Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins

BACKGROUND. Patients with varicose veins seek medical assistance for many reasons, including esthetic ones. The development of suitable and more flexible instruments, along with less invasive techniques, enables the establishment of new therapeutic procedures. OBJECTIVE. To compare endovenous great saphenous vein photocoagulation with an 810 nm diode laser and the conventional stripping operation in the same patient. METHODS. Twenty patients selected for operative treatment of primary great saphenous vein insufficiency on duplex scanning were assigned to a bilateral random comparison. In all cases, both techniques were performed, one on each lower limb. Clinically, evaluation was assessed on the seventh, thirtieth, and sixtieth postoperative days. Patients underwent examination with duplex ultrasonography and air plethysmography during the follow-up. RESULTS. Patients who received endovenous photocoagulation presented with the same pain but fewer swellings and less bruising than the stripping side. Most patients indicated that the limb operated on by laser received more benefits than the other. There was only one recanalization and no adverse effects. The venous filling time showed better hemodynamics in both techniques. CONCLUSION. The endovenous great saphenous vein photocoagulation is safe and well tolerated and presents results comparable to those of conventional stripping.31121685169

Superior mesenteric artery syndrome: An uncommon complication of abdominal aortic aneurysm repair

The superior mesenteric artery syndrome (SMAS) is an uncommon finding, especially when occurring after open abdominal aortic aneurysm (AAA) repair. Very few cases have been previously reported in the literature. The underlying anatomic mechanism as well as a better way to manage this complication remains controversial. We report a case of well-documented duodenum obstruction occurring after an elective, uneventful open AAA repair in an 83-year-old white male. The patient was initially discharged from hospital on the fifth postoperative (PO) day but was readmitted on the seventh PO day with suspicion of intestinal obstruction caused either by adhesions or extrinsic pressure by a retroperitoneal hematoma. A laparotomy carried out on the 10th PO day was unremarkable and the patient continued vomiting until a left lateral decubitus positioning was assumed. The patient was discharged home on the 19th PO day and has remained well since.18225025

Relationship between the diameter of great saphenous vein and body mass index Relação entre o diâmetro da veia safena magna e o índice de massa corporal

OBJECTIVE: This study has been designed to correlate the diameter of the greater saphenous vein in different levels of the lower limbs with the body mass index of each individual to determine a possible relation between them. METHODS: Fifty-two lower limbs in 26 volunteers (six males and 20 females) without a chronic venous disease record, aged 21-68 were evaluated. Prior to color-flow duplex scanning the body mass index was defined. The deep and superficial venous systems and perforator veins were assessed as described in the literature. The diameter of the greater saphenous vein was measured with ultrasound longitudinal imaging in seven different levels. For the statistical analysis, Student t test for paired data and Spearman test were used. RESULTS: The difference observed in saphenous venous in the second and third levels when compared to the lower right and left limbs was not considered significant and a single group was formed to correlate with body mass index. The correlation was considered statistically irrelevant. CONCLUSION: By correlating the diameters of the greater saphenous vein with the body mass index of each individual it was noted that the relation between them is not significant, therefore it can be assumed that tall thin individuals can have greater saphenous vein with similar diameter as short fat individuals.<br>OBJETIVO: Este estudo teve o objetivo de comparar o diâmetro da veia safena magna em diferentes níveis dos membros inferiores e o índice de massa corporal dos sujeitos para determinar uma possível relação entre esses fatores. MÉTODOS: Cinqüenta e dois membros inferiores de 26 voluntários (seis homens e 20 mulheres) sem registro de doença venosa crônica, com idades entre 21 e 68 anos, foram avaliados. O índice de massa corporal foi definido antes do eco-Doppler colorido. Os sistemas venosos superficial e profundo e as veias perfurantes foram avaliados de acordo com a literatura. O diâmetro da veia safena magna foi medido através de imagem ultra-sonográfica longitudinal em sete níveis diferentes. Para a análise estatística, foram utilizados o teste t de Student para dados pareados e o teste de Spearman. RESULTADOS: A diferença observada na veia safena no segundo e terceiro níveis, quando comparada aos membros inferiores direito e esquerdo, não foi considerada significativa, e somente um grupo foi formado para a comparação com o índice de massa corporal. A correlação foi considerada estatisticamente irrelevante. CONCLUSÃO: Através da comparação dos diâmetros da veia safena magna com o índice de massa corporal dos sujeitos, percebeu-se que a relação entre esses dois fatores não é significativa e, portanto, pode-se concluir que indivíduos altos e magros podem ter veias safenas magnas com diâmetros similares aos de indivíduos baixos e gordos

Endolaser venoso: estudo série de casos Venous endolaser: a case series report

OBJETIVOS: Relatar nossa experiência de 14 meses, comparando o uso do laser 980 nm com fibra axial com o laser 1.470 nm com fibra radial. MÉTODOS: Foram revisados prontuários de 215 pacientes e comparados resultados de utilização do laser diodo 980 nm com fibra axial e laser diodo 1.470 nm com fibra radial, com e sem infiltração intumescente, respectivamente , analisando porcentagem de oclusão das safenas e complicações. RESULTADOS: Foram tratadas 294 pernas de 215 pacientes. Desse total, 141 casos (65,6%) (192 membros) foram submetidos ao tratamento com laser 980, e 74 casos (34,4%) (102 membros), com o 1.470. Houve ablação completa, com fechamento de 100% em 138 (97,9%) casos para o laser 980 e em 73 (98,6%) casos para o 1.470 (p = 0,999). Houve persistência de dor pós-operatória, necessitando analgésicos num período superior a 7 dias, em 4,3% dos pacientes (seis casos) tratados com o laser 980 e em 5,4% (quatro casos) tratados com 1.470 (p = 0,740). Não houve nenhum caso de hipercromia, trombose venosa profunda ou tromboembolismo pulmonar. Parestesias no trajeto da safena ocorreram em 2,17% dos pacientes tratados com o laser 980 e em 4% dos tratados com o 1.470. CONCLUSÃO: Nossa experiência inicial mostra uma boa efetividade quanto ao fechamento das safenas com laser, poucas complicações pós-operatórias, sendo encontrados resultados semelhantes com ambos os tipos de laser.<br>OBJECTIVE: To report our 14-month experience comparing the use of 980 nm laser with axial fiber with 1,470 nm laser with radial fiber. METHODS: Charts from 215 patients were reviewed in order to compare the results of the use of 980 nm diode laser with axial fiber and 1,470 nm diode laser with radial fiber, with and without intumescent infiltration respectively, analyzing the percentage of saphenous vein occlusion and complications. RESULTS: A total of 294 legs of 215 patients were treated. Among them, 141 cases (65.6%) (192 limbs) underwent treatment with 980 laser, and 74 (34.4%) (102 limbs) with 1,470 laser. There was complete ablation, with 100% closing, in 138 (97.9%) cases for 980 laser and 73 (98.6%) cases for 1,470 laser (p = 0.999). Persistent postoperative pain requiring analgesics for more than 7 days was reported in 4.3% of patients (six cases) treated with laser 980 and in 5.4% (four cases) treated with 1,470 laser (p = 0.740). There were no cases of hyperchromia, deep venous thrombosis or pulmonary thromboembolism. Paresthesias in the pathway of the saphenous vein occurred in 2.17% of the patients treated with 980 laser and in 4% of those treated with 1,470 laser. CONCLUSION: Our initial experience shows good effectiveness in closing saphenous veins with laser and few postoperative complications, with similar results for both types of laser