Efficacy and safety of Aethoxysklerol® (polidocanol) 0.5%, 1% and 3% in comparison with placebo solution for the treatment of varicose veins of the lower extremities in Chinese patients (ESA-China Study).

OBJECTIVES: To assess efficacy and safety of polidocanol (POL) versus placebo in the treatment of C1 and C2 non-saphenous varicose veins in Chinese patients. METHODS: Patients were randomly assigned to POL or placebo. POL 0.5%, 1% and 3% were administered depending on varicose vein type. Response after 12 weeks was defined as Grade 4 or 5 on a digital imaging-based five-point scale (C1 veins) or occlusion and/or absence of reflux >0.5 second (C2 veins). Safety was evaluated with a five-point scale and standard safety assessments. RESULTS: Two hundred and eighty-five patients were treated. POL 0.5%, 1% and 3% were each superior to placebo (P < 0.001); response rates: 87.1% versus 13.6%, 86.4% versus 12.5% and 88.6% versus 4.3%, respectively. Significantly more POL than placebo patients were satisfied/very satisfied with treatment. POL was well tolerated, with mostly symptoms at the injection site reported. CONCLUSIONS: Sclerotherapy with POL 0.5%, 1% and 3% was efficacious and safe in Chinese patients.

Intramuscular haemangioma of the thigh in a basketball player.

Haemangioma is a common benign soft tissue tumour. Intramuscular haemangiomas may present as a perceived sporting injury. Magnetic resonance imaging is the investigation of choice. Intramuscular haemangioma should be considered in the differential diagnosis of unexplained pain and swelling in a muscle.

The Australian polidocanol (aethoxysklerol) study. Results at 2 years.

BACKGROUND: An ongoing study of the safety and effectiveness of polidocanol by 98 investigators in Australia infecting 16,804 limbs over 2 years. OBJECTIVE: To evaluate the complications of polidocanol and compare its effectiveness and complications with sodium tetradecyl sulphate (STD) and hypertonic saline. METHODS: A single-arm prospective study of polidocanol complications and its effectiveness as a sclerosant was performed. This was compared with each investigator's previous experience with other sclerosing agents. Patients had either varicose veins or venule ectasias and/or spider veins (telangiectasia). A total of 16,804 limbs were injected by 98 investigators. Sclerotherapy was performed with 0.5% or 1% polidocanol for telangiectasias or spider veins, and with 3% polidocanol for varicose veins. The effectiveness of the sclerotherapy and any complications were reported during a 2-year period. RESULTS: There were very few complications reported with polidocanol. There were no reported deaths or anaphylaxis. The investigators with previous experience of other sclerosants considered that the effectiveness of polidocanol was superior to STD (85%) and hypertonic saline (84%). Ninety percent of investigators considered that polidocanol had less frequent complications than STD, and 80% considered that these were less severe. Seventy-four percent considered that polidocanol had fewer side effects than hypertonic saline, and 74% considered that these were less severe. CONCLUSIONS: Polidocanol is an effective sclerosant that has few complications.

Haemodynamic significance of incompetent calf perforating veins.

A total of 149 consecutive unselected patients (221 limbs) who presented with signs and symptoms of chronic venous problems (varicose veins with or without ankle oedema, skin changes and leg ulcers) have been studied by clinical examination, ascending deep to superficial venography, Doppler ultrasound and ambulatory venous pressure measurements. Of the limbs, 180 (82 per cent) had varicose veins without obstruction in the deep veins or reflux in the popliteal or femoral veins while 41 (18 per cent) had deep venous disease. Of the 180 limbs with 'primary' varicose veins 110 (60 per cent) did not have incompetent calf perforating veins (group A) while 70 (40 per cent) did (group B). On the basis of the ambulatory venous pressure after calf muscle exercise and the refilling time, the incompetent calf perforating veins of limbs in group B belonged to three subgroups of different haemodynamic significance. In 20 limbs (30 per cent) they were found to be of no haemodynamic significance, in 25 (35 per cent) of moderate haemodynamic significance and in 25 (35 per cent) of major haemodynamic significance. The last were, on clinical examination, indistinguishable from limbs with deep venous disease although they had patent deep veins with competent popliteal valves.

Number and anatomical distribution of incompetent thigh perforating veins.

Although incompetent thigh perforating veins are considered to be a common cause of recurrence of varicose veins after high saphenous ligation, the number and distribution of such incompetent veins have not been reported. The aim of the study was to determine the number and anatomical distribution of incompetent thigh perforating veins. Sixty-five limbs in 48 patients with varicose veins who were found to have incompetent thigh perforating veins on ascending deep to superficial venography were studied. In 80 per cent of patients one incompetent thigh perforating vein was found and in 20 per cent more than one was found. Concomitant incompetent calf perforating veins were found in 92 per cent of the limbs studied. The incompetent thigh perforating veins were found to occur anywhere in the thigh, from the upper edge of the patella to a few centimetres below the saphenofemoral junction. The majority (71 per cent) were found in the middle third of the thigh. All incompetent thigh perforating veins were communicating with the long saphenous vein, including those in five patients with incomplete stripping. The surgeon should be aware of incompetent thigh perforating veins which may be multiple and occur at any site on the medial aspect of the thigh.

Duplex scanning in the assessment of deep venous incompetence.

A noninvasive method to evaluate deep venous incompetence by duplex scanning is presented. For this test, it was decided to have the patient standing so as to make the test less dependent on the need for patient cooperation and to allow gravity to produce reflux. Results were validated against ambulatory venous pressure measurements. The method described had a sensitivity of 84% and specificity of 88%. Duplex scanning is a useful screening test for detecting the presence and site of incompetence in patients with deep venous disease.

The correlation between carotid plaque ulceration and cerebral infarction seen on CT scan.

The purpose of the study was to determine the association between cerebral infarction seen on CT scan and macroscopic ulceration of atheromatous carotid plaques in patients undergoing carotid endarterectomy. Following carotid endarterectomy in 65 patients, specimens were examined for the presence of ulceration without knowing the result of the preoperative CT brain scan. The 65 patients thus investigated underwent 68 carotid endarterectomies: 36 for a history of transient ischemic attacks (TIAs), 13 for amaurosis fugax, and six for prior strokes; 13 asymptomatic patients had prophylactic carotid endarterectomy prior to coronary bypass. A macroscopic ulcer was present in 42 specimens. Twenty-six (62%) of the patients with ulceration had one or more ipsilateral cerebral infarcts on CT scan. Only two (8%) of the 26 patients without an ulcer had cerebral infarcts. Of the 36 patients who presented with TIAs, 26 (72%) had carotid plaque ulcers and 23 (88%) of these had cerebral infarcts on CT scan also. In contrast, only three of 13 asymptomatic patients had plaque ulcers and only one of these had a cerebral infarct. There is a high incidence of cerebral infarction seen on CT scan in patients presenting with TIAs. These infarcts occur predominantly in patients with ulcerated atheromatous carotid lesions.