Management of superficial vein thrombosis and thrombophlebitis: status and expert opinion document.

Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb, Lipohep, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.

Prevention of recurrent deep venous thrombosis with sulodexide: the SanVal registry.

The aim of this study was to evaluate the prevention of recurrent deep vein thrombosis (R-DVT) with an oral antithrombotic agent (sulodexide) in moderate to high-risk subjects. A group of 405 patients was included into the multicenter registry. Both compression and an exercise program were used as well as a risk-factors control plan. After diagnosis of DVT, patients were treated with oral anticoagulants for 6 months. At the end of this period a coagulation study was made and patients started treatment with oral sulodexide capsules for a period of 24 months. The femoral, popliteal, tibial, and superficial veins were scanned with high-resolution ultrasound at inclusion;scans were repeated at 6, 12, 18, and 24 months. Of the 405 subjects included into the registry 178 in the control group (mean age 52.2; SD 11; M:F=90:88) and 189 in the treatment group (mean age 53.2; SD 10.3; M:F=93:96) completed the analysis period of 24 months. At 6 and 12 months the incidence of R-DVT was lower (p<0.05) in the treatment group. At 24 months the global incidence of R-DVT was 17.9% in the control group and 7.4% in the sulodexide group (p<0.05), 2.42 times lower than in controls. The 2 groups were comparable for age and sex distribution and for the localization of the thrombi at inclusion. Also the 2 groups of dropouts were comparable. In the control group there were 32 recurrent DVTs and 24 subjects lost to follow-up (total of 56) of 202 included subjects (27.7%) in comparison with 28 failures (14 recurrent DVTs and 14 lost subjects) of 203 subjects (13.8%) in the treatment group. This difference was statistically significant. In this analysis the incidence of DVT in controls was 2.07 times higher than in the treatment group subjects. In conclusion sulodexide was effective in reducing recurrent thrombotic events in high-risk subjects.

[Chronic treatment of vascular diseases with indobufen]. / Trattamento cronico della patologia vascolare con indobufene.

The effects of chronic treatment with indobufen, an inhibitor of platelet aggregation, was studied in a group of 1428 patients with vascular problems treated in a period of about 6 years in our Units. Venous problems were the major vascular problem in 313 patients, peripheral vascular diseases in 553 and cerebrovascular problems in 562. In patients with venous problems the range of the treatment period in different groups of patients varied from 2 to 42 months. The range was from 1 to 48 months in the group of patients with peripheral vascular diseases and from 2 to 48 in patients with cerebrovascular diseases. An analogic score was used to evaluate the efficacy of indobufen, which was also compared for the occurrence of side-effects with ASA (acetylsalicylic acid) and dipyridamole. Results obtained in this large, chronic open study confirmed the efficacy of indobufen in preventing (or reducing the occurrence) of vascular problems which was significantly greater than that observed with the other two drugs used for comparison. Indobufen also resulted in a lower incidence of side-effects (particularly gastrointestinal disorders) and it was better tolerated than both dipyridamole and ASA.

[Injury of the popliteal artery & the popliteal branches: analysis of 31 consecutive cases]. / I traumi dell'arteria poplitea e dei rami infrapoplitei: analisi di 31 casi consecutivi.

In complex traumas of lower limbs it is fundamental the reducing of the time of ischemia to reduce the number of failures in repairing surgery and the percentage of the demolishing of necessity surgery. The experience of the authors is based on 31 complex traumas of lower limbs with distal vascular injuries to Hunter's canal, which were associated to bone, nervous and muscular lesions. In total we are treated 37 vascular injuries by interposition of venous autografts in 37 cases, lateral pacth in one case ant suture T-T in two cases. The protection of the reconstructed vases, in case of a concomitant loss of substance, was entrused to microvascular flaps for 7 times latissimus dorsi, iliac crest and fascio-cutaneous for 5 times posterior reversed with distal baset and for three times antero-lateral, which in three cases of them needed successively a dermoepidermic grafts. The bone injuries, which were treated by external fixation, intramedullary nailing, plate and screws, just in two cases became worse in pseudoarthroses and just in one in osteomyelitis. The reparation of nervous injuries had bad results just in two cases. The percentage of saving of the limb it was about 83.9%.

[The distal pedicle fasciocutaneous flaps of the leg. Analysis of 21 cases of lower limb reconstruction]. / I lembi fascio-cutanei di gamba a peduncolo distale. Analisi di 21 casi di ricostruzione dell'arto inferiore.

The fascio-cutaneous flaps with distal pedicle, with the new discoveries on fascial and septal circulation of the lower limbs, are a valid reconstructing method for the loss of substance localized on the third inferior of the leg and in the heel's region. In 21 patients, 18 men and 3 women, fascio-cutaneous flaps were employed for the traumatic loss of substance, just in two cases consequentially to removal of maligns lesions, all of them were omolaterals except in three cases in which cross-leg were used. The results are satisfying if we remember that just in two cases we had partial necrosis and in other two cases we had to reinstate the flap which had survived just in his deep position. The advantages of using this technique are supported by his good results and simple execution, realising anyhow that complicated or contaminated trumas need more complex plastic reconstruction.

[Gynecomastia: our experience in surgical treatment]. / La ginecomastia: nostra esperienza nel trattamento chirurgico.

A group of 78 patients with gynecomastia was observed between 1974-1987. Idiopathic gynecomastia was referred in 33 cases, cirrhosis in 31 cases, prostatic hypertrophy in 2 cases, while in 12 cases gynecomastia was induced by drugs. All patients with idiopathic form and 11 patients with secondary form were surgically treated by mastectomy (20 bilaterally and 24 unilaterally). The authors emphasize that, in this pathology, is much more important restoring the masculine feature of thorax without esthetic damage than removing the hypertrophic gland.

[Acute thrombosis of the infrarenal aorta]. / Trombosi acuta dell'aorta infrarenale.

The Authors report three cases of patients operated for acute thrombotic aortic occlusion. All the three patients were treated with an aortic transabdominal approach, thromboendarteriectomy and aorto-femoral by-pass. In two patients the result was satisfying, one with a late and partial recovery of the motility of the inferior limbs. One patient died for heart failure in eighth postoperative day. The Authors believe that this unsatisfying result was caused by delay in the surgical treatment (almost 30 hours).