Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins.

BACKGROUND: Endovenous ablation techniques and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced open surgery for treatment of great saphenous varicose veins. This was a randomized trial to compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery. METHODS: Patients with symptomatic, uncomplicated varicose veins (CEAP class C2-C4) were examined at baseline, 1 month and 1 year. Before discharge and at 1 week, patients reported a pain score on a visual analogue scale. Preoperative and 1-year assessments included duplex ultrasound imaging and the Aberdeen Varicose Vein Severity Score (AVVSS). RESULTS: The study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0·001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days). CONCLUSION: In comparison with open surgery and EVLA, UGFS resulted in equivalent improvement in quality of life but significantly higher residual GSV reflux at 12-month follow-up.

Non-iatrogenic civilian vascular trauma in a well-defined geographical region in Finland.

PURPOSE: The purpose of this study was to assess the incidence, treatment and outcome of vascular trauma in a well-defined geographical region in Finland. METHODS: A retrospective analysis was conducted of patients admitted to Tampere University Hospital (TAUH), Pirkanmaa, Finland, due to vascular trauma between January 2006 and December 2010. Data regarding trauma mechanism, anatomical location, treatment, and short-term outcome were collected from patients' files and vascular register. RESULTS: Altogether, 143 non-iatrogenic vascular traumas occurred during the study period resulting in an annual trauma incidence of 5.8/100,000/year in the TAUH region. The majority of the injuries were located in the upper extremities (N = 83, 58%). Penetrating injuries comprised 58% (83 patients) of all vascular trauma admissions and were significantly more common among men compared to women (83 and 17%, respectively). The majority (N = 93, 65%) of the injuries were treated surgically, while in 15 (11%) patients the trauma was resolved by endovascular means. The remaining 35 (24%) patients were successfully managed conservatively, i.e., by observation or wound exploration only without the need for later (30-day) vascular repair. Two out of 17 patients (12%) with lower extremity vascular trauma required major amputation. Procedure-related complications occurred in five patients. In-hospital and 30-day mortality was zero. CONCLUSIONS: This paper demonstrates that the incidence of non-iatrogenic civilian vascular trauma in the Pirkanmaa region is low and mainly caused by penetrating injury. Further, the majority of vascular traumas are still treated surgically. In general, the short-term survival of patients who survive the initial trauma is good.

Comparison of above-the-knee prosthetic femoro-popliteal bypass versus percutaneous transluminal angioplasty and stenting for treatment of occlusive superficial femoral artery disease.

BACKGROUND AND AIMS: Treatment of occlusive femoro-popliteal artery disease has changed during the last decade because of intensive development of endovascular technology. The aim of this study was to evaluate patient treated endovascularly or surgically for femoro-popliteal atherosclerotic lesions and to assess perioperative and mid-term outcome. MATERIAL AND METHODS: This is a retrospective analysis of consecutive patients who had undergone prosthetic above-the-knee femoro-popliteal bypass or percutaneous transluminal angioplasty and stenting of superficial femoral artery stenosis or occlusion at Tampere University Hospital, Finland, between January 2007 and December 2009. Patients who were alive were re-evaluated in 2010. Primary and secondary patency and outcomes were assessed. RESULTS: A total of 131 patients were treated; surgically 63 patients (69 procedures) and endovascularly 68 patients (74 procedures). The mean follow-up time was 17 months (SD ± 13 months). In the late follow-up visit, 8 (18%) patients in the bypass group suffered from claudication and 9 (20%) from critical limb ischemia. The corresponding figures for the endovascular group were 20 (36%) and 8 (20%), respectively. The primary patency was 60% at 2 years in the bypass group and 73% in the endovascular group (p = 0.092); the primary assisted patency was 62% versus 76%, respectively (p = 0.068). The secondary patency was 74% in the bypass group versus 79% in the endovascular group (p = 0.487). CONCLUSIONS: According to current results following TASC II guideline, satisfied overall mid-term results can be achieved in the treatment of superficial femoral artery atherosclerotic disease.

PAD as a risk factor for mortality among patients with elevated ABI--a clinical study.

OBJECTIVE: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality. DESIGN: This is a retrospective clinical study. MATERIAL AND METHODS: A total of 2159 patients referred with a suspicion of PAD had their ABI and toe brachial index (TBI) measured by photoplethysmography. ABI > or =1.3 was considered falsely elevated while TBI <0.60 was the diagnostic criterion for PAD among the subjects. The cohort was followed up for total and cardiovascular mortality until 30 June 2008, by record linkage with the National Causes-of-Death Register. RESULTS: The average follow-up time was 39 months. A total of 576 (26.7%) patients died during the follow-up. Mortality was highest in the elevated ABI group (35.7% for elevated ABI; 30.1% for low ABI and 16.0% for normal ABI, p < 0.001). There was a greater than twofold risk of total, and an increased but statistically non-significant risk of, cardiovascular mortality among patients with elevated ABI. Similar risk ratios were noted for the low ABI (< or =0.9) group. More pronounced associations were observed at both ends of the scale when ABI was divided into sub-categories. The overall survival was significantly worse for the elevated ABI group than for both the normal and the low-ABI group (p < 0.01 and p = 0.013, respectively). PAD was found to be independently associated with both total and cardiovascular mortality among those with elevated ABI (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.01-4.85 and OR: 4.90; 95% CI: 1.50-16.04, respectively). CONCLUSIONS: The association between elevated ABI and poor survival is similar to that of low ABI. PAD appears to be an independent risk factor for mortality among patients with elevated ABI.

Drug-eluting bioabsorbable stents - an in vitro study.

The aim of this study was to investigate the drug elution properties of novel drug-eluting bioabsorbable stents in vitro with four different drugs: dexamethasone, indomethacin, simvastatin and ciprofloxacin. Braided stents of poly-lactic acid (96l/4d) fibers were coated with a solution containing the appropriate bioabsorbable polymer and drug, with acetone as the solvent. Two different drug concentrations for both non-sterile and gamma sterilized stents were used for dexamethasone and indomethacin. For ciprofloxacin and simvastatin, only one drug dose was used. The stents were placed in sodium-phosphate-buffered saline in a shaking incubator (pH 7.4, +37 degrees C) and the eluted drug was measured periodically using an ultraviolet spectrometer. The drugs were hydrophobic to different degrees, as demonstrated by their various speeds of elution. In general, the higher the drug load in the stent, the faster the drug elution and the more hydrophilic the elution profile. In the cases of dexamethasone, indomethacin and ciprofloxacin, the sterilization decreased the drug elution rate slightly and the elution started earlier. However, in the case of ciprofloxacin, the gamma sterilization increased the drug elution rate slightly. Sustained elution was achieved for all four drugs. It was also evident that both the concentration and the hydrophility of the drug had a great influence on the drug elution profile. Gamma sterilization modified the drug elution profiles of dexamethasone, indomethacin and simvastatin, but had little effect on the drug elution profile of ciprofloxacin compared to three other drugs.