VaSa

Despite remarkable developments in vascular medicine in the last decades and intensive research on the improvement of bypass materials, an ideal bypass graft comparable to autologous veins or arteries is still not available for peripheral vascular and coronary artery bypass grafting. This article reviews established bypass materials and provides an overview over interesting new technologies particularly those associated with tissue-engineering and those already adopted clinically.

Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP), The aim was to obtain a consensus of international experts on the methodology to be used for assessment of anatomy of superficial and perforating veins in the lower limb by ultrasound imaging. Consensus conference leading to a consensus document. The authors performed a systematic review of the published literature on duplex anatomy of the superficial and perforating veins of the lower limbs; afterwards they invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the authors and the experts (text and images) were made available to all participants via the UIP website. The authors prepared a draft document for discussion at the UIP Chapter meeting held in San Diego, USA in August 2003. ...

Background: Verbal Autopsy/Social Autopsy (VASA) tools should be based on a well-holistic conceptual framework, allowing them to record and organize a wide range of determinants and contributors of child mortality in developing countries. This paper aims to review how successfully VASA studies have been able to record and organize biological and social determinants of child mortality, in pursuit of World Health Organization's (WHO) guidelines for verbal autopsy (VA) and Kalter's recommendations for social autopsy (SA). Methodology: A systematic search of literature from January 1995 to January 2018 was conducted on primary studies which attempted VA and SA on deceased cases of under-5 child mortalities using VA and SA questionnaires. A thorough search revealed 16 directly relevant papers. Results: Sixteen relevant studies from 14 countries revealed the two most common conceptual frameworks which were utilized for VASA studies. VA component of three studies followed W.H.O.'s guidelines, while the SA component of the other three studies followed Kalter's recommendations. The most robust VA tools identified were INDEPTH Network VA tool, INCLEN VA tool, and WHO VA tool; while CHERG SA tool and BASICS SA tool were found as the most robust SA tools. Conclusion: Due to the fact that only separate recommendations for VA, and conceptual frameworks for SA exists and no evidence on integrated conceptual framework exists, we suggest that there is a great need for developing a conceptual framework, based on which an integrated VASA tool can be developed and utilized in VASA based child mortality investigations in developing countries.

Background: Physical therapy has not been evaluated much for the treatment of chronic venous insufficiency before. The question is whether balneohydrotherapy and usual care combined is superior to usual care alone. Patients and methods: In a randomized trial comparing spa therapy versus waiting list patients were treated on an out-patient basis in a private spa center. Patients had to be between 18 and 80 years old, with chronic venous insufficiency (stage 3 or 4 according to the CEAP classification). The balneohydrotherapy group received 18 days of treatment in Aix-Les-Bains spa center continuing their usual care. The control group continued their usual care as well during the study. The balneohydrotherapy program consisted of Kneipp therapy (10 minutes), walking 10 minutes in a special mineral water pool with underwater jets at 23 °C, massage and bathing in a mineral water tub at 34 °C. The main outcome criterion was the number of patients with 20 % self assessed improvement on th...

We report a case of an isolated atherosclerotic true aneurysm of the profunda femoris artery. The aneurysm was surgically ligated. The clinical presentation, diagnostic algorithm and therapeutic options are discussed in the scope of the English-language literature.

Summary. Phlebosclerosis is a venous wall degenerative disease which has gained little popularity in the literature due to its uncertain clinical significance. The objective of this review is to evaluate the epidemiology, etiology and clinical significance of phlebosclerosis in lower extremities veins, particularly the effect of preexisting phlebosclerosis of the great saphenous vein on vein graft patency. Medline was searched from inception until November 1, 2019. Reference lists of included studies were scanned. Only articles published after 1949 were included. Two reviewers independently screened titles/abstracts and full-text papers for any study design in relation to phlebosclerosis in lower extremities veins and abstracted data. A total of 16 Cohort studies and one case-control study (3708 participants, mean age 61.8 years, 59.3 % men, and 40.7 % women) were included after screening 317 titles and abstracts, and 80 full-text articles. The incidence of phlebosclerosis ranged fr...

A rare case of a 79-year old women with dysphagia and dyspnea secondary to compression of the esophagus by an aberrant right subclavian artery (ARSA, A. lusoria) is presented. This abnormality is generally silent and often an incidental x-ray finding. Computed tomography and intraarterial angiography, including direct catheterization of the ARSA, established the diagnosis. The interdependence with a co-existing coronary artery disease is discussed. Thus, ARSA has to be taken into account in patients with abnormal x-ray findings presenting with dysphagia and dyspnea.

Summary: Background: Varicosis of the great saphenous vein (GSV) is a common disease. Most of the therapeutic concepts attempt to remove or destroy the truncal vein. However, the absence of the GSV could be harmful for further treatments of artherosclerotic disease as the GSV is often used as bypass graft in lower extremity or coronary artery revascularisations. External valvuloplasty (EV) is one of the vein-sparing treatment options. The aim of this clinical study was to describe the outcome, safety and complications of this procedure in a prospective multicentre trial. Patients and methods: The function of the terminal and preterminal valve was restored by external valvuloplasty. Furthermore, multiple phlebectomies of tributaries were performed. Patients were reinvestigated six weeks after surgery. Primary endpoint was the function of the external valvuloplasty measured by diameter of the GSV and the prevalence of reflux in the GSV. The eligibility of the vein as a potential bypas...

Previous general reservations against carotid endarterectomy (CEA) early after stroke, which were primarily based on concerns of postoperative intracerebral hemorrhage, are resolved. Moreover, a delay of surgery is proofed to be associated with a risk of recurrent cerebral ischemia. However, the complication rate of CEA seems to increase with less time interval to the onset of symptoms. The main purpose of this study was to assess the safety of very early CEA. Patients having a symptomatic high-grade (> 70%) internal carotid artery (ICA) stenosis were referred by neurologists for CEA within different timeframes, so that they were later differentiated depending on whether surgery was performed within 2 days (immediate CEA = iCEA) or 2 weeks (urgent CEA = uCEA) after neurological deficits have occurred primarily. The perioperative complication rate in these groups was than evaluated and compared. From January 2000 until August 2006 130 consecutive patients (median age 68 years, ran...

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of th...

Summary: Background: Chronic liver disease (CLD) patients are at greater risk for developing splenic artery aneurysm (SAA). Treatment for aneurysms > 2.5 cm in this population is considered. However, the procedure might be challenging in CLD patients, and complications may interfere in liver transplantation. We, therefore, sought to estimate the prevalence, growth rate and complications of SAA in patients with CLD. As secondary objective, we sought to evaluate whether those features differ in pre and post transplantation follow-up and among aneurysms with diameters greater or less than 2.5 cm at diagnosis. Patients and methods: We searched for the terms “SAA” and “CLD” on CT or MRI reports from January 2009 to December 2016. Patients with single examination or less than 6 months follow-up were excluded. Results: Fifty nine out of 2050 CLD patients presented SAA (prevalence of 2.9%). Fifteen patients were excluded (due to exclusion criteria). Forty-four CLD patients (mean age 55.9...

Summary. Phlebosclerosis is a venous wall degenerative disease which has gained little popularity in the literature due to its uncertain clinical significance. The objective of this review is to evaluate the epidemiology, etiology and clinical significance of phlebosclerosis in lower extremities veins, particularly the effect of preexisting phlebosclerosis of the great saphenous vein on vein graft patency. Medline was searched from inception until November 1, 2019. Reference lists of included studies were scanned. Only articles published after 1949 were included. Two reviewers independently screened titles/abstracts and full-text papers for any study design in relation to phlebosclerosis in lower extremities veins and abstracted data. A total of 16 Cohort studies and one case-control study (3708 participants, mean age 61.8 years, 59.3 % men, and 40.7 % women) were included after screening 317 titles and abstracts, and 80 full-text articles. The incidence of phlebosclerosis ranged fr...

Infection of an alloplastic vascular graft is a serious complication and often involves the groin. We propose a therapeutic concept using extraanatomic bypass to avoid the septic groin in case of an infected alloplastic vascular reconstruction. The course of 25 patients (18 men, 7 women, mean age 61 years) with a grade III inguinal infection following placement of an aortic or femoro-distal synthetic graft made of Dacron or PTFE was analysed. The treatment consisted of excision of the infected graft material and extraanatomic reconstruction with ringed PTFE grafts in all patients. Mean follow-up after the extraanatomic procedure was 21 months (1-91 months). Direct surgical exploration definitely secured graft infection in almost three-quarters of the cases. The most common organism isolated was Staphylococcus aureus (13/22 = 59%). At the time of infection 60% of the patients had critical limb ischemia necessitating vascular reconstruction simultaneously with total or partial excision of the infected graft. Complications of the extraanatomic bypass occurred in 7 cases (overall morbidity 28%). Postoperatively, one patient required major amputation. Hospital mortality was 8%. Primary patency and secondary patency rates of extraanatomic grafts amounted to 78.0% (+/- 10.0 SD) and 84.1% (+/- 8.7 SD) respectively after two years. Limb salvage rated 78.4% (+/- 11.6 SD) after 2 years, the 2-year-survival rate was 73.8% (+/- 9.3 SD). According to the favourable long-term limb salvage and survival rates, we support simultaneous vascular reconstruction by extraanatomic bypass and explanation of the infected graft material in case of grade III inguinal infection of alloplastic vascular reconstructions.

Congenital afibrinogenemia is a rare genetic disorder characterized by the complete absence of functional fibrinogen. We report a 22-year-old female who developed nephrogenic arterial hypertension and intestinal ischemia due to congenital afibrinogenemia-associated angiopathy of large abdominal arteries. We describe, for the first time, the capsule findings and discuss the pathophysiology of this unusual condition.

The aim of this study was to investigate whether frequency of concomitant peripheral arterial disease (PAD) is associated with angiographic severity of coronary artery disease (CAD), as well as to ascertain if diabetic patients differ from those without diabetes in the association between these two manifestations of atherosclerosis. This study included 302 patients (229 men, mean age 62.2 +/- 11.5 years) with documented CAD, divided into groups I-III, according to the angiographic severity of coronary atherosclerosis. Group I comprised 140 patients (104 men) with severe CAD, group II comprised 63 patients (48 men) with moderate CAD and group III comprised 99 patients (77 men) with mild CAD. Each of the groups I-III was further divided into the subgroups of diabetic and non-diabetic patients. Included were also 88 patients (42 men, mean age 61.7 +/- 9.5 years) without CAD and a control group of 60 healthy volunteers (30 men), aged 18-40 years. PAD was diagnosed by means of a Doppler apparatus. Frequency of PAD was associated with angiographic severity of CAD (p = 0.0001). This association was shown both in diabetic (p = 0.012) and in non-diabetic patients (p = 0.0041). Significantly (p < or = 0.01) higher frequency of PAD among diabetic patients was found in each of the groups I-III. Among patients with CAD, frequency of concomitant PAD is associated with angiographic severity of coronary atherosclerosis. This association is demonstrated both in diabetic and in non-diabetic patients. Finally, PAD is significantly more frequent in diabetic patients, irrespective of the angiographic severity of CAD.