[Ultrasound angiography in diagnosis of deep venous thrombosis and post-thrombotic syndrome. A prospective comparative study]. / Ultraschallangiographie zur Diagnostik der tiefen Beinvenenthrombose und des postthrombotischen Syndroms. Eine prospektive vergleichende Untersuchung.

PURPOSE: Aim of the present study was to establish the value of ultrasound angiography compared with colour duplex sonography and phlebography in the diagnosis of deep venous thrombosis of the leg and insufficiency of the perforating vein. METHOD: Sixty-two patients with deep venous thrombosis of the leg and 30 patients with post-thrombotic syndrome and perforating vein insufficiency underwent diagnostic examination by colour duplex sonography, ultrasound angiography and phlebography. Endoscopic varicose surgery was taken as the gold standard for diagnosis of perforating vein insufficiency. RESULTS: In the diagnosis of deep venous thrombosis, the specificity of colour duplex sonography was 92% in the thigh, 100% in the popliteal area and 89% in the lower leg. Colour angiography showed higher specificity. 95%, in the lower leg. In a diagnosis of perforating vein insufficiency, accuracy specificity of the three procedures was 60% for colour duplex sonography, 47% for phlebography and 80% for ultrasound angiography. CONCLUSIONS: The diagnosis of venous thromboses in the lower leg can be further improved by means of ultrasound angiography. Ultrasound angiography is the best method for demonstrating insufficiency of the perforating vein.

Beta-blockers and nitrates in patients with peripheral arterial occlusive disease: long-term findings.

METHODS: The effect of 6 months' administration of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial occlusive disease (PAOD), double-blind and placebo-controlled, was investigated in 56 patients with chronic ischaemic heart disease and stage IIb PAOD, using as criteria the walking distance and the change in resistance index in the femoral artery. The placebo group consisted of 14 patients with chronic ischaemic heart disease and the same stage of PAOD. RESULTS: Patients on 50 mg/day atenolol showed a significant reduction in both pain-free and maximal walking range compared with the controls. In contrast, those taking 200 mg/day celiprolol and those on 80 mg/day isosorbide dinitrate demonstrated significant increases in pain-free and maximal, walking distance compared with the control group. The colour duplex sonographically measured Doppler flow through the femoral artery showed a significant decrease both in the patients taking celiprolol and in those on isosorbide dinitrate, while in those receiving atenolol the resistance index increased significantly. CONCLUSIONS: The study shows that the beta-adrenoceptor blocker celiprolol also possesses a nitrate-like vasodilatory property and can be used in patients with chronic ischaemic heart disease and impaired peripheral arterial blood flow.

[Are beta-blockers generally contraindicated in patients with peripheral arterial occlusive disease?]. / Sind Betablocker bei Patienten mit peripherer arterieller Verschlusskrankheit generell kontraindiziert?

Ninety patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease were investigated to determine the effect of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial blood flow. Walking distance and the resistance index in the femoral artery were measured before and after 3 months medication and compared with the findings in controls (30 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease) who received placebo. Patients with peripheral arterial occlusive disease who were treated with atenolol 50 mg/day demonstrated significant decreases in both pain-free and maximal walking distance. In contrast, the walking distances in those given celiprolol 200 mg/day and those who received isosorbide dinitrate 80 mg/day did not differ from the distances in control subjects. The Doppler flow through the femoral artery, as measured by color duplex sonography, showed a significant decrease in resistance index, both in patients given celiprolol and in those given isosorbide dinitrate. In patients treated with atenolol the resistance index rose significantly. The results of this study confirm that the beta-adrenoceptor blocker celiprolol exerts a supplementary vasodilatory action resembling that of nitrates and hence can be used in patients with chronic ischemic heart disease and impaired peripheral arterial perfusion.