A French-Italian survey on the prevalence of isolated varices (C2) and complicated varices (C2+). Results of a multi-centre study conducted by the SFA and the SFP under the auspices of the European Venous Forum.

AIM: The advanced CEAP classification allows one to differentiate between isolated varicose veins (C2) and complicated varicose veins (C2, 3 - C2, 3, 4 - C2, 4 or C2, 3, 4, 5 etc) named (C2+). METHODS: The main objective of this study was to identify when using the advanced classification the prevalence of isolated varicose veins (C2) and complicated varicose veins (C2+) among patients consulting vascular specialists and to compare their symptomatic status and the data issued from the advanced CEAP including also the headings, Anatomy (A), Etiology (E) and Pathophysiology (P). RESULTS: 171 patients were evaluated, 100 in France and 71 in Italy. The prevalence of C2 and C2+ was the same in both countries: 64.4% in France and 63.3% in Italy. Also no difference was found in the prevalence of other descriptors: etiology, anatomy or pathophysiology. The time to complete the advanced form was less than 5 minutes for 65% of the investigators. CONCLUSION: The advanced CEAP is easy to use in daily pratice. We have the same prevalence of patients in France and in Italy, who consulted for isolated varicose veins or associated with other signs of chronic venous disorders.

Ruptured pancreaticoduodenal artery aneurysm. A case report and review of the literature.

Pancreaticoduodenal artery aneurysms (PDAA) are very rare (2% of the visceral aneurysms) but characterized by a high mortality rate if ruptured. Here a case of ruptured PDAA with an atypical clinical presentation that simulated an acute hepatobiliar syndrome is reported. A 60-year-old female presented with epigastric pain, nausea, gastric vomiting, elevated levels of hepatic enzymes, normal hemoglobin and cholelithiasis on echography. With persistent pain and progressively decreasing hemoglobin, an urgent contrast computed tomography was performed and revealed a large retroperitoneal hematoma that appeared to come from a branch of the superior mesenteric artery (SMA). A selective SMA-angiography showed a small aneurysm of the antero-superior pancreaticoduodenal artery with signs of hemorrhage. The patient underwent surgical ligature of the PDAA, after superselective transcatheter arterial embolization appeared technically impossible. The postoperative period was characterized by a progressive normalization of the hepatic values and hemoglobin and a post-operative angiogram confirmed the total exclusion of the PDAA and the integrity of the posterior pancreaticoduodenal arch. The pre-operative diagnosis of PDAA is usually very difficult. Symptoms can be vague or misleading, as in our case. Angiography is the most accurate diagnostic tool to locate a ruptured PDAA. Moreover, it can be immediately used for urgent endovascular treatment. Post-operative angiography is essential to confirm the total exclusion of the PDAA and demonstrate visceral circulation.