Quantifying the degree graduated elastic compression stockings enhance venous emptying.

OBJECTIVES: Graduated elastic compression (GEC) stockings reduce reflux and venous volume but their performance on augmenting venous return is unproven. The aim of this study was to quantify the ability of stockings to increase venous outflow from the leg. DESIGN: A prospective study comparing venous emptying without compression, versus class 1 (18-21 mmHg) and class 2 (23-32 mmHg) compression, using air-plethysmography (APG). METHODS: The right legs of 20 healthy subjects were studied supine. A 12-cm thigh-cuff was inflated in 10 mmHg steps from 0 to 80 mmHg while the corresponding increase in calf volume was recorded using the APG sensor calf-cuff. At the 80 mmHg plateau, the thigh-cuff was released suddenly to measure the unrestricted venous emptying. Venous return was assessed by: (a) identifying the incremental thigh-cuff pressure causing the maximal incremental increase in calf volume (IPMIV); (b) measuring the percentage reduction in calf volume in 1 second following thigh-cuff release - outflow fraction (OF); (c) time to empty 90% of the venous volume - venous emptying time (VET90). RESULTS: Median and inter-quartile range (IQR) baseline values of IPMIV, OF, and VET90 without compression were 20 mmHg (range: 20-30 mmHg), 44% (39-50%) and 13 seconds (8.8-15.9 seconds), respectively. These improved significantly with all stockings. The application of any stocking raised the median IPMIV by 30 mmHg. The change from a class 2 stocking compared with no stocking versus the change from a class 1 stocking to no stocking had a more pronounced effect (p < .005). After sudden thigh-cuff deflation, the venous emptying was 41-45% greater and 9-10 seconds faster with all stockings (p < .005). CONCLUSIONS: This is the first study to quantify the venous return of below-knee GEC stockings. Assessments of stockings in augmenting venous return may be of use as a way of optimising compression for individual patients unresponsive to standard conservative treatment.

Common carotid artery occlusion treatment: revealing a gap in the current guidelines.

OBJECTIVE: To review the literature on the management of common carotid artery occlusion (CCAO). METHODS: A review of English-language medical literature from 1965 to 2012 was conducted using the PubMed and EMBASE databases to find all studies involving management of CCAO. The search identified 21 articles encompassing 146 patients/arteries (73.2% men; mean age 65 ± 6.9 years). RESULTS: The majority of the patients (93.8%) were symptomatic. Most of the patients (61.5%) had ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) patent, while an occluded ICA and a patent ECA were found in 26.6% of the patients. Eighty per cent of the patients treated underwent a surgical bypass procedure, with the subclavian artery as the most common inflow vessel (64.1%). During the first 30 days of the procedure two strokes (1.5%) were reported. During a follow-up period spanning an average of 25.6 ± 11.2 months nine patients (6.6%) experienced a clinical cerebrovascular event. Seven restenoses (5.1%) and two reocclusions (1.5%) also occurred-eight after open surgical and one after endovascular repair. CONCLUSION: The necessity to intervene to a CCAO remains controversial. This review shows that open surgical management of symptomatic CCA occlusive disease is a safe, durable, and effective therapeutic strategy with low perioperative cerebrovascular morbidity.

Elective bypass surgery for chronic mesenteric ischemic disease: report of 3 cases and review of the literature.

Chronic mesenteric ischemic disease is an unusual cause of chronic abdominal pain. We present our experience from open surgical treatment of patients with this rare disease followed by a short review of the literature. During the period 2006-2008, three patients were referred to our department with clinical and radiological findings of chronic mesenteric ischemic disease. In all patients, at least 2 out of 3 splachnic vessels (celiac artery, superior and inferior mesenteric artery) were occluded, with severe stenosis of the third. Open surgical revasculation was performed in all patients, using autologous or synthetic (Dacron) bypass grafts. Graft patency was examined with triplex ultrasound studies at 3, 6 and 12 months postoperatively and/or follow up CT angiography. All patients had patent grafts during the follow up period and have regained their normal body weight. Immediate and late results, technical details and controversies in open surgical revasculation for chronic mesenteric ischemic disease are reviewed. In conclusion open surgical revasculation for chronic mesenteric ischemic disease is a technically challenging procedure with good results in patients younger than 70 years old , with long occlusions of the splachnic vessels and severe calcification of the vessel wall.