1
|
Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A, Coleridge-Smith P. Duplex-Ultraschalluntersuchung der Venen der unteren Extremitäten bei chronischer Veneninsuffizienz. Phlebologie 2018. [DOI: 10.1055/s-0037-1622151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund: Die Duplex-Ultraschalluntersuchung ist der Goldstandard zur Beurteilung von Morphologie und Hämodynamik der Venen der unteren Extremitäten. Das in der vorliegenden Arbeit beschriebene Projekt wurde auf Grund einer Initiative der UIP (Union Internationale de Phlébologie) ins Leben gerufen. Das Ziel war es, einen Konsens internationaler Experten zu erreichen, wie die Methodologie der bildlichen Darstellung mittels Ultraschall zur Untersuchung der Venen der unteren Extremitäten verwendet werden kann. Design: Konsensuskonferenz, die zu einem Konsensusdokument führte. Methoden: Die Autoren luden eine internationale Expertengruppe zur Teilnahme an diesem Projekt ein. Elektronische Eingaben der Autoren sowie der internationalen Experten waren allen Teilnehmern auf der UIP-Website zugänglich. Die Autoren bereiteten ein erstes Dokument vor, welches auf dem UIP-Kongress in San Diego 2003 diskutiert wurde. Das überarbeitete Manuskript wurde im Anschluss an alle Experten geschickt und die Kommentare trugen zu weiteren Revisionen des Dokuments bei. Die endgültige Version wurde von allen Teilnehmern akzeptiert. Ergebnisse: Die Experten sprachen detaillierte Empfehlungen für die Duplex-Untersuchung der Venen der unteren Extremitäten sowie über die Interpretation der Befunde und Messergebnisse aus. Dieses Dokument enthält eine detaillierte Methodologie für eine komplette Beurteilung der oberflächlichen Venen sowie der Perforantes der unteren Extremität mittels Duplex-Ultraschall. Weiters enthält es Empfehlungen bezüglich der Erstellung von Befunden sowie bezüglich des Trainings von Mitarbeitern, welche diese Untersuchungen durchführen. Schlussfolgerung: Die Autoren und eine große Expertengruppe einigten sich auf eine Methodologie zur Untersuchung der Venen der unteren Extremitäten mittels Duplex-Ultraschall.
Collapse
|
2
|
Mosti G, Cavezzi A, Massimetti G, Partsch H. Recalcitrant Venous Leg Ulcers May Heal by Outpatient Treatment of Venous Disease Even in the Presence of Concomitant Arterial Occlusive Disease. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.08.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
3
|
Mosti G, Cavezzi A, Massimetti G, Partsch H. Recalcitrant Venous Leg Ulcers May Heal by Outpatient Treatment of Venous Disease Even in the Presence of Concomitant Arterial Occlusive Disease. Eur J Vasc Endovasc Surg 2016; 52:385-91. [DOI: 10.1016/j.ejvs.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/04/2016] [Indexed: 01/09/2023]
|
4
|
Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Coleridge-Smith P. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP Consensus Document. Part II: Anatomy. Phlebology 2016. [DOI: 10.1258/026835506779115799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: 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 the anatomy of superficial and perforating veins in the lower limb by ultrasound imaging. Design: Consensus conference leading to a consensus document. Methods: 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. Following this meeting, a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed on the final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. Conclusions: The authors and a large group of experts have agreed on a methodology for the investigation of the lower limbs venous system, by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.
Collapse
Affiliation(s)
| | | | - H Partsch
- University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
5
|
Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs – UIP Consensus Document. Part I: Basic principles. Phlebology 2016. [DOI: 10.1258/026835506779115780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: 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 veins in the lower limb by ultrasound imaging. Design: Consensus conference leading to a consensus document. Methods: The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at a UIP Chapter meeting held in San Diego, USA, in August 2003. Following this meeting, a revised manuscript was circulated to all participants, and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed on a final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination, as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. Conclusions: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography.
Collapse
Affiliation(s)
| | | | - H Partsch
- University of Vienna, Vienna, Austria
| | | | | | | |
Collapse
|
6
|
Abstract
Objective: To assess the efficacy and safety of sclerotherapy of varicose veins (VV) with sclerosing foam (SF) made using Tessari's method (three-way tap and two plastic syringes). Design: Two multi-centre prospective clinical series were documented (CS1 and CS2). In CS1, which ran from March to December 2000, 177 patients (39 men, 138 women), mean age 56 years, were treated in three centres for W related to incompetence of saphenous veins, recurrence, perforators or collaterals. Conventional or duplex-guided sclerotherapy was performed using SF made of purified sodium tetradecyl sulphate (PSTS) 0.2−3% (Fibro-vein, STD Pharmaceuticals, UK) and air. An average of 1.6 (SD 0.8) sessions per patient were performed and 2.9 (SD 1.0) ml of SF (i.e. 0.6 ml of PSTS) per session was employed. An elastic stocking providing 20 −30 or 30−40 mmHg compression was worn by patients following treatment. All the patients were reviewed (clinical examination and colour duplex ultrasonography) at 1 month. Sixty-six patients had a further follow-up 45−370 days after treatment. The 17 patients in CS2, a multi-centre study, were treated in March and April 2001. An independent observer assessed patients with major W (CEAP and W type distribution similar to CS1) before and after the treatment, and also observed the treatment, which was carried out using the technique employed in CS1. Results: In CS1 at 1 month follow-up there was: (A) obliteration of the vessel or antegrade flow in 161 (91%) patients, (B) minimal retrograde flow in the treated vein, without visible W, in 15 (8.4%) cases and (C) persistence of vessel patency with retrograde flow and visible W (failure) in 1 (0.6%) case. At 45−370 days (mean 138 days) follow-up results were: type A in 44 (67%) cases, type B in 17 (26%) cases and type C in 5 (8%) cases. The main complications were extension of sclerothrombus from superficial to deep veins (n = 2), allergy (n = 1), malaise (n = 1) and scotoma (n = 1). In CS2 at 30 days follow-up 100% of the treated venous segments had a type A outcome after an average of 1.4 sessions. No relevant complication occurred in this series. Conclusions: Sclerotherapy of major VV by means of SF prepared by Tessari's method is a safe and effective form of treatment. Low doses and a low concentration of drug may be successfully employed. Further studies are needed to establish the long- term results and overall safety of this form of foam sclerotherapy.
Collapse
|
7
|
Abstract
Objective: Ultrasonography of the anatomical course of the long saphenous vein (LSV) and its tributaries to produce and verify an anatomical classification (five types). Methods: Four hundred and ninety-three limbs (293 healthy; 200 with varicose veins, VV) were investigated by ultrasonic duplex imaging by the two authors independently, identifying the LSV as the vessel in the (ultrasonic) saphenous fascial ‘eye’ compartment (SFEC), in the thigh, and within two fascial layers between tibia and medial gastrocnemius muscle, below the knee. Results: Type A: LSV runs entirely in the SFEC without relevant tributaries: overall (O) 112 (23%), limbs with vv (V) 13, normal limbs (N) 99. Type B: LSV runs in the SFEC with one or more relevant tributaries below the knee: O 133 (27%), V 70, N 63. Type C: LSV runs in the SFEC with a relevant tributary above the knee: O 89 (18%), V 28, N 61. Type D: LSV runs in the SFEC from the foot upwards, continuing at the middle third of the leg in a large side vein with the calibre and role of the LSV but in a more superficial location. LSV stem is absent (or hypoplasic) in the para-tibial position. At the thigh level the tributary re-enters the true LSV: O 72 (14.5%), V 42, N 30. type E: similar to type D but the LSV is absent only at the knee level: O 72 (14.5%), V 38, N 34. Unclassified: O 15 (3%), V 9, N 6. Conclusions: We found a good reproducibility and clinical utility of the suggested classification. Remarks: (a) the absence (or hypoplasia) of LSV at the knee level with prevalence of a tributary in almost 30% of the limbs is of importance for arterial bypass and saphenous sparing management; (b) there is a low rate of LSV complete incompetence (6%); (c) there is a correlation between absent LSV (or presence of a relevant tributary) and the incidence of VV.
Collapse
Affiliation(s)
| | - A. Cavezzi
- Clinic ‘Stella Maris’, S. Benedetto del Tronto, Italy
| |
Collapse
|
8
|
Mosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable Velcro ® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
9
|
Mosti G, Cavezzi A, Partsch H, Urso S, Campana F. Adjustable Velcro Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial. Eur J Vasc Endovasc Surg 2015; 50:368-74. [PMID: 26160211 DOI: 10.1016/j.ejvs.2015.05.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase. METHODS Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale. RESULTS At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices. CONCLUSION Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.
Collapse
Affiliation(s)
- G Mosti
- Clinica MD Barbantini, Via del Calcio n.2, 55100 Lucca, Italy.
| | - A Cavezzi
- Eurocenter Venalinfa, San Benedetto del Tronto, Italy
| | - H Partsch
- Medical University Vienna, Vienna, Austria
| | - S Urso
- Ospedale Privato Prof. Nobili, Bologna, Italy
| | - F Campana
- Clinica Privata Villa Igea, Forlì, Italy
| |
Collapse
|
10
|
Mosti G, De Maeseneer M, Cavezzi A, Parsi K, Morrison N, Nelzen O, Rabe E, Partsch H, Caggiati A, Simka M, Obermayer A, Malouf M, Flour M, Maleti O, Perrin M, Reina L, Kalodiki E, Mannello F, Rerkasem K, Cornu-Thenard A, Chi YW, Soloviy M, Bottini O, Mendyk N, Tessari L, Varghese R, Etcheverry R, Pannier F, Lugli M, Carvallo Lantz AJ, Zamboni P, Zuolo M, Godoy MF, Godoy JM, Link DP, Junger M, Scuderi A. Society for Vascular Surgery and American Venous Forum Guidelines on the management of venous leg ulcers: the point of view of the International Union of Phlebology. INT ANGIOL 2015; 34:202-218. [PMID: 25896614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- G Mosti
- Department of Angiology, Barbantini Clinic, Lucca, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 493] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
12
|
Elio C, Guaitolini E, Paccasassi S, Rosati N, Cavezzi A. Application of microcurrents of bioresonance and transdermal delivery of active principles in lymphedema and lipedema of the lower limbs: a pilot study. GIORN ITAL DERMAT V 2014; 149:643-647. [PMID: 25664822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Application of microcurrents of bioresonance may allow protein aggregates lysis and a related enhancement of lymphatic drainage. Combining bioresonance with transcutaneous passage of active principles, by means of skin electroporation, microcirculation and clearance of connective tissues may be theoretically activated. A pilot study on an electro-medical device which includes these two technologies (Transponder(®)), has been performed on patients affected by lymphedema (LYM) and/or lipedema (LIP) of the lower limbs. METHODS Eight patients affected by primary or secondary unilateral LYM or LIP were submitted to six consecutive daily sessions with the medical device; the first two sessions were performed by a trained physiotherapist, whilst the following four sessions were self-administered by the patients themselves at home (who were educated about the technique). Magnesium silicate was delivered transcutaneously by means of the device at each session. Pre-post-treatment assessment included: 1) limb volumetry by means of tape measurement; 2) segmental multifrequency bioimpedance spectroscopy for fluid changes, with L-DEX measurement; 3) visual analogue scale (VAS) (0-10 score) questionnaire for related symptoms. RESULTS All the patients completed the scheduled treatment. After the treatment the mean volume of the whole limb decreased from 9462.85 (±3407.02) to 9297.37 cc (±3393.20), which accounts for a 165.48 cc (2%) reduction after six days of treatment. The pre/post-treatment VAS mean score changes were: heaviness from 4.57±3.46 to 2.43±2.57 (-47%), dysesthesias from 1.71±2.63 to 0.71±1.50 (-58%), pain from 1.57±2.57 to 0.57±0.79 (-64%). Diuresis VAS measurement passed from 7.43±1.81 to 8.57±0.98 (15% increase). The average L-DEX percentage reduction was 21%. No side effects were reported and a good patients' compliance was recorded. CONCLUSIONS The preliminary data of this pilot study show that the combination of microcurrents of bioresonance with transdermal delivery of active principles indicate that it could result in edema decrease and symptom improvement in patients affected by LYM and/or LIP of the lower limbs. Self-administered modality of the electrical device is possible and effective; no side effects have been reported.
Collapse
Affiliation(s)
- C Elio
- Vascular Unit, Poliambulatorio Hippocrates San Benedetto del Tronto, Ascoli Piceno, Italy -
| | | | | | | | | |
Collapse
|
13
|
Cavezzi A, Mosti G, Di Paolo S, Tessari L, Campana F, Urso S. Re: ‘Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia’. Eur J Vasc Endovasc Surg 2014; 48:597. [DOI: 10.1016/j.ejvs.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
|
14
|
Cavezzi A, Paccasassi S, Elio C. Lymphedema treatment by means of an electro-medical device based on bioresonance and vacuum technology: clinical and lymphoscintigraphic assessment. INT ANGIOL 2013; 32:417-423. [PMID: 23822945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of the study was to assess efficacy and safety of a new medical device, based on electric microcurrents and vacuum mechanism, on lymphedema of the lower limbs. METHODS This was an observational clinical and instrumental study was performed on eight patients (2 males and 6 females, mean age 40.5 years), affected by secondary (3) or primary (5) lymphedema of the lower limbs. Ten daily sessions with an electro-sound wave and vacuum medical device were performed. Patients did not discontinue antecedently worn compression stockings. Lymphoscintigraphy of the lower limbs was performed before and after the treatment and an independent observer scored the images. Circumference tape measurement and relative volumetry were calculated before and after the treatment. RESULT Total limb mean volumetry decreased from 9145 cc (±3439 SD) to 8714 (±3307) after 10 sessions (5% improvement); reduction in the lower leg volumetry was 8%. Ankle and mid calf mean circumference (in cm) decreased from 27.7 to 27.2 and from 36.2 to 35.2. Popliteal and inguinal lymph node visualisation at lymphoscintigraphy improved of 72%, 41%, 95% and 192% and of 0%, 33%, 110% and 245% respectively, 5', 45',120' and 180' after the injection. Radiotracer ascension along the leg and the thigh increased respectively of 48% and 33%, 39% and 64%, 50% and 62% and finally of 55% and 78% at the same intervals. Dermal back flow did not significantly vary till 45', whereas it improved of 25% both 120' and 180' after injection. No side effects were highlighted during the treatment. CONCLUSION In this observational study the application of a medical device, based on bioresonance and vacuum mechanisms, on limbs with lymphedema proved to be both safe and effective in terms of limb volume reduction and of lymphoscintigraphy parameters.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Hippocrates Poliambulatory and Stella Maris Clinic, S. Benedetto del Tronto, Ascoli Piceno, Italy.
| | | | | |
Collapse
|
15
|
Rabe E, Breu FX, Cavezzi A, Smith PC, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Kern P, Partsch B, Ramelet AA, Tessari L, Pannier F. European guidelines for sclerotherapy in chronic venous disorders. Phlebology 2013; 29:338-54. [DOI: 10.1177/0268355513483280] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. Methods This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7–10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Results This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations.
Collapse
Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - FX Breu
- Practice for Vascular Medicine, Tegernsee, Germany
| | - A Cavezzi
- Vascular Unit, Poliambulatorio Hippocrates and Clinic Stella Maris, San Benedetto del Tronto (AP), Italy
| | | | - A Frullini
- Studio Medico Flebologico – Figline Valdarno, Florence, Italy
| | - JL Gillet
- Vascular Medicine and Phlebology, Bourgoin-Jallieu, France
| | - JJ Guex
- Cabinet de Phlébologie, Nice, France
| | - C Hamel-Desnos
- Department of Vascular Medicine, Saint Martin Private Hospital, Caen, France
| | - P Kern
- Private office Vevey, Service of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - AA Ramelet
- Department of Dermatology, University of Bern, Switzerland
| | | | - F Pannier
- Department of Dermatology, University of Cologne, Cologne, Germany
| | | |
Collapse
|
16
|
Abstract
Foam sclerotherapy may result in drug and/or gas-related complications of a generalized or localized nature. Significant complications include anaphylactic/anaphylactoid reactions (very rare), deep vein thrombosis (1–3%), stroke (0.01%), superficial venous thrombosis (4.4%), tissue necrosis (variable frequency), oedema (0.5%) and nerve damage (0.2%). Cosmetic complications include telangiectatic matting (15–24%) and pigmentation (10–30%). Patent foramen ovale and other cardiopulmonary right-to-left shunts seem to play a role in the systemic gas-related complications. In conclusion, foam sclerotherapy is characterized by an overall high degree of safety, though special attention should be given to the embolic and thrombotic complications. Good technique, adequate imaging, general precautions and compliance with post-treatment instructions may help avoid some of the adverse events and an appropriate early intervention may minimize possible sequelae. Higher volumes of sclerosant foam have been attributed to local and distant thrombotic complications and should be avoided.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Poliambulatorio Hippocrates
- Clinica Stella Maris, San Benedetto del Tronto, Italy
| | - K Parsi
- Department of Dermatology, St Vincent's Hospital
- University of New South Wales, Sydney, Australia
| |
Collapse
|
17
|
De Maeseneer M, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith P. Duplex Ultrasound Investigation of the Veins of the Lower Limbs after Treatment for Varicose Veins – UIP Consensus Document. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
De Maeseneer M, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith P. Duplex Ultrasound Investigation of the Veins of the Lower Limbs after Treatment for Varicose Veins – UIP Consensus Document. Eur J Vasc Endovasc Surg 2011; 42:89-102. [DOI: 10.1016/j.ejvs.2011.03.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
|
19
|
Cavezzi A, Schingale F, Elio C. Limb volume measurement: from the past methods to optoelectronic technologies, bioimpedance analysis and laser based devices. INT ANGIOL 2010; 29:392-394. [PMID: 20924339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Accurate measurement of limb volume is considered crucial to lymphedema management. Various non-invasive methods may be used and have been validated in recent years, though suboptimal standardisation has been highlighted in different publications.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Stella Maris Clinic and Hippocrates Poliambulatory, S. Benedetto del Tronto, Ascoli Piceno, Italy.
| | | | | |
Collapse
|
20
|
Abstract
INTRODUCTION Foam sclerotherapy has gained a great popularity among phlebologists worldwide, although a major lack of homogeneity in the material used to produce sclerosant foam (SF) and to inject SF has been reported. AIMS To highlight the literature data and a few personal clinical and experimental outcomes concerning the main variables in SF production and injection. METHODS A review of the published literature and of our own 12 year clinical and experimental experience has been undertaken in order to focus on a few variables of the material and methods used to produce SF with Tessari method and to inject SF. RESULTS In SF production, differences in gas components, liquid to gas ratio, as well in disposable material can variably influence the resulting SF. Similarly SF injection through ultrasound guidance, with needle, or with short/long catheter may exhibit different foam behaviours according to the variable material and techniques which are employed. More recently the introduction of long catheters, possibly together with hook phlebectomy, seems to potentiate the short-mid term outcomes of foam sclerotherapy. CONCLUSION SF formation is greatly influenced by the choice of the gas component, the liquid-to-gas ratio, the type of syringes; also larger needles are to be preferred for injection of SF, while long catheters seem to represent a valid alternative especially when combined with tumescence to minimise saphenous diameter.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Poliambulatorio Hippocrates, Via Gioranni XXIII 7, 63039 San Benedetto del Tronto (AP), Italy.
| | | |
Collapse
|
21
|
Cavezzi A. Invited Commentary re: Comparison of 1% and 3% Polidocanol Foam in Ultrasound Guided Sclerotherapy of the Great Saphenous Vein: A Randomised, Double-blind Trial with 2 Year-Follow-up. "The 3/1 Study". Eur J Vasc Endovasc Surg 2007; 34:730. [PMID: 17888692 DOI: 10.1016/j.ejvs.2007.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 07/23/2007] [Indexed: 11/21/2022]
Affiliation(s)
- A Cavezzi
- Clinica Stella Maris and Poliambulatorio Hippocrates, Vascular Unit, San Benedetto del Tronto, AP, Italy
| |
Collapse
|
22
|
Cavezzi A, Labropoulost N, Partscht H, Ricci S, Caggiati A, Myers K, Nicolaides A, Coleridge-Smith P. [Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document - Parte II: anatomy]. Rev Port Cir Cardiotorac Vasc 2007; 14:99-108. [PMID: 17684606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES 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. DESIGN Consensus conference leading to a consensus document. METHODS 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. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually all participants agreed the final version of the paper. RESULTS The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. CONCLUSIONS The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.
Collapse
|
23
|
Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs-UIP consensus document. Part I. Basic principles. VASA 2007; 36:53-61. [PMID: 17323300 DOI: 10.1024/0301-1526.36.1.53] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: 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 veins in the lower limb by ultrasound imaging. Methods: The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at an UIP Chapter meeting held in San Diego, USA in August 2003. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually all participants agreed the final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. Conclusions: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography.
Collapse
|
24
|
Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Smith PC. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs-UIP consensus document. Part II. Anatomy. VASA 2007; 36:62-71. [PMID: 17323301 DOI: 10.1024/0301-1526.36.1.62] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: 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. Methods: 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. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed the final version of the paper. Results: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. Conclusions: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Clinic Stella Maris, San Benedetto del Tronto, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Smith PCC, Cavezzi A. Duplex-Ultraschalluntersuchung der Venen der unteren Extremitäten bei chronischer Veneninsuffizienz. Phlebologie 2007. [DOI: 10.1055/s-0037-1622166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund: Die Duplex-Ultraschalluntersuchung ist der Goldstandard zur Beurteilung von Morphologie und Hämodynamik der Venen der unteren Extremitäten. Das in der vorliegenden Arbeit beschriebene Projekt wurde auf Grund einer Initiative der UIP (Union Internationale de Phlébologie) ins Leben gerufen. Das Ziel war es, einen Konsens internationaler Experten zu erreichen, wie die Methodologie der bildlichen Darstellung mittels Ultraschall zur Untersuchung der Anatomie von oberflächlichen Venen sowie von Perforantes verwendet werden kann. Design: Konsensuskonferenz, die zu einem Konsensusdokument führte. Methoden: Die Autoren führten eine systematische Literatursuche über die Duplex-Anatomie der oberflächlichen Beinvenen sowie der Perforantes durch. Im Anschluss wurde eine internationale Expertengruppe zur Teilnahme an diesem Projekt eingeladen. Elektronische Eingaben der Autoren sowie der internationalen Experten waren allen Teilnehmern auf der UIP-Website zugänglich. Die Autoren bereiteten ein erstes Dokument vor, welches auf dem UIP-Kongress in San Diego 2003 diskutiert wurde. Das überarbeitete Manuskript wurde im Anschluss an alle Experten geschickt und die Kommentare trugen zu weiteren Revisionen des Dokuments bei. Die endgültige Version wurde von allen Teilnehmern akzeptiert. Resultate: Die Experten sprachen detaillierte Empfehlungen für die Duplex-Untersuchung der Venen der unteren Extremitäten sowie über die Interpretation der Befunde und Messergebnisse aus. Dieses Dokument enthält eine detaillierte Methodologie für eine komplette Beurteilung der oberflächlichen Venen sowie der Perforantes der unteren Extremität mit Duplex-Ultraschall. Schlussfolgerung: Die Autoren und eine große Expertengruppe einigten sich auf eine Methodologie zur Untersuchung der Venen der unteren Extremitäten mittels Duplex-Ultraschalls mit spezifischer Bezugname auf die Anatomie der wichtigsten oberflächlichen Venen sowie der Perforantes bei Gesunden und Varizen-Patienten.
Collapse
|
26
|
Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. [Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document part I: basic principles]. Rev Port Cir Cardiotorac Vasc 2007; 14:53-60. [PMID: 17530066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES 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 veins in the lower limbs by ultrasound imaging. DESIGN Consensus conference leading to a consensus document. METHODS The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at a UIP Chapter meeting held in San Diego, USA in August 2005. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually all participants agreed to the final version of the paper. RESULTS The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. CONCLUSIONS The authors and a large group of experts have agreed to a methodology for the investigation of the lower limbs venous system by duplex ultrasonography.
Collapse
|
27
|
Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Smith PC. Duplex Ultrasound Investigation of the Veins in Chronic Venous Disease of the Lower Limbs—UIP Consensus Document. Part II. Anatomy. Eur J Vasc Endovasc Surg 2006; 31:288-99. [PMID: 16230038 DOI: 10.1016/j.ejvs.2005.07.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 07/05/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES 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. DESIGN Consensus conference leading to a consensus document. METHODS 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. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed the final version of the paper. RESULTS The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. CONCLUSIONS The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.
Collapse
Affiliation(s)
- A Cavezzi
- Vascular Unit, Clinic Stella Maris, S. Benedetto del Tronto, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg 2005; 31:83-92. [PMID: 16226898 DOI: 10.1016/j.ejvs.2005.07.019] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 07/05/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES 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 veins in the lower limb by ultrasound imaging. DESIGN Consensus conference leading to a consensus document. METHODS The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at a UIP Chapter meeting held in San Diego, USA in August 2003. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually all participants agreed the final version of the paper. RESULTS The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. CONCLUSIONS The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonographpy.
Collapse
|
29
|
|
30
|
|
31
|
|
32
|
Abstract
BACKGROUND Recently a new method of using a foam sclerosing agent for the treatment of leg veins has been described. We present a pilot study of a new technique for producing the sclerosing foam (Tessari's method) (SFT) and its use in sclerotherapy of major and minor varicosities. OBJECTIVE A preliminary multicenter experience of sclerotherapy performed by means of this new kind of sclerosing foam made of purified sodium tetradecylsulfate is described. The authors evaluated the safety and efficacy of different doses and concentrations of the drug as well as different methods of preparing the foam in addition, the results of this technique were evaluated. METHODS Over a 6-week period the three authors performed sclerotherapy or duplex-guided sclerotherapy using SFT, treating 77 patients. The SFT was formed using a three-way stopcock and two syringes, mixing air with liquid sodium tetradecylsulfate to create a foam. Each author used different concentrations (0.1-3%) and doses (2-8 ml) of SFT according to the size and number of the veins. Alternate methods of preparing the foam were examined as well. Seventy percent of the sclerotherapy sessions were performed on either the long or short saphenous veins, recurrent varices, or collaterals. Thirty percent of the treatments were for reticular varices and telangiectases. RESULTS At 1-month follow-up, the vast majority of treated larger veins were either obliterated or showed a normal state of cephalad blood flow. Results for minor varicosities were good, but with related complications of hyperpigmentation and small areas of cutaneous necrosis. Two patients experienced transient scotomas and one patient developed segmental phlebitis of a collateral vein. The best foam was obtained by mixing one part liquid sodium tetradecylsulfate and four to five parts air, but the duration of the foam product was also related to several other factors. CONCLUSION This preliminary pilot study demonstrates that the technique of producing sclerosing foam according to Tessari's method (three-way stopcock device) is very promising, especially for larger veins. No serious complications were reported, and further standardization of the method may improve the results and feasibility of this technique. Further studies are needed to validate this new technique.
Collapse
Affiliation(s)
- L Tessari
- Glauco Bassi Foundation, Trieste, Italy.
| | | | | |
Collapse
|
33
|
Cavezzi A, Carigi V, Collura M. Colour Flow Duplex Scanning as a Preoperative Guide for Mapping and for Local Anaesthesia in Varicose Vein Surgery. Phlebology 2000. [DOI: 10.1007/s005230070033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Abstract
Objective: To evaluate duplex or colour flow duplex ultrasound scanning (CFDS) in varicose vein surgery as a perioperative guide for mapping, marking and local anaesthesia (LA), on the basis of our experience since 1990. Design: Retrospective clinical series. Patients and methods: A total of 3150 interventions for varicose veins were performed on an outpatient basis since 1990. This review of the last 4 years' experience (January 1996 to December 1999) deals with 1824 operations (457 men, 938 women; mean age 55.3 years). Duplex scanning or CFDS was used for perioperative investigation in all the patients, but also to guide skin marking and to help in the injection of LA (mepivacaine chloridrate 0.25–0.4%). The surgical approach varied according to the patient's morphohaemodynamic findings. Results: Several different preoperative patterns of varicose vein disease resulted in a ‘made-to-measure’ surgical approach, allowing segmental saphenous stripping in 99.9% of the patients, and ligation of perforating veins in 0.9% of cases. Immediate postoperative walking was possible in 99.8% of the patients and 3–6 h hospitalisation time in 99.5%. LA caused only minor complications (haematoma, urticaria) in 15 cases. Duplex monitoring of infiltration has facilitated LA usage, decreasing the doses and concentrations required and improving its efficacy. The operation costs decreased with time; major complications were 2 deep vein thromboses, one with a probable pulmonary embolism. Conclusion: The use of duplex scanning or CFDS in varicose vein surgery has permitted accurate preoperative evaluation and a guide to injection of LA, resulting in more conservative and targeted surgery. Patient compliance and cost-efficacy were also improved.
Collapse
Affiliation(s)
- A. Cavezzi
- Stella Maris Clinic, San Benedetto del Tronto (AP); Villa Maria Clinic, Rimini; and Villa Erbosa Clinic, Bologna, Italy
| | - V. Carigi
- Stella Maris Clinic, San Benedetto del Tronto (AP); Villa Maria Clinic, Rimini; and Villa Erbosa Clinic, Bologna, Italy
| | - M. Collura
- Stella Maris Clinic, San Benedetto del Tronto (AP); Villa Maria Clinic, Rimini; and Villa Erbosa Clinic, Bologna, Italy
| |
Collapse
|
35
|
Cavezzi A. Isolated thrombosis of plantar veins. Case report. Minerva Cardioangiol 1999; 47:309-13. [PMID: 10630069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The author reports a case of isolated thrombosis of plantar veins, a rare finding in the international medical literature, in a patient who had a previous knee arthrocentesis and a strict localized bandage. The clinical aspect of perimalleolar-podalic (mainly plantar) oedema, with localized pain, was followed by colour flow duplex investigation, which is considered the fundamental and most useful means to achieve the diagnosis and to perform an adequate follow-up. Pharmacological therapy of such kinds thrombosis may be of an antithrombotic or anticoagulant nature, always associating elastic compression. Aethiopathogenesis of this localized thrombosis is still uncertain, but probably in situ mechanical compressions may play an important role.
Collapse
Affiliation(s)
- A Cavezzi
- Servizio di Patologia Vascolare Clinica Stella Maris S. Benedetto del Tronto
| |
Collapse
|
36
|
Michelini S, Campisi C, Cavezzi A, Boccardo F, Failla A, Moneta G. [National epidemiologic study of lymphedema]. Minerva Cardioangiol 1998; 46:393-4. [PMID: 10021824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
37
|
Cavezzi A, Ragazzi G, Lonardi R, Tuscano G. [Hematoma of the rectus abdominis as a complication of anticoagulant therapy with subcutaneously administered heparin calcium]. Minerva Cardioangiol 1997; 45:273-7. [PMID: 9432568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The use of anticoagulant therapy with subcutaneous heparin calcium has long become an established routine for both arterial and venous pathologies. However, albeit with a lower percentage than in intravenous anticoagulant therapy, it is not free from complications. The authors report their experience regarding two cases of hematoma of the rectus abdominis muscle that occurred after anticoagulant treatment with full dose subcutaneous heparin calcium in patients suffering from severe chronic obliterating arterial disease of the lower limbs. From a diagnostic point of view, in addition to the clinical examination of the patient, which often does not results in the decisive confirmation of diagnosis, ultrasound and computerized tomography are essential not only to confirm the suspected diagnosis but also to monitor the evolution of the hematoma over time. In both cases the hematoma resolved spontaneously following gradual resorption, although treatment, especially in cases in which the hematoma is not blocked by the suspension of anticoagulant therapy, may include surgical draining. In view of the frequency with which this treatment is used in arteriopathic or phlebopathic subjects, including elderly patients who may present concauses for the formation of a hematoma of the rectus abdominis muscle (connectivitis, chronic or acute renal insufficiency, hemodyscrasia in terms of hypocoagulation), the authors suggest that high-risk patients should be identified for the possible use of an alternative route of administration.
Collapse
Affiliation(s)
- A Cavezzi
- Cattedra e Scuola di Specializzazione in Chirurgia Vascolare, Università degli Studi, Modena
| | | | | | | |
Collapse
|
38
|
Cavezzi A, Sabatini D, Lonardi R, Hussein H, Sfrappini M, Infriccioli P. Preventing pulmonary embolism using venous caval filter in elderly patients. Arch Gerontol Geriatr 1996; 22 Suppl 1:447-9. [DOI: 10.1016/0167-4943(96)86980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|