Posture commonly and considerably modifies stenosis of left common iliac and left renal veins in women diagnosed with pelvic venous disorder.

OBJECTIVE: Pelvic venous incompetence or pelvic congestion syndrome (commonly referred to as pelvic venous disorder [PVD]) is increasingly diagnosed, especially in multiparous women. This may be either primary or secondary to pelvic venous outflow obstruction-left common iliac vein (LCIV) or left renal vein (LRV) stenosis. Intravascular ultrasound (IVUS) examination performed in the supine position is commonly used for diagnosis of LRV and LCIV stenosis; however, body position may affect the cross-sectional area (CSA) of both of these veins during IVUS. The aim of the study was to test the hypothesis that postural changes may significantly affect the CSA of the LRV and LCIV. METHODS: A single-arm, single-center cohort study of women suffering from PVD was performed at a tertiary hospital in Poland. It comprised consecutive patients with either pelvic vein reflux or suggestion of LCIV or LRV obstruction but no signs of deep venous thrombosis. IVUS examination of the iliac veins, inferior vena cava, and LRV was performed in the supine position. IVUS of the LRV and LCIV was performed also with a Valsalva maneuver and with patients lying on the left side and standing. A 60% CSA reduction was used as a cutoff value between significant and nonsignificant vein stenosis. RESULTS: A total of 41 women were examined. Significant stenosis of the LRV was seen in 22 patients (55%) supine but in only 4 (10%) patients studied when lying on the left side and in 27 (67.5%) patients studied while standing. Significant stenosis of the LCIV was seen in 26 supine patients (63.4%), in 8 lying on the left side (19.5%), and in 10 (24.4%) standing. CONCLUSIONS: Postural changes dramatically affect CSA of the LCIV and LRV and thus the degree of stenosis in women diagnosed with PVD. Stenosis found in patients while supine often disappears when the position is changed to lying on the left side or to standing. Therapeutic decisions based on assessment of CSA reduction in the supine position are likely to be inadequate.

Clinical assessment of a foam dressing containing growth factor-enhancing hydrated polyurethanes.

OBJECTIVE: This study assesses a novel dressing concept in venous leg ulcer (VLU) patients. It is based on boosting endogenous growth factor activities synthesised by functional granulation tissue. METHODS: Patients received treatment for eight weeks with a hydrated polyurethane-containing foam dressing plus concomitant compression therapy. Wound area reduction (WAR), percentage of wounds achieving a relative WAR of ≥40% and ≥60%, wound pain ratings for the last 24 hours and at dressing changes, EQ-5D Quality of Life questionnaire data, dressing handling and safety parameters were recorded. RESULTS: There were 128 patients who received treatment and data for 123 wound treatment courses were documented. Wound area size decreased from 13.3±9.8cm2 to 10.5±12.2cm2 at week eight and median relative WAR was 48.8%. At week eight, a relative WAR ≥40% was reached by 54.5% of the wounds, 41.5% reached a relative WAR of ≥60% and complete healing was observed in 13.5% of wounds. Median wound pain ratings (last 24 hours before dressing change) declined significantly from 30 to 15.5 (100 visual analogue scale [VAS], p=0.0001) and pain at dressing changes from 30 to 12.5 (p≤0.0001). The EQ-5D VAS rating increased from 58.4±19.2mm to 63.1±19.1mm (p=0.0059). CONCLUSION: This clinical assessment shows that the concept of boosting endogenous growth factors through hydrated polyurethanes has the potential to accelerate WAR in VLU patients while decreasing pain levels and improving quality of life parameters.

Patients' satisfaction with therapy methods of advanced chronic venous disease.

BACKGROUND: To assess patients' satisfaction from the therapy of advanced chronic venous disorders (CVD) in everyday clinical practice in Poland, and to compare the efficacy of various venoactive drugs (VADs) in venous ulcers healing process. METHODS: Seven hundred and eighty unselected adult patients with active (N.=441) or healed (N.=339) venous ulcers participated in the non-interventional observational 6-week study. RESULTS: Compression therapy and VADs were utilized by 81.5% and 89.2% of patients respectively: 31.2% of all patients underwent surgical procedures for vein incompetence, 61.3% were satisfied with surgical methods, 43% with compression therapy, and 32.6% with VADs ­ with highest rate of satisfied patients in the group taking Ruscus aculeatus and HMC and ascorbic acid (51.4%). Of 377 patients with active venous ulcers smaller than 200 cm2, adherent to VADs, 18.0% have been cured, and 66.6% have improved during 6-week period of observation. Multiple logistic regression analysis revealed that the compression therapy (OR=2.74), the size of ulcer ≤10 cm2 (OR=2.70) were increasing the change of ulcer healing. No VADs was better than another in the healing process. CONCLUSION: 1) Compression therapy and VADs are highly utilized by patients with advanced CVD. 2) Patients are more satisfied with surgical than conservative treatment of advanced CVD. 3) More than half of the patients with the advanced stage CVD taking Ruscus aculeatus and HMC and ascorbic acid is satisfied with the obtained improvement. 4) Ruscus aculeatus and HMC and ascorbic acid is similarly effective as other frequently used VADs in venous ulcer healing. 5) Ruscus aculeatus and HMC and ascorbic acid exerting effects on veins, capillaries and lymphatic vessels may explain the positive results observed in this study.

Varicose veins of lower extremities, hemodynamics and treatment methods.

Chronic venous insufficiency is one of the most common disorders of the vascular system, affecting approximately 50% of adults. If left untreated it can lead to a number of complications, including venous ulceration and venous thrombosis. This review paper outlines the epidemiology and ethiopathogenesis of the disease with regard to hemodynamics and microcirculation disturbances. It describes the medical treatment as well as the traditional surgical approach to varicose veins (with several modifications of this technique), and its limitations and contraindications. Furthermore, it discusses a number of new, minimally invasive treatment methods, namely thermal in form (radiofrequency ablation, endovenous laser ablation, steam ablation) and nonthermal (sclerotherapy, echosclerotherapy, Clarivein, Sapheon). For each method, there is a brief historical overview, a description of its mechanism of action, and its indications and limitations. The results of comparative studies on individual treatment methods as well as meta-analyses on this topic are briefly discussed. This paper highlights the progressive trend towards minimally invasive methods and attempts to predict the further development.

[Simultaneous repair of aortic aneurysm and removal of renal tumor--a report of two cases]. / Jednoczasowe operacje tetniaka aorty i guza nerki--opis dwóch przypadków.

We report two cases of simultaneous operations for abdominal aortic aneurysm and renal tumor. It appears that one-stage surgery does not increase the surgical injury and more importantly, does not increase the risk of graft infection. We believe that the increasing number of diagnosed aneurysms and renal malignancies will increase the number of one-stage operations.