Endovenous laser ablation vs phlebectomy of foot varicose veins.

OBJECTIVE: The aim of this study was to compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins. METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed, and the outcomes were compared. Patients were classified according to the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the Venous Clinical Severity Score (VCSS), and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using the χ2, Student t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (standard deviation or median (interquartile range). RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (standard deviation, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (interquartile range, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (P = .507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (P = .001). The two approaches had an equal impact on quality of life and disease severity. CONCLUSIONS: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.

A comparison of tablet-based and paper-based venous insufficiency epidemiologic and economic study quality of life/symptom questionnaire for assessment of chronic venous disease.

OBJECTIVE: To comparatively evaluate performances of tablet-based versus paper-based Venous Insufficiency Epidemiologic and Economic Study-Quality of Life/Symptom (VEINES-QOL/Sym) questionnaire. METHODS: We prospectively evaluated 78 consecutive patients who completed tablet-based and paper-based VEINES-QOL/Sym questionnaires and compared their scores, completion time, data entry time, and ease of use. We used Student's t-test and Wilcoxon test for quantitative variables, Bland-Altman test and kappa coefficient for agreement between questionnaires and patients, respectively. Spearman's correlation coefficient was used to assess correlations. RESULTS: Most participants (83.3%) found it easier to use the tablet device. Less time was needed to complete the tablet-based (median, 4.75; IQR, 3-7 min) than the paper-based (median, 8.3; IQR, 6.3-11.3 min) questionnaire (p < .001). Better educated patients took less time to complete paper-based (p = .003) and tablet-based (p = .001) questionnaires and considered the latter easier to use (p = .010). CONCLUSIONS: The tablet-based VEINES-QOL/Sym proved to be an easy-to-use and time-saving tool.

Treatment of foot varicose veins: A study of 119 consecutive patients.

Objective To analyze the outcomes of 119 (188 feet) patients undergoing foot varicose vein phlebectomy with and without sclerotherapy between 2013 and 2015. Methods Legs and feet were treated in one single procedure. Clinical and ultrasound assessments were carried out at 7, 30, and 90 days for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep vein system. Results Mean age was 50 ± 12 years (25-79 years); 67 patients were female (56.3%). Median venous clinical severity score was 4 (range 2-5) before and 1 (range 0-2) at 90 days ( p < 0.001). Edema and transient paresthesia were the most frequent complications (13 (10.92%) and 11 (9.24%) patients, respectively). All complications were resolved at 90 days except one case of edema (resolved after 150 days with compression stockings and lymphatic drainage manual therapy). Conclusions Symptomatic foot varicose vein intervention was safe and effective. Further studies should focus on assessment of vein-specific quality of life questionnaires.

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.

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.

Doença cística da artéria poplítea: relato de caso / Cystic disease of the popliteal artery: a case report

Apesar de sua raridade, a doença cística da artéria poplítea (DCAP) deve ser lembrada no diagnóstico diferencial de claudicação intermitente de membros inferiores em pacientes jovens. A literatura brasileira apresenta poucos relatos dessa doença. Este trabalho reportou o caso de um paciente masculino portador de DCAP e revisou a literatura, traçando um paralelo com a síndrome de aprisionamento da artéria poplítea.

Although its rarity, the adventitial cystic disease of the popliteal artery (ACDPA) must be remembered in the differential diagnosis of intermittent claudication in young patient's lower limbs. Brazilian literature presents a few cases of this disease. This study is a case report of ACDPA in a male patient, with a literature review, comparing to popliteal artery entrapment syndrome.

Lesöes traumáticas de fígado / Traumatic injuries of liver

O fígado é o órgäo mais comumente lesado nos pacientes com traumatismo abdominal. Realizamos um estudo retrospectivo no serviço de cirurgia do Hospital Nossa Senhora da Conceiçäo com o objetivo de definir condutas para lesöes traumáticas de fígado