Successful embolization of vulval varices arising from the external pudendal vein†.

Varicose veins in the vulvar and peri-vulvar area are seen in 4% of women and most commonly seen during pregnancy. It is thought to be as a direct result of the presence of ovarian and pelvic varicosities. Diagnostic modalities used in the investigation of this condition included pelvic ultrasound, computed venography, magnetic resonance venography and catheter-directed venography. The treatment options in the past were hysterectomy and/or ligation of ovarian veins by open or laparoscopic approach. Modern techniques involve embolization of the varicosity via radiological techniques. In this case the patient presented with vulval and upper thigh varices associated with pelvic pain. They were located to be from the superficial external pudendal vein, which is not a common source but worth considering with other causes. They were treated successfully with fluoroscopy-guided embolization.

The results of high-frequency duplex surveillance after iliac arterial stenting in a single center.

Frequent duplex surveillance after iliac arterial stenting is time-consuming and costly, so solid benefits of this approach must be available. Frequent duplex surveillance was performed at our center, this was reviewed retrospectively.A total of 117 stents were assessed. Duplex was done for 84 (71.8%) of 117 patients at 1 year and 25 (21.4%) of 117 at 5 years, mean follow-up 27.6 months. Totally, 456 scans were performed; 386 (84.6%) scans were normal, 43 (9.4%) showed an abnormality for which intervention was not necessary, 27 (5.9%) showed abnormalities which needed interventions. The maximum attendance of patients was 62%. In all, 18 patients had interventions unrelated to scheduled follow-up; 15 (83.3%) of 18 had no prior abnormalities on duplex, 3 (16.6%) of 18 had prior abnormalities which were not acted upon after clinical assessment. Our findings demonstrate a high nonattendance rate with frequent emergency presentations due to acute complications. We cannot, therefore, recommend frequent duplex surveillance program both in terms of results or resource allocation.

Duplex ultrasound scanning (DUS) versus computed tomography angiography (CTA) in the follow-up after EVAR.

INTRODUCTION: Computed tomography angiography (CTA) is the gold standard follow-up modality after endovascular aneurysm repair (EVAR). A potential alternative noninvasive and less expensive modality is duplex ultrasound scanning (DUS). METHODS: We studied 314 follow-up paired scans (DUS and CTA) in 59 patients with EVAR. RESULTS: Endoleak--Endoleak was detected in 23.7% patients. The sensitivity and specificity rates of DUS were 54% and 95.3%, respectively. All 9 endoleaks that needed secondary intervention were detected on DUS. Eight of those were identified within a year after EVAR. Sac size--The mean difference in maximum diameter between the DUS and CTA was < or =5 mm in 84.5% of cases and < or =10 mm in 97.1%. Graft patency--There was 100% agreement between CTA and DUS. CONCLUSIONS: Duplex ultrasound scanning was reliable as it detected all the leaks that needed reintervention after EVAR. Duplex ultrasound scanning showed similar results to CTA in detecting sac size and patency.

Soluble but not platelet P-selectin correlates with spontaneous platelet aggregation: a pilot study.

BACKGROUND: P-selectin (PS) is a marker of platelet activation measured on the platelet surface as platelet PS (pPS) or in serum as soluble PS (sPS). Controversy remains over the exact relationship between sPS, pPS, and other markers such as spontaneous platelet aggregation (SPA). OBJECTIVE: To investigate correlations between pPS, sPS, and SPA in patients with peripheral arterial disease. METHODS: SPA, pPS, and sPS levels were measured in venous blood sampled from patients following intermittent claudication (n = 18) or an acute stroke (n = 18). RESULTS: SPA and sPS correlated significantly in the claudicants (Pearson correlation coefficient, r = 0.661; P = .0020) and stroke patients (r = 0.514; P = .020). No significant correlation was identified between pPS and SPA, or sPS and pPS. CONCLUSIONS: The 2 methods of assessing PS are not comparable. Although pPS is accepted as a platelet activation marker, sPS may be a better indicator of aggregation represented by SPA.

Comparison of new continuous measurements of ambulatory venous pressure (AVP) with conventional tiptoe exercise ambulatory AVP in relation to the CEAP clinical classification of chronic venous disease.

INTRODUCTION: Quantitative measurements of chronic venous insufficiency (CVI) are sensitive in detecting the presence of CVI but have low specificity in differentiating clinical severities of CVI as defined by the CEAP classification. One possible reason for this is measurement techniques do not assess variables that reflect hemodynamic changes that occur during normal exercise. Our aim was to compare the association of variables determined from a new technique, continuous ambulatory venous pressure monitoring (CAVPM), and those of conventional AVP measurement with the clinical severity of chronic venous insufficiency in patients with primary venous reflux. METHODS: Fifty-four limbs of 49 patients with CVI and 15 healthy controls were studied. CVI clinical severity was classified according to CEAP as C2&C3 (mild disease), C4 (moderate disease), and C5&C6 (severe disease). All participants underwent duplex ultrasound scanning to rule out the presence of reflux in the control group and to confirm it in the patient groups. Conventional AVP measurements, including 90% refilling time (RT90), were compared with the new CAVP variables of mean walking pressure (MWP) and percentage fall in walking pressure (%FWP). Data were analyzed by analysis of variance using the Kruskal-Wallis test, and comparisons between groups were performed using Mann-Whitney tests. Discriminant analysis was used to determine the ability of a test to classify limbs into clinical classes. RESULTS: Conventional AVP measurements could not differentiate between the control group and the presence of mild disease (P = .56) but did differentiate between controls and severe disease as well as mild and severe disease (P < .001). RT90 detected differences between controls and reflux groups (P < .001) but not between moderate (C4) and severe (C5&C6) clinical groups (P > .5). MWP and %FWP showed significant differences between all clinical severities and controls (P < .001). CONCLUSION: In the assessment of CVI, mean walking pressure and percent fall in walking pressure are more reliably associated with anatomic distribution of reflux and clinical severity of CVI than the gold standard investigations of conventional AVP and RT90.

Association of 24-hour activity levels with the clinical severity of chronic venous disease.

INTRODUCTION: The pathophysiology underlying the skin changes seen in chronic venous insufficiency (CVI) is multifactorial. Sedentary lifestyle and prolonged sitting and standing at work have been proposed by some authors to be influential in the development of CVI skin changes. This study compared the 24-hour activity profiles in patients with different clinical severities of CVI and normal controls. METHODS: Patients were classified into groups according to CEAP clinical severity classes: mild (C2&C3), moderate (C4) and severe (C5&C6). Activity profiles were measured in 60 patients and 15 controls using a Newcastle Universities Medical Activity (NUMACT) monitor, which recorded the duration spent in supine, sitting, and standing postures as well as duration spent walking and the walking intensity over a 24-hour period. Analysis was performed by Kruskal-Wallis and Mann-Whitney tests and Spearman correlation. RESULTS: Walking intensity was significantly different between the controls and patient groups during prolonged walking (P < .001). The controls spent significantly more time standing in a 24-hour period than any of the CVI clinical groups (P = .036), and the percentage time spent sitting was significantly higher in the patient groups (P = .025). No significant differences were found in the total number of steps taken or total duration spent walking in the 24-hour period between any of the groups. CONCLUSION: This study shows that walking intensity is lower in the more severe clinical groups and may be influenced by the clinical severity of CVI. The study provides evidence that prolonged sitting and reduced standing is associated with increased severity of CVI, which may by an effect of the patient's symptoms rather than a cause of disease progression.