Ultrasound guided foam sclerotherapy like an alternative method of elimination of high veno-venous reflux for the treatment chronic venous insufficiency

An experience of treatment of 519 patients (651 Great Saphenous Veins) by ultrasound guided foam sclerotherapy on outpatient basis is discussed. All the patients had C2-C6 class of chronic venous insufficiency and GSV valves incompetence. There were 2 groups. The first one consisted of patients who had GSVs diameter 10 mm (90 GSVs). Results were assessed after 2 weeks. 6 and 12 months. The closure rate after 2 weeks was 98,8% in the first group and 97,8% in the second. There were 4 complications (0,62%): non-occlusive common femoral vein thrombosis, which resolved after 3-6 months. After 6 and 12 months the closure rate in the first group was 94.8% and 95.7% respectively, 88% and 91,7% in the second group.Представлен опыт амбулаторного лечения 519 больных (651 подвергнутая склеротерапии вена) с использованием Эхо-FOAM-склеротерапии и компрессионной склеротерапии без операций. Все пациенты имели хроническую венозную недостаточность (ХВН) нижних конечностей С2-С6 классов (СЕАР) и несостоятельность остального и стволовых клапанов большой подкожной вены (БПВ). Выделено 2 группы: первая с диаметром приустьевого отдела большой подкожной вены 10 мм и менее — 561 вена. Вторая группа— 90 несостоятельных БПВ с диаметром приустьевого отдела более 10 мм. Результаты оценены спустя 2 недели после вмешательства, а также 6 и 12 месяцев. Частота окклюзии через 2 недели в первой группе была 98,8%, во второй — 97,8%. Отмечено 4 осложнения (0,62%) — неокклюзивный пристеночный тромбоз общей бедренной вены выше сафено-феморального соустья, который не потребовал госпитализации и реканализовался спустя 3-6 месяцев. В сроки 6 и 12 мес отсутствие гемодинамически значимого рефлюкса зафиксировано в 94,8% и 95,1% вен соответственно в первой группе, и 88% и 91,7% — во второй группе

THE RUSSIAN DATA OF INTERNATIONAL ENDORSE REGISTER (EPIDEMIOLOGIC INTERNATIONAL DAY FOR THE EVALUATION OF PATIENTS AT RISK OF VENOUS THROMBOSIS IN ACUTE HOSPITAL CARE SETTING)

Aim. To estimate a risk factor frequency of venous thromboembolism (VTE) in patients urgently hospitalized in hospitals, and also to estimate of patients part having effective prevention of VTE.Material and methods. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Setting) is the international register. Patients of 40 years and older hospitalised in therapeutic departments as well as patients of 18 years and older hospitalised in surgical departments (358 hospitals in 32 countries) were included in the register. The case history analysis of all patients was performed for estimation of risk VTE and evaluation of preventive therapy quality according to American College of Chest Physicians (ACCP) Recommendation 2004.Results. Totally 68 183 patients (including 30 827 (45%) surgical patients and 37 356 (55%) therapeutic patients) were enrolled in Global ENDORSE Register. Russian centers enrolled 4 788 patients (including 2 829 (59%) surgical patients and 1 959 (41%) therapeutic patients). Totally 35 329 (51,8%) patients enrolled in Global ENDORSE Register (64,4% of surgical patients (19 842) and 41,5% of therapeutic patients (15 487)) had VTE risks. In Russia 2 188 enrolled patients (45,7%) had VTE risks (52% of surgical patients (1 470) and 36,7% of therapeutic patients (718). Totally 17 732 (50,2%) patients enrolled in Global Register ENDORSE and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. In Russia 521 (23,8%) patients enrolled in Global ENDORSE Register and having VTE risks received VTE preventive therapy according to АССР Recommendations 2004. It is more than 2 times less in comparison with world level (р<0.001).Conclusion. There are a lot of patients with VTE risks in hospitals. It is necessary to improve preventive therapy of VTE due to better hospital management and more active use of АССР Recommendations 2004

Comparison of fondaparinux with low molecular weight heparin for venous thromboembolism prevention in patients requiring rigid or semi-rigid immobilization for isolated non-surgical below-knee injury

Background: In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. Objectives: To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 mL min-1) over nadroparin 2850 anti-factor Xa IU. Patients and Methods: In this international, multicenter, randomized, open-label study, patients with an isolated non-surgical unilateral below-knee injury having at least one additional major risk factor for VTE and requiring, in the Investigator's opinion, rigid or semi-rigid immobilization for 21-45 days with thromboprophylaxis up to complete mobilization received subcutaneously once-daily either fondaparinux or nadroparin. The primary efficacy outcome was the composite of VTE (symptomatic or ultrasonographically detected asymptomatic deep vein thrombosis of the lower limb or symptomatic pulmonary embolism) and death up to complete mobilization. The main safety outcome was major bleeding. Results: We randomized 1349 patients (mean age 46 years): 88.7% had a bone fracture, and 83.8% had a plaster cast fitted (mean duration of immobilization, 34 days). The primary efficacy outcome occurred in 15 of 584 patients (2.6%) in the fondaparinux group and 48 of 586 patients (8.2%) in the nadroparin group (odds ratio, 0.30; 95% confidence interval [CI], 0.15-0.54; P < 0.001). A single major bleed was experienced by fondaparinux-treated patients and none by nadroparin-treated patients. These results were maintained up to the end of follow-up. Conclusions: Fondaparinux 2.5 mg day-1 may be a valuable therapeutic option over nadroparin 2850 anti-FXa IU day-1 for preventing VTE after below-knee injury requiring prolonged immobilization in patients with additional risk factors