[Color Doppler echography in the diagnosis of deep venous thrombosis of the lower limbs]. / L'ecocolordoppler nella diagnosi della trombosi venosa profonda degli arti inferiori.

Deep venous thrombosis (DVT) is a common and severe disease which can produce a pulmonary embolism as an acute consequence and post-phlebitic syndrome as a late complication. Since DVT symptoms and clinical features are almost no sensitive and specific, its diagnosis is usually achieved by instrumental exams. Until few years ago phlebography was considered the "gold standard" diagnostic test, although its invasivity prevented it from becoming routinely used in symptomatic and non-symptomatic patients. The aim of our study was to emphasize the usefulness of echo color Doppler (ECD), a non-invasive method, as a first-choice exam to diagnose and manage the therapy of DVT symptomatic patients and to address an early diagnosis in high risk non-symptomatic patients. We studied 375 patients, aged from 13 months to 92 years. In most of the cases patients were seen because suffering from DVT symptoms, after surgery, or because suspected to have a pulmonary embolism. All the patients underwent a venous ECD of the lower limbs, whereas 16 of them had also a phlebography. ECD disclosed an acute DVT in 15% of the patients and a chronic DVT in 3% of them, whereas 17% of the cases were diagnosed as having other pathologies which can clinically mimic a DVT. ECD sensitivity and specificity is higher than that of other exams, both invasive and non invasive, as it allows a thorough assessment of both iliac and distal vessels, a better detection of non-occluding wall thrombi, and has been found to be very helpful in the evaluation of chronic DVT changes.

Duplex ultrasound diagnosis of symptomatic proximal deep vein thrombosis of lower limbs.

Real time ultrasound (US) was used to examine 165 consecutive inpatients with clinically suspected deep vein thrombosis of lower limbs. In order to evaluate accuracy, the results of non-invasive techniques were compared with ascending venography, performed in all patients. Assessment included only femoro-popliteal veins, because of difficulty in visualizing calf vein with US. Diagnosis of thrombosis was based on noncompressibility of the examined veins; pulsed Doppler provided further information by evaluating blood flow. In our series Duplex ultrasound was very accurate in detecting acute thrombosis of the proximal veins, sensitivity being 97% and specificity 98%. With US it is also possible to detect conditions that mimic deep vein thrombosis, such as muscular rupture, hematoma, popliteal cyst or compressive tumors. In conclusion US is considered a valid alternative to contrast venography in the diagnosis of proximal vein thrombosis of lower limbs.

[Recanalization with laser and angioplasty of atherosclerotic lesions of the legs. Personal experience with 31 treated lesions]. / Ricanalizzazione mediante laser ed angioplastica nelle lesioni aterosclerotiche degli arti inferiori. Esperienza personale su 31 lesioni trattate.

From January to November 1989, 31 iliac and femoro-popliteal atherosclerotic lesions were treated in 29 patients (age range: 33-80 years) by means of percutaneous laser-assisted angioplasty. The lesions were 6 iliac tubular stenoses, 6 iliac occlusions and 19 femoro-popliteal occlusions, 2-20 cm long. The laser equipment employed was in 10 cases a Cardiolase 4000 Nd:YAG "hot tip" unit, and in 21 cases a Nd:YAG "sapphire contact probe" unit. Initial success was achieved in 23/31 lesions (74%); the follow-up, by clinical examination, Doppler US, and ankle-arm pressure index performed every 4th month, showed 1-year actuarial patency of 80% for femoro-popliteal occlusion and 100% for iliac lesion, with 87% cumulative patency. Overall complication rate was 22.5%. There were 6 local complications, 4 of which were hematomas at the arterial puncture site, and 2 were performation of the superficial femoral artery, all without any clinical sequelae; one patient developed rethrombosis within 72 hours from treatment, which needed amputation after an emergency bypass. Our preliminary results show no significant improvement when compared with conventional balloon angioplasty results both in immediate success rate and in short-to-midterm patency; furthermore, laser therapy was burdened by a higher complication rate. We believe that laser angioplasty should be employed only in arterial occlusion uncrossable with angiographic guidance alone.

Transinguinal dissection of the femoral artery for aorto-bifemoral bypass.

The authors report a surgical technique for high approach to the common femoral artery, just below the inguinal ligament, which can be useful in cases of difficult dissection of the femoral region or those with diffuse fibrosis or multiple scars. It is also useful when there is a concomitant inguinal hernia to repair.

[Ultrasonography in the diagnosis of deep venous thrombosis of the legs]. / Gli ultrasuoni nella diagnosi di trombosi venosa profonda dell'arto inferiore.

One hundred consecutive inpatients with clinically suspected deep venous thrombosis (DVT) were examined by US; the last 19 cases were studied also by means of color-Doppler US. In order to evaluate the method reliability, US results were compared with those obtained with contrast venography, which was performed on all patients. The studied region included the femoro-popliteal vein, while no attempt was made to image the calf veins, which are difficult to evaluate with US. In our series, venographic results were in substantial agreement with US findings, with 99% and 100% sensitivity and specificity, respectively. Diagnosis was based only on noncompressibility of the thrombotic vein, despite the absence of visible clots; pulsed Doppler information supported diagnosis by evaluating blood flow. Further diagnostic progress was provided by color-Doppler US, which allows flow lumen to be defined in color. US also allowed the detection of the conditions mimicking DVT, such as muscular ruptures, hematomas, popliteal cysts, or compressive tumors. In conclusion, US and color-Doppler US prove to be valid alternatives to contrast venography in the diagnosis of proximal DVT of the lower limbs.

[Fractures of the pelvis and associated abdominal lesions]. / Fratture del bacino e lesioni addominali associate.

106 cases of pelvic fracture and blunt abdominal trauma are reported and relationships between type of fracture, associated lesions and prognosis assessed. The presence of associated lesions, with the exception of urologic types, would appear to be correlated to the extent and prevalent application site of the trauma rather than to fracture morphology. The prognosis for patients with pelvic fractures is related to the frequency of associated lesions of intra-abdominal viscera and urological or retroperitoneal vascular structures.