"In Vitro" Evaluation of Energy-Based Sealing of Graft Side Branches in Bypass Surgery.

INTRODUCTION: Our objective was to compare the in vitro efficacy of electrothermal bipolar [EB] vessel sealing and ultrasonic harmonic scalpel [HS] versus mechanical interruption, with conventional ties or surgical clips (SC), in sealing saphenous vein (SV) collaterals, during its eventual preparation for bypass surgery. METHODS: Experimental in vitro study on 30 segments of SV. Each fragment included two collaterals at least 2 mm in diameter. One of them was sealed by ligation with 3/0 silk ties (control) and the other one with EB (n = 10), HS (n = 10) or medium-6 mm SC (n = 10). After incorporation in a closed circuit with pulsatile flow, the pressure was progressively increased until causing rupture. Collateral diameter, burst pressure, leak point, and histological study were recorded. RESULTS: Burst pressure was higher for SC (1320.20 ± 373.847 mmHg) as compared with EB (942.2 ± 344.9 mmHg, p = 0.065), and especially with HS (637.00 ± 320.61 mmHg, p = 0.0001). No statistically significant difference between EB and HS was found, and bursting always happened at supraphysiological pressures. The leak point for HS was always detected in the sealing zone (10/10), while for EB and SC, it occurred in the sealing zone only in 6/10(60%) and 4/10(40%), respectively (p = 0.015). CONCLUSIONS: Energy delivery devices showed similar efficacy and safety in sealing of SV side branches. Although bursting pressure was lower than with tie ligature or SC, non-inferiority efficacy was shown at the range of physiological pressures in both, EB and HS. Due to their speed and easy handling, they may be useful in the preparation of the venous graft during revascularization surgery. However, remaining questions about healing process, potential spread of tissue damage and sealing durability, will require further analysis.

Long-standing hemospermia in a patient with megacava associated to a circumaortic renal vein.

Hemospermia may have a broad range of functional and organic causes. It is defined as the presence of blood in seminal fluid and usually tends to resolve spontaneously within a few weeks. We present the case of a patient with a 10-year history of hemospermia associated with megacava and circumaortic renal vein. The diagnosis, treatment, and evolution of the condition are reported. Vascular anomalies are rare causes of chronic hemospermia, and the one described in our patient may constitute the first case reported in the literature.

Negative impact of deep venous thrombosis on chronic venous disease.

INTRODUCTION: There are several conditions that may cause chronic venous disease (CVD). It is not known whether the aetiology of CVD can predict disease severity and quality of life (QoL). Our objective is that the severity and QoL of patients with CVD secondary to DVT is different from those without prior DVT. MATERIAL AND METHODS: We compare patients with CVD caused by DVT (n=125) and patients with non-DVT CVD (n=1435) with respect to disease severity (CEAP and Venous Clinical Severity Score-VCSS) and quality of life (Health Survey Short-Form-SF12 y Chronic Lower Limb Venous Insufficiency Questionnaire-CIVIQ20). RESULTS: Regarding to non-thrombotic CVD, patients with CVD due to DVT showed more severe disease [C6 grade (14.4% vs 3.6%) (p<0.05); score VCSS (1,33±0,65 vs 0,84±0,49) (p<0.05)] and poorer QoL [global score CIVIQ-20 (57,84±15,57 vs 65,75±14,07) (p<0.05); global score SF-12 (45,98±18,79 vs 57,79±19,64) (p<0.05).]. These differences remained statistical significant in all parameters - attributed measured at each severity score and QoL questionnaires. CONCLUSION: A history of DVT leads to worse clinical severity and quality of life in CVD patients. These data support even more the need to implement programs to prevent DVT and/or its evolutionary consequences.

Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV / Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document

La Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y la Sociedad Española de Angiología y Cirugía Vascular (SEACV) han elaborado, mediante un grupo de trabajo conjunto, un documento de derivación entre niveles asistenciales de los pacientes con las principales patologías vasculares: enfermedad arterial periférica, insuficiencia venosa y pie diabético. Se han definido las responsabilidades y habilidades requeridas de cada nivel asistencial y también los criterios de derivación mutua, así como los de priorización. La elaboración de este documento consensuado pretende aportar una herramienta eficiente que asegure la continuidad en la asistencia sanitaria, respetando siempre las particularidades y necesidades específicas de cada zona sanitaria(AU)

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area(AU)

Criterios de derivación entre niveles asistenciales de pacientes con enfermedad vascular. Documento de consenso SEMFYC-SEACV. Resumen ejecutivo / Criteria for referral between levels of care of patients with peripheral vascular disease. SEMFYC-SEACV consensus document

La coordinación entre niveles asistenciales constituye un elemento esencial para incrementar la eficiencia del sistema sanitario; en este sentido, la enfermedad vascular ocupa un lugar destacado por incluir entidades frecuentes, graves y vulnerables. Los documentos de consenso constituyen una herramienta fundamental para conseguir este objetivo. Este documento no pretende sustituir a las guías clínicas, sino que trata de establecer las bases del manejo compartido del paciente con enfermedad vascular (enfermedad arterial periférica, pie diabético e insuficiencia venosa crónica) en tres aspectos: determinar el perfil del paciente cuyo seguimiento ha de ser realizado de forma prioritaria en cada nivel; establecer las competencias que debe asumir cada profesional, y fijar y priorizar los criterios de derivación en ambos sentidos(AU)

Coordination between care levels is essential to increase the efficiency of the Health System; vascular disease has an important role in this respects, as it includes frequent, serious and vulnerable conditions. Consensus documents are an essential tool to obtain these aims. This document is not expected to replace the Clinical Guidelines, but tries to establish the basis of the shared management of the patient with vascular disease (peripheral arterial disease, diabetic foot, and chronic venous insufficiency) in three ways: to determine the profile of the patient who should receive priority follow-up at every level; to establish the skills that every professional must have, and to set and to prioritise the referral criteria in both directions(AU)

[Criteria for referral between levels of care of patients with peripheral vascular disease. SEMFYC-SEACV consensus document]. / Criterios de derivación entre niveles asistenciales de pacientes con enfermedad vascular. Documento de consenso SEMFYC-SEACV. Resumen ejecutivo.

Coordination between care levels is essential to increase the efficiency of the Health System; vascular disease has an important role in this respects, as it includes frequent, serious and vulnerable conditions. Consensus documents are an essential tool to obtain these aims. This document is not expected to replace the Clinical Guidelines, but tries to establish the basis of the shared management of the patient with vascular disease (peripheral arterial disease, diabetic foot, and chronic venous insufficiency) in three ways: to determine the profile of the patient who should receive priority follow-up at every level; to establish the skills that every professional must have, and to set and to prioritise the referral criteria in both directions.

[Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document]. / Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV.

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area.