Ultrasound-guided foam sclerotherapy of great saphenous vein with 2% polidocanol - one-year follow-up results.

INTRODUCTION: Ultrasound-guided foam sclerotherapy (UGFS) of varicose veins is a useful treatment option. It is a relatively safe method in the case of limited, small varicose veins. In theory, a justified concern could be raised that the injection of an active drug into the large superficial venous vessels may potentially cause life-threatening consequences. AIM: To assess the safety and efficacy of UGFS using a 2% solution of polidocanol (Aethoxysklerol 2%) in the case of great saphenous vein incompetence. MATERIAL AND METHODS: Fifty-two patients with great saphenous vein incompetence underwent ultrasound-guided foam sclerotherapy. The efficacy criterion was the elimination of reflux measured ultrasonographically and withdrawal or decrease of complaints: 1 week, and 1, 3, 6 and 12 months after the treatment. Complications of sclerotherapy were reported during follow-up. RESULTS: Decrease or withdrawal of complaints of chronic venous insufficiency was reported in 96% of cases (50 patients). Disappearance or decrease of varicose veins was noted in all patients (100%). During examination after 12 months, full success of ultrasound was achieved in 38 (73%) cases, and 11 (21%) patients presented a partial desired effect according to the consensus from Tegernsee. Persistence of reflux longer than 1 s in the treated great saphenous vein was reported in 3 (6%) cases. Serious complications, such as deep vein thrombosis, pulmonary embolism, dyspnea, anaphylaxis, or neurological abnormalities, were not recorded. CONCLUSIONS: Ultrasound-guided foam sclerotherapy of incompetent great saphenous vein and varicosities with 2% polidocanol was found to be an effective and safe method of treatment during 1 year of observation. However, longer observation is necessary.

Endovascular treatment of traumatic rupture of thoracic aorta: long term results.

BACKGROUND: The aim of this study was to evaluate the endovascular treatment of acute post-traumatic thoracic aorta rupture. Rupture of the thoracic aorta is caused in a majority of cases by blunt trauma of the chest as a result of motor vehicle accident. Hypovolemic shock due to massive hemorrhage leads to death in almost 90% of victims. Nowadays the treatment of choice is endovascular procedure with stent-graft, which quickly seals the rupture site. METHODS: Forty patients with post-traumatic rupture were treated in our department. In 92.5% of them, the aneurysm appeared after a road traffic accident. In all cases but one it was located below the left subclavian artery. RESULTS: All patients underwent surgery. One-hundred per cent technical success was observed with no device failure. Six patients (15%) died in the postoperative period. All fatalities were attributable to severe generalized trauma, not to the endovascular procedure. In early postoperative follow-up we saw no serious stent-graft related complications, such as spinal cord ischemia. Nine patients (22.5%) were operated later on, due to other organs trauma. In one case (2.5%), in which the endograft was deployed below the left subclavian artery, the patient suffered from stroke, requiring conservative treatment. One early type IA endoleak was diagnosed and sealed by proximal extension. Among the patients still being followed for up to 14 years, 82% remain asymptomatic, without evidence of endoleak or stent-graft migration on angio-CT. Two type IA endoleak were found due to stent-graft infolding: one was solved with balloon-plasty, the other with a proximal extension. CONCLUSIONS: Endovascular procedure in traumatic rupture of descending aorta is the method of choice. Endovascular procedures have a lower mortality and morbidity than open surgery.