality was 7% (9 patients); 33 patients (24%) progressed to the combined outcome of major amputation or death. Patients having amputation and/or death (n = 33; 24%) initially presented with elevated pulse wave velocity (PWV) (13.41 ± 1.21 m/s vs 11.54 ± 1.65 m/s; P < .001), elevated augmentation index corrected to 75 beats per minute (40.42 ± 6.65% vs 27.12 ± 9.19%; P < .001), and high augmentation pressure (AP) (29.98 ± 4.32 mm Hg vs 13.40 ± 7.05 mm Hg; P < .001) compared with patients with preserved limbs. The initial ankle-brachial index (ABI) was lower in patients having amputation and/or death (0.43 ± 0.94 vs 0.62 ± 0.12; P < .001). Multivariable analysis identified PWV (odds ratio [OR], 2.62; P = .013), AP (OR, 1.56; P < .001), and ABI (OR, 0.01; P < .001) as predictors of amputation or death. ROC analysis identified patients with PWV ≤12.7 m/s (hazard ratio, 4.71; P < .001), AP ≤22.15 mm Hg (hazard ratio, 13.03; P < .001), or ABI >0.52 with an increased rate of limb preservation. CONCLUSIONS: PWV and AP, measurements of arterial stiffness, as well as the ABI, predict amputation or death in patients with CLTI.

Intraoperative vascular Doppler ultrasound blood flow and peak systolic velocity predict early patency in hemodialysis arteriovenous fistula.

BACKGROUND: Chronic kidney disease is a major public health problem. Hemodialysis is the most common renal replacement therapy. Arteriovenous fistulas (AVF) are a possible access option, but early failure rates remain high. OBJECTIVES: to investigate the value of intraoperative vascular Doppler ultrasound for predicting early AVF patency. METHODS: Prospective observational study. Consecutive patients undergoing AVF were assessed with vascular Doppler ultrasonography intraoperatively and on days 1, 7, 30, and 60. Patients were divided into groups according to presence or absence of primary and secondary patency. Blood flow (BF) and peak systolic velocity (PSV) were compared. ROC curves were plotted and used to define the PSV and BF values that yielded greatest sensitivity (Sens) and specificity (Spec). RESULTS: 47 patients met the inclusion criteria and were analyzed. Higher intraoperative PSV and BF values were observed in patients who had primary and secondary patency than in patients with access failure. The values with greatest sensitivity and specificity for predicting 30-day primary patency were 106 cm/s for venous PSV (Sens: 75% and Spec: 71.4%) and 290.5 ml/min for arterial blood flow (Sens: 80.6% and Spec 85.7%). Values for 30-day secondary patency were 106 cm/s for arterial PSV (Sens: 72.7%, Spec: 100%) and 230 ml/min for venous blood flow (Sens: 86.4%, Spec100%). Values for 60-day primary patency were 106 cm/s for venous PSV (Sens: 74.4%, Spec: 62.5%) and 290.5 ml/min for arterial blood flow (Sens: 80%, Spec: 75%). CONCLUSIONS: Peak systolic velocity and blood flow measured using intraoperative vascular Doppler ultrasound can predict early patency of hemodialysis arteriovenous fistulas.

Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness.

BACKGROUND: Arterial stiffness analysis has been done to classify cardiovascular risk. The aim of this article is to analyze whether the group of patients with chronic limb-threatening ischemia (CLTI) has higher arterial stiffness indices than controls. The secondary objectives are to assess whether patients with advanced stages of Wound, Ischemia, and foot Infection (WIfI) classification have high levels of arterial stiffness, through multiple linear regressions to analyze whether the ankle-brachial index (ABI) and other variables are predictive of arterial stiffness. METHODS: We conducted a cross-sectional study with 66 patients with CLTI and 66 age- and sex-matched controls using brachial artery oscillometry. Hemodynamic and arterial stiffness measurements, clinical characteristics, laboratory data, and stages of WIfI classification were compared between the groups CLTI and controls. Through multiple linear regression, we identified predictors of pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75). RESULTS: Patients with CLTI had PWV (11.8 ± 1.6 m/sec vs. 10.0 ± 1.8 m/sec, P < 0.01) and AIx@75 (29.2 ± 9.8% vs.18. ± 10.35%, P < 0.01) higher than controls. In the multiple regression model, there was influence of age (ß = 0.17, P < 0.01), antiplatelet therapy (ß = -0.15, P = 0.04), peripheral systolic pressure (ß = 0.03, P < 0.01), and clustered WIfI stages 3 and 4 (ß = 0.17, P = 0.02) of benefit of revascularization on PWV. Multiple regression analysis identified diabetes (ß = 7.51, P < 0.01) and the degree of ischemia measured by ABI (ß = -23.89, P < 0.01) as predictors of elevated AIx@75. WIfI stages 3 and 4 of estimate risk of amputation at 1 year predicts a high AIx@75 (ß = 9.77, P < 0.001) compared with stages 1 and 2. CONCLUSIONS: The degree of ischemia in CLTI patients determined by the ABI is associated with elevated arterial stiffness as measured by the AIx@75. Advanced WIfI stages were predictors of elevated PWV and AIx@75.

Brachial vein transposition: an alternative to hemodialysis arteriovenous graft.

BACKGROUND: There is currently a worldwide effort to increase the options for autogenous hemodialysis access. OBJECTIVES: To evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses. METHODS: A retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35. RESULTS: There were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts. CONCLUSIONS: Transposition of brachial vein is an alternative to arteriovenous graft.

Risk factors for mortality among patients undergoing major amputations due to infected diabetic feet.

BACKGROUND: Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. OBJECTIVES: To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. METHODS: This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. RESULTS: The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL. There was a 47.4% rate of readmissions to the same hospital. Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. CONCLUSIONS: Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death.

Persistent fever after pacemaker lead extraction.

The implant indication of cardiac electronic devices continues to expand; therefore, we have observed increasing complications related to their removal. We describe the case of a patient who presented with prolonged bloodstream infection after having undergone removal of a pacemaker. After extensive workup for fever of unknown origin and antibiotic therapy without any improvement, it was possible to demonstrate a foreign body in the right subclavian vein and superior vena cava corresponding to the distal part of the right ventricular lead. Endovascular removal of the foreign body and prolonged antibiotic administration was followed by complete resolution of the clinical picture. We ascribed the difficulty in diagnosing the source of the infection especially to the lack of local manifestations.

Anatomical and physiological changes in the venous system of lower limbs in pregnant women and findings associated with the symptomatology.

PURPOSE: Quantify the volume and diameter of veins in the lower limbs of primigravidae and associate the presence of venous signs and symptoms with the vascular measurements. METHODS: A cross-sectional study assessed 64 lower limbs of 32 healthy women of whom 16 were primigravidae between 22 and 36 weeks pregnant, and 16 nulligravidae. The women were submitted to physical assessment, air plethysmography and vascular ultrasound. The volumes and diameters of the main veins in the lower limbs were compared between pregnant and non-pregnant women. In the group of pregnant women, the attempt was also made to associate such measurements to the presence of vascular signs and symptoms. RESULTS: The average venous volume of the lower limbs (110.1 ± 30.2 and 94.7 ± 27.3 mL; p = 0.036), as well as the diameters of the common femoral (12.72 ± 2.27 and 10.14 ± 1.24 mm; p < 0.0001), saphenous (4.81 ± 1.15 and 3.55 ± 0.98 mm; p < 0.0001) and popliteal (6.87 ± 1.68 and 5.36 ± 1.07 mm; p < 0.0001) veins were, respectively, greater in the pregnant women compared with the control group. In pregnant women with venous stasis symptoms, a venous diameter of the saphenous vein compared to those without no symptoms (5.05 ± 1.19 and 4.09 ± 0.70 mm; p = 0.011) was noted. CONCLUSIONS: Anatomical and functional changes in the venous system during pregnancy were detected by the air plethysmography and the vascular ultrasound in primigravidae. In pregnant women, the presence of venous stasis symptoms found an anatomical and functional substrate detected in the differences in diameter of the saphenous vein.

Structural numerical analysis of a branched modular stent-graft for aneurysms encompassing all zones of the aortic arch.

The development of stent-grafts for the total repair of aneurysms in the aortic arch is still a technical challenge due mainly to the anatomical complexity of this region. Research performed here structurally evaluated a modular branched stent-graft for aneurysms encompassing all zones of the aortic arch by means of numerical simulations using fluid-structure interaction. The geometric domain obtained by means of computed tomography was subjected to physiological boundary conditions. The blood was modelled as non-Newtonian by the Carreau model, and the arterial wall was modelled as anisotropic hyperelastic by the Holzapfel model. The material adopted for the stents was Nitinol, and expanded polytetrafluoroethylene (ePTFE) was used for the graft. A comparison of the structural behaviour of the aneurysmal aortic arch before and after stent-graft implantation was performed. The numerical flow model was experimentally verified in vitro on a representative test bench of blood flow in the aortic arch. The stent-graft was shown to minimally modify arterial wall dynamics and was not susceptible to migration and endoleak. Peak stresses and strains were found in the stents and graft, respectively, while the stresses in the aneurysm sac were significantly reduced, of the order of 97.5%, due to the isolation of the arterial wall by the stent-graft.

Tools and scores for perioperative pulmonary, renal, hepatobiliary, hematological, and surgical site infection risk assessment: an update.

INTRODUCTION: perioperative risk assessment is essential to mitigate surgical complications, which suggests individual and collective interest since the number of surgical procedures in Brazil has been expanding steadily. The aim of this study was to summarize and detail the main calculators, indexes and scores regarding perioperative pulmonary, renal, hepatobiliary, hematological and surgical site infection risks for general non-cardiac surgeries, which are dispersed in the literature. METHOD: a narrative review was performed based on manuscripts in English and Portuguese found in the electronic databases Pubmed/MEDLINE and EMBASE. RESULTS: the review included 11 tools related to the systems covered, for which the application method and its limitations are detailed. CONCLUSION: the non-cardiovascular perioperative risk estimation tools are beneficial when disturbances are identified in the preoperative clinical examination that justify a possible increased risk to the affected system, so the use of these tools provides palpable values to aid in the judgment of surgical risk and benefit as well as it identifies factors amenable to intervention to improve outcomes.

Tools and scores for general and cardiovascular perioperative risk assessment: a narrative review.

The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.

Transcutaneous Electric Nerve Stimulation on ischemic rest pain in inpatients: randomised trial.

OBJECTIVE: To investigate the efficacy of a short-term application of Transcutaneous Electric Nerve Stimulation to relieve rest pain in patients with chronic limb-threatening ischemia. METHODS: In patients ³18 years old, with chronic limb-threatening ischemia and rest pain ³3 in the Visual Analogue Scale, without diabetic neuropathy were randomly assigned to 1) Transcutaneous Electric Nerve Stimulation (100 Hz, 200 µs) or 2) sham intervention, both during one or two 20 min treatment sessions. The primary outcome was pain intensity, assessed by the visual analogue scale (0-10 cm) and described by the McGill Pain Questionnaire. We used a t-test for difference of means. RESULTS: A total of 169 patients were assessed, 23 met the study criteria and were randomized. Thirty-four applications were performed in two days: in the 17 Transcutaneous Nerve Stimulation and 17 sham. The within-group analysis indicated a pain decrease in both groups (Transcutaneous Electric Nerve Stimulation, from 7-3.9 cm, p<0.0001, and sham from 5.8-3.2 cm, p<0.0001). No statistically significant difference was verified between-groups (p=0.5). CONCLUSIONS: Both groups showed a decrease in rest pain of 54 and 55%, respectively. However, there was no difference between short-term high-frequency Transcutaneous Electric Nerve Stimulation and sham intervention to relieve ischemic rest pain in chronic limb-threatening ischemia patients.

Relationship of the Pelvic-Trochanteric Index with greater trochanteric pain syndrome.

OBJECTIVES: This study aimed to correlate a higher Pelvic-Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case group) with asymptomatic female participants (control group) from March 2011 to June 2017. On an anteroposterior pelvic radiograph, lines were drawn by two radiologists, and the PTI (ratio of the distance between the greater trochanters and distance between the iliac crests) was defined and the femoral neck-shaft angle was measured. RESULTS: Data collected based on radiographs of 182 female patients (cases) and 150 female participants (controls) showed that the mean PTI was 1.09 (SD=0.01) in the case group and 1.07 (SD=0.01) in the control group (p<0.05), regardless of age. The distance between iliac crests increased with age (p<0.05) in symptomatic and asymptomatic individuals. It was also found that the mean femoral neck-shaft angle was 130.6° (SD=0.59) and progression of the varus angulation occurred with age in both groups, with a significance level of 5%. CONCLUSIONS: The PTI was higher in patients with GTPS. The femoral neck-shaft angle does not differ between individuals with and without GTPS; however, it does decrease with age. The pelvic width tends to increase with aging in symptomatic or asymptomatic individuals; therefore, the increase in the pelvic width and decrease in the femoral neck-shaft angle can be interpreted as normal in aging women, which could alter the biomechanics of the hips and pelvis.

Elastic compression after ultrasound-guided foam sclerotherapy in overweight patients does not improve primary venous hemodynamics outcomes.

OBJECTIVE: Lower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. METHODS: Overweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcome measure was the absence of venous reflux in the great saphenous vein. RESULTS: One hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P = .64) or the mean foam volume per procedure (P = .27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P = .16) or 3 months (25% vs 21%; P = .85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups-2 of 62 in control patients and 2 of 69 in compression patients (P = .45). Venous diameter reduction was noted in both groups during treatment (P < .05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. CONCLUSIONS: Elastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.