Deep venous reconstructions: long-term outcome in patients with primary or post-thrombotic deep venous incompetence.

OBJECTIVES: To evaluate long-term durability and clinical success of deep venous reconstruction for severe chronic venous insufficiency as a part of routine workload at a university vascular surgery department. STUDY DESIGN: Retrospective analysis of clinical series. PATIENTS: Between 1996 and 2000, 43 patients underwent deep venous reconstruction, and 38 were available for follow-up. Of these, 29 had secondary valve disease. Median follow-up time was 4.5 years (range, 2-6.5). Preoperatively, 20 had active or healed ulcers. METHODS: Severity of the disease was assessed by the CEAP classification, clinical severity and disability scores, and duplex evaluation. Criteria for clinical success were the following: no or mild symptoms and ability to work for eight hours. Surgical reconstructions included 12 internal and seven external valvuloplasties, 14 vein transpositions, and 29 valve transplantations. Of the 38 patients, six needed at least one further reconstruction. Follow-up visits were set at one month, six months, and thereafter annually. Two independent examiners performed the final examination. RESULTS: The overall cumulative clinical success rate at four years was 23%, and freedom from ulcer 54%. Valvuloplasties were the most durable techniques with a cumulative 4-year durability rate of 55%. The durability rate for transpositions was 43%, and for transplantations 16%. Of 13 reconstructions for primary insufficiency, nine were durable. CONCLUSIONS: Overall results were unsatisfactory, although the durability of reconstructions for primary insufficiency were acceptable.

Communicating Doppler-derived information in superficial venous surgery.

OBJECTIVE: The aim was to evaluate how Doppler-derived information could be communicated in written form to surgeons before superficial vein surgery. PATIENTS AND METHODS: The study included 78 patients with 102 limbs operated on for C2-4 superficial venous insufficiency. A vascular surgeon, in a vascular reference centre, preoperatively examined all patients with duplex ultrasound or hand-held Doppler and prepared a treatment plan accordingly. The plan was then sent to operative units. Patients were cohorted and operated on in two groups either with or without preoperative Doppler marking. At two years postoperatively, an independent examiner performed a follow-up duplex examination. RESULTS: Elimination of preoperatively identified axial reflux succeeded better in preoperatively marked than in non-marked group: axial reflux sites in saphenofemoral junction (SFJ), great saphenous vein (GSV), main branches of GSV or small saphenous vein (SSV) remained in five vs. 12 limbs (10 vs. 26%, P = 0.063). Overall, some axial reflux remained in 11 vs. 21 limbs (22 vs. 41%, P = 0.033). CONCLUSION: Preoperative Doppler-derived information was not communicable in written form. Thus, it is important for the operating surgeon to do ultrasound-based preoperative marking allowing him to perform more accurate surgery.

Service comparison between vascular and general surgery in the treatment of chronic venous insufficiency with special reference to preoperative Doppler techniques.

AIMS: To compare the ability of vascular and general surgical services to abolish reflux in superficial venous system with a special reference to preoperative use of Doppler techniques. MATERIALS AND METHODS: 68 lower limbs operated on for venous insufficiency based on either preoperative Duplex evaluation and Doppler marking in a vascular surgical unit (Vascular Surgical Service, VSS: 33 limbs, clinical class C2-C6) or clinical findings in a general surgical unit (General Surgical Service, GSS: 35 limbs, clinical class C2-C4) were re-examined clinically and with duplex scanning for reflux some three years postoperatively. RESULTS: Marked superficial or perforator vein reflux was observed in 27 of 68 (39.7 %) operated limbs, thirteen of which in VSS and fourteen in GSS. However, axial reflux at saphenofemoral or thigh level was observed significantly less in VSS compared to GSS (3 vs 13, p = 0,006). CONCLUSION: Total ablation of any reflux appeared difficult irrespective of the preoperative assessment. Preoperative Duplex examination, however, aided in identifying and treating axial reflux at thigh level.

Preservation of venous valve function after catheter-directed and systemic thrombolysis for deep venous thrombosis.

OBJECTIVES: The aim of the study was to assess venous reflux and the obstruction pattern after catheter-directed and systemic thrombolysis of deep iliofemoral venous thrombosis. PATIENTS: Thirty-two patients treated either with systemic (16) or catheter-directed local thrombolysis (16) for massive iliofemoral thrombosis were identified from the hospital registry. METHODS: Clinical evaluation at follow up was based on the CEAP classification and disability score. Reflux was assessed by colour duplex ultrasonography and standardised reflux testing. A vascular surgeon blinded to treatment established the clinical status of the lower limb following the previous DVT. RESULTS: Valvular competence was preserved in 44% of patients treated with catheter-directed thrombolysis compared with 13% of those treated with systemic thrombolysis (p=0.049, Chi squared). Reflux in any deep vein was present in 44% of patients treated by catheter-directed lysis compared with 81% of patients receiving systemic thrombolysis (p=0.03, Chi squared). Reflux in any superficial vein was observed in 25% vs. 63% of the patients, respectively (p=0.03, Chi squared). There were significantly more patients with venous insufficiency of classes C0-1 in the group treated with catheter-directed thrombolysis. CONCLUSION: In this clinical series venous valvular function was better preserved after iliofemoral DVT when treated with catheter-directed thrombolysis.

Overexpression of the Aspergillus niger pH 2.5 acid phosphatase gene in a heterologous host Trichoderma reesei.

An Aspergillus gene coding for a pH 2.5 acid phosphatase enzyme was successfully overexpressed in Trichoderma reesei under the strong main cellobiohydrolase I (cbh 1) promoter. The best transformants produced up to 240 times more of the acid phosphatase than the Aspergillus strain from which the phosphatase gene was originally isolated. The recombinant enzyme was effectively secreted into the culture medium both by its own and the cbh 1 secretion signal. The heterologous pH 2.5 acid phosphatase enzyme produced by the Trichoderma transformants was seen as four protein bands of about 55-66 kD resulting from variable glycosylation in Trichoderma. The activity of the recombinant enzyme was not affected. Enzyme preparations rich in both cellulose and phytate hydrolysing enzymes are of interest in the animal feed industry.

The cloning and sequencing of the genes encoding phytase (phy) and pH 2.5-optimum acid phosphatase (aph) from Aspergillus niger var. awamori.

The genes encoding phytase (EC 3.1.3.8) and pH 2.5-optimum acid phosphatase (EC 3.1.3.2) have been cloned and sequenced from Aspergillus niger var. awamori. The translated nucleotide sequences yielded polypeptides of 467 and 479 amino acids (aa) for phytase and acid phosphatase, respectively. The genes were isolated using oligodeoxyribonucleotide probes based on the aa sequences of the purified proteins. Recombinant A. niger var. awamori strains carrying additional copies of the gene sequences demonstrated elevated enzyme activities.