How does the patho-physiology influence the treatment of pelvic congestion syndrome and is the result long-lasting?

The objectives of this study are to consider the influence of pathophysiology in the treatment of pelvic congestion syndrome (PCS) and to determine the criteria which impact on the long-term results. A classification of venous pathology including three types of pathophysiological conditions, independent of the location of the pelvic venous pathology, is developed and illustrated. These types, diagnosed by cross-sectional imaging and confirmed by phlebography, are associated with a specific therapeutic plan. The long-term results are dependent on the quality of the initial phlebographic mapping that must be selective and complete, the angiographic findings, in particular the study of collaterals feeding the venous anomalies, the treatment of all venous anomalies, the respect of contraindications, the use of appropriate materials and the occurrence of new pregnancies. In conclusion, the feasibility and satisfactory short-term results of endovascular treatment of PCS are admitted. Questions remain regarding the effectiveness of the different embolic agents and the long-term results of this treatment.

Short- and medium-term duplex sonography follow-up of deep venous thrombosis of the lower limbs.

PURPOSE: We conducted this study to assess the progression or regression of venous thrombi during and after treatment and to search for criteria of embolism risk. METHODS: We prospectively studied 75 patients with lower limb deep venous thrombosis. We used B-mode sonography for the diagnosis and follow-up of these thrombi. Pulmonary scintigraphy was performed at days 1 and 10. We evaluated the topography, echogenicity, and structure of the thrombus; the location and wall attachment of its head; and the vein diameter. Each venous segment was semiquantitatively scored as follows: 0, no thrombosis; 1, partially obstructive thrombosis; or 2, complete thrombosis. RESULTS: The decreases in the total thrombosis score were 4%, 11%, 51%, 72%, and 84% on days 5, 10, 30, 90, and 365 (1 year), respectively. Pulmonary embolism occurred in 27 patients, of whom 16 were asymptomatic. Thrombi in iliac veins exhibited a slower regression rate than those in calf and femoral veins. Pulmonary embolism occurred in 54% of patients with versus 24% of patients without a floating thrombus head. CONCLUSIONS: Sonography is useful for the early detection of thrombus progression and the evaluation of embolism risk, which seems to be greater in patients with a floating thrombus head.

[Current studies useful for indications in the treatment of varicose veins of the lower limbs. Preoperative explorations]. / Explorations actuellement utiles pour l'indication du traitement des varices des membres inférieurs. Les explorations pré-opératoires.

The preoperative assessment of varicose veins usually requires the use of ultrasound methods to specify and localize the various sources of reflux in the saphenous junctions, perforating veins and saphenous branches. Continuous wave Doppler (CW) is the basic technique used to investigate reflux and usefully completes clinical examination of varicose veins. Duplex-scan provides morphological analysis of the veins and studies the direction of flow in a precise site. It is particularly useful to study the saphenous-junction, perforating veins and deep vems. Color Doppler imaging (CDI) offers the advantage of duplex-scanning, withe visualization of great volumes of measurement whit blue or red colour-coding according to the direction of flow. All haemodynamic and morphological findings must be reported on a diagram to establish "mapping" of pathological veins.

[Value of echo-marking in the surgical treatment of varicose veins (outside the CHIVA treatment)]. / Intérêt de l'écho-marquage dans la cure chirurgicale des varices (en dehors de la cure CHIVA).

It is in fact only the cutaneous reflection of venous cartography established by echo-doppler investigation. The procedure is pre-surgical. Its chief value is the more accurate identification of hemodynamic and anatomical data, in particular when they are sub-clinical. Such data can then be actually used by surgeons, who are able to perform a procedure precisely suited to the individual patient. This greater accuracy enables the following aims to be achieved:--correction of all leak points;--excision of all pathological veins;--avoidance of any damage to healthy areas;--esthetic results;--prevention of recurrences, etc. However, it remains for angiologists and surgeons to evaluate and validate this method by prospective trials.

[Doppler ultrasonic evaluation of the embolism-causing potential of carotid artery plaques. Apropos of 113 macroscopic findings]. / Evaluation du potentiel emboligène des plaques carotidiennes par l'écho-Doppler. A propos de 113 confrontations macroscopiques.

Comparison was made between precise descriptions of gross pathology of 113 carotid artery atheromatous plaques (69 symptomatic, 44 asymptomatic) operated upon by thromboendarterectomy and results of ultrasound-Doppler examinations, to determine possible specific ultrasound criteria for precise anatomical lesions. Echographic criteria studied were: ultrasonic structure of plaques; relation of plaque to wall; existence or absence of a solution of continuity; regular or irregular nature of endoluminal border of plaque; and finally the notion of discordance between degree of stenosis as shown by Doppler (D) and ultrasound (E) imaging (E much less than D). Principal results were as follows. Images of the regular, homogeneous highly echogenic plaques (36 cases) corresponded in 69.4% of cases to simple fibrous or calcified plaques with regular endoluminal borders. Irregular heterogeneous plaques (31 cases) were suggestive of irregular, friable and/or ulcerated material in 64.4% of cases. Weakly echogenic plaques (9 cases) suggested mainly thrombus (44.4%) or soft, friable plaques (33.3%). Plaques with solution of continuity do not correspond to a precise lesion but, in contrast, are specific (with weakly echogenic plaques) of the emboligenic character of the plaques (100%). The criterion ultrasound "Doppler was specific for thrombus in 75% of cases. In contrast, the thrombus can also demonstrate very different ultrasound images. Finally, in this study ultrasound-Doppler findings produced 3 false negatives (2.6%). Combined ultrasound-Doppler imaging allows quantitative evaluation and particularly qualitative assessment of carotid artery atheromatous lesions, with sufficiently reliable criteria to detect lesions of high emboligenic potential.

[Evaluation of the emboligenic potential of carotid plaques. Apropos of 113 echographic and macroscopic comparisons]. / Appréciation du potentiel emboligène des plaques carotidiennes. A propos de 113 confrontations échographiques et macroscopiques.

113 cases of atheromatous plaques in carotid arteries (69 cases where symptoms were present and 44 were asymptomatic) surgically treated by endarterectomy, including an accurate description of gross lesions, were compared to findings obtained with echographic examination to determine if there are specific echographic criteria corresponding to exact anatomical lesions. The echographic criteria selected for this study were the echo-inducing structure of the plaques; the relationship of the plaque with the artery wall (presence of a lesion continuous with the wall); the regular configuration of the endoluminal edge of the plaque or not; and finally, the notion of a discrepancy between the extent of the carotid artery stenosis visualized by ultrasound and that observed with echography (E much less than U). The primary results of this study demonstrate that echo-inducing, uniform and regular (36 cases) atheromatous plaques corresponded to ordinary, fibrous or calcified plaques in 69.4% of cases, with regular endoluminal borders. Irregular and non-uniform plaques (31 cases) suggested irregular, friable and/or ulcerated substance in 64.4% of cases. Poor echo-conducting plaques (9 cases) suggested formation of a thrombus, basically, in 44.4% or of soft and friable plaques (33.3% of cases). Those plaques which were continuous with the wall do not correspond to a precise type of lesion but, rather, are characteristic (with poor echo-conducting plaques) of the embolic nature of the plaques (100%). The criteria echo much less than ultrasound is specific for a thrombus in 75% of cases. On the other hand, the thrombus may also assume very diverse echographic presentations. Finally, three negative echo-ultrasound results were observed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)