Progression of reflux patterns in saphenous veins of women with chronic venous valvular insufficiency.

BACKGROUND: Venous ultrasonography identifies reflux patterns of the great and small saphenous veins (GSV, SSV), allowing evaluation of lower extremities for treatment planning and patient follow-up. OBJECTIVE: To determine progression of saphenous vein reflux patterns in women with primary venous valvular insufficiency. METHODS: Venous ultrasonography was performed in the extremities of 92 women, 43 ± 12 (23-77) years old, CEAP (clinical, aetiological, anatomical and pathological elements) clinical classes C1-C2. Two examinations were performed 33 ± 19 (8-89) months apart in patients without saphenous vein treatment. GSV and SSV reflux patterns were classified as segmental, multisegmental, distal, proximal, diffuse and normal. Prevalence was determined for each examination, separately for right and left extremities, and jointly. Prevalence was compared using χ2 statistics. RESULTS: Reflux prevalence was higher for the GSV, 89% (164/184) and 88% (n = 162), than for the SSV, 24% (n = 45) and 30% (n = 56), respectively for first and second examinations (P < 0.001). Reflux pattern prevalence was not significantly different in the right and left extremities (1.0 > P > 0.14). Most prevalent patterns were (a) GSV segmental reflux initially, 41% (76/184), decreasing to 28% (52/184) (P = 0.009), and (b) GSV multisegmental reflux at the second examination, increasing from 26% (48/184) to 40% (73/184) (P = 0.006). Prevalence of other GSV or SSV reflux patterns did not change significantly (0.88 > P > 0.19). CONCLUSIONS: We documented early findings and venous reflux progression in a specific population of women with varicose veins, reticular veins and telangiectasias. GSV segmental reflux was most prevalent initially, progressing to GSV multisegmental reflux.

Assessment of venous thrombus time of progression by gray-scale median analysis.

AIM: To determine if gray-scale median (GSM) analysis could differentiate acute and recent deep venous thrombosis (DVT). METHODS: Patients submitted to vascular ultrasound examination of lower extremities due to suspected DVT were evaluated. Patients with acute or recent femoropopliteal DVT were included, whereas those without DVT, with chronic or isolated calf DVT were excluded. Time of onset of DVT symptoms was recorded. A transverse image of the thrombosed vein and adjacent artery was obtained. Two sonographers determined a subjective impression of thrombus time of progression and classified it as acute or recent. Thrombus GSM was calculated with a software. ROC curve was used to determine GSM cut-off points. Fischer's exact and Student´s t tests were also used. P<0.05 indicated statistical significance. RESULTS: 128 veins of 63 extremities were studied. Thrombus GSM correlated with time of onset of DVT symptoms (P=0.005) and with subjective evaluation of thrombus time of progression (P<0.001). When DVT symptoms had begun up to two weeks before and thrombus was classified as acute, GSM was lower. Area under ROC curve for thrombus GSM was 0.76 (P<0.001). GSM 17.90, 23.03, and 40.02 cut-off points differentiated between acute and recent thrombi with 35.59% sensitivity and 91.30% specificity, 59.32% sensitivity and 84.06% specificity, 91.53% sensitivity and 31.88% specificity, respectively. CONCLUSION: GSM was a reliable tool for objectively differentiating acute and recent DVT in most thrombus images. GSM 17.90 and 40.02 cut-off points showed high specificity and high sensitivity, respectively, for acute and recent DVT differentiation. In 17.90 to 40.02 interval, GSM cut-off point that best distinguished acute from recent DVT was 23.03.

Does the number of pregnancies affect patterns of great saphenous vein reflux in women with varicose veins?

OBJECTIVES: Impact of pregnancies on great saphenous vein (GSV) reflux patterns deserves clarification. Which GSV segment is most affected? Is the saphenofemoral junction (SFJ) involved? METHODS: Colour-flow duplex ultrasonography was performed in 583 women extremities with primary varicose veins (clinical, aetiological, anatomical and pathological elements [CEAP C2]), without oedema, skin changes or ulcer. Women with previous thrombosis or varicose surgery were excluded. GSV reflux sources and drainage points were located at SFJ, thigh, knee and calf. Prevalence of most proximal reflux source was noted as a function of 0, 1, 2, 3 and 4 or more pregnancies. chi(2) statistics was employed. RESULTS: Prevalence of GSV reflux was not dependent on 0, 1, 2, 3 or >or=4 pregnancies: 75%, 69%, 79%, 70% and 76% for right leg (P = 0.79) and 78%, 81%, 82%, 79% and 73% for left leg (P = 0.87), respectively. Prevalence of SFJ reflux and GSV reflux, starting at the thigh, knee or calf, was similar and showed no tendencies to increase with number of pregnancies. CONCLUSIONS: Number of pregnancies did not influence GSV reflux patterns in women with primary varicose veins.

[Treatment of femoral false aneurysms following cardiac catheterization with compression and color Doppler echocardiography monitoring]. / Tratamento de falsos-aneurismas femorais pós-cateterismo cardíaco pela compressão com monitorização pelo ecodoppler a cores.

PURPOSE: To evaluate the efficiency of a non-surgical treatment of the femoral false aneurysm following cardiac catheterization using the color Doppler echocardiography monitorization. METHODS: From August 1993 to October 1996, 17 patients were evaluated by the color Doppler echocardiography, 7 women and 10 men, between 58 and 77 years of age, with the diagnosis of femoral false aneurysms after cardiac catheterization. All the cases were selected for therapy with this new technique, that consisted of the compression of the false aneurysm with the transducer of the ultrasound device and monitorization of the evolution of the false aneurysm thrombosis, through image observation in real time, on the equipment monitor. RESULTS: There were 17 selected patients, 16 were successfully treated, requiring an average of 30 minutes of compression with consequent thrombosis of the false aneurysm, without recurrence in 30 days of follow-up. No complications with the use of this technique were noted and the hospitalization period was, on average, 1 day. CONCLUSION: This technique is efficient, safe and should be the first choice for the therapy of patients with femoral aneurysm following cardiac catheterization.