Bipolar radiofrequency induced thermotherapy and 1064 nm Nd:Yag laser in endovenous occlusion of insufficient veins: short term follow up results.

BACKGROUND: The aim of this study is to report our results in main stem vein closure using the bipolar radiofrequency induced thermotherapy (RFITT) system and the 1064 nm Nd:Yag laser. PATIENTS AND METHODS: 44 incompetent main stem veins (37 great saphenous veins, one lesser saphenous vein, and 6 anterior accessory saphenous veins) in 29 patients were treated using RFITT. 53 incompetent main stem veins (45 great saphenous veins, 4 lesser saphenous veins, and 4 anterior accessory saphenous veins) in 43 patients were treated endovenously with 1064 nm Nd:Yag laser. All patients underwent postoperative duplex scanning within a month after procedure, as well as a short interview regarding postoperative discomfort. RESULTS: In main stem veins treated with RFITT, the success rate within the first month was 86,4 % (38 out of 44 veins). Complete failure rate was 13,6 % (6 out of 44 veins). In 53 main stem veins treated by 1064 nm Nd:Yag laser, the success rate was 100 %, consisting of 98,1 % complete success (52/53 veins), and 1,9 % partial success (1/53 veins). None of the patients treated with RFITT experienced postoperative adverse effects, whereas 13/43 (30,2 %) patients treated with laser had to use oral analgesics after the treatment, and 21/43 (48,8 %) patients reported transient skin changes, such as bruising or skin redness. CONCLUSIONS: RFITT system was fairly efficient in the short term for closure of main trunk veins, whereas longer term results are still scarce. Postoperative side effects of RFITT were minimal. 1,064 nm Nd:Yag laser, according to short term results, proved to be very effective for main stem vein closure. Postoperative side effects related to 1064 nm Nd:Yag endovenous laser treatment proved to be minor, transient, and acceptable.

Duplex scanning compared with intra-arterial angiography in diagnosing peripheral arterial disease: three analytical approaches.

BACKGROUND: This study was undertaken to assess the reliability of duplex scanning, as compared with digital subtraction angiography, in diagnosing peripheral arterial disease of the lower limbs. PATIENTS AND METHODS: 60 legs were studied. Each leg was divided in 5 arterial segments, from aortoiliac to popliteal. Duplex scanning and digital subtraction angiography were performed. The disease in each segment was assessed as significant or insignificant or classified into five categories concerning the grade of stenosis (patent vessel or no diameter reduction, mild stenosis, i.e. 1-19% diameter reduction, moderate and severe stenosis, i.e. 20-49% and 50-99% diameter reduction, respectively, and occluded vessel). Three statistical approaches were applied: calculating sensitivity and specificity, Kappa statistics, and weighted Kappa value. Median grades of arterial stenosis across different segments, according to angiography measurements, were also calculated. RESULTS: The duplex sensitivity in detecting significant lesions ranged from 0.46 to 0.88. The Kappa values of agreement between duplex and angiography ranged from 0.35 to 0.64. Weighted Kappa values ranged from 0.45 to 0.72. Median grades of arterial lesions ranged from 2 (interquartile range 1-2) to 4 (3-4) and differed significantly (Kruskal-Wallis H test, p < 0.001). CONCLUSIONS: The sensitivities and specificities suggested various duplex reliabilities in detecting significant arterial disease across different lower limbs segments. The Kappa values, in general, testified duplex's insufficient accuracy in grading the severity of stenosis. However, weighted Kappa values confirmed duplex's better ability to approximate the grade of stenosis. The arterial segments themselves were unevenly affected with the peripheral arterial disease.