The CHIVA strategy applied to large-diameter saphenous veins.

BACKGROUND: CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified two-stage strategy is used in patients with a great saphenous vein (GSV) diameter ≥9 mm with the goal to decrease the risk of symptomatic superficial vein thrombosis (SVT), as the risk of complications is higher when first and second stage is performed simultaneously. METHODS: We conducted a retrospective observational study of 111 patients with CVD and a GVS diameter ≥9 mm treated with two possible stages of the CHIVA strategy, between January 2010 and December 2019. The goal of the first stage was to interrupt the main reflux escape point (incompetent saphenofemoral junction), thereby lowering the venous pressure and achieving a sufficient reduction in GSV diameter to enable, if necessary, a second stage that consists of disconnection of secondary reflux exit point (incompetent saphenous tributaries), with a lower risk of symptomatic SVT when patients do not show significant clinical improvement. Reductions in GSV diameter, postoperative complications and clinical improvement were analyzed. RESULTS: There were 60 men (54.1%) and 51 women (45.9%) with a mean age of 57±11.9 years. All patients undergone first surgical stage, and this interruption of the saphenofemoral junction was the single procedure in 77.5% of cases (86 patients). Mean follow-up time was 19.8 months. The second stage was performed in 25 patients (22.5%). Mean preoperative GSV diameter was 10.2±1.1 mm and this decreased to 7.1±1.5 mm after the first surgery (mean reduction, 3±1.5 mm, P<0.001). Six patients (5.4%) experienced recurrence due to recanalization of the reflux point and 16 patients (14.4%) developed SVT, which was symptomatic in 12 cases (10.8%). CONCLUSIONS: Interruption of the main reflux escape point as a single procedure in patients with a GSV diameter ≥9 mm led to a significant reduction in diameter and sufficient clinical improvement in almost 80% of cases.

Guías de diagnóstico de la enfermedad cerebrovascular extracraneal / Diagnostic guidelines for extracranial cerebrovascular disease

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Hábitos quirúrgicos de los cirujanos zurdos / The surgical habits of left-handed surgeons

Objetivos. Interrogar al personal quirúrgico, médico y de enfermería sobre su conocimiento de los distintos hábitos quirúrgicos de los cirujanos zurdos, sus posibles problemas de adaptación, así como sobre las posibilidades de complementariedad que puede suponer operar con un cirujano zurdo. Sujetos y métodos. Entre enero y mayo de 2003 se encuestó a 145 médicos cirujanos y a 17 enfermeros instrumentistas. La encuesta se componía de 15 preguntas con respuestas múltiples. Se realizó un análisis descriptivo de las respuestas y se comprobó si existían diferencias estadísticamente significativas entre las respuestas de los distintos grupos con el test de chi al cuadrado. Resultados. La muestra presenta igual prevalencia de cirujanos zurdos y ambidextros (6,2% frente a 6,8%). El 100% de la enfermería instrumentista y el 72% de los cirujanos de staff han instrumentado o ayudado a un cirujano zurdo. El 93% de los encuestados opina que los cirujanos zurdos operan igual que los diestros. El 65% opina que el instrumental estándar no es igualmente útil para diestros y zurdos. El 45% de los encuestados desconoce la existencia de instrumental específico para zurdos, si bien el 80% cree que mejoraría su capacidad quirúrgica. Es opinión mayoritaria que la implementación de material específico para zurdos no se produce por problemas de costes. Conclusiones. Existe un desconocimiento notable de la problemática del cirujano zurdo, y no se valoran las posibles ventajas que puede aportar su ayuda. La implementación de instrumental diseñado para cirujanos zurdos sería, en opinión general, una ayuda valiosa (AU)

Aims. To question members of surgical, medical and nursing staff about their knowledge of the different surgical habits of left-handed surgeons, the possible problems they may have as regards adaptation, and also about the chances of complementarity that may be required when operating with a left-handed surgeon. Subjects and methods. Between January and May 2003 a survey was conducted on 145 surgeons and 17 instrument nurses. The survey consisted of 15 questions with multiple-choice answers. Responses were submitted to a descriptive analysis and the chi squared test was use to determine whether there were statistically significant differences between the answers given by the different groups. Results. The prevalence of left-handed and ambidextrous surgeons in the sample was the same (6.2% versus 6.8%). 100% of the instrument nurses and 72% of the staff surgeons have assisted or acted as scrub nurses with a left-handed surgeon. 93% of the respondents stated that left-handed surgeons operate in the same way as their right-handed colleagues. 65% said that standard instruments are not as easy to use for left- and right-handers. 45% of the respondents did not know that there are instruments specifically designed for left-handed users, although 80% thought that they would improve their surgical capacity. The majority said that specific left-handed material was not implemented due to the extra cost involved. Conclusions. The problems left-handed surgeons face are something that is largely unknown and the possible advantages that could be gained by helping them are not taken into account. In general respondents thought that implementing instruments designed for left-handed surgeons would be a valuable aid (AU)