Can bilateral varicose vein surgery be performed safely in an ambulatory setting?

Surgery for varicose veins is still the method of choice worldwide. When varicose veins require bilateral surgery, a single procedure often is the preferred choice by the patient. Today, unilateral varicose vein surgery is frequently performed as an outpatient procedure, while in many institutions bilateral surgery is done as an in-hospital procedure

Somatostatin treatment of a persistent chyloperitoneum following abdominal aortic surgery

Chyloperitoneum is an uncommon but serious complication of abdominal aortic surgery. There are no optimal guidelines for the management of chyloperitoneum. We present here our experiences regarding the treatment of chyloperitoneum with somatostatin for three patients who underwent surgery for abdominal aortic disease. Milky, odorless liquid was observed in the abdominal drain of these patients. The conservative treatment with total parenteral nutrition failed; therefore, in parallel, we initiated a somatostatin treatment as a continuous perfusion. Drain loss decreased in all up to the second day of treatment. The probable mechanisms of the somatostatin decrease the intestinal absorption of fats via the specific receptors, decrease triglyceride concentration in the thoracic duct, and attenuate lymph flow in the major lymphatic channels. The presented cases showed successful treatment using somatostatin and may be a new generation of effective treatments for chyloperitoneum

The relationship between increased body mass index and primary venous disease severity and concomitant deep primary venous reflux

The role of overweight in chronic venous disease is still controversial. The aim of this study was to evaluate the impact of overweight and obesity in chronic primary venous disease in relation to disease severity, using the CEAP and the Venous Clinical Severity Score (VCSS) as well as well as body weight on the presence of concomitant primary deep venous reflux

Off-label use of a reversed flared endurant iliac limb stengraft for the management of a life-threatening internal iliac artery aneurysm rupture

We report a case of a life-threatening internal iliac artery aneurysm rupture managed successfully with an on-table reversed flared iliac limb stentgraft and embolization. This easily off-the-shelf reproducible technique avoids using a more complex and expensive bifurcated aorto-iliac graft and could be a good solution in emergency situation where a custom graft is not available

Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up

BACKGROUND: Endovenous laser therapy (EVLT) for ablation of the great saphenous vein (GSV) is thought to minimize postoperative morbidity compared with high ligation and stripping (HL/S). Only a few randomized trials have reported early results. This prospective randomized trial compared EVLT (980 nm) and HL/S results at 1 and 2 years after the intervention. METHOD: Patients with symptomatic varicose veins due to GSV insufficiency were randomized to HL/S (100 limbs) or EVLT (104 limbs). Four EVLT procedures failed primarily and were excluded. Phlebectomy and ligature of incompetent perforators were performed whenever indicated in both groups. Patients were re-examined clinically and by duplex ultrasound imaging preoperatively and at 12 days and at 1 and 2 years after treatment. Closure rate, complication rate, time to return to normal activity, the Aberdeen Varicose Vein Symptom Severity Score (AVVSS), the Varicose Venous Clinical Severity Score (VVCSS), and the Medical Outcome Study Short Form-36 scores were also recorded. RESULTS: There were no differences in patient demographics, CEAP class, Widmer class, or severity scores between the groups. Simultaneous interventions did not differ between the groups. Similar times for the return to normal activity and scores for postoperative pain were reported. No major complications after treatment were recorded. HL/S limbs had significantly more postoperative hematomas than EVLT limbs, and EVLT patients reported more bruising. Follow-up at 1 year was 100% for HL/S and 99% for EVLT. Two GSVs in the EVLT group reopened and three partially reopened. No open GSVs occurred in HL/S limbs. Ninety-eight percent of the limbs in both groups were free of symptoms. VCSS, AVVSS, and Short Form-36 scores did not reveal any group differences. At 2 years, no differences compared with 1-year results were observed, except that two more GSVs in the EVLT group were partially reopened. CONCLUSIONS: Abolition of GSV reflux and improvement in quality of life was similar after HL/S and EVLT. After EVLT, however, two GSVs were found completely reopened and five were partially reopened, which was significantly higher than after HL/S. A prolonged follow-up is ongoing

Embolization of a Large Rapidly Growing Aortic Pseudo-Aneurysm Not Amenable to Open or Endovascular Repair

To report the case of a rapidly growing aortic false aneurysm because of Q fever infection that was managed by embolization