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1.
Phlebology ; 32(2): 89-98, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27221810

RESUMO

Background Endovenous thermal ablation has revolutionised varicose vein treatment. New non-thermal techniques such as mechanical occlusion chemically assisted endovenous ablation (MOCA) allow treatment of entire trunks with single anaesthetic injections. Previous non-randomised work has shown reduced pain post-operatively with MOCA. This study presents a multi-centre randomised controlled trial assessing the difference in pain during truncal ablation using MOCA and radiofrequency endovenous ablation (RFA) with six months' follow-up. Methods Patients undergoing local anaesthetic endovenous ablation for primary varicose veins were randomised to either MOCA or RFA. Pain scores using Visual Analogue Scale and number scale (0-10) during truncal ablation were recorded. Adjunctive procedures were completed subsequently. Pain after phlebectomy was not assessed. Patients were reviewed at one and six months with clinical scores, quality of life scores and duplex ultrasound assessment of the treated leg. Results A total of 170 patients were recruited over a 21-month period from 240 screened. Patients in the MOCA group experienced significantly less maximum pain during the procedure by Visual Analogue Scale (MOCA median 15 mm (interquartile range 7-36 mm) versus RFA 34 mm (interquartile range 16-53 mm), p = 0.003) and number scale (MOCA median 3 (interquartile range 1-5) versus RFA 4 mm (interquartile range 3-6.5), p = 0.002). ' Average' pain scores were also significantly less in the MOCA group; 74% underwent simultaneous phlebectomy. Occlusion rates, clinical severity scores, disease specific and generic quality of life scores were similar between groups at one and six months. There were two deep vein thromboses, one in each group. Conclusion Pain secondary to truncal ablation is less painful with MOCA than RFA with similar short-term technical, quality of life and safety outcomes.


Assuntos
Ablação por Cateter/métodos , Procedimentos Endovasculares/métodos , Varizes/cirurgia , Adulto , Ablação por Cateter/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Varizes/fisiopatologia
2.
Obes Surg ; 14(10): 1435-6, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15603667

RESUMO

Obesity is an increasing burden on health-care globally. Significant obesity is presenting at a younger age, with pathology that has not been previously seen. This case report illustrates the catastrophic consequences which may occur when minor trauma occurs in a young person who suffers from morbid obesity. A 19-year-old woman with BMI 50 tripped over an uneven curb, and suffered complete dislocation of the knee with associated popliteal artery injury. She required femoro-popliteal bypass using vein. This case reports the youngest person to suffer from this injury and the first in the UK.


Assuntos
Arteriopatias Oclusivas/cirurgia , Luxações Articulares/diagnóstico , Traumatismos do Joelho/diagnóstico , Obesidade Mórbida/diagnóstico , Artéria Poplítea/lesões , Acidentes por Quedas , Adulto , Angiografia , Arteriopatias Oclusivas/diagnóstico por imagem , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Luxações Articulares/complicações , Traumatismos do Joelho/cirurgia , Obesidade Mórbida/complicações , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Medição de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
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