Correlation between the intensity of venous reflux in the saphenofemoral junction and morphological changes of the great saphenous vein by duplex scanning in patients with primary varicosis.

AIM: One of the major causes of chronic venous disease is venous reflux, the identification and quantification of which are important for diagnosis. Duplex scanning allows for the detection and quantification of reflux in individual veins. Evaluation of the great saphenous vein in primary varicosis is necessary for its preservation. Objective of the study is to evaluate a possible correlation between the intensity of reflux at the saphenofemoral junction, diameter alterations of the incompetent great saphenous vein and the practical effect of such correlation. Also to compare the clinical severity of the CEAP classification with such parameters. METHODS: Three hundred limbs were submitted to duplex evaluation of their insufficient saphenous veins. Vein diameter was measured on five different points. Velocity and flow at reflux peak and reflux time were determined. The saphenous vein's diameters were correlated with velocity, flow and time. The three latter parameters and diameters were compared with clinical severity according to CEAP. RESULTS: Correlation was found between the saphenous vein's diameters, velocity and flow. No correlation was observed between time and diameter in the thigh's upper and middle thirds. When comparing diameter, velocity and flow with CEAP clinical severity classification, an association was observed. The correlation between reflux time with clinical severity was weak. CONCLUSION: Reflux time is a good parameter for identifying the presence of reflux, but not for quantifying it. Velocity and peak flow were better parameters for evaluating reflux intensity as they were correlated with great saphenous vein alterations, and were associated with the disease's clinical severity.

Advances in ultrasound techniques improve early detection of deep vein thrombosis.

AIM: This study aimed at assessing the accuracy of ultrasound (US) in the diagnosis of recent deep vein thrombosis (DVT) in an experimental study in dogs. DESIGN: blinded and randomized experimental study. Twenty dogs were randomly divided in two groups: control group (CG) and thrombosis group (TG). US was performed in the pre- and postoperative period. Phlebography was performed immediately prior to the postoperative US. After the second US, a surgery was performed to detect whether thrombus was present or not. US results were compared to those of phlebography and surgical findings. RESULTS: In all dogs, inferior vena cava (IVC) was compressible. The relations of IVC diameter with the aorta were higher (P<0.005) in TG than in CG. Spectral Doppler in spontaneous breathing, tissue harmonic imaging, power Doppler and B flow showed sensitivity, specificity and accuracy of 1. Phlebography presented sensitivity of 90%, specificity of 80% and accuracy of 85%, when compared to surgical finding. CONCLUSIONS: For the diagnosis of recent DVT in the experimental model used, venous compressibility proved to be inefficient. The ratio of IVC diameter to aorta, when increased, suggests thrombosis. The use of new US technological advances increases accuracy. Phlebography was less accurate than US.

Arteriovenous fistula between the right internal mammary artery and the subclavian vein: percutaneous closure with detachable balloon-catheter embolization.

A case of iatrogenic fistula from the right internal mammary artery to the subclavian vein following subclavian vein catheterization is reported. The patient had undergone percutaneous Intracath catheterization of the subclavian vein to treat hypovolemic shock during the surgical treatment of ectopic pregnancy. She had remained symptom-free for 7 years and then started to complain of effort dyspnea. The patient was found to have a thrill and a bruit at the subclavian region, and arteriography demonstrated a fistula between the right internal mammary artery and the subclavian vein. The fistula was successfully closed by embolization with a percutaneous detachable balloon catheter.

Heparin, heparin plus ASA and dipyridamole, and arteriovenous fistula as adjuvant methods to prevent rethrombosis after venous thrombectomy. Experimental study in rabbits.

Venous rethrombosis following thrombectomy is a common event. The aim of the present study was to verify the action of heparin, heparin plus acetyl salicylic acid (ASA) and dipyridamole, and of an arteriovenous fistula (AVF) in the prevention of this complication. Thrombosis was induced in 48 male rabbits by the injection of thrombin in a segment of the left jugular vein, in which the blood flow was arrested for 10 minutes. After 48 hours, the animals were randomly allocated into one of 4 groups of treatment: (1) control, (2) subcutaneous heparin (600 S.I. Units/kg--8/8 hours), (3) heparin, in the same dose, plus ASA (10 mg/kg/once a day), and dipyridamole (0.5 mg/kg thrice a day), (4) an AVF was surgically constructed between the left carotid artery and the left maxillar vein. After 30 minutes, thrombectomy was performed. The venous blood flow, the hematocrit, activated partial thromboplastin time and thrombin time tests were performed before, right after the thrombectomy and 48 hours after thrombectomy. Venography was performed after thrombectomy and at the end of the experiment. The animals were killed 48 hours after thrombectomy and the veins were examined macroscopically. Venous rethrombosis was significantly prevented only in the AVF group (9/12), when compared to control group (0/12), heparin group (1/12) and heparin plus antiaggregating agents group (2/12). These results validate further clinical and experimental investigations with the use of AVF to prevent rethrombosis after venous thrombectomy, when a reduction of venous flow is present.

Comparative study of the action of topical heparinoids on the evolution of experimental thrombophlebitis.

The action of three different topical heparinoids on the evolution of experimental thrombophlebitis was studied. Thrombophlebitis was induced in the marginal vein of the ear of rabbits by stasis and injection of hypertonic glucose solution. Forty-eight hours later the animals were allocated to three treatment groups and a control group. The substances were applied over the affected vein three times a day for 6 days and the ears inspected daily by transilumination. After 7 days, the animals were killed and anatomopathological studies performed. No difference in thrombus frequency or inflammatory reaction was observed between the animals treated with heparinoids and the control groups, or among the treated groups.

Lumbar sympathectomy and distal arteriovenous fistula as adjuncts to prevent arterial rethrombosis after thrombectomy: experimental study in dogs.

The role of lumbar sympathectomy and distal arteriovenous fistula (AVF) in preventing rethrombosis of femoral arteries with intimal injury and poor run-off was studied in 21 dogs. Femoral artery thrombosis was induced by endothelial lesion in all animals (phase 1) and 24 hours later the arterial flow was restored by thrombectomy. The dogs were then randomly allocated into 3 experimental groups: control, sympathectomy, and AVF (phase 2). Critical stenosis of the popliteal artery was then created by a partially occluding ligature in all animals in order to simulate poor run-off. After 24 hours the femoral arteries were studied for the presence of rethrombosis (phase 3). At the end of phase 2 and during phase 3, femoral pressure and flow, fluorescein circulation time and paw temperature were measured, and arteriography was done. Arterial rethrombosis was significantly prevented in the AVF group (6/7) when compared to the control group (2/7) or the sympathectomy group (1/7). These data suggest an effective action of an adjuvant AVF, but not of sympathectomy in preventing rethrombosis after thrombectomy in arteries with poor run-off.

Comparative study of the action of topical heparinoids on the evolution of experimental thrombophlebitis

The action of threem different topical heparinoids on the evolution of experimental thrombophlebitis was studies. Thrombophlebitis was induced in the marginal vein of the ear of rabbits by stasis and inection of hypertonic glucose solution. Forty-eight hours later animals were allocated to three treatment groups and a control group. The substances were applied over the affected vein three times a day for 6 days and the ears inspected daily by transillumination. After 7 days, the animals were killed and anatomopathological studies performed. No difference in thrombus frequency or inflamatory reaction was observed between the animals treated with heparinoids and the control group, or among the treated groups

Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country town.

The prevalence of varicose veins (VV) and of chronic venous insufficiency (CVI) was studied among 1755 adults over 15 years of age (443 men and 1312 women). These people attended the University Health Center in Botucatu, a country town in the State of Sao Paulo, Brazil, for routine examination or for any disease complaints. The prevalence of all grades of VV not including telangiectasis and reticular varices grade I was 47.6% (37.9% in men and 50.9% in non-pregnant women). The prevalence of VV recorded as moderate or severe was 21.2%. The more severe form of CVI with active or healed ulcer was present in 3.6% of the subjects (2.3% of men and 4% of women). For only 5.5% of the patients was VV or CVI the reason for medical consultation. The prevalence of VV increased with age and number of pregnancies and was greater among white than non-white people. Working posture or posture adopted for defaecation did not influence the prevalence of VV. Our data show the prevalence of VV and CVI to be higher or as high as the prevalence found in developed western countries. We therefore propose that studies of these conditions should be included in epidemiological surveys of other developing areas or countries, so that if data similar to ours are verified prophylaxis and early treatment could be included in health planning for these areas with the aim of reducing future morbidity and the related social onus.

Tratamento de trombose venosa profunda com doses fixas de heparina subcutanea. / Treatment of deep venous thrombosis with fixed doses of subcutaneous heparin

Com base na observacao de bons resultados em alguns casos de TVP excepcionalmente tratados com heparina subcutanea e em dados de literatura, os autores compararam prospectivamente um grupo de 19 pacientes portadores de trombose venosa profunda dos membros, tratados com heparina subcutanea em doses fixas de 30.000U/dia durante 10 dias, com um grupo de 17 pacientes tratados com heparina intravenosa em administracao continua, controlada pelo tempo de tromboplastina parcial ativada. Os pacientes foram controlados clinicamente e por flebografias realizadas antes e apos o tratamento. Nao se verificou diferenca na evolucao clinica ou flebografica entre os pacientes tratados com um outro regime.Nenhum doente apresentou quadro clinico sugestivo de embolia pulmonar ou complicacao hemorragica. Os resultados obtidos ate o presente sugerem que o tratamento da TVB distal dos membros com doses fixas de heparina por via subcutanea podera vir a ser um tratamento alternativo, justificando a continuacao de pesquisas nesse sentido

Adventitial cystic disease of the popliteal artery in Brazil: additional data on the geographical distribution of the disease.

Adventitial cystic disease of the popliteal artery is an uncommon condition. Previous reports show a grouping of cases of this disease in Europe and Australasia. With the purpose of widening the knowledge of the geographical distribution of the disease, 3 cases from Brazil are described, and reference is made to 1 previously reported. It is suggested that not recognizing or not reporting the disease could be the cause for this grouping and that the number of diagnosed cases may increase in different parts of the world due to the greater awareness of the disease.

Cisto de adventicia em arteria poplitea. Relato de dois casos. / Adventitial cyst in popliteal artery. Report of 2 cases

Por ser uma afeccao de diagnostico raro no Brasil, os autores apresentam dois casos de cisto de adventicia em arteria poplitea em pacientes masculinos, tratados no Hospital das Clinicas da Faculdade de Medicina de Botucatu. Os achados clinicos, radiologicos, histopatologicos e o tratamento sao descritos e comparados com os da literatura

Prevention of experimental venous thrombosis induced by contrast medium in the rat.

In order to assess experimentally the usefulness of some procedures employed in man to prevent venous thrombosis following phlebography, thrombosis was induced in rats using sodium diatrizoate in a temporarily isolated segment of a jugular vein. The prevention of thrombosis was attempted by washing out the vein with physiologic saline or saline plus heparin or by injecting saline plus heparin in the opposite jugular vein. Thrombosis occurred in all animals in the control group and in the group treated with saline alone. Both treatment schemes with heparin significantly reduced the incidence of thrombosis, the wash out with heparin being more effective than systemic heparin.