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OBJECTIVE: While it is generally considered that patients with diabetes mellitus (DM) have more distal peripheral arterial disease (PAD), there is little information on how individual vessels are affected. The aim of this study was to adapt Bollinger's scoring system for lower limb angiograms (DSAs) to include the distal and planter vessels. The reliability of this extension was tested and was used to compare the distribution of disease in two cohorts of patients with and without DM. METHODS: Patients who had undergone DSA ± angioplasty for PAD at a single centre between September 2010 and April 2014 were identified. Twenty-five patients' images were reviewed by four clinicians and scored using an extended version of the Bollinger score. A total of 153 patients with DM were matched, for age, sex, ethnicity, smoking, and hypertension, with 153 patients without DM. The infrainguinal vessels were divided into 16 arterial segments, including plantar vessels, and scored using the Bollinger score. The score ranges from 0 to 15. Fifteen represents an arterial segment with more than 50% of its length occluded. Interobserver reliability was tested using interclass correlation (ICC) and Cohen's kappa coefficient. RESULTS: The ICC demonstrated good agreement between observers (0.76 [0.72-0.79]) with good internal consistency (Cronbach's alpha 0.93). When the Bollinger scores were categorised, the results were weaker, Cohen's kappa ranged from 0.39 (standard error 0.033) to 0.54 (0.030). Patients with DM had a higher burden of disease in the anterior tibial and posterior tibial arteries with relative sparing of the peroneal artery and no difference in the plantar vessels. CONCLUSION: It has been demonstrated that the Bollinger score can be extended to include the distal vessels. This amended scoring system can be used to compare the burden of distal disease in patients with PAD. How the score relates to clinical presentation and outcomes needs further investigation.
Assuntos
Angiografia Digital , Angiopatias Diabéticas/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Variações Dependentes do Observador , Doença Arterial Periférica/etiologia , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Frailty is a global state that does not relate directly to comorbidities and is prevalent among patients with vascular disease. The Clinical Frailty Scale (CFS) is a rapid assessment tool to identify vulnerable and frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to independently predict mortality and morbidity after elective open abdominal aortic aneurysm (AAA) repair. METHODS: We retrospectively reviewed our institutional National Vascular Registry (NVR) data to identify all patients who underwent an elective open juxta or infrarenal AAA repair between January 2014 and December 2018. The NVR data set included preoperative risk factors, imaging findings, intraprocedural variables, and postprocedural outcomes. RESULTS: A total of 184 patients were assessed using the CFS before they underwent elective open AAA repair. Among 26 (14%) individuals categorized as vulnerable using the CFS, there was no significant difference in age or preoperative cardiac and respiratory testing compared with nonfrail patients. However, vulnerable patients were significantly more likely to have a longer length of stay (12.2 days vs. 8.8 days, P-value 0.044), suffer from respiratory complications (35% vs. 15%, P-value 0.022) and renal failure (23% vs. 6%, P-value 0.013), or die (23% vs. 2%, P-value 0.0003). The regression analysis identified a vulnerable frailty score to be the only significant predictor of mortality (odds ratio = 36.7, P < 0.001), all other factors were not shown to be independent predictors. CONCLUSIONS: The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective open AAA repair and can be used to predict mortality and morbidity after surgery.
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Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Regras de Decisão Clínica , Idoso Fragilizado , Fragilidade/diagnóstico , Fatores Etários , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Comorbidade , Procedimentos Cirúrgicos Eletivos , Feminino , Fragilidade/mortalidade , Nível de Saúde , Humanos , Masculino , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Reino UnidoRESUMO
BACKGROUND: Neurogenic thoracic outlet syndrome is a condition that is both complex to diagnose and manage successfully. The aim of our study was to present our experience and outcomes of surgical management of thoracic outlet syndrome in adolescents. METHODS: We performed a retrospective analysis of a prospectively held database of consecutive adolescents (age 10-19 years) who underwent surgery for neurogenic thoracic outlet syndrome between 2005 and 2017 at our university hospital. RESULTS: Fourteen patients were identified (19 operations), with a mean age of 16.5 years (SD: 1.9). All patients had symptomatic relief with surgery with low complication rates (1 pneumothorax). Median hospital stay was 2 days (IQR: 1). There were no early recurrences but 5 late ones which occurred 2, 2.5, 3, 4 and 10 years after surgery (20%). None required a second procedure and were managed successfully with physiotherapy. CONCLUSIONS: Surgical intervention for thoracic outlet syndrome in the adolescent population results in excellent outcomes in the short term. However, we found that recurrence of symptoms in this population is common and patients need to be counseled clearly about this prior to surgical intervention. However in our experience these do not require further surgery.
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Costela Cervical/cirurgia , Descompressão Cirúrgica , Músculo Esquelético/cirurgia , Osteotomia , Síndrome do Desfiladeiro Torácico/cirurgia , Adolescente , Fatores Etários , Criança , Bases de Dados Factuais , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. METHODS: We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. RESULTS: There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7 years (standard deviation 8.2 y). Nine patients underwent major limb amputation for severe limb ischemia (7 transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24 days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. CONCLUSIONS: Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.
Assuntos
Amputação Cirúrgica , Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Artéria Femoral/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Bases de Dados Factuais , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Humanos , Tempo de Internação , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Fatores de Tempo , Resultado do TratamentoRESUMO
This case describes a patient being considered for combined liver-kidney transplantation for Caroli's disease with a failed renal transplant. A chronic septic focus could not be located with standard imaging techniques, such as ultrasonography and computed tomography. This case report highlights the observation that a retained non-functioning transplant can be the cause of fever of unknown origin and PET-CT can be useful in diagnosing these challenging cases.
Assuntos
Aloenxertos/diagnóstico por imagem , Doença de Caroli/cirurgia , Febre de Causa Desconhecida/diagnóstico por imagem , Rim/diagnóstico por imagem , Transplante de Fígado/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Aloenxertos/microbiologia , Aloenxertos/patologia , Aloenxertos/cirurgia , Febre de Causa Desconhecida/microbiologia , Febre de Causa Desconhecida/patologia , Febre de Causa Desconhecida/cirurgia , Rejeição de Enxerto/microbiologia , Humanos , Rim/microbiologia , Rim/patologia , Rim/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Cirrose Hepática/congênito , Cirrose Hepática/cirurgia , Masculino , Necrose , Nefrectomia , Doenças Renais Policísticas/cirurgia , Cuidados Pré-Operatórios/métodos , Transplantados , Falha de Tratamento , UltrassonografiaRESUMO
OBJECTIVE: After carotid endarterectomy (CEA), patients have been regularly followed up by duplex ultrasound imaging. However, the evidence for long-term follow-up is not clear, especially if the results from an early duplex scan are normal. This study assessed and systematically reviewed the evidence base for long-term surveillance after CEA and a normal early scan. METHODS: Electronic databases were searched for studies assessing duplex surveillance after CEA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome for this study was the incidence of restenosis after a normal early scan. The secondary outcome was the number of reinterventions after a normal early scan. RESULTS: The review included seven studies that reported 2317 procedures. Of those patients with a normal early scan, 2.8% (95% confidence interval, 0.7%-6%) developed a restenosis, and 0.4% (95% confidence interval, 0%-0.9%) underwent a reintervention for their restenosis during the follow-up period. CONCLUSIONS: This review confirms that routine postoperative duplex ultrasound surveillance after CEA is not necessary if the early duplex scan is normal.
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Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Ultrassonografia Doppler Dupla , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Endarterectomia das Carótidas/efeitos adversos , Humanos , Valor Preditivo dos Testes , Recidiva , Retratamento , Fatores de Tempo , Resultado do Tratamento , Procedimentos DesnecessáriosRESUMO
BACKGROUND: In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK. METHODS: A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs. RESULTS: In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft. CONCLUSIONS: The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for dialysis vascular access.
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Implante de Prótese Vascular/economia , Prótese Vascular/economia , Cateterismo Venoso Central/economia , Cateteres de Demora/economia , Cateteres Venosos Centrais , Custos de Cuidados de Saúde , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Diálise Renal/economia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Obstrução do Cateter/economia , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/economia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Inglaterra , Oclusão de Enxerto Vascular/economia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/terapia , Humanos , Falência Renal Crônica/diagnóstico , Modelos Econômicos , Desenho de Prótese , Falha de Prótese , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Medicina Estatal/economia , Trombose/economia , Trombose/etiologia , Trombose/terapia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: The fistula first initiative has promoted arteriovenous fistulas (AVFs) as the vascular access of choice. To preserve as many future access options as possible, multiple guidelines advocate that the most distal AVF possible should be created in the first place. Generally, snuff box and radiocephalic (RC) are accepted and well-described sites for AVFs; however, the forearm ulnar-basilic (UB) AVF is seldom used or recommended. The aim of this study is to assess and systematically review the evidence base for the creation of the UB fistula and to critically appraise whether more attention should be given to this site. METHODS: Electronic databases were searched for studies involving the creation of UB fistulas for dialysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of hemodialysis access-induced distal ischemia (HAIDI) and infection. RESULTS: After strict inclusion and/or exclusion criteria by 2 reviewers, 8 studies were included in our review. Weighted-pooled data reveal 1-year primary patency rate for UB AVFs of 53.0% (95% confidence interval [CI]: 40.1-65.8%) with a secondary patency rate of 72.0% (95% CI: 59.2-83.3). HAIDI and infection rates were low. CONCLUSIONS: Our review has shown that the UB AVF may be a viable alternative when a RC AVF is not possible, and dialysis is not required urgently. It has adequate 1-year primary and secondary patency rates and extremely low risk of HAIDI. While it may be more challenging for both surgeons and dialysis nurses to make it a successful vascular access it offers a further option of distal access which may be overlooked.
Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Insuficiência Renal Crônica/terapia , Artéria Ulnar/cirurgia , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Isquemia/etiologia , Insuficiência Renal Crônica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Artéria Ulnar/fisiopatologia , Grau de Desobstrução Vascular , Veias/fisiopatologiaRESUMO
OBJECTIVE: Over several decades, there has been an increase in the number of elderly patients requiring hemodialysis. These older patients typically have an increased incidence of comorbidities including diabetes, hypertension, and peripheral vascular disease. We undertook a systematic review of the current literature to assess outcomes of arteriovenous fistula (AVF) formation in the elderly and to compare the results of radiocephalic AVFs vs brachiocephalic AVFs in older patients. METHODS: A literature search was performed using MEDLINE, Embase, PubMed, and the Cochrane Library. All retrieved articles published before December 31, 2014 (and in English) primarily describing the creation of hemodialysis vascular access for elderly patients were considered for inclusion. We report pooled AVF patency rates and a comparison of radiocephalic vs brachiocephalic AVF patency rates using odds ratios (ORs). RESULTS: Of 199 relevant articles reviewed, 15 were deemed eligible for the review. The pooled 12-month primary and secondary AVF patency rates were 53.6% (95% confidence interval [CI], 47.3-59.9) and 71.6% (95% CI, 59.2-82.7), respectively. Comparison of radiocephalic vs brachiocephalic AVF patency rates demonstrated that radiocephalic AVFs have inferior primary (OR, 0.72; 95% CI, 0.55-0.93; P = .01) and secondary (OR, 0.76; 95% CI, 0.58-1.00; P = .05) patency rates. CONCLUSIONS: This meta-analysis confirms that adequate 12-month primary and secondary AVF patency rates can be achieved in elderly patients. Brachiocephalic AVFs have both superior primary and secondary patency rates at 12 months compared with radiocephalic AVFs. These important data can inform clinicians' and patients' decision-making about suitability of attempting AVF formation in older persons.
Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial , Artéria Radial , Grau de Desobstrução Vascular , Idoso , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Falência Renal Crônica/terapia , Diálise Renal , Resultado do TratamentoRESUMO
Charcot arthropathy is a progressive condition primarily affecting the lower limbs in patients with diabetes mellitus. It is a rare complication of diabetic neuropathy and if left untreated can lead to severe limb destruction necessitating major amputation. Here, we report the case of a 41-year-old female who presented with rapidly progressive Charcot foot over a 10-day period, necessitating open reduction and internal fixation of Lisfranc-type fracture dislocations. Her presentation with a rapidly progressing red, swollen foot with a blister on the plantar aspect prompted initial treatment on the basis of a diabetic foot infection. The report will therefore serve as a useful reminder to maintain a high index of suspicion for Charcot foot, which may present in an atypical manner.
RESUMO
PURPOSE: Early cannulation grafts are specifically designed for dialysis, whereas standard expanded polytetrafluoroethylene grafts were not. There is developing collective experience and literature available to allow the assessment of outcomes of these early cannulation grafts. The aim of this review was to review the evidence for both short- and long-term outcomes of early cannulation grafts. METHODS: Using standardized searches of electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the primary outcomes for this study were primary and secondary patency rates for early cannulation grafts for dialysis at 12 months and beyond. Secondary outcomes were timing of first cannulation, rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection. RESULTS: A total of 19 studies were identified and included. These were divided into different graft types. Flixene™, Avflo™, Acuseal™ and Vectra™ grafts all showed that early cannulation within 72 h is possible. Twelve-month pooled primary and secondary patency rates were 43.3% (95% confidence interval: 31.6-55.4) and 73.4% (95% confidence interval: 63-82.7) for the Flixene graft, 58.2% (95% confidence interval: 48-68.1) and 79.2% (95% confidence interval: 68-88.7) for the Avflo graft, 43.6% (95% confidence interval: 30.7-56.9) and 70.5% (95% confidence interval: 49.7-87.8) for the Acuseal graft and 63.7% (95% confidence interval: 53.4-73.4) and 85.8% (95% confidence interval: 82.9-88.4) for the Vectra graft. Data for outcome beyond 12 months were limited to the more recent studies. CONCLUSION: This review confirms that early cannulation is not detrimental on the early outcome of early cannulation graft patencies. It has also shown that both Vectra and Avflo grafts have adequate long-term patencies. The data do not allow specific graft recommendations, as comparative trials would be required.
Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Cateterismo , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Cateterismo/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
INTRODUCTION:: Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. METHOD:: A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. RESULTS:: Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. CONCLUSION:: Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.
Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Cateterismo Venoso Central , Hemodiálise no Domicílio , Serviços Hospitalares de Assistência Domiciliar , Adolescente , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Obstrução do Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Hemodiálise no Domicílio/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Adulto JovemRESUMO
BACKGROUND: The correct positioning of the laser tip at the saphenofemoral or saphenopopliteal junction during endovenous laser therapy is paramount to ensure a safe and effective procedure. The aim of this study was to demonstrate how patient positioning and tumescence infiltration can affect this safe junctional distance. METHODS: A retrospective review of a prospectively maintained database was carried out for all patients who received endovenous laser treatment for symptomatic varicose veins between February 2008 and February 2014 in one surgeon's practice in a teaching hospital vascular unit. The junctional distance of the laser tip from the saphenofemoral or saphenopopliteal junction was measured two times during the procedure: before tumescence and before laser deployment with the patient in a Trendelenburg position. RESULTS: Junctional distance was found to have increased in 62% cases (490 patients; great saphenous vein [GSV], 348; small saphenous vein [SSV], 142). Of these, 17% (84) required the laser tip to be advanced (GSV, 56; SSV, 28) to maintain a desired junctional distance of 0.75 to 2 cm. In 185 patients (23%), the junctional distance was noted to have been reduced (GSV, 155; SSV, 30), with 58% (GSV, 79; SSV, 28) requiring the laser tip to be withdrawn to the desired junctional distance; 23% of patients (185) had no change in the junctional distance. CONCLUSIONS: This study has demonstrated the effect of tumescence infiltration and Trendelenburg positioning on laser tip placement, and thus a final junctional measurement before activation of the laser is recommended to maintain a safe and optimal junctional distance.
Assuntos
Anestesia Local , Decúbito Inclinado com Rebaixamento da Cabeça , Terapia a Laser/instrumentação , Posicionamento do Paciente/métodos , Veia Safena/cirurgia , Varizes/cirurgia , Pontos de Referência Anatômicos , Bases de Dados Factuais , Hospitais de Ensino , Humanos , Terapia a Laser/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia , Varizes/diagnóstico por imagemRESUMO
OBJECTIVE: The aim of this review was to identify the evidence regarding the optimal duration of compression therapy after endovenous ablation of varicose veins. METHODS: Electronic databases were searched for studies assessing the use of compression after endovenous ablation in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcomes for this study were pain score and complications. Secondary outcomes were time to full recovery, quality of life score, leg circumference, bruising score, and compliance rates. RESULTS: Following strict inclusion and exclusion criteria, five studies were included in our review, including a total of 734 patients. The short-duration compression therapy ranged from 4 hours to 2 days, whereas the longer duration ranged from 3 to 15 days. A single study showed a better outcome in terms of complications with a short compression therapy. A single study showed a benefit to pain and quality of life with extended compression therapy, whereas the others did not. There was no significant difference in terms of bruising, recovery time, and leg swelling. CONCLUSIONS: Our review showed that there is no evidence for the extended use of compression after endovenous ablation of varicose veins.