Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results.

OBJECTIVES: to compare Transilluminated Powered Phlebectomy (TIPP) (TriVex System) with Muller's hook phlebectomy. MATERIALS AND METHODS: between January and April 2001, 40 patients (group 1) undergoing TIPP were non-randomly compared to 40 patients undergoing Muller's hook phlebectomy (group 2) in the course of conventional vein stripping and perforator ligation. All patients had at least C2 CEAP disease. RESULTS: hospital stay averaged 2 days (range 1-3 days; median 2 days) and was similar for the two groups. TIPP took significantly longer (56+/-12 vs 45+/-10 min, p<0.001) but was associated with significantly fewer incisions (6 [2-8] vs 8 [4-21], p<0.001). The mean pain score (out of 10) at 2 and 7 days and 6 weeks was 5, 2 and zero after TIPP and 4, 2 and zero after hook phlebectomy. The incidence of postoperative haematoma formation was significantly higher after TIPP (45 vs 25%, p=0.06), especially in the calf region (25 vs 2.5%,p =0.003). CONCLUSION: TIPP was slower (although speed increased with practice) associated with more haematoma (although this reduced with practice) and fewer incisions. In other respects (pain, cosmetic satisfaction, other complications, residual varices) it was not significantly different from hook phlebectomy. Greater clinical experience with the technique and randomized studies are required to determine whether TIPP is a valuable addition to our armamentarium.

Balloon-expandable endobypass for femoropopliteal atherosclerotic occlusive disease. A preliminary evaluation of fifty-five patients.

PURPOSE: The purpose of this study was to evaluate the early results of a newly developed endovascular technique for the treatment of superficial femoral artery occlusion. METHODS: Fifty-five patients with total occlusion of the superficial femoral artery with patent popliteal artery were treated and evaluated over a 21-month period. The endovascular treatment was performed through a groin incision and consisted of a recanalization of the occluded femoral artery, balloon dilatation, and intraluminal placement of a 3-mm polytetrafluoroethylene graft, distal fixation with a stent, dilation of the graft, and proximal suture anastomosis in the common femoral artery. RESULTS: At a 1-year follow-up the Kaplan-Meier method revealed a primary patency rate of 73.1% (95% confidence limits: 59.6 to 86.6) and a secondary patency rate of 86.3% (range 75.8% to 96.9%). The procedure morbidity rate was 3.6%; the mortality and amputation rate at 12 months was nil. CONCLUSIONS: The early 1-year results of this endovascular study support the concept that femoropopliteal endobypass for atherosclerotic occlusive disease may be an acceptable alternative to classic direct femoropopliteal bypass operations. Further study is necessary.

Traumatic false aneurysm of the superficial temporal artery.

Traumatic false aneurysms of the superficial temporal artery are very infrequent. They usually do not reveal themselves clinically until 1 to 6 weeks after the initial trauma. Diagnostic techniques are echo-doppler, CT-scan and arteriography; treatment is surgical.

The use of the stomach in repairing tracheal leaks after resection of the oesophagus for carcinoma.

A 44-year old male with carcinoma of the upper third of the oesophagus and invasion of the trachea recently underwent surgical treatment at our institution. After oesophageal resection tracheal and main bronchial leaks were unsuccessfully closed with pleural patches. The stomach was subsequently used to seal the remaining leaks. The post-operative recovery was uneventful and the patient was discharged after a hospital stay of 41 days.

Adequate global myocardial perfusion provided by a left internal mammary artery. A case report.

We report a 57-year-old patient who developed a significant stenosis in a proximal anastomosis after CABG. Reconstruction was carried out with the left internal mammary artery which provided the global myocardial perfusion with an excellent longterm functional result.