Endovenous radiofrequency ablation for the treatment of varicose veins.

Varicose veins are a common condition that can be treated surgically. Available operative modalities include saphenous venous ligation and stripping, phlebectomy, endovenous laser therapy and radiofrequency ablation. Radiofrequency ablation is the newest of these technologies, and to our knowledge our group was the first to use it in Canada. Our experience suggests that it is a safe and effective treatment for varicose veins, with high levels of patient satisfaction reported at short-term follow-up. More studies are needed to assess long-term effectiveness and compare the various available treatment options for varicose veins.

A single center study of clinical success in radiocephalic fistula creation.

PURPOSE: To compare standard methods (control) with a new protocol for radiocephalic fistula (RCF) creation involving ultrasound vein mapping by the surgeon in the operating room, ligation of cephalic vein branches in the lower forearm, and use of a tourniquet for the arteriovenous anastomosis. METHODS: This is a retrospective cohort study of patients who underwent radiocephalic fistula creation between April 2008 and March 2010 in a regional vascular center. Patients were identified retrospectively by reviewing hospital operating room and office billing records. The electronic charts of all patients were reviewed. The primary endpoint was functional RCF patency at last follow-up. RESULTS: A total of 118 patients underwent arteriovenous (AV) fistula creation by 3 surgeons during the two-year study period. Of these, 59 patients underwent RCF creation, 33 of whom were managed using the new protocol. The two groups were comparable, except for age (66 in the study group vs. 60 in the control group, P=.04). Tourniquet use shortened operative time from 48 to 36 minutes (P=.04). Functional patency was 82% vs 77% (P=.64). CONCLUSION: The new protocol for RCF creation results in shorter operative times and high functional patency rates.

Heparin-induced thrombocytopenia and endovascular procedures: report of two cases / Trombocitopenia induzida por heparina e tratamento endovascular: relato de dois casos

Heparin-induced thrombocytopenia (HIT) is a transient disorder caused by platelet-activating antibodies against platelet factor 4 (PF4)-heparin complexes. Clinically it translates into arterial or venous thrombosis and carries high morbidity and mortality. The use of large doses of heparin during endovascular repair of abdominal aortic aneurysm could increase the incidence of HIT. We report two cases associating the use of heparin during endovascular repair of abdominal aortic aneurysm with the development of HIT.

Trombocitopenia induzida por heparina (TIH) é um distúrbio transitório causado pela ativação de anticorpos anti-plaquetários contra o fator plaquetário 4 (FP4) combinado com a molécula de heparina, formando complexos que clinicamente se traduzem em tromboses arteriais ou venosas com alta morbimortalidade. O uso de altas doses de heparina durante procedimentos endovasculares para o tratamento de aneurisma de aorta abdominal pode aumentar a incidência de TIH. Relatamos dois casos em que o uso de heparina durante tratamento endovascular de aneurisma de aorta abdominal estava associado ao aparecimento de TIH.

Tibial angioplasty for limb salvage in high-risk patients and cost analysis.

BACKGROUND: We examined the efficacy and cost of tibial angioplasty in patients with critical limb ischemia (CLI) at high operative risk. METHODS: A retrospective analysis of all consecutive patients who underwent tibial angioplasty with critical ischemia Rutherford class 4 and 5 from January 2001 to April 2007 was performed. Demographic information, presentation, and angiographic characteristics of the lesions were analyzed. The primary end point was freedom from major amputation. Secondary end points were overall survival and recurrence. Cost comparison was performed between the endovascular group and a matched group of high-risk patients submitted to femoral tibial bypass in the same period. RESULTS: Forty-five patients, with mean age of 69.6 years and a 2.5:1 (male:female) ratio, had 49 limbs treated. The mean follow-up was 7.7 months (range 1-61.5). Eighty percent of the patients were Rutherford class 5. Incidence rates were as follows: diabetes 90%, chronic renal failure 73%, end-stage renal disease (ESRD) on hemodialysis 45%, and coronary disease 69%. Single vessel run-off to the foot was present in 57% of patients and complete occlusion of all tibial vessels in 12%. Only the tibial vessels were angioplastied in 55% of patients. Angiographic success rate was 84%. Thirty-day mortality was 2% and major complications occurred in 6.1%. A poor angiographic result was a statistically significant predictor (p = 0.009) of symptomatic recurrence (43%) (worsening of preexisting symptoms and/or signs or new ones). Cardiac disease was the major cause of mortality beyond 30 days (12.5%). Freedom from major amputation in the entire group was 75.5%, with no difference between tibial and diffuse infrainguinal angioplasty (p = 0.61). Recurrence, especially early recurrence, was a significant predictor of amputation (p = 0.04 and p = 0.0008, respectively). There was a trend toward presence of ESRD and recurrence (p = 0.06). Both average hospital cost ($2,910.60 vs. $17,703.50) and length-of-stay (LOS) (<1 vs. 9 days) were significantly reduced in the angioplasty group (p < 0.0001). CONCLUSION: Tibial angioplasty has acceptable rates of limb salvage in patients with CLI considered to be at high risk for surgery, despite high recurrence rates. The presence of diabetes or ESRD did not reduce the rate of success in this series, although ESRD seemed to predict recurrence. The procedure has low morbidity and mortality with lower cost and LOS compared with open revascularization. Aggressive angioplasty should be an option to patients who otherwise would face primary amputation.