Radiofrequency ablation for treatment of varicose veins of lower limbs

Catedra chirurgie 1, Universitatea Naţională de Medicină „N.Pirogov”, Vinniţa, Ucraina, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Venele varicoase ale extremităţilor inferioare sunt frecvent întîlnite în populaţia ţărilor occidentale industrial dezvoltate afectînd 10-15% de bărbaţi şi 20-25% de femei. Această prevalenţă înaltă este responsabilă pentru costuri sociale şi medicale majore. Scopul studiului a fost evaluarea rezultatului clinic al tratamentului chirurgical prin ablaţie cu radiofrecvenţă (RFA) la bolnavii cu varice ale membrelor inferioare. Material şi metode: O sută patruzeci şi doi de bolnavi cu vene varicoase au fost supuşi RFA al segmentului proximal de venă safenă magna cu ajutorul dispozitivului “VNUS Closure”™. Diametrul venei a variat între 5 şi 20 mm. Cateterul pentru RFA a fost introdus prin puncţie percutană sau o incizie cutanată minimă. Toate intervenţiile au fost realizate sub anestezia locală infiltrativă cu ghidaj ultrasonor. Au fost studiate schimbările morfologice la nivelul peretelui venei safene magna supuse tratamentului prin RFA.Rezultate: Profunzimea necrozei a fost determinată la nivelul stratului endotelial şi subendotelial cu detaşarea caracteristică a acestora, cu colabarea şi îngustarea lumenului vascular. Specificul particular reprezintă lipsa fenomenului de neoangiogeneză la nivelul joncţiunii safenofemurale şi safenopopliteale. Aşa complicaţii ca parestezii sau echimoze au fost observate doar în 5 cazuri. Merită de subliniat absenţa sindromului dolor semnificativ în grupul pacienţilor studiaţi. Toţi bolnavii au fost externaţi peste 2 ore după intervenţie. Concluzii: Metoda are următoarele avantaje: durata scurtă a incapacităţii de muncă, utilizarea anesteziei locale, rezultatul estetic bun, durata redusă a intervenţiei, rezultatele precoce şi la distanţă favorabile, posibilitatea de obliterare a venelor cu diametrul mare şi lipsa necesităţii în analgezie postoperatorie.Introduction: Varicose veins of the lower limbs are a common condition affecting 10-15% of men and 20-25% of women in the developed countries of western world. This high prevalence is responsible for high medical and social costs. The aim was to study the clinical results of surgical treatment of patients with varicose veins of lower limbs using radiofrequency ablation (RFA). Material and methods: One hundred forty two patients with varicose veins underwent RFA of the above knee great saphenous vein by “VNUS Closure”™ procedure. The vein diameters were from 5 to 20 mm. The RF catheter was inserted via percutaneous puncture or through a small skin incision. All operations were performed under local, tumescent anesthesia, with ultrasound guidance. We studied morphological changes of the wall of great saphenous vein in patients who underwent treatment with RFA. Results: The depth of necrosis was within endothelial and subendothelial layer, but detachment of endothelial and subendothelial layers was characteristic with collapse and narrowing of vessel lumen. The special feature was lack of neoangiogenesis at the level of saphenofemoral and safenopopliteal junction. Such complications as paresthesia or ecchymosis were observed only in 5 cases. It should be noted that the studied patients had no significant pain syndrome. All patients were discharged 2 h after operation. Conclusions: Advantages of the method are shorter sick leave, using of local tumescent anesthesia, good cosmetic result, shorter duration of surgery, good immediate and late results, possibility to close the veins with a large diameter and no use of postoperative analgesics

Experience of VenaSeal system using in treatment of chronic venous insufficiency

Highly Specialized Clinical Center for Cardiovascular and X-ray Vascular Surgery with an Intensive Care Unit, Vinnytsya Regional Clinical Hospital Named After M.I. Pirogov, Department of Endoscopic and Cardiovascular Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroduction: The VenaSeal device is a disposable, single use system for administering cyanoacrylate adhesive into an incompetent truncal vein which can be used without tumescent anesthesia and without application of heat. The aim of the study was to evaluate our experience of VenaSeal system using. Methods: Our experience included 9 patients (16 lower limbs) with chronic venous insufficiency C2-C4 (CEAP). 2 patients received monoprocedures of VenaSeal, 2 patients – VenaSeal + miniflebectomy, 4 patients – VenaSeal + foam sclerotherapy, 1 patient – RFA of great saphenous vein + VenaSeal closure of perforator vein. Results: The average diameter of the treated vein area in patients of our study was 9.5±2.0 mm. Cyanoacrylate embolization was associated with low pain scores. Moreover, presumably because it does not require tumescent anesthesia, treatment resulted by the absence of ecchymosis. Our patients had no postoperative burns and pigmentation at all. Also, there was no even mild paresthesia in any patient. According to ultrasonography great saphenous veins were closed in all patients both on day 3 and on day 30. The severity and impact of venous disease on quality of life were measured with several end points in our study. Subjects treated with VenaSeal system showed significantly improving of quality of life over time. Conclusions: Using of VenaSeal is a fast and effective method of eliminating the incompetence of the saphenous veins, without the need for tumescent anesthesia, wearing compression knitwear, not accompanied by paresthesias, postoperative burns and pigmentation

A Panchromatic Cyclometalated Iridium Dye Based on 2-Thienyl-Perimidine

Though 2-arylperimidines have never been used in iridium(III) chemistry, the present study on structural, electronic and optical properties of N-unsubstituted and N-methylated 2-(2-thienyl)perimidines, supported by DFT/TDDFT calculations, has shown that these ligands are promising candidates for construction of light-harvesting iridium(III) complexes. In contrast to N-H perimidine, the N-methylated ligand gave the expected cyclometalated μ-chloro-bridged iridium(III) dimer which was readily converted to a cationic heteroleptic complex with 4,4′-dicarboxy-2,2′-bipyridine. The resulting iridium(III) dye exhibited panchromatic absorption up to 1000 nm and was tested in a dye-sensitized solar cell

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.)