A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease.

AIM: The aim of this study was to compare the effects of iloprost and lumbar sympathectomy (LS) in the treatment of Buerger's disease. METHODS: Two hundred patients with rest pain and/or ischemic ulcers were randomized to undergo LS or 28-day intravenous treatment of iloprost. The primary endpoint was complete healing without pain or major amputation at 4 and 24 weeks. The secondary endpoints were analgesic requirement, reduction in the ulcer size, 50% reduction of the ulcer, and shift in the modified SVS/ISCVS clinical status grading scale. RESULTS: The comparison was carried out in 162 patients (iloprost: n=84; LS: n=78). Complete healing rate was 61.9% in the iloprost group, but 41% in the LS group at the 4th week (P=0.012); respective values for the 24th week were 85.3%, 52.3%, P<0.001. Analgesic requirement was lower in the iloprost group at the 4th and 24th weeks (P=0.01, and P=0.098, respectively). The size of the ulcers decreased more in the iloprost group than the LS group (P=0.044 and P=0.035 at 4th and 24th weeks); 50% reduction in the ulcer size in the iloprost group was greater than in the LS group (P=0.001 and P=0.009 at 4th and 24th weeks). SVS/ISCVS grading scale demonstrated a better clinical benefit in patients treated with iloprost (P<0.001 at 4th week, and P<0.001 and at 24th week). CONCLUSIONS: The results of this independent study indicate that using iloprost relieves ischemic symptoms better than LS. In the era of stable prostacyclin analogues, there is no reliable evidence to support the use of LS in Buerger's disease.

Upper extremity deep vein thrombosis: clinical and treatment characteristics.

We aimed to evaluate patients with upper extremity deep vein thrombosis (UEDVT) in terms of the risk factors, symptoms, clinical course, diagnostic approaches and treatment outcome. Thirty-six patients with a diagnosis of UEDVT, comprising 19 males (52.7%) and 17 females (47.3%), were included in the study; the mean (+/- SD) age was 54 +/- 12.3 years. The most common risk factor was central venous catheter use. The treatment protocol consisted of low molecular weight heparin for up to 7 days, followed by oral anticoagulants for up to 6 months. All patients were followed up for 1 year. More than 90% of the patients responded well to treatment. Nine patients (25%) died due to underlying diseases; no patients died secondary to UEDVT. None of the patients developed pulmonary embolus or recurrent deep venous thrombosis, and post-thrombotic syndrome was not observed. The mortality rate was related to the underlying diseases.

Surgical management of giant aneurysms complicating arteriovenous fistulae.

The creation of an arteriovenous fistula (AVF) is frequently used to achieve easier access for haemodialysis in patients with chronic renal insufficiency. The most frequent late complication of AVFs is aneurysm formation, which carries the risk of spontaneous rupture. This study reports on 18 patients with giant aneurysms that developed on antebrachial AVFs who were operated on over a period of 6 years. Colour duplex ultrasonographic examination of the upper extremity was performed in all but one patient in the preoperative period. Surgical management included resection of the aneurysm and re-establishment of arterial continuity. There were no complications such as infection, ischaemic extremity loss, neurological sequelae or mortality. Colour duplex ultrasonographic examinations after 6 months were all normal. The mean follow-up period was 29.1 months (range 7-50 months). There were no additional vascular complications observed during follow-up. Early surgical intervention is the recommended treatment of choice for giant aneurysm complicating antebrachial AVF.