[Quality standards for ultrasound assessment of the superficial venous system of the lower limbs. Report of the French Society for Vascular Medicine]. / Standards de qualité pour la pratique des examens écho-Doppler dans l'exploration du réseau veineux superficiel des membres inférieurs. Rapport de la Société française de médecine vasculaire (SFMV).

The quality standards of the French Society for Vascular Medicine for the ultrasound assessment of the superficial venous system of the lower limbs are based on the two following requirements: technical know-how (mastering the use of ultrasound devices and the method of examination); medical know-how (ability to adapt the methods and scope of the examination to its clinical indications and purpose and to rationally analyze and interpret its results). AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis; to achieve consistent practice, methods, glossary terminologies and reporting; to provide good practice reference points and to promote a high quality process. THEMES OF THE QUALITY STANDARD: The three levels of examination. Their clinical indications and goals. The reference standard examination (level 2) and its variants according to clinical needs. The minimal content of the examination report, the letter to the referring physician (synthesis, conclusion and management suggestions) and iconography. Commented glossary (anatomy, hemodynamics, semiology). Technical basis. Ultrasound devices settings. We discuss of use of Duplex ultrasound for the assessment of the superficial veins of the lower limbs in vascular medicine practice.

[Predictive value of D-dimer assay in superficial thrombophlebitis of the lower limbs]. / Valeur des D-dimères lors des thromboses veineuses superficielles des membres inférieurs.

OBJECTIVE: The negative predictive value of D-dimer (DD) assay in patients with venous thromboembolic disease is well established for deep vein thrombosis and pulmonary embolism. Little is known about the value of DD assay in patients with superficial thrombophlebitis (ST). The purpose of this study was to assess the value of DD assay in patients with ST of the lower limb. METHOD: The study group was composed of 100 consecutive patients, irrespective of age. Patients with clinical manifestations suggestive of ST of the lower limbs with positive duplex color Doppler evidence confirming the diagnosis and DD assay results (Vidas D-Dimer Exclusion) within 24 hours were included in the study. Patients with thrombosis in another site in addition to the superficial vein of the lower limb, those taking anticoagulants for more than 48 hours, and those with a condition known to potentially elevate DD levels were excluded. The volume of the thrombus was determined echographically and reported as mean diameter and length. RESULTS: Sixty-two women and 38 men were included. Mean age (+/- 5) was 58 years +/- 13.48 (range 18-90; median: 57). The ST involved the Great saphenous (n=74), the small saphenous (n=11) or another vein (n=15). Mean thrombus volume was 4453 mm(3) +/- 7101 (range 94-38484; median: 1751). Mean DD level was 829 ng/ml +/- 516.72 (range 100-2567; median: 715.5). DD assay was negative (<500 ng/ml) in 32 patients (32%) and positive in 68 (68%). For these three items, there was no significant difference between ST with and without varicose veins. DD assay was always positive (>or=500 ng/ml) in all patients aged over 70 years (n=22). In patients aged less than 70 years (n=78), DD assay was positive in 46 (59%) and negative in 32 (41%). DD level was positively correlated with thrombus volume in patients aged less than 70 years (P<0.0001). ROC analysis, sensitivity as a function of specificity by thrombus volume for the entire population, determined the usefulness of a negative DD assay. Considering the critical threshold at 5914 mm(3), sensitivity was 1.0 (95CI 0.89-1.0), with 0.29 specificity (95CI 0.19-0.42), 1.00 negative predictive value and 0.75 positive predictive value. However, the thrombus volume was less than this threshold value in three of the nine cases of ST with extension to the terminal portion of the saphenous. CONCLUSION: A positive DD assay was observed in 68% of patients with ST, with no significant difference with or without varicose veins. The test was positive in all patients aged over 70 years and in 59% of those aged under 70 years. There was a correlation between DD level and thrombus volume, yielding a threshold volume (5914 m(3)) above which all DD tests were positive. Nevertheless, this threshold volume was too great to include all ST extending to the terminal portion of the saphenous. Measurement of DD level is thus not contributive to the diagnosis of ST.

¿Cómo hacer una presentación en público? / How to make a public presentation?

Que el autor pueda dar a conocer su trabajo y que el público pueda conocer los avances realizados: tal es la finalidad de una conferencia. En un primer momento, que la forma sea perfectamente respetada (tiempo de la palabra, redacción de cuadros según normas definidas para ser proyectados por diversos medios). En un segundo momento, conviene dedicarse al fondo y redactar correctamente el título, una introducción concisa y precisa que defina el objetivo perseguido, el material y los métodos utilizados, los resultados y la discusión. La conclusión se limitará a hacer aparecer los puntos salientes del trabajo y, si quedan incertidumbres, a evocar perspectivas para el futuro

¿Cómo hacer una presentación en público? / How to make a public presentation?

Que el autor pueda dar a conocer su trabajo y que el público pueda conocer los avances realizados: tal es la finalidad de una conferencia. En un primer momento, que la forma sea perfectamente respetada (tiempo de la palabra, redacción de cuadros según normas definidas para ser proyectados por diversos medios). En un segundo momento, conviene dedicarse al fondo y redactar correctamente el título, una introducción concisa y precisa que defina el objetivo perseguido, el material y los métodos utilizados, los resultados y la discusión. La conclusión se limitará a hacer aparecer los puntos salientes del trabajo y, si quedan incertidumbres, a evocar perspectivas para el futuro

[Ultrasonography of postoperatively recurrent varicose veins in the area of the short saphenous vein]. / Aspect échographique des récidives variqueuses postopératoires du territoire de la veine petite saphène.

STUDY AIM: The aim of this retrospective study was to classify postoperative recurrent varicose veins in the area of the short saphenous vein. PATIENTS AND METHOD: This retrospective ultrasound Doppler exploration was performed in 60 patients (77 limbs) who had been operated with crossectomy, isolated or associated with a stripping of the short saphenous vein, after a mean 9.2-year interval. RESULTS: Recurrences were classified in five categories: 14.8% of the patients had a recurrence in relation to a venous stump at the level of the crossectomy; 32.1% had a saphenous vein in its anatomical location, 21% had reflux due to incompetence; in 28.4%, recurrence was not correlated with the short saphenous vein; and in only 3.8%, there was a pseudo-angiomatosis appearance. In half of these patients, recurrence was related to an incomplete stripping of the short saphenous vein. CONCLUSION: In order to avoid incomplete and inefficient treatments leading to recurrent varicose veins, an ultrasound Doppler exploration is necessary before and after crossectomy and stripping of the short saphenous vein.

[Echo Doppler classification of postoperative recurrence of varicose veins in the region of the internal saphenous vein]. / Classification écho-Doppler des récidives variqueuses post-opératoires du territoire saphène interne.

OBJECTIVES: Surgical treatment of varicose veins of the lower limbs is frequently complicated by recurrence. Although recurrence was long thought to result from technical errors, certain patients have progressive disease. METHODS: We used duplex-Doppler to assess 102 patients (160 limbs) with recurrence after resection of the saphene-femoral junction with stripping of the internal saphenous vein and the varicose network on the medial aspect of the leg. A vein map was established to classify recurrences. RESULTS: Type I, junctional stump with incontinent collateral, was observed in 22.5% of the cases. Type II, sapheno-femoral junction in an anatomic position, was found in 18.1%. Type III, backward flow from a perforating vein or a collateral of the common femoral was found in 13.1% and type IV, cavemomous aspect, in 7.5%. In 45% of the cases, the patient had a progressive condition with backward flow from collateral branches in the perineal or inguinal area unconnected to the common femoral. DISCUSSION: The cause of recurrent varicose veins is a question of debate: inadequate or incomplete treatment versus disease progression. Due to the chronic and evolutive nature of varicose veins, duplex Doppler exploration is essential for the preoperative work-up. Follow-up examinations should also be performed every year when the clinical examination suggests recurrence.

[Simultaneous echographic and endoscopic examination of morphologic anomalies of the valves of the internal saphenous vein]. / Examen simultané échographique et endoscopique des anomalies morphologiques des valvules de la saphène interne.

We attempted to determine whether the duplex-scan of valves is sufficiently specific and sensitive. We also studied morphological anomalies identified endoscopically leading to the pretherapeutic classification (VCT) to determine whether they are recognized by sonography. Finally, we studied valve kinetics to search for a correlation between morphological anomalies and changes in valve kinetics. We performed an endoscopy of the long saphenous vein during 3S procedures (saphenous vein-section-sclerosis) and a simultaneous duplex scan. The probe was positioned ahead of the endoscope which could visualize its tip. B mode and TM mode were used to evaluate valve kinetics. There was a satisfactory correlation between the ultrasonic findings and the endoluminal aspect. Certain abnormalities, visualized sonographically but of imprecise etiology, were identified endoscopically. The results of the two endoscopic and sonographic examinations were compared with clinical experience with valve diseases.

[Sclerotherapy section of incompetent short saphenous veins: indications, technique, results]. / Section sclérothérapie des saphènes internes incontinentes. Indications, technique, résultats.

UNLABELLED: Sclerotherapy section of the long consists of a combination of ligations, with section and injection of the proximal and distal segment of the long saphenous vein. This technique is performed under local anesthesia 10 centimeters from the saphenofemoral junction and can be performed as an outpatient procedure. MATERIALS AND METHODS: Inclusion criteria are incompetent long saphenous vein diameter over 9 millimeters in older patients whose Duplex-scan examination eliminated other leaking points such as anterior or posterior tributaries or the junction, reflux coming from superficial iliac circonflex veins or from vulvo-pudendal varicose veins. Our study concerned 75 patients. 78 limbs were operated, 72 were reviewed after 1 year and 65 after 3 years. RESULTS: 66 of the 72 limbs (91.6%) had an incompressibility without flux or reflux at the sapheno-femoral junction level after 1 year and 59 of the 65 limbs (90.8%) after 3 years. Sclerosis with incompressibility without flux or reflux was observed in the lower third of the thigh in 51 of the 72 limbs (70.8%) after 1 year and in 40 of the 65 limbs (61.5%) after 3 years, without any clinically detectable underlying varicose recurrence. DISCUSSION: This technique is ambulatory and economic and ensures control of sapheno-femoral junction reflux. In the majority of reflux cases, the reflux observed in the lower third of the thigh is related to a Hunter perforanting vein that can feed an underlying varicose network. They were treated by ultrasound-guided ossifying injection. CONCLUSION: The indications for this technique are incompetence of the sapheno-femoral junction in older patients with trophic disorders, allowing effective treatment of the source of the reflux with rapid healing of underlying trophic disorders.

An ambulatory treatment of varicose veins associating surgical section and sclerotherapy of large saphenous veins (3S technique). Preliminary study with results at one year.

BACKGROUND: The 3S technique enables treatment of large incontinent greater saphenous veins in patients who, for medical or social reasons, refuse traditional surgical methods. It associates phlebectomy with section-ligation and injection of a sclerosing solution in the proximal and distal segments. The 3S technique is merely one stage in the treatment of the saphenous vein, aimed at suppressing reflux, and associated with sclerosis of the junction. It must always be combined with later sclerotherapy sessions. METHODS: One hundred and eight patients were operated on by the 3S technique, of which 100 had 1-year follow-up. Each patient was checked by duplex scan examination before treatment, and 1 month and 1 year after. RESULTS: We obtained good results without reflux in 96% at the sapheno-femoral junction at 1 year. CONCLUSIONS: Superficial venous insufficiency is a chronic disease with evolution or recurrences. To appreciate the efficiency of 3S technique, it will be better to have 5 years worth of follow-up. This is a preliminary study with a short follow-up.

[Does the inferior vena cava have 2 surfaces and 2 borders also?]. / La veine cave inférieure a-t-elle aussi deux faces et deux bords?

The vena cava that has a preferential flattening axis, has also 2 wall sides and 2 borders. The back wall fits closely round on the back vertebral plane and the main colaterals terminate on the borders of the vein. TM echography perfectly analyses the movements of the walls of the vein, as well as the respiratory and auricular movements. In a lying patient, echo-doppler colour shows the expiratory acceleration of the vena cava flow in subrenal area associated with an inspiratory slowing down (as well as for the femoral veins) and the inspiratory acceleration of the flow in suprarenal area associated with an expiratory slowing down. In a standing patient, the vena is cylindrical. When he/she walks on a treadmill, the diameter of the cava seems to be constant, i.e. quasi identical to the aorta's, as fluxes vary in the aorta according to the ventricular contractions and in the LVC according to the patient's gait.