A history of injection treatments - II sclerotherapy.

INTRODUCTION: Sclerotherapy in all its current forms is based on experience going back to the 1850s. METHODS: To trace the evolution of sclerotherapy over the past 250 years, using the internet for past documentation and the literature. CONCLUSION: Sclerotherapy principles were established long ago, although current modifications have been made possible by the introduction of detergent sclerosants and ultrasound guidance.

Heroic Measures for an American Hero: Attempting to Save the Life of General Douglas MacArthur.

General Douglas MacArthur was a towering public figure on an international stage for the first half of the 20th century. He was healthy throughout his life but developed a series of medical problems when he entered his 80s. This article reviews the General's medical care during two separate life-threatening medical crises that required surgical intervention. The first episode occurred in 1960 when MacArthur presented with renal failure due to an obstructed prostate. Four years later after his 84th birthday, MacArthur developed bile duct obstruction from common duct stones. He underwent an uncomplicated cholecystectomy and common duct exploration but developed variceal bleeding requiring an emergent splenorenal shunt. His terminal event was precipitated by strangulated bowel in long-ignored very large inguinal hernias. MacArthur died, despite state-of-the-art surgical intervention, due to renal failure and hepatic coma.

Variação anatômica venosa rara em membros inferiores / A rare venous anatomic variation of the lower limb

Resumo A anatomia do sistema venoso dos membros inferiores é uma das mais complexas no corpo humano. Devido a essa condição, é de extrema importância saber identificar variações que possam acometê-la, como as malformações congênitas. Em casos de agenesia de veias profundas, como uma malformação vascular rara, o quadro clínico pode manifestar-se com insuficiência venosa crônica, que pode evoluir com edema, hiperpigmentação e úlcera de membro inferior. Assim, em muitos casos, torna-se uma doença incapacitante e de difícil tratamento. Apresenta-se um caso de agenesia de segmento venoso femoropoplíteo no membro inferior direito em paciente de 36 anos de idade, que cursou com edema e varizes de grosso calibre no membro acometido.

Abstract The anatomy of the venous system of the lower limbs is among the most complex in the human body. In view of this, it is extremely important to know how to identify variations that can affect it, such as congenital malformations, for example. In cases of a rare vascular malformation such as agenesis of deep veins, clinical status may manifest with chronic venous insufficiency, which can progress with edema, hyperpigmentation, and lower limb ulcers. This is very often therefore an incapacitating disease that is difficult to treat. This article describes a case of agenesis of a segment of femoropopliteal vein in the right lower limb of a 36-year-old patient who had edema and large caliber varicose veins in the affected limb.

La vena lo soporta todo / The vein withstands all

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Varicose veins: a critical review of the definition and the therapeutical options.

This review intends to give an overview of the present therapeutic options for varicose vein disease. The definition of varicose vein disease and its recurrence are made and discussed with new aspects including duplexsonography assessment. All therapeutic approaches have developed and refined their treatment modalities, the open surgical as well as the endovenous techniques. In particular the “new” endovenous techniques are described with regard to safety and outcome, the published literature in this respect is summarized. The studies comparing the different techniques are listed, the prospective long term studies comparing the new techniques with the so called gold standard (open surgery) shall decide on the fate of the different techniques.

Historical overview of varicose vein surgery.

Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical procedures. The history of varicose vein surgery has been traced. We note the first descriptions of varicose veins, and we particularly focus on the ligation of the saphenofemoral junction, stripping of the great saphenous veins, phlebectomy, and perforant vein surgery. We end with the rapid rise of minimally invasive procedures, such as foam sclerotherapy, radiofrequency ablation, and endovenous lasertherapy. Within 10 years, the advantages of minimal invasiveness for these procedures, combined with claims of equivalent short-term outcomes and even better long-term results, have already influenced our everyday practice. At present, the gold standard treatment of varicose veins still is surgical ligation and stripping of the insufficient vein. Concomitantly or sequentially with the treatment of truncal insufficiency, residual varicosities can be treated by phlebectomy. New minimally invasive techniques, however, have changed the clinical landscape for varicose vein surgery tremendously. The dramatic changes of the last decade are probably the precursors of the next generation.

Catheter-directed sclerotherapy.

BACKGROUND: Catheter directed sclerotherapy (CDS) involves the use of a long catheter to deliver a sclerosing agent into a target vessel (saphenous trunks or venous malformations) under ultrasound guidance. Aims and Methods This article reviews the history, current techniques and devices and the evidence as it relates to these procedures. RESULTS: CDS was developed to increase the safety and efficacy of ultrasound-guided sclerotherapy (UGS). With the advent of foam sclerosants and tumescent anaesthesia, the procedure has enjoyed a higher primary success rate. CDS has a better safety profile when compared with UGS with virtually no risk of intra-arterial injection or sclerosant extravasation. Compared with endovenous laser (EVLA) and radiofrequency ablation (RFA), CDS is a quicker procedure with less associated pain. Some balloon catheters, however, have been found to force the sclerosant down the perforators causing femoral vein occlusion. Based on the current level of evidence, no firm conclusion regarding the efficacy of CDS techniques can be drawn in comparison with EVLA or RFA, but the primary success rate is probably higher than the standard UGS. CONCLUSION: CDS ensures a safe intraluminal delivery of the sclerosing agent into the trunk of the saphenous veins using a single access point. This procedure preceded EVLA and RFA, and remains a safe alternative for the treatment of saphenous incompetence and venous malformations.

Varicose veins: Hippocrates to Jerry Moore.

Seven volumes from the Cowlishaw Collection were selected for review. The authors highlight the evolution of treatment of venous diseases from the ancient Greek times to the modern day through the writings of Hippocrates, Ambroise Pare, Richard Wiseman and other famous physicians of the past. An important Australian contribution by Jerry Moore is described in detail. Jerry Moore introduced 'high ligation' of the great saphenous vein late in the nineteenth century by modifying Trendelenburg's original procedure. The operation withstood the test of time and it is performed today according to his recommendations.

[Surgical treatment of the lower extremities varicose veins throughout the ages]. / Zabiegowe leczenie zylaków konczyn dolnych na przestrzeni wieków.

The authors describe a historical review of surgical treatment of varicose veins from antiques to modern methods. Diseases of the veins have been recognized and attempts of their surgical resection have been described since antiquity. Hippocrates wrote about surgical treatment of varicose veins, Celsus and also Galien himself described varicose veins ligatures. The end of 19th century with Trendelenburg and Madelung was a start of modern period of varicose vein surgery. Parallel to surgical the less invasive methods of varicose veins treatment developed and gave a base for modern sclerotherapy.

[Historical review of opinions on the nature of varicose veins and leg ulcers and their treatment]. / Historický prehled názoru na povahu a lécení varixu a bércových vredu.

The development and changes of opinions concerning the nature and treatment od varicose veins and varicose ulcers are summarized in this article covering a long period from the Greek antiquity till the 20th century. Whereas in the ancient times (Hippokrates, Celsus, Galen) the meanings did not contradict the contemporaneous knowledge, curious opinions dominated from the 11th till the half of the 19th century, obviously influenced by the humoral theory of Avicenna. The official teaching claimed that black bile and other bad humours collected in varicose veins. Bandaging was thought to push back these humours into the body and cause madness or other serious illness and, therefore, was refused. On the contrary, ulcers were considered to be a favourable condition because their function was to drain the bad humours. The fundamentals of modern surgical treatment of varicose veins were presented by Madelung, Trendelenburg and Babcock at the end of the 19th and the beginning of the 20th century. Trendelenburg deserves acknoledgement of having introduced physiological and pathophysiological reasoning into the field of phlebology. The conception of the role of incompetent calf perforators for the development of leg ulcers advocated by Cockett and others represents a derailment on the way of evidence based medicine. The substance of this theory, although supported by most autors till the present time, have been repeatedly confuted by exact hemodynamic measurements. Evidence based medicine whose basement was laid by Trendelenburg more than 100 years ago cuts a difficult way through the field of phlebology.

Surgery on varicose veins in the early Ottoman period performed by Serefeddin Sabuncuoglu.

Serefeddin Sabuncuoglu, a pioneer of surgery, is known to be the author of first illustrated surgery textbook, Cerrahiyyetu'l Haniyye (Imperial Surgery), which was written in Turkish in 1465 AD at the age of 80 years. The purpose of this article is to describe his contributions to varicose vein surgery. In addition to vascular surgery, Serefeddin Sabuncuoglu was interested in a wide range of surgical specialities including thoracic surgery, general surgery, pediatric surgery, ophthalmology, orthopedic surgery, urologic surgery, and obstetrics and gynecology. His book was the first illustrated textbook of surgery in the Turkish medical literature, containing color illustrations of surgical procedures, incisions, and instruments. The book has been known of for only the past 60 years. There are 137 different medical observations and recommendations in Cerrahiyyetu'l Haniyye, along with translated passages from the works of Ebu Kasim-ul Zahravi (Albucasis), Al-Tasrif (Textbook of Surgery), including Sabuncuoglu's additional original contributions. In chapter 90 of the book, Sabuncuoglu describes lower extremity varices and their surgical treatment and provides a few color illustrations. Although not recognized and rewarded in his time, Serefeddin Sabuncuoglu was a great surgeon in Turkish-Islamic medical history. This review demonstrates that his textbook, Cerrahiyyetu'l Haniyye, was the first illustrated textbook including various surgical procedures, incisions, and instruments of varicose vein surgery.

[Improvement of pharmacological and surgical methods and techniques for the treatment of varicose disease]. / Sovershenstvovanie farmakokhirurgicheskikh metodov i tekhnicheskikh sredstv lecheniia varikoznoi bolezni.

Information about a surgical treatment of the varicose disease, its description, and the results of practical application, specific features, used drugs and technical appliances is reported. The remote results are indicative of a sufficiently high efficacy of the offered method.