A Case of Intrathoracic Stomach and Spleen After Aortic Repair: An Unusual Complication

A patient is described who presented with an intrathoracic stomach and spleen two weeks after aortic repair for an aortoduodenal fistula. At an urgent laparotomy the stomach was repositioned and the spleen removed. The patient recovered fully. The possible mechanism of this severe complication is discussed and relevant literature reviewed

A Pseudoaneurysm of the Deep Palmar Arch After Penetrating Trauma to the Hand: Successful Exclusion by Ultrasound Guided Percutaneous Thrombin Injection

: Introduction: Pseudoaneurysm of the hand is a rare condition; most are treated surgically. Ultrasound guided thrombin injection has not previously been reported as a treatment option for pseudoaneurysms of the deep palmar arch. Report: A man was referred to the emergency department with a swollen, painful hand after penetrating trauma. On physical examination, a pulsating tumor was found on the dorsum of the hand. Imaging revealed a pseudoaneurysm vascularized by the deep palmar arch. Ultrasound guided percutaneous thrombin injection was successfully performed. Conclusion: Thrombin injection might be a safe alternative option in the treatment of pseudoaneurysm of the deep palmar arch. Keywords: Deep palmar arch, Pseudoaneurysm, Thrombin injectio

Endoveneuze lasertherapie: een nieuwe behandeling van varices.

– Varicositas is een veelvoorkomende aandoening. De meest toegepaste behandeling van een insufficiënte V. saphena magna (VSM) bestaat al jaren uit het chirurgisch verwijderen van de vene en een crossectomie. – Sinds een aantal jaren zijn de minimaal-invasieve technieken sterk in opkomst, onder andere de endoveneuze lasertherapie. – Bij endoveneuze lasertherapie wordt percutaan een laserdraad in de VSM ingebracht. De positie wordt echografisch gecontroleerd. Daarna wordt het endotheel van de VSM door laserlicht beschadigd. Er treedt vervolgens een lokale occlusie van de VSM op. – De procedure is in korte tijd populair geworden bij de behandelaars van varices vanwege zijn relatieve eenvoud en een hoge patiënttevredenheid. De resultaten zijn goed, met een acuut succespercentage tot 100. Rekanalisatie lijkt, ook na enkele jaren, weinig op te treden. – Pijn, hematomen en flebitis zijn veelvoorkomende bijwerkingen van de endoveneuze lasertherapie, maar hebben een zelflimiterend karakter. Ernstige complicaties, zoals diepveneuze trombose, worden nauwelijks beschreven. – Voordelen van de endoveneuze lasertherapie zijn het ontbreken van chirurgische wonden en daarmee het uitblijven van wondinfecties en littekenvorming, en de mogelijkheid om deze techniek in een poliklinische setting onder lokale anesthesie uit te voeren. – Endoveneuze lasertherapie lijkt een veilige en effectieve behandelingsoptie voor varices ten gevolge van reflux in de VSM

Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital: The First 400 Procedures

AbstractEndovenous laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our learning curve.MethodsThree hundred and twenty-three patients (403 limbs) with incompetence of the GSV underwent ELA. Patients were assessed by clinical examination and venous duplex ultrasound was performed 6 weeks after operation. Visual analog scale (VAS) pain scores of the first postoperative week were recorded. Operative time and success rate were analysed.ResultsAfter 6 weeks, 301 (74.7%) treated legs were examined by duplex ultrasound imaging. Successful complete occlusion was present in 282 (93.7%) GSVs. Partial occlusion was present in 12 (4.0%) GSVs. In seven (2.3%) limbs the GSV was not occluded. The maximum mean VAS pain score was noted on the 5th postoperative day. From the start of this series, the operation time decreased rapidly for each surgeon, stabilising after 15 limbs.ConclusionELA of the incompetent GSV is effective and safe. ELA is simple to perform, well accepted by patients and relatively atraumatic. In our opinion, ELA can be easily implemented in surgical practice

Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital: The First 400 Procedures

Endovenous Laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our learning curve. Methods: Three hundred and twenty-three patients (403 limbs) with incompetence of the GSV underwent ELA. Patients were assessed by clinical examination and venous duplex ultrasound was performed 6 weeks after operation. Visual analog scale (VAS) pain scores of the first postoperative week were recorded. Operative time and success rate were analysed. Results: After 6 weeks, 301 (74.7%) treated legs were examined by duplex ultrasound imaging. Successful complete occlusion was present in 282 (93.7%) GSVs. Partial occlusion was present in 12 (4.0%) GSVs. In seven (2.3%) limbs the GSV was not occluded. The maximum mean VAS pain score was noted on the 5th postoperative day. From the start of this series, the operation time decreased rapidly for each surgeon, stabilising after 15 Limbs. Conclusion: ELA of the incompetent GSV is effective and safe. ELA is simple to perform, well accepted by patients and relatively atraumatic. In our opinion, ELA can be easily implemented in surgical practice. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved