The place of heparins in the treatment of venous thromboembolism

Venous thromboembolism, in the form of lower limb deep vein thrombosis and its most dangerous complicationthat is a pulmonary embolism, is a common disease with an increasing incidence associated with the ageingpopulation. The scheme of VTE treatment underwent changes when a new drug group — directly and selectivelyacting oral anticoagulants — was introduced. However, the scope of VTE therapy with parenterally administeredlow-molecular-weight heparins was wide, i.e., they produced vast progress in the disease’s treatment in the 1980s

The role of VEGF in psoriasis: an update

Psoriasis is a common, chronic immune-mediated multifactorial skin disease. In its pathogenesis altered differentiationand hyperproliferation of keratinocytes, dysregulation of immunological cell functions, together withabnormal angiogenesis are involved. Angiogenesis is defined as the formation of new blood vessels from thepre-existing vascular bed. This complex and multistep process is regulated by different factors among whichvascular endothelial growth factor (VEGF) is considered to be the most important. The aim of this paper isa review of the current literature considering the role of vascular endothelial growth factor in psoriasis. Manystudies have focused on the role of VEGF in psoriasis and revealed its increased serum and tissue levels whichcorrelated with disease severity. Recent data indicate that VEGF is not only responsible for angiogenesis, butalso regulates keratinocyte differentiation. Moreover, it has been suggested that vascular endothelial growthfactor could be a link between psoriasis and its comorbidities. So far, there are single clinical cases that reportedclearance of psoriasis after anti-VEGF therapy. Therefore, the VEGF pathway might be a potential new therapeuticalternative leading to improvement of psoriasis. However, further clinical studies are needed to evaluatethe efficacy and safety of this therapy in psoriasis

The novel minimally invasive mechano-chemical technique of the saphenous vein ablation. Our center experience: results of 24 months follow-up

Introduction: The aim of the study was to evaluate the efficacy of the endovascular ablation method of GSV//SSV superficial venous insufficiency using Flebogrif® catheter, the safety of the method, expressed in numberand quality of observed complications in 24-month observation. Material and methods: Initially, the observed group included 200 patients undergoing ablation of insufficientGSV/SSV. During 24 months of observation, this number decreased to 158, which seems to be a natural process.All patients signed the informed consent form approved by the Bioethics Committee of the Medical Universityof Lublin. Based on clinical evaluation, including ultrasound assessment, 200 patients, including 170 womenand 30 men, were admitted to the study using the adopted criteria of inclusion/exclusion. In the studied groupof patients, 172 great saphenous veins (GSV) and 28 short saphenous veins (SSV) were ablated. The treatedinefficient veins were punctured at three levels depending on the length of the segment of insufficient GSV/SSV.Each patient was treated with a compression agent in the form of a second compression class elastic stockings(20–30 mm Hg). Control visits on the basis of the accepted protocol were established in 1, 3, 6, 12, 24, 36months after the procedure. Results: During 24 months of observation, the evaluation of the Flebogrif® catheter method was based on theanalysis of results obtained in four categories: effectiveness of the method, expressed as the ratio of the numberof successfully closed veins ablated with the Flebogrif® catheter to the number of observed cases of recanalization;clinical improvement of venous insufficiency symptoms, based on the VCSS, CEAP, VAPS scale; safety ofthe method, expressed in terms of quantity and quality of observed complications; technical characteristicsof the method. The obtained results were analyzed statistically using tests for non-parametric variables. Theeffectiveness of the method based on the obtained results was 92%. A statistically significant decrease in theintensity of clinical symptoms in relation to the preoperative condition was observed. The number and quality ofthe observed complications allow considering the procedure of vein ablation with the use of Flebogrif® catheteras safe, possible to perform in ambulatory conditions. Conclusions: Effectiveness of the method of 92% in 24-month observation; good cosmetic effect; a statisticallysignificant decrease in the intensity of clinical symptoms in 24-month observation; the low incidence ofcomplications allows to consider the method safe; the method of surgery allows to perform the procedure inambulatory conditions

Respiratory endurance training by means of a Spirotiger in extending intermittent claudication distance — a case study

According to Fontaine’s classification, intermittent claudication is a symptom of the 2nd stage of peripheralarterial occlusive disease. Intermittent claudication is described as muscle pain that occurs during walking. Patientsexperiencing it observe major reduction of exercise tolerance. Rehabilitation of patients with peripheral arterialocclusive disease uses many different training programs which lead to extension of intermittent claudicationdistance. Respiratory training is one of them and it is the training of the respiratory muscles that improves theirendurance, force, speed, coordination, and elasticity. Respiration therapy causes delayed metaboreflex, whichin turn the blood flow in lower limbs increases..We present a case of a patient who underwent percutaneous balloon angioplasty of iliac artery and then conductedrespiratory training by means of Spirotiger what resulted in further increase of claudication distance

Do anatomical aspects of great saphenous vein insufficiency determine the course of its operational treatment?

Background. Great saphenous vein insufficiency is the most common type of chronic vein insufficiency, and the most common treatment option is crossectomy with short stripping of the great saphenous vein (GSV) trunk. In our work, we confront this option with the anatomical range of GSV insufficiency revealed in preoperative duplex examination. Material and methods. In the presented publication, we analyze the anatomical range of great saphenous vein insufficiency in 157 patients (158 limbs) admitted to our ward for surgical treatment of the condition between 01.01.2005 and 10.01.2006. Results. We obtained the following rates of anatomical variants of GSV insufficiency: 1. isolated saphenofemoral junction (SFJ) insufficiency - 1%; 2. insufficiency in SFJ and thigh segment of GSV - 61%; 3. insufficiency in SFJ and thigh segment of GSV, isolated second insufficient crural segment - 9%; 4. insufficiency in SFJ and proximal thigh segment - 15%; 5. sufficient SFJ, insufficient proximal thigh segment - 5%; 6. sufficient SFJ, insufficient whole thigh segment - 8%; 7. sufficient SFJ, insufficient distal thigh segment - 1%. Conclusions. Our results confirm that short stripping of GSV is the treatment of choice in the majority of patients. On the other hand, we document a high rate of other anatomical variants of the condition. Using one routine procedure in all cases may consequently be an inadequate treatment. It also occurs that in 30% of cases, proper introduction of a stripper may be difficult.Wstęp. Najczęstszą postacią przewlekłej choroby żylnej kończyn dolnych jest niewydolność w układzie żyły odpiszczelowej, a najczęstszą opcję leczenia operacyjnego stanowi krosektomia z krótkim strippingiem jej pnia. W niniejszej pracy skonfrontowano to postępowanie z anatomicznym zakresem niewydolności żyły odpiszczelowej ustalonym w przedoperacyjnym badaniu ultrasonograficznym. Materiał i metody. W pracy przeanalizowano ustaloną w przedoperacyjnym badaniu ultrasonograficznym niewydolność pnia żyły odpiszczelowej w odniesieniu do jej anatomicznych odcinków u 157 pacjentów (158 kończyn), przyjętych na oddział autorów pracy w celu leczenia operacyjnego, w okresie 01.01.2005-10.01.2006. Wyniki. Odnotowano następujące wartości procentowe częstości występowania poszczególnych typów anatomicznych zakresu niewydolności w układzie żyły odpiszczelowej: 1 - izolowana niewydolność ujścia odpiszczelowo- udowego (SFJ) - 1%; 2 - niewydolność SFJ i pnia w całym odcinku udowym - 61%; 3 - niewydolność SFJ i pnia w odcinku udowym, izolowany drugi niewydolny odcinek na podudziu - 9%; 4 - niewydolność SFJ i pnia w proksymalnym odcinku udowym - 15%; 5 - ujście odpiszczelowo-udowego wydolne, niewydolność proksymalnego odcinka udowego - 5%; 6 - SFJ wydolne, niewydolność całego odcinka udowego - 8%; 7 - SFJ wydolne, niewydolność dystalnego odcinka udowego - 1%. Wnioski. Uzyskane wyniki z jednej strony potwierdzają zasadność wykonywania krótkiego strippingu żyły odpiszczelowej jako optymalnego rozwiązania u większości pacjentów, z drugiej dokumentują częste występowanie niewydolności wieloodcinkowej oraz innych wariantów anatomicznych schorzenia. Potwierdza się stanowisko, że stosowanie jednej, rutynowej procedury (krosektomia i krótki stripping) we wszystkich przypadkach choroby żylnej może być leczeniem nieadekwatnym do schorzenia. Z analizy powyższych danych wynika również, że w około 30% przypadków mogą wyniknąć trudności z takim wprowadzeniem strippera do pnia żyły odpiszczelowej, aby usunięty został właściwy jej odcinek

Role of 18F-FDG PET/CT in the diagnosis of inflammatory and infectious vascular disease

This review article discusses the utility of 18F-FDG PET/CT in diagnosis and management of vascular disease. We stress usefulness of this method in large vessel inflammation and infection. In our work we based on the literature analysis and clinical cases diagnosed in our institution by use of 18F-FDG PET/CT. The literature exploration was focusing on vascular inflammation and infections and 18-FDG PET. The search was performed on PubMed database and cross referencing. We present the practical review with several images of vascular diseases like: Takayasu arteritis, giant cell arteritis, vascular graft infections, abdominal aortic aneurysm infections and cases of aortitis and periaortitis. From this work inflammation associated with atheromatic process and vulnerable atherosclerotic plaque we excluded. 18F-FGD PET/CT is a sensitive metabolic, reliable, non-invasive imaging modality suitable for diagnosis and follow-up of inflammation and infections in vascular system. This review article discusses the utility of 18F-FDG PET/CT in diagnosis and management of vascular disease. We stress usefulness of this method in large vessel inflammation and infection. In our work we based on the literature analysis and clinical cases diagnosed in our institution by use of 18F-FDG PET/CT. The literature exploration was focusing on vascular inflammation and infections and 18-FDG PET. The search was performed on PubMed database and cross referencing. We present the practical review with several images of vascular diseases like: Takayasu arteritis, giant cell arteritis, vascular graft infections, abdominal aortic aneurysm infections and cases of aortitis and periaortitis. From this work inflammation associated with atheromatic process and vulnerable atherosclerotic plaque we excluded. 18F-FGD PET/CT is a sensitive metabolic, reliable, non-invasive imaging modality suitable for diagnosis and follow-up of inflammation and infections in vascular system

Results of endovascular treatment of iliac and femoral symptomatic lesions. Identification of re-intervention risk factors

Introduction. The aim of the study was to assess a presence of peripheral arterial disease risk factors in patients with symptomatic femoral and iliac lesions treated with use of Jaguar and Supera nitinol stents and to estimate potential relation between these factors and reintervention rate. Material and methods. The study group consisted of 60 patients between 46 and 85 years of age who presented with typical symptoms of intermittent claudication or critical limb ischemia and underwent percuta­neous transluminal angioplasty with stenting. We examined and divided group into two subgroups — patients who experienced or did not experience need of reintervention in treated lesion. Results. During the follow-up 24 (40%) of patients underwent reintervention in treated artery due to re­current symptoms of disease. Need of target lesion revascularization occurred more frequent in patients with hypertension (OR = 2.5), patient older than 68 (OR = 1.75) and smokers (OR = 1.75). Patency of all three arteries below knee protected from reintervention. Conclusions. Jaguar and Supera self-expanding nitinol stents has several advantages and its use were char­acterized by high procedural success and moderate frequency of reintervention correlated to some clinical findings like hypertension. Further studies are necessary to estimate factors disturbing and interfering with long-term patency.Introduction. The aim of the study was to assess a presence of peripheral arterial disease risk factors in patients with symptomatic femoral and iliac lesions treated with use of Jaguar and Supera nitinol stents and to estimate potential relation between these factors or some angiographical conditions and reintervention rate. Material and methods. The study group consisted of 60 patients between 46 and 85 years of age who presented with typical symptoms of intermittent claudication or critical limb ischemia and underwent percutaneous transluminal angioplasty with stenting using Supera or Jaguar self-expanding nitinol stent. We examined and divided group into two subgroups – patients who experienced or didn’t experience need of reintervention in treated lesion.Results. In 33 patients (55%) nitinol stent Jaguar and in 27 patients (45%) Supera were implanted. During the follow-up 24 of patients (40%) underwent reintervention in treated artery due to recurrent symptoms of disease. Need of target lesion revascularization occurred more frequent in patients with hypertension (OR=2,5), patient older than 68 (OR=1,75) and smokers (OR=1,75). Patency of all three arteries below knee protected from reintervention. Diabetes mellitus type 2, chronic kidney disease, kind or size of implanted stent and antiplatelet therapy model didn’t determine a need of reintervention. Conclusions. Jaguar and Supera self-expanding nitinol stents has several andvantages and its use were characterized by high procedural success and moderate frequency of reintervention correlated to some clinical findings like hypertension. Further studies are necessary to estimate factors disturbing and interfering with long-term patency