ABSTRACT
OBJECTIVE: To evaluate the efficacy of endovenous laser ablation of incompetent perforating veins. STUDY DESIGN: Prospective cohort study. PATIENTS: A total of 58 perforating veins in 33 limbs of 28 patients were treated between March 2008 and February 2009 in an outpatient clinic setting. The average age was 65 years (range 30-81 years); 64% female; CEAP clinical stage C4 (67%), C5 (17%) and C6 (16%) (Clinica, Etiology, Anatomy and Pathophysiology, CEAP). METHODS: All patients underwent a standardised clinical examination and duplex ultrasonography. Guided by duplex ultrasonography, the perforating veins were cannulated percutaneously and tumescent local anaesthesia was given. An 810-nm diode laser was used to deliver 14 W power. Mean total energy delivered was 187 (range 87-325) J. Three months post-treatment, all patients underwent a further duplex ultrasound examination, to determine the treatment outcome. RESULTS: Occlusion of the perforating veins was achieved after 3 months in 78% of the cases. In the CEAP C6 group, four of five ulcers had healed after 6 weeks. No serious complications, including deep venous thrombosis, were encountered. CONCLUSIONS: Endovenous laser therapy for treating incompetent perforating veins is a safe and technically feasible technique. The initial occlusion rate is acceptable.
Subject(s)
Laser Therapy , Venous Insufficiency/surgery , Adult , Aged , Aged, 80 and over , Anesthesia, Local , Chronic Disease , Female , Humans , Laser Therapy/adverse effects , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Duplex , Varicose Ulcer/etiology , Varicose Ulcer/surgery , Venous Insufficiency/complications , Venous Insufficiency/diagnostic imaging , Wound HealingABSTRACT
This review assesses molecular aspects of the rescue of disease-causing mutations in genodermatoses by means of naturally occurring secondary genetic phenomena. Such data have important implications for the design of gene therapy approaches for inherited skin diseases. Reversal of the phenotype depends on three elements: the number of cells involved; the degree of gene reversal; and the specific timing of the reversion. If reversion occurs in somatic cells, revertant mosaicism may occur. This is the situation in which a patient's skin is generally affected by the genodermatosis, but islands of normal skin stand out. These reflect the presence of revertant cells that are sufficient to restore a normal local skin phenotype. Reversion of the original mutation may also be partial, in which case the phenotype may display no, or only limited, improvement. Nevertheless, the phenotype may ameliorate with age if the reverted cells preferentially expand in time or if the time of onset of reversion is after birth. In essence, the complexities of naturally occurring rescue processes are important to understand because the inherent mechanisms may provide clues and insight into optimal therapeutic gene manipulation, and the possibility of mimicking nature in the management of patients with diverse genodermatoses.
