Endovenous Laser Ablation of the Great Saphenous Vein with a 1470 nm Wavelength Laser : Results of a Prospective, Single Centre Cohort Study.

BACKGROUND: Endovenous laser ablation (EVLA) is a widely accepted treatment for venous insufficiency. Our aim was to report the standardised technique used in our centre and to evaluate the anatomic and clinical success rates. METHODS: All details of patients treated with EVLA were prospectively collected in a database. A standardized examination and surgical protocol was used, and every detail in the technique was registered. A follow-up visit was organised after 1 week and after 4-6 weeks with a duplex. RESULTS: A total of 441 limbs were treated in 366 patients using a 1470 nm wavelength laser with bare tip fiber -(Biolitec(®)). At 6 weeks postoperative a total obliteration of the vein was established in 98.62% of the cases with 78.67% of the patients free from complaints. No major complications were reported. Minor complaints were low (10.74% induration, 3.9% paresthesia). 93.11% reported no pain, 5.2% mentioned moderate pain. Mean duration of absence was equal or less than 1 week (65,28%). Satisfaction level was high (92.84%, level 10). CONCLUSIONS: EVLA of the GSV and the Anterior Accessory Vein (AAV) with a 1470 nm wavelength laser with bare tip fiber is a minimally invasive, safe and effective technique. We are convinced that every detail is important : tumescence technique, Trendelenburg position, no external compression, and the position of the vein in the fascial sheath. Further reduction of linear endovenous energy density (LEED) used for EVLA can improve the therapy. This is possible by using a new fiber tip design (radial optical fiber) and needs further investigation.

BRAVISSIMO: 12-month results from a large scale prospective trial.

The BRAVISSIMO study is a prospective, non-randomized, multi-center, multi-national, monitored trial, conducted at 12 hospitals in Belgium and 11 hospitals in Italy. This manuscript reports the findings up to the 12-month follow-up time point for both the TASC A&B cohort and the TASC C&D cohort. The primary endpoint of the study is primary patency at 12 months, defined as a target lesion without a hemodynamically significant stenosis on Duplex ultrasound (>50%, systolic velocity ratio no greater than 2.0) and without target lesion revascularization (TLR) within 12 months. Between July 2009 and September 2010, 190 patients with TASC A or TASC B aortoiliac lesions and 135 patients with TASC C or TASC D aortoiliac lesions were included. The demographic data were comparable for the TASC A/B cohort and the TASC C/D cohort. The number of claudicants was significantly higher in the TASC A/B cohort, The TASC C/D cohort contains more CLI patients. The primary patency rate for the total patient population was 93.1%. The primary patency rates at 12 months for the TASC A, B, C and D lesions were 94.0%, 96.5%, 91.3% and 90.2% respectively. No statistical significant difference was shown when comparing these groups. Our findings confirm that endovascular therapy, and more specifically primary stenting, is the preferred treatment for patients with TASC A, B, C and D aortoiliac lesions. We notice similar endovascular results compared to surgery, however without the invasive character of surgery.

Endovenous laser treatment for primary varicose veins.

Venous insufficiency of the lower extremities is a highly prevalent condition. Successful treatment of superficial venous insufficiency will most often necessitate treatment of the saphenofemoral junction incompetence with correction of saphenous vein reflux. In the majority of patients it concerns a reflux of the greater saphenous vein. The standard procedure consists of ligation and stripping of the greater saphenous vein combined with with additional phlebectomies or ligation of insufficient perforant veins if necessary. Although the standard procedure is widely known and accepted, the postoperative morbidity and postoperative limitations of activity are high. In this context minimally invasive percutaneous endovenous techniques were developed to improve the patients comfort and faster resumption of work. Among these, endovenous laser ablation of the greater saphenous vein is a relatively new procedure. Percutaneous introduction of a laser fiber into the incompetent vein and ablation with pulsed laser energy is far less invasive than stripping.

Thoracoscopic-assisted pulmonary resection in lung cancer.

BACKGROUND: Thoracoscopic-assisted pulmonary resection for lung cancer is controversial. The appropriateness of this approach has to be compared with the golden standard of an open resection. METHODS: This study consists of 66 patients with a clinical stage 1 disease. A thoracoscopic exploration was executed in 41 patients. Only in 16 cases was a thoracoscopic resection finally possible. The clinical and pathological TNM classification, the histological types and the surgical procedure are reported. The reasons for conversion are documented. RESULTS: To investigate the appropriateness of the thoracoscopic approach we evaluated only the pathologically proven stage 1 disease in both groups. Postoperative complications, hospital stay and survival are compared. CONCLUSION: Until now we can conclude that there is no adverse effect on survival because of the thoracoscopic approach.

Chronic small bowel obstruction due to intestinal malrotation in the older child: an often missed diagnosis.

A case of chronic small bowel obstruction due to intestinal malrotation in a 13.5-year-old girl is reported. The importance of the patient's history revealing the recurrent character of the symptoms, and of different radiological features are emphasized, in order to prevent late diagnosis. Diagnosis of psychogenic disorder is only retained after exclusion of all organic anomalies. At surgery the bowel is placed in the primitive position of the non-rotated gut, after reduction or resection of the volvulus, if present.