Complications of sclerotherapy with sclerosing foam in lower extremity varicose veins

Using sclerotherapy with foam has caused a great change in treatment of varicose veins. Although, it is more than a century that it is being used, no exact and comprehensive knowledge of its complications has been published yet with regard to the existing facilities in Iran. In this cross-sectional study, Patients with varicose veins of lower extremity referred to cardiology clinic of Razi hospital, Rasht were included in the study after doppler sonography and in case of presence of varicose veins with more than 2 mm diameter in lower extremities without inadequacy of saphenofemoral and saphenopopliteal valve. They then underwent sclerosing with foam treatment. The total number of patients was 156 who were examined 2 weeks and 3 months after sclerotherapy in terms of complications such as pain, pigmentation, recurrence, phlebitis, deep vein thrombosis and skin necrosis. Out of 156 patients, 47 were men and 109 women whose mean +/- SD age was 46.5 +/- 12.2 years. Two weeks after sclerotherapy, pain in 95 patients [65.1%], pigmentation in 79 patients [53.4%], recurrence in 5 patients [3.4%], necrosis in 8 patients [5.5%] and no phlebitis was witnessed. Three months after sclerotherapy, pain in 10 patients [6.8%], pigmentation in 52 patients [35.1%], recurrence in 13 patients [8.8%] and phlebitis in 13 patients [8.8%] were seen; however, necrosis was not observed. Sclerotherapy with foam is an effective, safe and inexpensive method for treatment of varicose veins of lower extremities. Thus, in case of a careful selection of patients and conduction in an equipped center, few complications will be seen

Anatomical variations of the saphenofemoral junction in patients with varicose veins

Varicose veins are an extremely common medical condition [present in 5-30% of adults]. Surgery remains the gold standard of care in patients with varicose veins, however several newer interventions have been recently introduced which need to be evaluated. During the standard surgery it is imperative to demonstrate and ligate the tributaries of the saphenofemoral junction in combination with stripping of the great saphenous vein. We studied 228 patients with varicose veins who underwent surgery during two years. The number and name of tributaries at the saphenofemoral junction, presence of external pudendal artery and its relationship to the saphenofemoral junction were recorded. The number of tributaries varied from 2 to 7 at the first five centimeters of the great saphenous vein. The average number of branches was 3.87 and the most common branch was the superficial external pudendal vein. The external pudendal artery was identified during all surgical exploration. It crossed anterior to saphenofemoral junction in 39.5% and posterior in 60.5%. Anatomical variations in venous branches at the saphenofemoral junction are varied [from 2 to 7], so it is recommended to explore the location of varicose veins precisely to ensure appropriate surgical technique.

Vascular access and survival in hemodialysis patients in Rasht, Iran

Arteriovenous fistulas and grafts are two common permanent access methods for hemodialysis. Selection of an appropriate access, appropriate surgical techniques, and treatment of complications are basic principles of long-term maintenance of vascular access. We aimed to assess the survival of arteriovenous fistulas and grafts in our dialysis center. A total of 200 cases of vascular access placement in 155 patients were reviewed. Data on the type of access and the duration of a functional access were collected for survival analysis. The median duration of dialysis was 70.6 months. Among different methods of vascular access, elbows' wrinkle arteriovenous fistulas [57.0%] were the most frequently used vascular access. The longest mean survival period based on the anatomical location was seen in patients with the arteriovenous fistulas of the wrist [100.2 months]; however, there were no significant relationships between anatomical location and durability of vascular access. The mean survival of vascular access was 96.4 months in men and 104.9 months in women. The mean vascular access survival in diabetic patients was 78.8 months as compared with 101.6 months in nondiabetics. Antecubital arteriovenous fistulas were the most common forms of vascular access among our hemodialysis patients; however, arteriovenous fistulas of the wrist provided a better survival. Monitoring of the arteriovenous access and early diagnosis of its insufficiency can guarantee timely intervention and a better survival time