Graft Failure After Revascularization for Chronic Limb-Threatening Ischaemia (CLTI) Patients: The Role of Graft Surveillance.

Introduction Failure of infrainguinal bypass grafts remains a major problem tackled by vascular surgeons despite a meticulous surgical technique. All infrainguinal bypasses should go under routine surveillance to pick the grafts at risk for the prevention of graft failure. Objectives The aim was to find out if we were adhering to the European Society of Vascular Surgery (ESVS) guidelines in the management of chronic limb-threatening ischaemia (CLTI) patients, including postoperative follow-up and to monitor whether the patients were having postoperative duplex surveillance scans to pick any graft at risk. Methods All patients who underwent infra-inguinal bypass procedures for CLTI during the last eight months (from mid-January to mid-September 2023) in our vascular unit were included. Retrospective data were collected. Results A total of 38 patients had lower limb bypass procedures over the last eight months (from 15 January till 14 September 2023). However, two femoral-femoral (fem-fem) crossovers, one Ilio-popliteal, and one pedal bypass were excluded. Thus, a total of 36 patients were included in the study (n=34). The vast majority (n=27, 79.4%) had femoro popliteal bypass anastomosing distally to above knee (AK) or below knee (BK) popliteal artery, and the rest (n=7, 20.5%) had distal bypass (fem-distal or pop-distal bypass). Moreover, 18% of patients had amputation, 15% of patients died, and 61% of the remaining patients were on surveillance. Of those, who were not on surveillance, 44% of them had graft occlusion. Conclusion Surveillance can predict graft at risk, and the graft occlusion can be prevented by appropriate intervention. Every vascular unit should have its own post-procedural follow-up strategies.

Analysis of atherosclerotic plaque distribution in the carotid artery.

BACKGROUND: The present study was designed to investigate the hypothesis that the outer wall at the carotid bifurcation is the most common area of atherosclerotic plaque deposition due to the low shear stress. HYPOTHESIS: We hypothesized that the most common site of arteriosclerosis in carotid arteries is different in the early and late stages. METHODS: This is an observational study of patients with <50% stenosis of the common and internal carotid arteries (ICAs) identified by Duplex ultrasound in our health promotion center. Plaque location was categorized as a quarter of the cross-section in the distal common carotid artery (CCA) and proximal ICA. Carotid plaque score (CPS) was calculated by the addition of one point for each detected section. The sum of CPSs was calculated for each section. RESULTS: Among 3996 Duplex scans of carotid arteries in 999 patients between June 2020 and October 2020, a total of 569 patients (73.6% male; mean age, 68.4± 9.1 years; 652 CCAs and 567 ICAs) were included. Total CPS was high in the anterior and posterior sections. The distribution in the ICA was: 308 (31.0%) anterior, 90 (9.0%) medial, 373 (37.5%) posterior, and 224 (22.5%) lateral section. The distribution in the CCA was 385 (32.6%) anterior, 103 (8.7%) medial, 528 (44.7%) posterior, and 165 (14.0%) lateral section. The axial distribution of posterior and lateral sections was significantly different according to the directional flow (p < .001). CONCLUSIONS: Anterior and posterior sections of the CCA and ICA were atherosclerotic plaque-prone sites. This result is different from the tendency of atherogenesis to affect the lateral section having low shear stress at the carotid bifurcation.

Ultrasound Use in Diagnosis and Management of Venous Leg Ulcer.

Leg ulcers caused by venous diseases are effectively assessed by Doppler ultrasonography. The examination provides clear anatomical and physiological information for the diagnosis, treatment planning, and real-time guiding during the surgical treatment. Diagnostic Doppler ultrasonography assesses deep, superficial, and perforator veins, starting from patency assessment by direct visualization and simply compression test. The internal flow can be assessed by pulse wave analysis, which is used for rule out downstream flow obstruction and valvular incompetence. The venous valve function of deep, superficial, and perforator systems can be evaluated by measuring the time of the retrograde flow after flow augmentation performing in the upright position. At the end of the study, the venous map will be obtained and this map will guide clinicians to target treatment where the culprit is. The ultrasound technology has made a big shift in the treatment in the venous disease. In recent years, after the evolution and wide availability of ultrasound, newer treatment modalities have emerged for venous treatment. These include endovenous thermal ablation, endovenous adhesive closure, and ultrasound-guided foam sclerotherapy. Patients no longer require general anesthesia or hospitalization. Therefore utilization of duplex ultrasound has also surged and played an essential role in both diagnosis and therapy in venous ulcer. This article has dedicated to reviewing basic anatomy, the technique in diagnosis, and treatment.

Feasibility for arteriovenous fistula creation with Ellipsys®.

OBJECTIVE: To investigate the feasibility of percutaneous arteriovenous fistula creation in consecutive patients screened for first access creation. METHODS: Prospective study of ultrasound mapping based on the following minimal anatomic requirements: a patent proximal radial artery and adjacent elbow perforating vein with straight trajectory, each greater than or equal to 2 mm in diameter and within 1.5 mm of each other. In addition, the same population was evaluated for feasibility of a distal radiocephalic fistula established. RESULTS: One hundred consecutive patients were examined between November 2018 and January 2019. Sixty-seven were male (67%) and mean age was 61 years. Sixty-three patients (63%) and a total of 100 limbs (50%) were found to be eligible for a percutaneous fistula creation with Ellipsys®. Thirty-seven percent of patients were ineligible because of the absence of both median cephalic and median cubital veins (15%), absence or inadequate elbow perforating vein and/or smaller than 2 mm proximal radial artery (14%), and/or distance greater than 1.5 mm (8%). We found suitable vessels for a surgical distal fistula creation in 91 extremities (45%), but this percentage dropped to 17% in patients over 70 years old. Among the 100 limbs eligible for percutaneous arteriovenous fistula, only 30 (30%) were eligible for radiocephalic arteriovenous fistula. CONCLUSION: More than 60% of patients were eligible for Ellipsys. The absence of veins at the elbow and a large distance between vessels were the most common limiting factors. Less than one half of the patients were candidates for surgical fistula and this percentage dropped significantly for older individuals.

Technique of Duplex Scanning for Selection of Optimal Peripheral Anastomosis Site for Distal Bypass.

INTRODUCTION: Selection of the optimal anastomosis site is essential for obtaining good results from distal bypass. Herein, a unique, precise technique that uses pre-operative duplex scanning for selecting this site is presented. TECHNICAL SUMMARY: Before distal bypass surgery, duplex scanning is performed to assess patency and flow. Use of the venous preset mode and controlling the slant function allows visualisation of colour Doppler flow inside the arteries, thus enabling selection of the best segment for anastomosis. CONCLUSION: Use of duplex scanning in the appropriate mode consistently enables selection of the best anastomosis site for distal bypass, even when there is heavy calcification.

Lower limb venous diameters and haemodynamics during pregnancy and postpartum period in healthy primigravidae.

Objective Analyse venous haemodynamics in healthy primigravidae during pregnancy and in the postpartum. Methods Cohort with primigravidae evaluated in the three trimesters of pregnancy and postpartum. Duplex evaluated venous diameters and reflux; air plethysmography evaluated venous filling index, ejection fraction, residual volume fraction and outflow fraction in both limbs. Results During pregnancy, diameters increased in bilateral common femoral and right infravalvar great saphenous, but returned to first trimester values after delivery. Reflux developed in one woman (5%) in the second trimester and in two more women (15%) in the third trimester. No reflux was detected in postpartum. Bilateral venous filling index was higher during pregnancy. Bilateral ejection fraction and residual volume fraction did not change. Bilateral outflow fraction increased progressively. The right limb outflow fraction in left lateral decubitus was similar. All changes returned to first trimester values after delivery. Conclusions Healthy primigravidae presented changes in lower limbs' veins during pregnancy: diameters in bilateral common femoral and infravalvar great saphenous veins increased; new reflux was developed in 15% of women, but there was no venous hypertension. Calf muscular pump function did not change. All changes returned to first trimester values after delivery.

Risk Factors in Patients with Venous Stasis-Related Skin Lesions without Major Abnormalities on Duplex Ultrasonography.

Purpose: To clarify the risk factors for venous stasis-related skin lesions in the legs in patients without major abnormalities on duplex ultrasonography (DUS). Methods: Fifty patients (nine males and 41 females, age 27-93 years) with symptoms of C4 or greater according to the Clinical, Etiological, Anatomical, Pathological (CEAP) classification, but having no abnormalities on DUS were reviewed for known risk factors for chronic venous insufficiency (CVI) such as older age (>70 years), obesity (body mass index [BMI] >30 kg/m2), short walking distance (<200 m/day), reduced ankle range of motion (<20°), and occupation requiring prolonged standing (>8h per day). Results: The risk factor was different between male and female patients; although all patients had at least one of the above risk factors, the most commonly found risk factor in male patients was occupation requiring prolonged standing (63%), while advanced age (78%) and limited walking distance (83%) were risk factors in female patients. Conclusions: Although male and female patients had different risk factors, insufficient walking seemed to be closely related to the development of venous stasis-related skin lesions.

Non-invasive assessment of peripheral arterial disease: Automated ankle brachial index measurement and pulse volume analysis compared to duplex scan.

OBJECTIVES: This cross-sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (1) ankle brachial index and (2) pulse volume waveform analysis recorded by the same automated device, with the presence or absence of peripheral arterial disease being verified by ultrasound duplex scan. METHODS: Patients (n=205) referred for lower limb arterial assessment underwent ankle brachial index measurement and pulse volume waveform recording using volume plethysmography, followed by ultrasound duplex scan. The presence of peripheral arterial disease was recorded if ankle brachial index <0.9; pulse volume waveform was graded as 2, 3 or 4; or if haemodynamically significant stenosis >50% was evident with ultrasound duplex scan. Outcome measure was agreement between the measured ankle brachial index and interpretation of pulse volume waveform for peripheral arterial disease diagnosis, using ultrasound duplex scan as the reference standard. RESULTS: Sensitivity of ankle brachial index was 79%, specificity 91% and overall accuracy 88%. Pulse volume waveform sensitivity was 97%, specificity 81% and overall accuracy 85%. The combined sensitivity of ankle brachial index and pulse volume waveform was 100%, specificity 76% and overall accuracy 85%. CONCLUSION: Combining these two diagnostic modalities within one device provided a highly accurate method of ruling out peripheral arterial disease, which could be utilised in primary care to safely reduce unnecessary secondary care referrals.

Innocuous-looking skin scab over an arteriovenous fistula: Case report and literature review.

Little is written on the management of an innocuous-looking skin scab over an autogenous arteriovenous fistula (AVF) used for haemodialysis. The seriousness of the underlying pathology can be under-estimated, and this may lead to early loss of the AVF, and major-life-threatening haemorrhage. We describe the management of a 78-year-old patient presenting with an innocuous-looking scab over an AVF and review the pertinent literature on this subject.

Recurrent varicose veins of the legs: a single centre experience.

AIM: The aim of our study is to report our experience on the surgery for recurrent varicose veins of the legs over the period 2007-2012. MATERIALS AND METHODS: A series of 480 consecutive surgical procedures for varicose veins of the legs was reviewed; among a total of 480 cases, 65 procedures were for recurrent varicose veins. Data collected included clinical characteristics, surgical techniques, cause of recurrence and surgical outcomes. We analyzed the causes of recurrences in order to determine factors that influence recurrence itself. RESULTS: Sixty-five procedures for recurrent varicose veins were analized. The main causes of recurrence were: persistence of collaterals at the saphenofemoral junction (27.7%), inadequate stripping of the long saphenous vein (18.5%), perforating veins insufficiency (66.1%), sapheno-femoral junction neovascolarisation (12.3%), inguinal or popliteal cavernoma (27.7%), recurrence after short saphenous venous surgery (4.5%). CONCLUSIONS: We concluded that, as is clear from our study, the main cause of recurrence is inadequate surgery. This can only be due to inadequate preoperative assessment (lack of rigorous clinical and US Doppler rigorous evaluation) and not correct surgical technique, as it may occur if the surgery is performed by a surgeon inexperienced in this type of surgery.

An evaluation of coronary atherosclerosis using coronary CT in subjects with asymptomatic carotid lesions.

UNLABELLED: The evaluation of coronary lesions in patients with asymptomatic carotid plaque represents a very promising line of research to assess cardiovascular risk and the possible implementation of a more aggressive prevention therapy. METHODS: In this study we enrolled 102 patients with intermediate to high cardiovascular risk but no history of coronary artery disease. The first group, consisting of 51 patients, underwent a Coronary CT scan (CCT-group) as well as carotid ultrasonography. The second group, also consisting of 51 patients, underwent coronary angiography (CA) and carotid ultrasonography. RESULTS: The absence of a statistically significant difference between the involvement of both coronary and carotid sites, assessed by CCT and CA, confirms the role of coronary CT as a useful method in the preclinical evaluation of cardiovascular risk. In the CCT group, the correlation between atherosclerosis of carotid artery and coronary disease, as well as between the mean carotid intimal medial thickness and the number of involved coronary vessels, and between the maximum values of carotid plaque and the presence of coronary artery stenosis > 50%, were statistically significant. The Agatson calcium score was also statistically associated with carotid plaque size. CONCLUSION: The imaging biomarkers have a key role in the evaluation of subclinical atherosclerotic disease. Moreover, carotid ultrasound examination and a CT-scan of coronary arteries, in a particular sub-group of patients with intermediate to high cardiovascular risk, can play a crucial role to assess the preventive therapeutic strategies.

Surgical retroperitoneoscopic and transperitoneoscopic access in varicocelectomy: duplex scan results in pediatric population.

OBJECTIVE: This is a retrospective study to compare duplex scan results of laparoscopic Palomo's technique through retroperitoneal and transperitoneal approach for varicocelectomy in children. We statistically analyzed recurrence, testicular volume growth and complications. PATIENTS AND METHODS: Surgical intervention was performed utilizing transperitoneoscopic (group A) or retroperitoneoscopic access (group B). Duplex scan control was performed after 12 months (T1), after 2 years (T2) and the last one at 18 years old in most patients. Statistical analysis was performed using the t-test for parametric data. Differences in proportions were evaluated using χ2 or Fisher's exact test. RESULTS: We treated 120 children (age range 10-17 years) who presented an asymptomatic IV grade of reflux, Coolsaet 1, associated with a left testicular hypotrophy in 36.6% of the cases (44 patients). No post-operative complications were verified. Duplex scan exam showed an increase of left testicular growth in both groups, with complete hypotrophy disappear in patients in both groups after 24 months. Hydrocele, diagnosed clinically and confirmed with duplex scan, was the most frequent post-operative complication (22/120 cases; 18.3%). CONCLUSIONS: This study showed the importance of duplex scan at all steps of this vascular pathology in children, and that there is no significantly difference in results between the two surgical techniques except for hydrocele in transperitoneoscopic access.

Long-term clinical and ultrasonographic evaluation of thrombophilic patients with deep venous thrombosis

OBJECTIVE: The purpose of this study was to evaluate the long term clinical and ultrasonographic outcomes of thrombophilic patients with deep venous thrombosis (DVT). METHOD: Cohort study, retrospective case-control with cross-sectional analysis. Thirty-nine thrombophilic patients and 25 non-thrombophilic patients were assessed 76.3 ± 45.8 months after diagnosis. Demographic and family data were collected, as well as data from clinical and therapeutic progress, and physical and ultrasound examinations of the limbs were performed. Groups were matched for age and gender and the variables studied were compared across groups. RESULTS: Deep venous thrombosis was more frequent in women. The most common thrombophilias were antiphospholipid syndrome and factor V Leiden mutation. There was no difference between groups in terms of the number of pregnancies or miscarriages and the majority of women did not become pregnant after DVT. Non-spontaneous DVT prevailed. Proximal DVT and DVT of the left lower limb were more frequent, and the main risk factor was use of oral contraceptives. All patients were treated with anticoagulation. There was a higher frequency of pulmonary embolism in non-thrombophilic patients. Most patients considered themselves to have a "normal life" after DVT and reported wearing elastic stockings over at least 2 years. Seventy-one percent of patients had CEAP > 3, with no difference between groups. Deep venous reflux was more frequent in thrombophilic patients. CONCLUSION: There were no significant differences between groups with respect to most of the variables studied, except for a higher frequency of pulmonary embolism in non-thrombophilic patients and greater frequency of deep venous reflux in thrombophilic patients. .

OBJETIVO: O objetivo deste estudo foi avaliar os resultados clínicos e ultra-sonográficos a longo prazo de pacientes com trombofilia com trombose venosa profunda (TVP). MÉTODO: Estudo de coorte, caso-controle retrospectivo, com análise transversal. Trinta e nove pacientes trombofilia e 25 pacientes não-trombofilia foram avaliados 76,3 ± 45,8 meses após o diagnóstico. Os dados demográficos e familiares foram coletadas, bem como dados de evolução clínica e terapêutica, e exames físicos e ultra-som dos membros foram realizados. Os grupos foram pareados por idade e sexo e as variáveis ​​estudadas foram comparadas entre os grupos. RESULTADOS: A trombose venosa profunda foi mais freqüente em mulheres. As trombofilias mais comuns foram síndrome antifosfolípide e mutação do fator V Leiden. Não houve diferença entre os grupos em termos do número de casos de gravidez ou aborto e que a maioria das mulheres não engravidar após TVP. TVP não-espontâneo prevaleceu. TVP proximal e TVP de membro inferior esquerdo foram mais freqüentes, eo principal fator de risco foi o uso de contraceptivos orais. Todos os pacientes foram tratados com anticoagulação. Houve uma maior frequência de embolia pulmonar em pacientes não-trombofilia. A maioria dos pacientes se consideravam ter uma "vida normal" depois de TVP e relatou uso de meias elásticas durante pelo menos 2 anos. Setenta e um por cento dos pacientes tiveram CEAP> 3, não havendo diferença entre os grupos. Refluxo venoso profundo foi mais freqüente em pacientes com trombofilia. CONCLUSÃO: Não houve diferenças significativas entre os grupos em relação à maioria das variáveis ​​estudadas, com exceção de uma maior frequência de embolia pulmonar em pacientes não-trombofilia e maior freqüência de refluxo venoso profundo em pacientes trombofilia.

Quantification of superficial venous reflux by duplex ultrasound-role of reflux velocity in the assessment the clinical stage of chronic venous insufficiency.

OBJECTIVES: This study we compare the duplex-derived parameters of reflux in patients with early and advanced superficial venous insufficiency (SVI) to identify parameters reflecting this. METHODS: Two thousand and one hundred sixty limbs with primary reflux, categorized according to the CEAP (clinical, etiologic, anatomic and pathophysiologic) classification, and the patients were divided into two groups (group I [C1-3, Ep, As, Pr]; group II [C4-6, Ep, As, Pr]) were studied. The vein diameter, reflux duration(s), mean reflux velocity (MRV; cm/s), peak reflux velocity (PRV; cm/s), and total reflux volume (TRV; ml/s) were determined at the sapheno-femoral junction (SFJ), great saphenous vein (GSV) and sapheno-popliteal junction (SPJ). RESULTS: Age and the proportion of males were greater in group II. MRV, PRV and TRV were greater in group II at the SFJ, SPJ and in GSV (p <0.01 for all), although the duration of SPJ reflux was non-discriminatory (p = 0.78). From receiver operating characteristic (ROC) curve, optimal cut-off points of 27.8, 47.8, and 36.2 cm/s for the PRV at the SFJ (p <0.01), GSV (p <0.01), and SPJ (p <0.01) discriminated between the two groups. CONCLUSION: PRV and MRV improved discrimination between early and advanced SVI compared to reflux duration.

Results of post-laparoscopic cholecystectomy duplex scan without deep vein thrombosis prophylaxis prior to surgery.

BACKGROUNDS: There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT) in laparoscopic cholecystectomy. The aim of this study was the assessment of patients' condition after laparoscopic cholecystectomy without any prophylactic measure. METHODS: 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. RESULTS: Only one case of partially thrombosis (1%) was found by duplex scanning which was managed conservatively. CONCLUSION: Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.

Routine diagnostic venous ultrasound and las for leg edema of unknown cause.

OBJECTIVE: To verify the diagnostic efficiency of venous duplex ultrasound and lymphangioscintigraphy (LAS) in establishing the cause of leg edema and to clarify the pathology of these leg edemas. MATERIALS AND METHODS: Between April 2009, and March 2010, 62 patients with leg edema of unknown origin were referred to the Edema Clinic of the Yamaguchi University Graduate School of Medicine. All patients underwent a venous duplex ultrasound scan and LAS. RESULTS: Of 62 patients, lymphatic insufficiency, venous insufficiency or both was diagnosed in 42 (68%), and lymphedema, in 29 (47%). Venous duplex ultrasound detected obvious venous disorders in only 13 (21%), and for 20 patients, the ultrasound and LAS did not reveal any abnormalities; however, for 15 of the 20 (24% of all patients), venous edema was attributed to functional causes. CONCLUSION: Venous duplex ultrasound and LAS assisted in the diagnosis of leg edema of unknown origin and also proved useful in establishing treatment strategies.

Neurofibromas of saphenous nerve mimicking thrombophlebitis.

Young man aged 25 years complained of persistent pain on the medial side of the lower part of the thigh for 2 months. A cord like structure was palpable with 3 small nodular swelling parallel to the course of the long saphenous vein. Initially he was treated as a case of thrombophlebitis of saphenous vein in a clinic near his home. When the pain persisted after receiving injection heparin therapy, he was referred to the vascular surgery clinic. Duplex scan reported as thrombophlebitis of a vein parallel to the great saphenous vein. We continued the injection heparin and suspected thrombophilia. There were no other known risk factors for thrombosis. The pain persisted, so we excised the cord like structure with nodular swellings and biopsy reported it as neurofibromatosis of the saphenous nerve. Postoperatively the pain subsided dramatically and in the follow up clinic he mentioned about the paresthesias in the distribution area of saphenous nerve. Diagnosis of the small tumors of the peripheral nerves is difficult at this site and they can be easily mistaken for thrombophlebitis. Unusual pain and nodularity of the swelling as in this case can help us to consider early biopsy or excision of the tumor.

Avaliação do refluxo venoso superficial ao mapeamento dúplex em portadores de varizes primárias de membros inferiores: correlação com a gravidade clínica da classificação CEAP / Evaluation of venous reflux by color duplex scanning in patients with varicose veins of the lower limbs: correlation with clinical severity by CEAP classification

Contexto: As alterações de pele manifestadas na insuficiência venosa crônica têm como etiologia mais comum o refluxo venoso. Alguns autores relatam que o refluxo venoso superficial é responsável por 40-60 por cento das úlceras de perna nos portadores de varizes primárias. Objetivo: Correlação do refluxo venoso superficial ao mapeamento dúplex com o quadro clínico (classificação CEAP - clínica, epidemiológica, anatômica e fisiopatológica) nos portadores de varizes primárias de membros inferiores. Método: Estudo transversal e descritivo, desenvolvido em portadores de varizes primárias. As variáveis primárias foram: refluxo venoso e quadro clínico. O quadro clínico foi caracterizado por grupos: A, B e C, representados pelas categorias clínicas da CEAP. Dados complementares foram: tipos de refluxo em veias safenas magnas e parvas, conforme classificação de Engelhorn (2004). Testaram-se as hipóteses de inter-relações entre presença de refluxo e quadro clínico, utilizando-se os testes exato de Fisher e qui-quadrado no nível de 5 por cento de probabilidade. Resultados: Das 242 extremidades inferiores examinadas, 15 foram excluídas, totalizando 227 na amostra final. Noventa e nove (83,9 por cento) pacientes eram do sexo feminino. A média de idade foi de 50 anos, com mediana igual a 49 anos. Noventa e três extremidades (41 por cento) não apresentavam refluxo, e 134 (59 por cento) o apresentavam isolado e/ou associado. O refluxo isolado em veias perfurantes (p = 0,0008) e destas em associação com o refluxo em veias safenas magnas (p < 0,0001) estão significativamente relacionados à gravidade do quadro clínico. Conclusão: Há correlação entre a presença do refluxo venoso superficial ao mapeamento dúplex e a gravidade do quadro clínico nos portadores de varizes primárias de membros inferiores.

Background: Skin changes observed in chronic venous insufficiency have venous reflux as the most common etiology. Some authors have reported that reflux in the superficial venous system accounts for 40-60 percent of leg ulcers in patients with primary varicose veins. Objective: To evaluate the correlation between superficial venous reflux and clinical status (CEAP classification - clinical, etiology, anatomy and pathophysiology) in patients with primary varicose veins of the lower limbs using duplex scanning. Method: A cross-sectional and descriptive study was performed in patients with primary varicose veins. Primary variables were venous reflux and clinical status. Clinical status was characterized by groups A, B, and C, represented by CEAP clinical categories. Types of venous reflux in the great and small saphenous veins were used as complementary data, according to Engelhorn's classification (2004). Hypotheses of interrelationship between incidence and types of reflux were statistically analyzed using Fisher's exact and chi-square tests. Significance was set at 0.05 percent. Results: Of 242 lower limbs, 15 were excluded, so that the final sample was comprised of 227 lower limbs. Ninety-nine (83.9 percent) patients were female. Mean age was 50 years and median was 49 years. Reflux was absent in 93 limbs (41 percent), and 134 (59 percent) showed isolated and/or associated reflux. Isolated reflux in perforating veins (p = 0.0008) or in association with great saphenous vein reflux (p < 0.0001) was significantly related to clinical status severity. Conclusion: Duplex scan showed correlation between presence of superficial venous reflux and clinical status severity in patients with primary varicose veins of the lower limbs.

Arterite de Takayasu: aspectos clínicos e terapêuticos em 36 pacientes / Takayasu's arteritis: clinical and therapeutic aspects in 36 patients

CONTEXTO: A arterite de Takayasu é uma vasculite crônica, geralmente com diagnóstico tardio devido à pouca especificidade dos sintomas durante a fase inicial do acometimento vascular. A terapêutica de eleição é o uso de imunossupressores. O procedimento cirúrgico, quando necessário, é sempre evitado na fase aguda. OBJETIVO: Descrever alterações clínicas, laboratoriais e vasculares de arterite de Takayasu no período de 1977 a 2006. MÉTODO: A amostra compreendeu 36 pacientes - 10 brancos, 35 mulheres, idade média de 31,7 anos (±13,7), com prevalência significante na quarta década (p < 0,005). Evolução de 3 anos e período até o diagnóstico de 7,9 anos. Velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) avaliaram atividade da doença, e o duplex scan aferiu a espessura médio- intimal da artéria carótida. RESULTADOS: Hipertensão arterial sistêmica e claudicação de membros superiores e inferiores foram ressaltados em 85,2, 69,5 e 30,5 por cento, respectivamente. O resultado da VHS foi > 60 mm em 50 por cento da amostra (p < 0,005). PCR mg/dL foi realizado em 18, variando de 0,4-25 na admissão para 0,11-1,9 na evolução. Doença auto-imune, tuberculose e HIV correlacionaram-se em 19,4, 8,3 e 2,7 por cento, respectivamente. Lesões aórticas foram significativas em 22 por cento (quatro oclusões, dois aneurismas infra-renais, um torácico). Em 19,4 por cento, foram acometidas artérias renais e subclávias uma oclusão bilateral de carótidas, e em 25 por cento os membros inferiores. A espessura médio-intimal da carótida comum foi estratificada em: > 3 mm, < 3 e > 1,7, < 1,7 e > 1,2 e < 1,2 mm, representando 41,6, 19,4, 8,37 e 30,50 por cento, respectivamente (p < 0,005). Glicocorticóides foram utilizados em 61,1 por cento, azatioprina em 16.6 por cento, e associada a ciclofosfamida em 8,3 por cento. Procedimento cirúrgico ou endovascular foi realizado em 30,5 por cento com dois óbitos por complicações cardiovasculares. CONCLUSÕES: A VHS,...

BACKGROUND: Takayasu arteritis is a chronic vasculitis often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. Treatment includes imunosuppression drugs. Surgical treatment, when necessary, should be avoided in the acute phase. OBJECTIVE: To describe clinical, laboratory and vascular findings in Takayasu's arteritis from 1977 through 2006. METHODS: The sample was comprised of 36 patients (10 Caucasians, 35 women), mean age of 31.7 (±13.7) years, and significant prevalence in the forth decade (p < 0.005). Disease course was 3 years and time until diagnosis was 7.9 years. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to assess disease activity, and duplex scan to measure carotid artery intima-media wall thickness. RESULTS: Hypertension was present in 85.2 percent, and upper and lower limb claudication in 69.5 and 30.5 percent, respectively. ESR was > 60 mm in 50 percent of the sample (p < 0.005). PCR mg/dL was performed in 18 cases, ranging from 0.4-25 on admission to 0.11-1.9 during disease course. Autoimmune diseases, tuberculosis and HIV correlated in 19.4, 8.3 and 2.7 percent, respectively. Major aortic lesions were detected in 22.2 percent (four occlusions, two infrarenal aneurysms, one thoracic aneurysm). Other arteries involved renal, subclavian and one carotid occlusion (19 percent), and some level of lower limb occlusion (25 percent). Intima-media thickness was stratified in > 3 mm (41.6 percent), < 3 and > 1.7 (19.4 percent), < 1.7 and > 1.2 (8.37 percent), and < 1.2 mm (30.50 percent) (p < 0.005). Glucocorticoids were used in 61 percent, azathioprine in 16.6 percent, and azathioprine combined with cyclophosphamide in 8.3 percent. Surgical and endovascular procedures were performed in 30.5 percent. Two patients died due to cardiovascular diseases. CONCLUSIONS: Carotid intima-media thickness, PCR, and ESR are important markers for the follow-up of...