ABSTRACT
OBJECTIVE: The aim was to assess short and midterm efficacy and safety of catheter directed foam sclerotherapy (CDFS) with tumescent anaesthesia in patients with recurrent symptomatic saphenous reflux. METHODS: This was a prospective observational study (February 2018 to February 2019) including 21 consecutive patients referred with recurrent symptomatic varicose veins. Standing duplex ultrasound (DUS) with saphenous vein diameter measurement 3 cm from the terminal valve was performed pre-operatively. All the patients were operated on under local anaesthesia. By ultrasound guided puncture a hydrophilic 0.035â³ guidewire and 5F Berenstein catheter were inserted through a 5F introducer sheath. Peri-saphenous tumescent anaesthesia (PSTA) was performed under ultrasound guidance. Sclerosant foam was prepared with sodium tetradecyl sulphate 3% or polidocanol 3% using the Tessari method. Concomitant phlebectomies were performed in 52%. Clinical evaluation and DUS were performed pre- and post-operatively at one week, six months, and 12 months. RESULTS: There were 11 men and 10 women (median age 52 years; interquartile range [IQR] 43 - 61). The great saphenous vein was treated in 18 patients. The median vein diameter was 6.8 mm (IQR 4.7 - 8.9). Previous procedures were Cure conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA), mechanochemical ablation, thermal ablation, and cyanoacrylate closure. The distribution of the clinical class (Clinical Etiology Anatomy Pathophysiology [CEAP] classification) was 16 C2, three C3, and two C4 limbs. Immediate technical success was 100%. There were no complications in the early post-operative period. The median follow up was eight months (IQR 5 - 10). The occlusion rate demonstrated by DUS was 100% (21/21) at one week, 100% (21/21) at six months, and 86% (18/21) at 12 months. The median post-procedural vein diameter at one week, six months, and 12 months was 4.8 mm (IQR 3.9 - 6), 4.3 mm (IQR 3.5 - 5.5), and 4 mm (IQR 3 - 4.9), respectively. CONCLUSION: Combination CDFS with PSTA achieves good short and medium term venous occlusion rates, associated with few complications in patients with recurrent symptomatic saphenous reflux.
ABSTRACT
INTRODUCTION: We here present a case of a ruptured giant popliteal artery aneurysm (PAA) successfully treated with endovascular surgery. CASE REPORT: A 88-year-old male presented with left limb massive swelling and pain. His general status was critical with acute respiratory insufficiency. CT scan showed massive haematoma in the thigh and a PAA of 9.1 cm in diameter. Urgent endovascular repair was successfully performed under local anaesthesia. Nevertheless, patient died, on second postoperatory day, because of respiratory failure. DISCUSSION: Up to 50% of PAA present with acute limb ischaemia is due to thrombosis or distal embolization. Rupture is an uncommon complication affecting less than 3% of PAA. Diameter greater than 2 cm or mural thrombosis are indications for elective intervention. Open surgical repair is the first treatment option. In selected patients, endovascular repair can be performed. Midterm results of this technique, recently reported, are comparable to open repair.
