Steam ablation versus radiofrequency and laser ablation: an in vivo histological comparative trial.

OBJECTIVE: There is an increasing use of minimal invasive techniques to treat saphenous vein reflux. Among these radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and foam sclerotherapy are frequently used. A new method of thermal ablation is the steam vein sclerosing (SVS) system. This study evaluates the histological changes after ablation of the saphenous veins in goats with RFA, EVLA, and SVS. METHODS: Twelve saphenous veins in six goats were treated with one of the three treatment modalities: four veins with RFA, four with EVLA, four with SVS. Seven days after treatment occlusion and diameter changes were evaluated by ultrasound imaging and histological changes were examined microscopically. RESULTS: Vein length, mean diameter, and the amount of tumescence was comparable between the three groups. Histological examination showed extensive vein wall destruction, the least in the outer layer of the vein wall. The total vein wall damage was 9.2/15 (SD 3.5) for EVLA, 13.3/15 (SD 3.3) for RFA, and 11.2/15 (SD 2.8) for SVS group. There was no significant difference among the three groups. Perivenous tissue damage was low. No extrafascial damage was seen. CONCLUSION: Histological findings after steam ablation are similar to the RFA and EVLA with a low perivenous tissue destruction score and a high vein wall destruction score.

Great saphenous vein ablation with steam injection: results of a multicentre study.

OBJECTIVE: To assess the safety and efficiency of steam vein sclerosis (SVS) of the great saphenous vein (GSV) in a multicentre open prospective cohort study. DESIGN: 75 consecutive adult patients with GSV reflux, CEAP C2-C5 and vein diameter 4-13 mm. METHODS: Patients treated using an SVS™ generator delivering homogenous pulses of superheated steam were followed up at 8 days and 1, 3, 6 and 12 months (clinical, duplex ultrasound, quality of life [QoL] with SF12). RESULTS: 88 veins were treated in 75 patients. At 6 months, 72/75 (96%) veins were obliterated (95% CI: 89-99) and Kaplan-Meier analysis found an obliteration rate of 96.1% at 12 months. QoL increased at 6 months for both the physical and mental components (p = 0.049 and p < 0.001 respectively). SVS was well tolerated: no major complications were reported. Adverse events occurred mainly at day 8 and incidents amounted to ecchymosis (n = 60) and pain (n = 7). CONCLUSIONS: SVS achieved an obliteration rate similar to that of other thermal ablation techniques. It was well tolerated with minimal post-operative pain.

[Modified Vigoni's operation for the treatment of sclerotic hypodermatitis]. / Opération de Vigoni Modifiée dans le traitement des hypodermites scléreuses.

Despite the new mechanical technologies help, particularly mercury pressotherapy, some lipodermatosclerosis are not easily treated and their prognosis is bad owing to their evolutive liability to sheathe the lower limb. For 2 years, we have been proposing to our patients the little practised in France Vigoni operation: one piece hypodermis plaque resection removing perforating and collateral veins and the fascia.

[Computers in the vascular research laboratory: treatment of Doppler signals by computer]. / L'informatique au laboratoire d'exploration vasculaire: traitement du signal Doppler par ordinateur.

The authors have developed a computing system to deal with the Doppler signals. They show how the programmes work, which make it possible both to print the classic curve by calculating the indices, and also to carry out a spectrum analysis. This technique makes it possible to evaluate the extent of stenoses and turbulence, particularly in the area of the carotid bifurcations. Computing improves the quality of vascular evaluations by non-invasive methods, it enables town-laboratories to follow in the best possible way the progress achieved by the new parometers and the complementary investigations of the classic Doppler.

[Prevention of fatal postoperative embolism using risk assessment tables and Greenfield filters]. / Prévention des embolies post-opératoires mortelles par table de cotation de risques et filtres de Greenfield.

The prevention of fatal post-operative pulmonary embolism requires a fair assessment of the risk. We have drawn up a score chart, applicable to the specific cases of arteritic amputation; based on the retrospective study of 45 cases operated on between 1977-1980. This chart was recorded on micro-computer, and used for the 20 cases of amputation in 1981. In the high risk cases, a caval Greenfield filter was applied in a prophylactic capacity: 4 patients were equipped with a filter. There was no case of pulmonary embolism in this group, whereas 4 patients had died of massive embolism between 1977-1980. The programme used means a progressive improvement of the score relative to the new case-histories studied. It may be quickly adapted to other cases of potentially high-risk patients.

[Comparative results of the use of Greenfields' filter, an umbrella filter, and a caval clip for vena cava interruption]. / Notre expérience du filtre de Greenfield. A propos de 40 observations comparées à 40 filtres-ombrelles et 40 clips.

Results of interruption of the vena cava for thromboembolic complications are reported. Greenfields filter was used in 40 cases, its introduction appearing to be a more delicate procedure than when other materials (caval clip in 40 cases and Mobin-Uddin's filter in 40 cases) were used. Results with regard to recurrence of emboli were comparable for the different materials, but Greenfield's filter becomes thrombosed less often and provokes fewer major sequelae.

[Cryoanalgesia of the nerves of the feet in distal arteritis in the elderly]. / La cryo-analgésie des nerfs du pied dans les artérites distales du vieillard.

Fifty limb salvages were attempted by using phenol sympathectomy combined with cryo-analgesia of foot nerves in patients with distal lesions. Cryo-analgesia does not interfere with walking and exercising and avoids oedema. Results were gratifying in patients with rest pain, and no gangrenous involvement: 80% of salvages. Very old patients (over 90 years) experienced satisfactory results in 60% of the cases. Even when a reconstructive procedure had failed previously, we achieved a 25% limb salvage rate. Thus cryo-analgesia under local anesthesia appears as a useful therapy for elderly patients with distal arterial disease.

[Surgery of deep venous reflux following phlebitis]. / Chirurgie des reflux veineux profonds dans les séquelles de phlébite.

Ten patients presenting major post-phlebitic sequels underwent the surgical restoration of their deep venous system, using valvular plastic, venous transposition, or the transplant of a section of counter-lateral saphenous vein. The techniques used, the preoperative assessment and the postoperative treatment are all described. With an average of 24 months since the operation, there are 8 successes; 7 out 9 patients are back at work, and 6 no longer wear elastic compression. However, this type of surgery is recent, and our knowledge of venous haemodynamics must be extended if we are to generalize these techniques.

[Cryosclerosis of the saphenous veins in varicose reflux in the obese and elderly]. / Cryosclérose des troncs saphéniens dans les reflux variqueux de l'obèse et du viellard.

We have developed an outpatient technique for high-risk varicose patients, using local anesthesia and cryo-sclerosis of the vein wall. A flexible cryo-probe is introduced in the vessel lumen, and its tip refrigerated to --89 degrees C. Thrombosis is thus induced with a limited inflammatory reaction and no pain. The vein then undergoes a progressive fibrosis, and recanalisation was not observed. Clinical results have been excellent on 44 patients who could not be submitted to standard surgical techniques, due to age and obesity.

[Technique of lymphatic-venous anastomosis. Initial results in secondary lymphedema]. / Technique d'anastomoses lymphatico-veineuses. Premiers résultats dans les lymphoedèmes secondaires.

The author describes the operatory technique and the protocole of post-operatory treatment carried out in three cases of secondary lymphoedema. He suggests a new sort of lympho-venous anastomosis using a venous collateral in which the lymph is cuffed. The short-term results are satisfactory, but the possibility of relapse or of spreading neoplasm lessens the patient's chances of complete recovery and means that the technique should only be used very selectively.

An unusual occurrence of toxaphene poisoning in swine.

Ten of 15 sows developed an acute nervous disorder that resembled the effects of water deprivation-salt poisoning. However, a unique set of circumstances had permitted the environmental persistence of a toxaphene-lindane insecticide combination for approximately 1 month, with toxaphene toxicosis resulting. The diagnosis was based on the lack of lesions of salt poisoning and the finding of 4 ppm of toxaphene in the cerebellum and 0.3 ppm of toxaphene in the serum of 1 of the 2 sows that died.

[Sympathectomy by phenol infiltration in the treatment of chronic obliterative arteriopathies of the lower limbs. Comparison between 60 statistical cases and 35 surgical sympathectomies (author's transl)]. / La sympathectomie au phénol dans le traitement des artériopathies chroniques oblitérantes des membres inférieurs. Comparaison d'une statistique de 60 cas avec 35 sympathectomies chirurgicales.

The authors compare the results obtained by the use of two different lumbar sympathectomy techniques in patients with chronic obliterative arterial disease of the lower limbs. Surgical resection was employed in 35 cases, and infiltration with phenol under radiological control in 60 cases. The proportion of successful results was about the same in both groups, best results being obtained in younger patients with less advanced disease. No mortality occurred in the group treated by phenol infiltration. Transient neuralgia was reported in some cases, but hospital stay was reduced by an average of 10 days, and many cases could be treated as out-patients. More than half of the patients did not require operation or amputation after phenol infiltration, which is, therefore, a very valuable associated therapeutic measure, especially in the elderly.