The outcome of endovenous intervention for acute iliofemoral deep venous thrombosis with and without inferior vena cava filter.

BACKGROUND: Catheter-directed thrombolysis (CDT) for acute iliofemoral deep venous thrombosis (DVT) is an endovenous interventional therapy that can quickly remove the acute thrombus, thereby improving the clinical outcomes of proximal DVT. However, instrumentation of extensive fresh thrombus may be associated with iatrogenic pulmonary embolism (PE). Therefore, we aimed to compare CDT's safety, complications, and perioperative embolic (PE) insults for acute iliofemoral DVT, with and without an IVC filter. METHODS: One hundred twenty patients having acute proximal DVT for less than 14 days and undergoing endovenous therapy were included and presented to the vascular surgery department of Al-Azhar University Hospitals, Egypt. The patients were randomized into two equal groups, Groups A and B, each having 60 patients. Group A was treated with IVC filter insertion, while Group B was treated without a filter. The anticoagulation and CDT procedures were similar between the two groups. RESULTS: The sample included 96 females (80%) and 24 males (20%), with a mean age of 32.6 ± 7.2 years. Clinically no clinical PE occurred in both groups. However, radiologically, new lesions in multislice CT pulmonary angiogram and V/Q scan were noted in two of 60 patients (3.33%) of the IVC filter group, compared with three patients (5 %) in the non-filtered group. CONCLUSION: Endovenous intervention in the form of CDT for acute iliofemoral DVT without an IVC filter is safe and not associated with an increased risk of pulmonary embolization than filter usage. The routine use of IVC filters should not be used mandatorily during CDT.

Outcomes of Alprostadil As an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization.

BACKGROUND: This study was carried out to assess the effectiveness of alprostadil (prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia (CLI) after the failure of direct revascularization (DR). METHODS: At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with CLI underwent a failed trial of DR procedure, all revascularization procedures were endovascular. Median follow-up was 2 years and 2.5 years for patients with and without diabetes mellitus (DM). In the alprostadil group, the mean age was 63.41 ± 12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention alprostadil was administrated immediately postoperatively by intravenous infusion of 40 µg alprostadil diluted in 100 ml of normal saline, over 2 hr every 12 hr for 6 days. RESULTS: In the alprostadil group, the mean ± standard deviation (SD) of the baseline ankle-brachial index (ABI) was 0.45 ± 0.175, while the mean ± SD of ABI at the end of our study was 0.65 ± 0.216 with a difference from the baseline of 0.2 ± 0.041 (P value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3- and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68 ± 0.22, while the mean ± SD of ABI at the end of our study was 0.69 ± 0.23 with a difference from the baseline of 0.01 ± 0.01 (P value >0.05 meaning that it is nonsignificant) 1-month patency rate was 89%, while 3- and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention in the alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation before the study ended. CONCLUSIONS: Our results show the efficacy and safety of alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to CLI.

Femoral vein stenting versus endovenectomy as adjuncts to iliofemoral venous stenting in extensive chronic iliofemoral venous obstruction.

PURPOSE: To compare femoral endovenectomy with the creation of an arteriovenous fistula (FE + AVF), versus iliofemoral endovenous stenting with the concurrent extended femoral vein (FV-S) stenting in patients with chronic iliofemoral venous obstruction (IFVO). MATERIALS AND METHODS: In a randomized prospective single-center study, 48 received (FV-S), while the other 54 had (FE + AVF). RESULTS: There were no statistically significant differences in the primary outcomes between the two groups (FV-S) and (FE + AVF) (59% vs 56.8%, 75% vs 79.1%, respectively). At a median of 13 months after the treatment. However, the FV-S group's patients experienced fewer postoperative problems (p = .012), shorter procedures (p = .001), and shorter stays in the hospital (p = .025). CONCLUSION: There is no difference between the efficacy and symptomatic resolution of the FV-S group and the FE + AVF group at the same time, FV-S has lower postoperative complications and a shorter procedure duration and hospital stay.

Outcomes of Cyanoacrylate Closure Versus Radiofrequency Ablation for the Treatment of Incompetent Great Saphenous Veins.

BACKGROUND: Evaluation of the efficacy and safety of cyanoacrylate closure (CAC) for treating incompetent great saphenous veins (GSVs) compared to radiofrequency ablation (RFA). METHODS: In this prospective, randomized controlled study, 248 symptomatic subjects with incompetent GSVs were assigned to either CAC or RFA. The primary end point, complete closure of the target GSV, was determined using a duplex ultrasound examination. RESULTS: In this study, 248 patients (mean age 33.64 ± 8.06 years including 71% women) were treated with either CAC (n = 128) or RFA (n = 120) between August 2018 to May 2022. As a follow-up, after a 1-month duration, the closure rates were 128/128 at the CAC and 154/158 at the RFA. At month 24, closure rates were 122/128 at CAC and 146/158 at RFA. Apart from phlebitis and pigmentation, the incidences of bruising, skin burn, and paresthesia were lower in the CAC group compared to the RFA group. The mean procedural times were shorter for CAC. The satisfaction level with the treatment was moderately higher among CAC patients than RAF patients. CONCLUSIONS: This study suggests that Cyanoacrylate glue closure of the GSV and RFA are effective techniques for managing primary varicose veins. Cyanoacrylate glue closure of the GSV appears to have a lower rate of complications and higher satisfaction levels, rapid return to normal activities, and improved procedure time without the need for perivenous tumescent anesthesia and postprocedure compression stockings when compared to RFA.

In vitro controlled elemental analysis to evaluate the combined effect of acidulated phosphate fluoride with Er:YAG and diode lasers.

Background: Acidulated phosphate fluoride (APF) application is used for dental caries prevention. Combining APF with different laser wavelengths increases acid resistance in enamel. Aim: To assess the effects of Er:YAG (2940 nm) laser and diode (940 nm) laser after the application of APF on morphology and mineral content of enamel surfaces of human teeth in vitro. Materials and Methods: Twenty (20) freshly extracted third molar crowns were collected and split longitudinally into halves. Ten (10) halves were given to each of the following groups: group 1 (control), group 2 (application of 1.23% APF gel only), group 3 (diode laser; 1 W for 60 sec, contact mode after APF gel), and group 4 (Er:YAG; 80 mJ, 0.8 W, 10 Hz; in pulsed mode for 10 sec after APF gel). Specimens were morphologically examined by scanning electron microscope (SEM), and mineral content was analysed by energy dispersive X-ray (EDX). Collected data were statistically analysed by ANOVA. Results: Morphologic results were superior in group 3 followed by group 2 and group 1 with the least change in group 4. EDX of calcium (Ca), phosphorous (P), and Ca/P ratio weight % showed the highest value with no statistical significance between groups 2 and 1, and higher with statistical significance in groups 3 and 4 in descending order. Carbon weight % showed highest results in group 4 then 3, 2, and 1. Fluoride weight % showed highest statistical results in group 4 then 2, 3, and 1. Conclusion: The diode laser showed superior morphological results after APF application compared to the Er:YAG laser. The Er:YAG increased fluoride absorption on outer enamel surfaces.

Contexte: L'application de fluorure de phosphate acidulé (FPA) est utilisée pour la prévention des caries dentaires. La combinaison de FPA avec différentes longueurs d'onde de laser augmente la résistance de l'émail aux acides. Objectif: Évaluer les effets du laser erbium YAG (2940 nm) et du laser à diode (940 nm) après l'application de FPA sur la morphologie et le contenu minéral des surfaces de l'émail des dents humaines in vitro. Matériaux et méthodologies: Vingt (20) couronnes de troisième molaire fraîchement extraites ont été recueillies et divisées longitudinalement en moitiés. Dix (10) moitiés ont été données à chacun des groupes suivants : groupe 1 (contrôle), groupe 2 (application de gel de FPA à 1,23 % seulement), groupe 3 (laser à diode; 1 W pendant 60 secondes, mode contact après le gel de FPA), et groupe 4 (erbium YAG; 80 mJ, 0,8 W, 10 Hz kl ; en mode pulsé pendant 10 secondes après le gel de FPA). Les spécimens ont été examinés morphologiquement au microscope électronique à balayage (MEB), et le contenu minéral a été analysé par rayons X à dispersion d'énergie (EDX). Les données recueillies ont été analysées statistiquement par ANOVA. Résultats: Les résultats morphologiques étaient supérieurs dans le groupe 3, suivi par le groupe 2 et le groupe 1, avec le changement le moins important dans le groupe 4. Le pourcentage de l'EDX du calcium (Ca), du phosphore (P) et du rapport Ca/P en poids a montré la valeur la plus élevée sans signification statistique entre les groupes 2 et 1, et la plus élevée avec signification statistique dans les groupes 3 et 4 par ordre décroissant. Le pourcentage en poids de carbone a montré les résultats les plus élevés dans le groupe 4, ensuite 3, 2 et 1. Le pourcentage en poids de fluorure a montré les résultats statistiques les plus élevés dans le groupe 4 puis 2, 3 et 1. Conclusion: Le laser à diode a montré des résultats morphologiques supérieurs après l'application de FPA par rapport au laser erbium YAG. L'erbium YAG a augmenté l'absorption du fluorure sur les surfaces externes de l'émail.