293 results on '"Bergan JJ"'
Search Results
2. Nomenclature of the veins of the lower limbs: An international interdisciplinary consensus statement
- Author
-
Caggiati, A., Bergan, Jj, Gloviczki, P, Jantet, G, WENDELL SMITH CP, Partsch, H, and INTERNATIONAL INTERDISCIPLINARY CONSENSUS COMMITTEE ON VENUS ANATOMICAL TERMINOLOGY
- Subjects
Leg ,medicine.medical_specialty ,anatomy ,business.industry ,Statement (logic) ,Terminologia Anatomica ,Library science ,veins ,lower limbs ,Lower limb ,Terminology ,Surgery ,medicine.anatomical_structure ,Terminology as Topic ,terminology ,Humans ,Medicine ,Federative International Committee on Anatomical Terminology ,business ,Medical science ,Vein ,Cardiology and Cardiovascular Medicine ,Nomenclature - Abstract
An agreement on anatomic terminology is the foundation for a common language in medical science and for an effective exchange of information. A thorough review of the literature has shown need for revision and extension of the official terminologia anatomica with regard to the veins of the lower limb. The foundation of this consensus document was laid by the faculty at a precongress meeting of The Fourteenth World Congress of the International Union of Phlebology (IUP), held in Rome on September 8-9, 2001, under the auspices of the IUP, the International Federation of Associations of Anatomists (IFAA), and the Federative International Committee on Anatomical Terminology (FICAT). The official names of some veins have been changed according to the guidelines of the FICAT. In addition, previously unnamed veins have received names relevant to their anatomy and clinical significance. Some of the terminology recommendations are innovative, but were judged to be correct by members of the committee. (J Vasc Surg 2002;36:416-22.)
- Published
- 2002
- Full Text
- View/download PDF
3. Mechanisms of disease: chronic venous disease.
- Author
-
Bergan JJ, Schmid-Schönbein GW, Smith PDC, Nicolaides AN, Boisseau MR, and Eklof B
- Published
- 2006
4. Non-elastic compression: an alternative in management of chronic venous insufficiency.
- Author
-
Bergan JJ, Sparks SR, and Pieper B
- Published
- 2000
- Full Text
- View/download PDF
5. There is no second
- Author
-
Bergan Jj
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Presidential address ,Medicine ,Surgery ,Vascular surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 1984
6. EXPERIMENTAL PANCREAS TRANSPLANTATION
- Author
-
Bergan Jj and Teixeira Ed
- Subjects
Blood Glucose ,Male ,Transplantation ,Pathology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Glucose Tolerance Test ,Pancreas transplantation ,Hypoglycemia ,Insulin Antagonists ,Dogs ,Pancreatitis ,Amylases ,Endopeptidases ,Insulin Secretion ,medicine ,Animals ,Insulin ,Transplantation, Homologous ,Female ,Pancreas Transplantation ,Tissue Preservation ,business ,Pancreas - Published
- 1967
7. STAPLER FOR A-V ANASTOMOSIS
- Author
-
K. Inokuchi, Kahan Bd, Peter Ivanovich, Bergan Jj, K. Ono, and S. Someya
- Subjects
Biomaterials ,medicine.medical_specialty ,business.industry ,Biomedical Engineering ,Biophysics ,medicine ,Vascular access ,Bioengineering ,General Medicine ,Anastomosis ,business ,Surgery - Published
- 1977
8. Donor HL-A incompatibility and lymphocytotoxic antibody response in human renal allotransplantation
- Author
-
Kakan Bd, Mittal Kk, and Bergan Jj
- Subjects
Graft Rejection ,medicine.medical_treatment ,Lymphocytotoxic antibody ,Antigen-Antibody Reactions ,Epitopes ,Antigen ,Antibody Specificity ,hemic and lymphatic diseases ,Histocompatibility Antigens ,medicine ,Humans ,Transplantation, Homologous ,Antilymphocyte Serum ,Renal allotransplantation ,Transplantation ,biology ,business.industry ,Histocompatibility Testing ,Circulating antibodies ,Cytotoxicity Tests, Immunologic ,Kidney Transplantation ,Tissue Donors ,surgical procedures, operative ,Immunology ,Renal allograft ,biology.protein ,Antibody ,business ,Allotransplantation - Abstract
When 81 recipients of primary renal allografts were examined for the influence of donor HL-A incompatibilities (DIC) on the survival of allografts, an association was found between greater DIC and not only an increased loss of allografts in the 1st year, but also a decreased survival of transplants in the subsequent years. However, three allografts with no DIC were rejected, whereas nine others with three to four imcompatibilities have functioned well for 1-5 years. A surprisingly high proportion (52%) of 81 renal allograft recipients produced lymphocytotoxic antibodies which lack HL-A specificity but apparently detect a polymorphic antigenic system on normal human lymphocytes. Only three patients who rejected the allografts made detectable circulating antibodies specific to DIC. However, when patients received grafts with fewer DIC, there was a greater number of no antibody or low frequency antibody producers, whereas with a greater number of DIC there was an increased occurrence of high frequency antibody producers. These results suggest that HL-A as well as non-HL-A systems may play a significant role in the success of allotransplantation. Although the presence of non-HL-A antibodies was not always associated with allograft loss, further characterization of these antibodies may reveal a new genetic system(s).
- Published
- 1975
9. Invited commentary
- Author
-
Bergan Jj
- Subjects
medicine.medical_specialty ,Mesenteric infarction ,Text mining ,business.industry ,General surgery ,Medicine ,Surgery ,business - Published
- 1979
10. Women's dermatology from infancy to maturity.
- Author
-
Goldman, MP, Bergan, JJ., Dawber, R, Bristow, I, Turner, W, and Wolverton, SE
- Subjects
- *
SKIN diseases , *PUBLISHING - Abstract
Presents several books on cutaneous pathology. 'Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins,' by M.P. Goldman and J.J. Bergan; 'Text Atlas of Pediatric Dermatology,' by R. Dawber, I. Bristow and W. Turner; 'Comprehensive Dermatology Drug Therapy,' by S.E. Wolverton.
- Published
- 2001
- Full Text
- View/download PDF
11. Pneumatic compression therapy available in the home care setting.
- Author
-
Hebron P and Bergan JJ
- Published
- 2000
- Full Text
- View/download PDF
12. Acute venous occlusion enhances matrix metalloprotease activity: Implications on endothelial dysfunction.
- Author
-
Alsaigh T, Pocock ES, Bergan JJ, and Schmid-Schönbein GW
- Subjects
- Animals, Biocatalysis drug effects, Dipeptides pharmacology, Endothelial Cells enzymology, Endothelial Cells metabolism, Endothelium, Vascular metabolism, Hypertension enzymology, Hypertension metabolism, Hypertension physiopathology, Leukocytes enzymology, Male, Matrix Metalloproteinase 1 metabolism, Matrix Metalloproteinase 2 metabolism, Matrix Metalloproteinase 3 metabolism, Matrix Metalloproteinase 8 metabolism, Matrix Metalloproteinase 9 metabolism, Matrix Metalloproteinase Inhibitors, Mesenteric Vascular Occlusion metabolism, Mesenteric Vascular Occlusion physiopathology, Mesenteric Veins metabolism, Mesenteric Veins physiopathology, Rats, Rats, Wistar, Reperfusion, Tissue Inhibitor of Metalloproteinase-1 metabolism, Tissue Inhibitor of Metalloproteinase-2 metabolism, Vascular Endothelial Growth Factor Receptor-2 metabolism, Venules enzymology, Venules metabolism, Venules physiopathology, Endothelium, Vascular enzymology, Endothelium, Vascular physiopathology, Matrix Metalloproteinases metabolism, Mesenteric Vascular Occlusion enzymology, Mesenteric Veins enzymology
- Abstract
Venous hypertension is associated with microvascular inflammation, restructuring, and apoptosis, but the cellular and molecular mechanisms underlying these events remain uncertain. In the present study, we tested the hypothesis that elevated venous pressure and reduction of shear stress induce elevated enzymatic activity. This activity in turn may affect endothelial surface receptors and promote their dysfunction. Using a rodent model for venous hypertension using acute venular occlusion, microzymographic techniques for enzyme detection, and immunohistochemistry for receptor labeling, we found increased activity of the matrix metalloproteases (MMPs) -1, -8, and -9 and tissue inhibitors of metalloproteases (TIMPs) -1 and -2 in both high- and low-pressure regions. In this short time frame, we also observed that elevated venule pressure led to two different fates for the vascular endothelial growth factor receptor-2 (VEGFR2); in higher-pressure upstream regions, some animals exhibited higher VEGFR2 expression, while others displayed lower levels upstream compared to their downstream counterparts with lower pressure. VEGFR2 expression was, on average, more pronounced upon application of MMP inhibitor, suggesting possible cleavage of the receptor by activated enzymes in this model. We conclude that venous pressure elevation increases enzymatic activity which may contribute to inflammation and endothelial dysfunction associated with this disease by influencing critical surface receptors., (2010 Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
13. Mechanisms in experimental venous valve failure and their modification by Daflon 500 mg.
- Author
-
Pascarella L, Lulic D, Penn AH, Alsaigh T, Lee J, Shin H, Kapur V, Bergan JJ, and Schmid-Schönbein GW
- Subjects
- Animals, Arteriovenous Shunt, Surgical, Blood Flow Velocity, Cardiovascular Agents therapeutic use, Chemotaxis, Leukocyte drug effects, Diosmin therapeutic use, Disease Models, Animal, Edema etiology, Edema physiopathology, Edema prevention & control, Femoral Artery surgery, Femoral Vein enzymology, Femoral Vein pathology, Femoral Vein physiopathology, Femoral Vein surgery, Granulocytes drug effects, Granulocytes pathology, Lymphocytes drug effects, Lymphocytes pathology, Macrophages drug effects, Macrophages pathology, Male, Matrix Metalloproteinase 2 metabolism, Matrix Metalloproteinase 9 metabolism, Rats, Rats, Wistar, Regional Blood Flow, Saphenous Vein enzymology, Saphenous Vein pathology, Saphenous Vein physiopathology, Stress, Mechanical, Time Factors, Venous Insufficiency complications, Venous Insufficiency enzymology, Venous Insufficiency pathology, Venous Insufficiency physiopathology, Cardiovascular Agents pharmacology, Diosmin pharmacology, Femoral Vein drug effects, Saphenous Vein drug effects, Venous Insufficiency drug therapy, Venous Pressure drug effects
- Abstract
Objectives: To characterize the acute response of the vein wall to venous hypertension and associated altered fluid shear stress and to test the effect of micronized purified flavonoid fraction (MPFF, Daflon 500), on this response., Material and Methods: A femoral arteriovenous fistula was created in Wistar rats (n=48). A cohort of 24 rats received oral treatment with MPFF (100 mg/kg/day body weight), 24 rats underwent the arteriovenous fistula procedure and received no treatment. At days 1, 7 and 21 the animals (n=8 at each time point) were killed. Experimental parameters measured included limb circumference, blood flow at the sapheno-femoral junction, leukocyte infiltration and gelatinase activity (matrix metalloproteinase, MMP)., Results: The acute rise in venous hypertension was accompanied by limb edema and venous reflux together with an eventual loss of valve leaflets in the saphenous vein. There was an increase in granulocyte and macrophage infiltration into the venous wall and the surrounding tissue, and a lesser increase in T- and B-lymphocyte infiltration. These changes were accompanied by a local increase in the proteolytic enzymes, MMP-2 and MMP-9. Administration of MPFF reduced the edema and lessened the venous reflux produced by the acute arteriovenous fistula. Decreased levels of granulocyte and macrophage infiltration into the valves were also observed compared with untreated animals., Conclusions: Venous hypertension caused by an arteriovenous fistula resulted in the development of venous reflux and an inflammatory reaction in venous valves culminating in their destruction. MPFF was able to delay the development of reflux and suppress damage to the valve structures in this rat model of venous hypertension.
- Published
- 2008
- Full Text
- View/download PDF
14. Pathogenesis of primary chronic venous disease: Insights from animal models of venous hypertension.
- Author
-
Bergan JJ, Pascarella L, and Schmid-Schönbein GW
- Subjects
- Animals, Arteriovenous Shunt, Surgical, Chronic Disease, Disease Progression, Femoral Artery surgery, Femoral Vein surgery, Humans, Ligation, Mesenteric Vascular Occlusion complications, Mesenteric Vascular Occlusion physiopathology, Mesenteric Veins surgery, Rats, Regional Blood Flow, Varicose Veins pathology, Varicose Veins physiopathology, Venous Insufficiency pathology, Venous Insufficiency physiopathology, Venules surgery, Disease Models, Animal, Varicose Veins etiology, Venous Insufficiency etiology, Venous Pressure
- Abstract
Background: Reflux of blood through incompetent venous valves is a major cause of the venous hypertension that underlies clinical manifestations of chronic venous disease, including varicose veins, lipodermatosclerosis, and venous ulcers., Objective: To review published literature relating to animal models in which venous hypertension has been produced and which have yielded information on the mechanisms by which venous hypertension may trigger inflammation and cause changes in the skin and venous valves., Methods: Medline searches, with additional papers identified from reference lists in published papers., Results: At least three types of animal model were identified that have contributed to a better understanding of the trigger mechanisms and role of inflammatory processes in chronic venous disease. These models involve venous hypertension induced either by acute venular occlusion, placement of a chronic arteriovenous fistula, or ligation of several large veins. Model results suggest that elevated venous pressure and altered flow can trigger inflammatory cascades in the vein wall and venous valves which can cause progressive valvular incompetence and eventual valvular destruction, and which are also important in the skin changes associated with venous disease. Treatment with agents that reduce oxidative stress by scavenging free radicals and that inhibit the inflammatory cascade can prevent the progressive deterioration of function in valves exposed to elevated venous pressure and can prevent the development of reflux blood flow., Conclusions: Understanding these processes suggests potential therapeutic targets that could be effective in slowing or preventing progression, and could help promote a more positive and proactive attitude towards treatment of the underlying disease process, rather than the later manifestations of chronic venous disease.
- Published
- 2008
- Full Text
- View/download PDF
15. Chronic venous disease.
- Author
-
Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, Nicolaides AN, Boisseau MR, and Eklof B
- Subjects
- Chronic Disease, Humans, Inflammation physiopathology, Quality of Life, Risk Factors, Saphenous Vein physiopathology, Varicose Ulcer etiology, Vascular Diseases etiology, Lower Extremity blood supply, Varicose Veins complications, Varicose Veins etiology, Varicose Veins physiopathology, Varicose Veins therapy, Venous Insufficiency etiology, Venous Insufficiency physiopathology, Venous Insufficiency therapy
- Published
- 2007
16. Regarding: "Neovascularization: an 'innocent bystander' in recurrent varicose veins".
- Author
-
Bergan JJ
- Subjects
- Clinical Competence, Humans, Neovascularization, Pathologic diagnostic imaging, Recurrence, Reoperation, Saphenous Vein diagnostic imaging, Treatment Outcome, Ultrasonography, Doppler, Duplex, Varicose Veins complications, Varicose Veins diagnostic imaging, Vascular Surgical Procedures, Neovascularization, Pathologic etiology, Saphenous Vein surgery, Varicose Veins surgery
- Published
- 2007
- Full Text
- View/download PDF
17. Chronic venous disease.
- Author
-
Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, and Eklof B
- Subjects
- Chronic Disease, Humans, Hypertension, Varicose Veins, Venous Insufficiency, Vascular Diseases diagnosis, Vascular Diseases pathology, Vascular Diseases physiopathology, Vascular Diseases therapy
- Published
- 2006
- Full Text
- View/download PDF
18. Severe chronic venous insufficiency treated by foamed sclerosant.
- Author
-
Pascarella L, Bergan JJ, and Mekenas LV
- Subjects
- Adult, Aged, Aged, 80 and over, Bandages, Chronic Disease, Female, Humans, Male, Middle Aged, Polidocanol, Sclerotherapy methods, Ultrasonography, Varicose Ulcer therapy, Venous Insufficiency diagnostic imaging, Leg blood supply, Polyethylene Glycols therapeutic use, Sclerosing Solutions therapeutic use, Venous Insufficiency therapy
- Abstract
Our objective was to chronicle our experience in using sclerosant foam to treat severe chronic venous insufficiency (CVI). Forty-four patients with 60 limbs severely affected by severe CVI were entered into the study. They had lipodermatosclerosis, CEAP 4 (seven limbs); atrophie blanche or scars of healed venous ulcerations, CEAP 5 (18 limbs); and frank, open venous ulcers, CEAP 6 (35 limbs). Patients and limbs were collected into three groups. In group I, all limbs were treated with compression without intervention. Group II consisted of crossover patients who failed compression treatment. Group III consisted of patients treated promptly with sclerosant foam therapy without a waiting period of compression. A standing Doppler duplex reflux examination was done in all cases. Compression was by Unna boot or long stretch elastic bandaging. Foam was generated from Polidocanol 1%, 2%, or 3% by the two-syringe technique and administered under ultrasound guidance. Posttreatment compression was used for 14 days. In addition to clinical and ultrasound evaluation at 2, 7, 14, and 30 days, venous severity scoring was noted at entry and discharge. In group I, 12 patients were discharged from care within 6 weeks of initiating compression. All eight of the class 6 limbs had healed. Group II consisted of four CEAP class 5 limbs and eight class 6 limbs that had failed to heal with compression. Five of eight venous ulcers healed within 2 weeks, two more healed by 4 weeks, and one required 6 weeks to heal. In group III, 7 of 11 venous ulcers healed within 2 weeks and four more within 4 weeks. Venous severity scores reflected the success of treatment, with the greatest change occurring in group III and the least in group I. Limbs treated with foam had a statistically better outcome than those without (p = 0.041). One patient failed foam sclerotherapy, another had pulmonary emboli 4 months after foam treatment, and a single medial gastrocnemius thrombus was discovered 24 hr after treatment. Treatment of severe CVI with compression and foam sclerotherapy causes more rapid resolution of the venous insufficiency complications and does so without an increase in morbidity.
- Published
- 2006
- Full Text
- View/download PDF
19. Microcirculation and venous ulcers: a review.
- Author
-
Pascarella L, Schönbein GW, and Bergan JJ
- Subjects
- Endothelium, Vascular physiopathology, Hemodynamics, Humans, Immunohistochemistry, Integrin alpha4beta1 blood, Intercellular Adhesion Molecule-1 blood, Leukocytes physiology, Lymphocyte Function-Associated Antigen-1 blood, Microcirculation, Reverse Transcriptase Polymerase Chain Reaction, Vascular Cell Adhesion Molecule-1 blood, Inflammation Mediators blood, Varicose Ulcer physiopathology
- Abstract
Recent histological and immunocytochemical analyses of venous leg ulcers suggest that lesions observed in the different stages of chronic venous insufficiency (CVI) may be related to an inflammatory process. This inflammatory process leads to fibrosclerotic remodeling of the skin and then to ulceration. The vascular network of the most superficial layers of the skin appears to be the target of the inflammatory reaction. Hemodynamic forces such as venous hypertension, circulatory stasis, and modified conditions of shear stress appear to play an important role in an inflammatory reaction accompanied by leukocyte activation which clinically leads to CVI: venous dermatitis and venous ulceration. The leukocyte activation is accompanied by the expression of integrins and by synthesis and release of many inflammatory molecules, including proteolytic enzymes, leukotrienes, prostaglandin, bradykinin, free oxygen radicals, cytokines, and possibly other classes of inflammatory mediators. The inflammatory reaction perpetuates itself, leading to liposclerotic skin and subcutaneous tissue remodeling. In light of the mechanisms of venous ulcer formation cited above, therapy in the future might be directed against leukocyte activation in order to diminish the magnitude of the inflammatory response. With this in mind, the attention of many investigators has been drawn to two different drugs with an anti-inflammatory effect: pentoxifylline and flavonoids.
- Published
- 2005
- Full Text
- View/download PDF
20. New clinical and laboratory staging systems to improve management of chronic lymphedema.
- Author
-
Lee BB and Bergan JJ
- Subjects
- Chronic Disease, Disease Progression, Humans, Lymphedema classification, Lymphedema therapy, Retrospective Studies, Lymphedema pathology, Quality of Life
- Abstract
We have developed new clinical (C) and laboratory (L) staging systems to improve the clinical management of chronic lymphedema. These systems were retrospectively assessed in 220 chronic lymphedema patients followed up for 4 years. Clinical evaluation of the treatment response/disease progression was performed at 6 month intervals and laboratory evaluation at a yearly interval except for recurrent sepsis cases. The reliability of C-stage and L-stage for the progression of disease were analyzed separately. The C-staging was based on the subjective and objective findings of local and systemic conditions, while L-staging was based on lymphoscintigraphicfindings. Clinical implementation of this new staging system facilitated interpretation of the progress/deterioration of the clinical response to CDT treatment, and it was found to be a useful guideline for the decision/selection of further surgical treatment. We propose that these two separate staging systems could now become a new guideline for improved management of lymphedema with a better prediction of treatment outcome and decision point for additional medical/surgical therapy. Further clinical implementation and evaluation is necessary to demonstrate clinical usefulness especially to guide surgical therapy and L-staging in followup.
- Published
- 2005
21. Chronic venous insufficiency and the therapeutic effects of Daflon 500 mg.
- Author
-
Bergan JJ
- Subjects
- Administration, Oral, Chronic Disease, Clinical Trials as Topic, Diosmin administration & dosage, Humans, Hypertension physiopathology, Inflammation drug therapy, Varicose Ulcer drug therapy, Varicose Ulcer etiology, Venous Insufficiency physiopathology, Wound Healing, Diosmin therapeutic use, Hypertension complications, Hypertension immunology, Venous Insufficiency drug therapy, Venous Insufficiency immunology
- Abstract
Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.
- Published
- 2005
- Full Text
- View/download PDF
22. Venous angiomata: treatment with sclerosant foam.
- Author
-
Pascarella L, Bergan JJ, Yamada C, and Mekenas L
- Subjects
- Adolescent, Adult, Aged, Angiomatosis diagnosis, Angiomatosis diagnostic imaging, Arteriovenous Malformations diagnosis, Arteriovenous Malformations diagnostic imaging, Diagnostic Imaging, Female, Humans, Klippel-Trenaunay-Weber Syndrome drug therapy, Magnetic Resonance Imaging, Male, Middle Aged, Polidocanol, Ultrasonography, Doppler, Duplex, Angiomatosis drug therapy, Arteriovenous Malformations drug therapy, Polyethylene Glycols therapeutic use, Sclerosing Solutions therapeutic use
- Abstract
Venous angiomata, or venous malformations, are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size. Treatment of venous angiomata is often requested for cosmetic reasons, but painful ulcerations, nerve compression, functional disability can command care. This presentation describes management using sclerosant foam as the treating agent. During a 30-month period ending March 2004, 1,321 patients were investigated for venous disorders at the Vein Institute of La Jolla. Fourteen (incidence 1%) were found to have venous angiomata (: nine women). The age range was 15-76 years (mean 30.8 +/- 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in two patients. Eight patients, three males, had manifestations of lower extremity Klippel-Trenaunay (syndrome; six had only venous angiomas. Only 10 of the 14 patients were treated. All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue. Foam was produced by the Tessari two syringes one three-way stopcock teclinique, with the air to Polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient. The SonoSite 190 plus Duplex Doppler was used for ultrasound guidance, whenever deep access was required and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun. Ten patients were treated, and four await treatment. The mean number of treatments was 3.6 +/- 2.8 (range 1-10). A primary goal of pain-free healing was set in patients with nonhealing, painful ulceration or symptomatic varicose veins. This was achieved in all treated patients. Cosmetically, all of the patients were improved, and symptomatic patients were relieved of pain. The single complication was formation of a cutaneous ulcer following injection of telangiectasias. Sclerosant foam is a satisfactory tool to use in treating venous angiomata including the Klippel-Trenaunay syndrome. Use of foam sclerotherapy in this experience has proven the technique to be effective, essentially pain-free, and durable in the short term.
- Published
- 2005
- Full Text
- View/download PDF
23. Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application.
- Author
-
Caggiati A, Bergan JJ, Gloviczki P, Eklof B, Allegra C, and Partsch H
- Subjects
- Humans, Pelvis blood supply, Practice Guidelines as Topic, Lower Extremity blood supply, Terminology as Topic, Veins
- Abstract
The relative deficiency of the official Terminologia Anatomica with regard to the veins of the lower limbs was responsible for a nonuniform anatomic nomenclature in the clinical literature. In 2001, an International Interdisciplinary Committee updated and refined the official Terminologia Anatomica regarding the veins of the lower limbs. Recommendations for terminology were included in an updating document that appeared in the Journal of Vascular Surgery (2002;36:416-22). To enhance further the use of a common scientific language, the committee worked on the present document, which includes (1) extensions and refinements regarding the veins of the lower limbs; (2) the nomenclature of the venous system of the pelvis; (3) the use of eponyms; and (4) the use of terms and adjectives of particular importance in clinical vascular anatomy.
- Published
- 2005
- Full Text
- View/download PDF
24. Severe chronic venous insufficiency: primary treatment with sclerofoam.
- Author
-
Bergan JJ and Pascarella L
- Subjects
- Chronic Disease, Humans, Injections, Intravenous, Sclerosing Solutions administration & dosage, Severity of Illness Index, Ultrasonography, Doppler, Duplex, Venous Insufficiency diagnostic imaging, Leg blood supply, Sclerosing Solutions therapeutic use, Sclerotherapy methods, Venous Insufficiency therapy
- Abstract
Venous insufficiency, for practical purposes, can be divided into primary venous insufficiency and chronic venous insufficiency. The latter is characterized by advanced skin changes of hyperpigmentation, edema, ulceration, scarring from healed ulcers or open ulcerations. These are summarized in the CEAP classification as Classes 4, 5 and 6. Pretreatment evaluation is done with a standing ultrasound reflux examination. Thorough mapping of the extremity reflux is desirable. Physiologic tests of venous function, such as plethysmography, are unnecessary. Treatment is directed at closing refluxing axial veins as well as controlling those perforating veins with outward flow. Varicose veins contribute to axial reflux and must be obliterated. Arterial occlusive disease may complicate venous ulceration in as many as 15% of cases. Initial treatment of severe chronic venous insufficiency is usually carried out by controlling the edema with elastic bandaging or nonelastic support, such as the Unna boot or the CircAid dressing. Surgical intervention has been successful but the advent of foam sclerotherapy has proven to be an attractive alternative to surgery and has added a new tool for the treatment of severe chronic venous insufficiency. In this preliminary experience, the results are quite satisfactory and the technique has been shown to be effective, pain-free, inexpensive, with very little morbidity. Guidelines for obtaining sclerosants for use in foam sclerotherapy legally are provided.
- Published
- 2005
- Full Text
- View/download PDF
25. Endovenous therapy--2005.
- Author
-
Bergan JJ and Rattner Z
- Subjects
- Electrocoagulation, Humans, Neovascularization, Pathologic, Saphenous Vein, Sclerotherapy, Varicose Veins etiology, Varicose Veins therapy
- Published
- 2005
26. Lower extremity superficial venous aneurysms.
- Author
-
Pascarella L, Al-Tuwaijri M, Bergan JJ, and Mekenas LM
- Subjects
- Adult, Aged, Aneurysm classification, Body Mass Index, Female, Femoral Vein diagnostic imaging, Humans, Male, Middle Aged, Sex Factors, Thigh blood supply, Ultrasonography, Doppler, Duplex, Venous Insufficiency diagnostic imaging, Aneurysm diagnostic imaging, Lower Extremity blood supply, Saphenous Vein diagnostic imaging
- Abstract
Venous aneurysms are not rare. But most attention has been paid to deep venous aneurysms. Because of their propensity to thrombose and cause pulmonary embolization. Increased availability of duplex Doppler ultrasound has allowed total evaluation of all venous segments in patients undergoing surgery for chronic venous insufficiency. In this study, patients were recorded consecutively and the venous reflux examination was carried out with the patient standing. The superficial venous system was studied with special interrogation of the great and small saphenous veins and their tributaries. Reflux >0.5 sec was recorded as positive. Data were analyzed using the Spearman's correlation index and the student's t-test. A strong correlation was considered for values of rho > 0.6. A total of 65 superficial venous aneurysms of the saphenous vein systems were found in 43 patients (33 women and 10 men) with an average age of 53 years (range, 34-70). The mean body mass index (BMI) overall was 25 +/- 4.6. The BMI in men was 29.5 +/- 2.5. The BMI in women was 23.6 +/- 4 (p < 0.05). Aneurysms of the saphenous systems were classified into four types. Type I aneurysms (52%) were located in the proximal third of the saphenous vein, not at the saphenofemoral junction but instead just distal to the subterminal valve. Type II aneurysms were located in the shaft of the saphenous vein in the distal third of the thigh (35%). The third classification (type III) of superficial saphenous vein aneurysms was an occurrence of types I and II in the same lower extremity (3 patients/43 patients). Superficial venous aneurysms of the short saphenous system were found and were classified as type IV (6%.) Strong correlations were found with female gender and a very strong correlation of larger aneurysms was found with an elevated BMI in men. There was a so a strong correlation between type III aneurysms of the proximal and distal thigh greater saphenous vein and greater saphenous vein reflux. Aneurysms of the saphenous veins are common and this may have an impact on choice of surgical treatment.
- Published
- 2005
- Full Text
- View/download PDF
27. Revision of the CEAP classification for chronic venous disorders: consensus statement.
- Author
-
Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, and Wakefield TW
- Subjects
- Chronic Disease, Humans, Venous Insufficiency classification
- Abstract
The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into "Reporting Standards in Venous Disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the American Venous Forum, working with an international liaison committee, has recommended a number of practical changes, detailed in this consensus report. These include refinement of several definitions used in describing CVD; refinement of the C classes of CEAP; addition of the descriptor n (no venous abnormality identified); elaboration of the date of classification and level of investigation; and as a simpler alternative to the full (advanced) CEAP classification, introduction of a basic CEAP version. It is important to stress that CEAP is a descriptive classification, whereas venous severity scoring and quality of life scores are instruments for longitudinal research to assess outcomes.
- Published
- 2004
- Full Text
- View/download PDF
28. Venous hypertension, inflammation and valve remodeling.
- Author
-
Takase S, Pascarella L, Lerond L, Bergan JJ, and Schmid-Schönbein GW
- Subjects
- Animals, Anti-Inflammatory Agents therapeutic use, Flavonoids therapeutic use, Male, Models, Animal, Rats, Rats, Wistar, Saphenous Vein immunology, Venous Insufficiency immunology, Venous Pressure physiology, Saphenous Vein drug effects, Saphenous Vein physiopathology, Venous Pressure drug effects, Venous Pressure immunology
- Abstract
Objectives: To identify possible mechanisms for destruction of valves in chronic venous hypertension and the results of treatment with an anti-inflammatory micronized purified flavonoid fraction., Material and Methods: The saphenous vein valves in a rat model of venous hypertension caused by a femoral arterial-venous fistula were studied. Studies included femoral venous pressure, valve morphology, femoral venous reflux and selected molecular inflammatory markers as examined by immunohistochemistry. The effects of treatment with the anti-inflammatory micronized purified flavonoid fraction (S 5628, Servier, 50 and 100 mg/kg/day) were investigated., Results: The femoral venous pressure was elevated close to arterial values for a period of 3 weeks. We then examined the morphology of the veins and selected molecular inflammatory markers were assessed. The results show that in this model venous reflux develops in response to venous hypertension. This can be inhibited by the administration of the anti-inflammatory micronized purified flavonoid fraction (S 5628, Servier, 50 and 100 mg/kg/day). The valve becomes incompetent by a combination of venous dilation and shortening of the valve leaflets. This is not inhibited by treatment with S 5628. The valve leaflets are infiltrated with granulocytes, monocytes and T-lymphocytes, and the endothelial cells express enhanced levels of P-selectin and ICAM-1. Cells in the valves are subject to extensive apoptosis although no enhancement of MMP 2,9 expression could be detected at the three-week time point examined in this study., Conclusions: These results indicate that in this model chronic elevation of venous pressure is associated with an inflammatory reaction in venous valves, a process that may lead to their dysfunction, reflux, and upstream elevation of venous pressure. These effects are mitigated by the anti-inflammatory micronized purified flavonoid fraction in a dose dependent manner.
- Published
- 2004
- Full Text
- View/download PDF
29. Hypertension-induced venous valve remodeling.
- Author
-
Takase S, Pascarella L, Bergan JJ, and Schmid-Schönbein GW
- Subjects
- Animals, Arteriovenous Fistula complications, Arteriovenous Fistula metabolism, Arteriovenous Fistula physiopathology, Blood Flow Velocity physiology, Blood Pressure physiology, Disease Models, Animal, Femoral Artery anatomy & histology, Femoral Artery metabolism, Femoral Artery pathology, Femoral Vein anatomy & histology, Femoral Vein metabolism, Hypertension metabolism, Hypertension physiopathology, Inflammation Mediators metabolism, Leukocytes metabolism, Models, Cardiovascular, P-Selectin metabolism, Pulsatile Flow physiology, Rats, Rats, Wistar, Saphenous Vein anatomy & histology, Saphenous Vein metabolism, Up-Regulation physiology, Venous Insufficiency metabolism, Venous Insufficiency physiopathology, Femoral Vein pathology, Hypertension complications, Saphenous Vein pathology, Venous Insufficiency etiology
- Abstract
Introduction: In human beings, chronic venous insufficiency is linked to venous hypertension. This in turn is associated with venous valve incompetence. This study was designed to test the hypothesis that venous hypertension serves to initiate a process that results in the venous valve and venous wall damage observed in venous insufficiency. Material and methods Acute venous hypertension was produced by creation of an arteriovenous (AV) fistula between the femoral artery and vein in Wistar rats. At specified intervals pressure in the veins was recorded. The proximal valve containing saphenous vein was exposed, and reflux was measured from reverse blood flow through the first proximal valve. The vein was excised, valve parameters were measured, a portion was taken for morphologic investigation, and the remaining specimen was frozen in liquid nitrogen for investigation of leukocyte infiltration, expression of adhesion molecules, matrix metalloproteinase (MMP) levels, and apoptotic markers. Contralateral nonpressurized saphenous veins were used as control specimens., Results: The saphenous and femoral veins were immediately distended by pulsatile blood flow from the arterial system. Pressure was significantly increased from 11 +/- 2 mm Hg to 94 +/- 9 mm Hg. At 2 days no reflux was detected in the saphenous veins. At 1 week, one of four rats exhibited reflux; at 2 weeks, two of four rats had reflux; and at 3 weeks, three of four rats showed reflux. Contralateral saphenous veins were uniformly competent. Compared with control specimens, the veins were dilated; leaflet length and leaflet width were significantly reduced. Granulocytes, monocytes, and macrophages were identified in all regions of the vein wall, and the number was increased by the presence of the AV fistula. The number of T-lymphocytes was increased, and B-lymphocytes were present. P-selectin was upregulated in the saphenous vein walls, as was intercellular adhesion molecules. MMP-2 and MMP-9 expression in the veins was not enhanced. In the nuclear factor kappabeta family, Ikappabeta was not increased in any hypertensive veins. The number of apoptotic cells in the vein wall was increased in the presence of the AV fistula., Conclusion: This study indicates that acute venous hypertension is accompanied by significant venous distention and some valve damage as early as 3 weeks after fistula creation. There is development of inflammatory markers, with leukocyte infiltration and increased adhesion molecule expression. We could not detect significant enhancement of MMP levels or nuclear transcription factors. It is uncertain whether this lack of evidence may be partially due to enhanced apoptosis in venous valves and vein walls. A detailed definition of the inflammatory reaction produced by venous hypertension should be the subject of further study. Clinical relevance Saphenous vein valves when observed at the time of vein stripping show deformities of shortening, scarring, and tearing. The current model of induced venous hypertension demonstrates early venous valve changes similar to those observed in human beings and links them to a venous hypertension-induced inflammatory reaction. Thus the model could be useful in pharmacologic testing to prevent or treat venous insufficiency and for defining the fundamental mechanisms that cause varicose veins.
- Published
- 2004
- Full Text
- View/download PDF
30. Radiofrequency therapy does not restore valve function in the long term.
- Author
-
Bergan JJ
- Subjects
- Humans, Time Factors, Treatment Outcome, Catheter Ablation, Recovery of Function physiology, Saphenous Vein physiopathology, Venous Insufficiency physiopathology, Venous Insufficiency therapy
- Published
- 2003
- Full Text
- View/download PDF
31. The "C" of CEAP: suggested definitions and refinements: an International Union of Phlebology conference of experts.
- Author
-
Allegra C, Antignani PL, Bergan JJ, Carpentier PH, Coleridge-Smith P, Cornu-Thénard A, Eklof B, Partsch H, Rabe E, Uhl JF, and Widmer MT
- Subjects
- Chronic Disease, Humans, Societies, Medical, Vascular Diseases classification, Veins
- Published
- 2003
- Full Text
- View/download PDF
32. Advanced management of congenital vascular malformations: a multidisciplinary approach.
- Author
-
Lee BB and Bergan JJ
- Subjects
- Adolescent, Adult, Arteriovenous Malformations diagnosis, Combined Modality Therapy, Embolization, Therapeutic methods, Enbucrilate therapeutic use, Ethanol therapeutic use, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Outpatient Clinics, Hospital organization & administration, Patient Care Team organization & administration, Treatment Outcome, Arteriovenous Malformations therapy, Sclerotherapy methods, Veins abnormalities
- Abstract
Introduction: Management of congenital vascular malformations (CVM) remains a major challenge because treatment carries a substantial risk of morbidity and recurrence of the fundamental problem. The new classification of CVM allows a multidisciplinary approach to the treatment with full integration of the several treatment modalities. The multidisciplinary approach was introduced at our CVM Clinic in 1995 and this report summarizes our results to date., Patients and Methods: The CVM Clinic is attended by 15 different specialties. These allow application of advanced diagnosis and treatments. The interdisciplinary consultation allows proper application of the various treatment modalities including embolosclerotherapy and surgical therapy. The embolosclerosants utilized are absolute ethanol and N-butyl cyanoacrylate (NBCA). These are used for venous malformations (VM), arteriovenous shunting malformations (AVM), and hemolymphatic malformations (HLM). These agents are used independently and as preoperative adjuncts. Among the 438 patients treated between September 1995 and September 1999, there were 99 patients treated with combinations of embolosclerotherapy. There were 286 sessions, 252 of which were for ethanol sclerotherapy and 247 of these employed ethanol alone and five were combined with NBCA. Independent embolotherapy with NBCA was instituted more recently and has been used in 28 sessions. Perioperative embolosclerotherapy has been performed in 43 sessions, mostly as preliminary preparation to reduce subsequent surgical morbidity. Followup assessment of immediate and interim results after completion of multisession therapy has been done using combinations of noninvasive diagnostic testing., Results: The immediate success rate of embolosclerotherapy has been 94.7% (271/286 sessions). There has been an immediate 5.2% failure (15/286 sessions). Failures have largely been due to forced abandonment of the sclerosing procedure due to risk of deep venous thrombosis. Interim results though short-term success following completion of multisession therapy, average 3.2 sessions per patient, were satisfactory. Complications, mostly skin damage from embolosclerotherapy were experienced in 31 patients during the 286 sessions performed on 99 patients. These skin complications were discussed and accepted by the multidisciplinary team which recognized unavoidable morbidity accompanying the ethanol therapy when applied to superficially located lesions. The overall morbidity included complication rate per session (14.7%, 42/286) and 31.3% per patient (31/99). Recovery from the skin complications has been mostly spontaneous but one case in which peroneal nerve palsy occurred became permanent. There has been no recurrence of the lesions treated successfully, and this has been confirmed through a battery of noninvasive testing. The average follow-up period after completion of multisession therapy is relatively short with 10.6 months (6.0-32 months) only to meet the condition as interim results. Fourteen patients have undergone surgical ablation after preoperative embolosclerotherapy and the surgical morbidity has been minimal., Conclusion: An accurate diagnosis and multidisciplinary treatment strategy for management of CVMs can improve overall treatment success with a reduced morbidity and recurrence over conventional approaches. This study reviews current trends in contemporary diagnosis and clinical management of congenital vascular malformations (CVM) of the peripheral vascular system emphasizing our new multidisciplinary approach.
- Published
- 2002
- Full Text
- View/download PDF
33. The unresolved problem of recurrent saphenofemoral reflux.
- Author
-
Fischer R, Chandler JG, De Maeseneer MG, Frings N, Lefebvre-Vilarbedo M, Earnshaw JJ, Bergan JJ, Duff C, and Linde N
- Subjects
- Humans, Ligation, Recurrence, Reoperation, Vascular Surgical Procedures, Femoral Vein, Saphenous Vein, Varicose Veins surgery, Venous Insufficiency surgery
- Published
- 2002
- Full Text
- View/download PDF
34. Surgical and endovascular treatment of lower extremity venous insufficiency.
- Author
-
Bergan JJ, Kumins NH, Owens EL, and Sparks SR
- Subjects
- Catheter Ablation, Female, Follow-Up Studies, Humans, Saphenous Vein physiopathology, Saphenous Vein surgery, Varicose Veins surgery, Varicose Veins therapy, Lower Extremity blood supply, Venous Insufficiency surgery, Venous Insufficiency therapy
- Abstract
Lower extremity venous insufficiency is a highly prevalent condition. Now it is understood that telangiectasias, reticular varicosities, and true varicose veins are physiologically similar and etiologically identical. The four main influences causing these abnormalities are heredity, female sex, gravitational hydrostatic forces, and hemodynamic muscular compartment pressure. There are clear indications and goals for intervention. A cornerstone in the treatment of venous insufficiency is elimination of sources of venous hypertension. One of these is the refluxing greater saphenous vein. Minimally invasive saphenous ablation can be achieved by radiofrequency energy and laser light energy. These new techniques eliminate the psychologic barrier to treatment caused by the term "stripping" and allow the objectives of surgery to be achieved with minimal invasion and quick recovery. Endovenous techniques show great promise. They provide minimal invasion, often under local anesthesia and intravenous sedation, thereby eliminating the need for general anesthesia. Objectives of venous insufficiency have been established and the endoluminal minimally invasive techniques developed in recent years appear to accomplish their goals.
- Published
- 2002
- Full Text
- View/download PDF
35. Enhancement of reperfusion injury by elevation of microvascular pressures.
- Author
-
Takase S, Lerond L, Bergan JJ, and Schmid-Schönbein GW
- Subjects
- Animals, Cell Survival, Chemotaxis, Leukocyte, Fluoresceins, Fluorescent Dyes, Hemorrhage pathology, Ischemia physiopathology, Male, Oxidative Stress, Rats, Rats, Wistar, Splanchnic Circulation physiology, Vasoconstriction, Venules pathology, Venules physiopathology, Blood Pressure physiology, Hemodynamics physiology, Microcirculation physiopathology, Reperfusion Injury physiopathology
- Abstract
Elevated venous pressure can be associated with severe tissue injury. Few links, however, between venous hypertension and tissue damage have been established. We examined here the effects of micropressure elevation on the outcome of venular occlusion/reperfusion in the mesenteric microvasculature of male Wistar rats. One hour of venular occlusion (diameter approximately 50 microm) by micropipette occlusion followed by reperfusion were carried out with sham surgery without occlusion as control. Leukocyte rolling, adhesion, and migration, oxygen radicals detected by dichlorofluorescein (DCF), and parenchymal cell death detected by propidium iodide (PI) were recorded simultaneously in the same vessel at a location upstream of the occlusion site with elevated micropressure and at a downstream location with low micropressure. The number of rolling, adhering, and migrating leukocytes increased on the upstream side of the occlusion to a higher level than downstream of the occlusion site. During occlusion, DCF intensity on the venular endothelium was greater on the upstream side than in the downstream side, but there were no differences during reperfusion. The number of PI-positive cells adjacent to the venules increased significantly compared with controls, and it remained greater on the upstream higher-pressure side than the downstream side. Leukocyte adhesion and transvascular migration in postcapillary venules as well as parenchymal cell death could be significantly reduced by the hydroxyl radical scavenger dimethylthiourea. Microhemorrhages of blood cells into the mesentery interstitium were observed only on the upstream side of the occlusion. These results indicate that an elevation of the venular blood pressure during occlusion/reperfusion exacerbates the inflammatory cascade and tissue injury. Venous occlusion may constitute an important mechanism for tissue injury.
- Published
- 2002
- Full Text
- View/download PDF
36. Varicose veins: hooks, clamps, and suction. Application of new techniques to enhance varicose vein surgery.
- Author
-
Bergan JJ
- Subjects
- Humans, Suction methods, Surgical Instruments, Varicose Veins surgery, Vascular Surgical Procedures methods
- Abstract
Surgical principles that guided varicose vein surgery for nearly 75 years have been time honored and taught to generations of surgeons. Each of these principles has been challenged successfully, and, as a result, varicose vein surgery has changed markedly. The fundamental principle of totally removing varicose clusters from the circulation remains firmly established. However, methods of accomplishing this have changed and continue to change. Hook phlebectomy and clamp phlebectomy have replaced open dissection and tributary ligation. The place of tumescent anesthesia, transilluminated-powered phlebectomy, and sclerotherapy remain unsettled. However, there now are a number of alternatives in planning patient care., (Copyright 2002 by W.B. Saunders Company)
- Published
- 2002
37. Surgical management of acute complications and critical restenosis following carotid artery stenting.
- Author
-
Owens EL, Kumins NH, Bergan JJ, and Sparks SR
- Subjects
- Aged, Carotid Artery, External diagnostic imaging, Carotid Artery, Internal diagnostic imaging, Carotid Stenosis diagnostic imaging, Endarterectomy, Carotid, Humans, Male, Middle Aged, Radiography, Recurrence, Retrospective Studies, Treatment Failure, Ultrasonography, Doppler, Duplex, Angioplasty, Balloon adverse effects, Carotid Artery, External surgery, Carotid Artery, Internal surgery, Carotid Stenosis therapy, Stents
- Abstract
Carotid artery angioplasty with stenting (CAS) is being increasingly used in the treatment of extracranial carotid artery stenosis. As in other catheter-based approaches to the treatment of arterial disease, surgical intervention may be required because of either acute complications or correct critical restenosis. We have reviewed our experience managing early complications and critical in-stent restenoses after CAS in a tertiary care university hospital and a Veterans Affairs Medical Center. During the last 5 years, 22 carotid arteries (21 patients) underwent CAS. One patient developed thrombosis and rupture of the carotid artery during stenting. Two other patients (3 arteries) developed critical restenosis within 12 months. Subsequent surgical reconstructions included an internal carotid artery (ICA)-to-external carotid artery (ECA) transposition and a common carotid artery (CCA)-to-ICA bypass with reversed saphenous vein (RSV). The patient who underwent CCA-to-ICA bypass later required subclavian-to-ICA bypass because of rapidly progressive intimal hyperplasia and subsequent occlusion of the CCA. The other patient has not had surgical repair because of his deteriorating condition and significant co-morbidities. During the same time period, two additional patients were referred from outside institutions specifically for surgical intervention after carotid stenting. One had delayed rupture of the carotid artery 1 day after stenting and underwent urgent surgical repair. Another patient had early, critical restenosis within the stent and underwent placement of a CCA-to-ICA interposition graft using RSV. Acute treatment failures after CAS can be successfully managed using standard surgical techniques. Patients who develop critical in-stent restenosis requiring surgical repair may need more challenging surgical reconstructions to maintain cerebral perfusion.
- Published
- 2002
- Full Text
- View/download PDF
38. Early experience using the Wallgraft in the management of distal microembolism from common iliac artery patholology.
- Author
-
Kumins NH, Owens EL, Oglevie SB, Ronaghi AH, Bergan JJ, Tripathy U, and Sparks SR
- Subjects
- Aged, Aged, 80 and over, Angiography, Blue Toe Syndrome pathology, Embolism etiology, Female, Humans, Iliac Aneurysm therapy, Iliac Artery diagnostic imaging, Male, Arteriosclerosis complications, Blood Vessel Prosthesis, Blue Toe Syndrome surgery, Embolism prevention & control, Iliac Aneurysm complications, Iliac Artery pathology
- Abstract
Blue toe syndrome commonly occurs as a result of aneurysmal or atherosclerotic disease in the iliac arteries. Surgery, angioplasty, or intraarterial stent placement are the most common treatment options but the optimal management has not been defined. Here we report managing distal microembolization from iliac artery atherosclerosis associated with aneurysmal dilation with the Wallgraft Endoprosthesis, a self-expanding metallic stent covered with Dacron. Three common iliac arteries in two patients were treated using this device. A 79-year-old male presented with unilateral symptoms and an 83-year-old female with bilateral disease. Arteriography demonstrated complex plaque at the aortic bifurcation associated with aneurysmal dilation of the distal common iliac artery in both patients. This complex disease was successfully covered using the Wallgraft Endoprosthesis. Postoperatively the patients received aspirin, their toe lesions healed, and neither has had a recurrence after 16 months. Covered stents offer the theoretic advantage of completely excluding the diseased segment, preventing the escape of thrombus or plaque debris, and covering aneurysmal dilation in the artery.
- Published
- 2002
- Full Text
- View/download PDF
39. Advances in venous surgery: SEPS and phlebectomy for chronic venous insufficiency.
- Author
-
Bergan JJ
- Subjects
- Chronic Disease, Humans, Saphenous Vein surgery, Endoscopy, Vascular Surgical Procedures methods, Venous Insufficiency surgery
- Abstract
Chronic venous insufficiency (CVI) and its complications of chronic pain, intractable ulceration, and infection are important conditions to treat by modern surgical techniques. As early as the 1930s, perforating veins with outward flow were implicated in the pathogenesis of this condition. Recognition that such outward flow promotes leukocyte adhesion and activation as the principal microcirculatory cause for the cutaneous changes has explained the importance of perforating vein interruption? Because of disability of CVI, surgeons and patients reluctantly tolerated the open Linton perforator interruption operation with its morbid knee-to-ankle incisions. It was tolerated because it worked. Modifications to reduce the morbidity of the procedure eliminated two of the three incisions used in the explorations of the 1930s. Other modifications such as DePalma's modification of the incisions further reduced wound complications. However, the most significant surgical alteration was to utilize the endoscopic techniques introduced in Europe by Fischer and Hauer. Very quickly it was obvious that the endoscopic technique minimized postoperative complications. Application of endoscopic perforator interruption to varicose vein surgery validated the safety of the procedure but did not contribute to knowledge about treating CVI.
- Published
- 2002
- Full Text
- View/download PDF
40. Small-caliber mesothelial cell-layered polytetraflouroethylene vascular grafts in New Zealand white rabbits.
- Author
-
Sparks SR, Tripathy U, Broudy A, Bergan JJ, Kumins NH, and Owens EL
- Subjects
- Animals, Endothelium, Vascular cytology, Graft Occlusion, Vascular etiology, Male, Models, Animal, Polytetrafluoroethylene adverse effects, Prosthesis Design, Rabbits, Thrombosis etiology, Ultrasonography, Doppler, Blood Vessel Prosthesis adverse effects, Endothelium cytology, Epithelium pathology, Graft Occlusion, Vascular prevention & control, Peritoneum cytology, Polytetrafluoroethylene therapeutic use, Thrombosis prevention & control
- Abstract
Reduction in the thrombogenicity of small-caliber synthetic vascular grafts by lining them with mesothelial cell has been suggested as a method to reduce thrombosis. The purpose of this research is to determine whether creation of a mesothelial lining on the inner surface of a synthetic vascular graft would improve the patency rate of a small-caliber vascular grafts. Carotid interposition grafting was performed using mesothelial-lined grafts (MLG) in 30 New Zealand rabbits and compared with similar carotid interposition grafts using non-mesothelial-lined grafts (NLG) on the contralateral side. The mesothelial lining was created by suturing a piece of harvested peritoneum with the visceral surface toward the lumen onto a 2-mm polytetraflouroethylene (PTFE) graft. Graft patency was studied by in vivo Dopler. In vitro evaluations were done with hematoxylin-eosin stains, broadband cytokeratin staining, and monoclonal antibodies for macrophages. Explanation of the grafts was done in terminal operation at 7, 14, and 21 days. The MLG showed progressive fibroblastic proliferation in direct proportion to the age of the graft, but this did not lead to graft occlusion. However, a significant number of NLG were not patent at each time period studied. We concluded that mesothelial cell lining of smallcaliber PTFE grafts could enhance the short-term patency more than using the PTFE without the mesothelial lining. The use of such hybrid small-caliber grafts has a potential for improving the patency of these artificial vascular graft substitutes.
- Published
- 2002
- Full Text
- View/download PDF
41. The saphenous vein: derivation of its name and its relevant anatomy.
- Author
-
Caggiati A and Bergan JJ
- Subjects
- Humans, Saphenous Vein anatomy & histology, Terminology as Topic
- Abstract
Generally, when the origin of the word saphenous is discussed, most affirm that the term derives from the Greek word safaina, which means "evident." The ancient Greeks knew only the caudal portion of the vein, and neither the Greeks nor the Romans used the term saphena. In fact, the term first appeared in the writings of Avicenna. In contrast, the term saphenous is derived from the Arabic el safin, which means "hidden" or "concealed." Ancient Arabic physicians knew the anatomy of superficial veins of the human body and its extremities because they performed therapeutic bleeding. Arabic physicians phlebotomized the distal portion of the greater saphenous vein (GSV) at the ankle. Such phlebotomies were never performed on the proximal portions of the GSV because they were not superficial enough to be clearly evident. As a consequence, the proximal GSV was called el safin, or "the concealed." The modern reader will recognize that based on duplex examination, the GSV is correctly identified on the basis of its deep position with the superficial fascia covering it. This information may be useful in modern saphenous vein surgery in identifying the proximal portion of the GSV.
- Published
- 2002
- Full Text
- View/download PDF
42. Growing the vascular surgical practice: venous disorders.
- Author
-
Bergan JJ, Sparks SR, Owens EL, and Kumins NH
- Subjects
- Adult, Age Factors, Aged, Female, Forms and Records Control, Humans, Male, Medical Records, Middle Aged, Patient Satisfaction, Prevalence, Varicose Veins physiopathology, Venous Insufficiency physiopathology, Varicose Veins surgery, Vascular Surgical Procedures methods, Venous Insufficiency epidemiology, Venous Insufficiency surgery
- Abstract
For the 48th meeting of the International Society for Cardiovascular Surgery, North American Chapter in June 2000, we were asked to organize a presentation with the title displayed above. We welcomed this opportunity because the phrase 'growing the practice' literally means giving greater service to underserved patients with vascular disorders. Underserved individuals with vascular disorders include those with nonatherosclerotic arterial disorders, patients with lymphedema, and individuals with a variety of venous disorders including venous insufficiency. The majority of these conditions are not surgical, but venous insufficiency commands attention because its treatments are interventional. Therefore, this presentation will discuss prevalence of venous insufficiency, a unifying concept of its pathophysiology, how treatment may be selected, what the new technology provides, and then a description of coding issues and whether or not interventions are actually worthwhile from the point of view of the patient.
- Published
- 2001
- Full Text
- View/download PDF
43. New advances in the understanding of the pathophysiology of chronic venous insufficiency.
- Author
-
Schmid-Schönbein GW, Takase S, and Bergan JJ
- Subjects
- Animals, Chronic Disease, Endothelium, Vascular physiopathology, Humans, Leukocytes physiology, Mast Cells physiology, Microcirculation pathology, Microcirculation physiopathology, Venous Insufficiency pathology, Venous Pressure, Venous Insufficiency physiopathology
- Abstract
Chronic venous insufficiency (CVI) is inseparably linked to elevated venous pressure and is accompanied by vascular, dermal, and subcutaneous tissue damage and restructuring. Abundant evidence exists both in humans and in experimental models to suggest that the tissue damage may be initiated by generation of an inflammatory reaction. Inflammatory indicators include elevation of endothelial permeability; attachment of circulating leukocytes to the endothelium; infiltration of monocytes, lymphocytes, and mast cells into the connective tissue; and development of fibrotic tissue infiltrates and several molecular markers, such as growth factor or membrane adhesion molecule generation. Indicators of an inflammatory reaction are already detectable at early stages of CVI and may be involved in the development of primary venous valve dysfunction. One of the important questions is to identify trigger mechanisms for the inflammatory reaction in CVI. Current evidence suggests that, among several possible mechanisms (hypoxia, humoral stimulation), a shift in fluid shear stress from normal physiological levels and endothelial distension under the influence of elevated venous pressure may serve as trigger mechanisms for inflammation.
- Published
- 2001
- Full Text
- View/download PDF
44. Therapeutic approach to chronic venous insufficiency and its complications: place of Daflon 500 mg.
- Author
-
Bergan JJ, Schmid-Schönbein GW, and Takase S
- Subjects
- Animals, Chronic Disease, Humans, Skin pathology, Skin Diseases etiology, Skin Diseases pathology, Venous Insufficiency complications, Venous Insufficiency pathology, Diosmin therapeutic use, Venous Insufficiency drug therapy
- Abstract
Early manifestations of chronic venous insufficiency (CVI) are edema, hyperpigmentation, and lipodermatosclerosis. Late complications are cutaneous ulceration and delayed healing. The specific hallmarks of this inflammation include CD68-positive infiltration into the dermal tissue, monocytes, and lymphocytes and enhanced endothelial permeability. This may lead to "fibrin cuff" formation. In addition, membrane adhesion molecules are present and cytokine expression is seen. In one experimental model of mesenteric venous hypertension, the inflammatory process was detected in its earliest stages. This was evident in the form of neutrophilic leukocyte adhesion to venular endothelium as well as migration of cells across the endothelium and basement membrane into the interstitial space. Simultaneously, parenchymal cell death was detected. This suggests that the mechanism that triggers the inflammatory reaction is venous hypertension. This may cause venous distension and a shift in fluid shear stress. Our observations suggest that patients with venous insufficiency demonstrate circulatory humoral stimulators for leukocyte activation. Otherwise, there is evidence that the inflammatory reaction is limited to the region of the venous ulceration or at least to the skin areas with severe microangiopathy. It may be that activated leukocytes traverse perivascular cuffs and release active transforming growth factor-beta1 (TGF-beta1) which has been found to be elevated exclusively in areas of clinically active CVI. Surgical intervention markedly decreases the number of dysfunctional vein segments and allows pharmacologic agents to protect normal structures from continuing damage. Daflon 500 mg, the purified micronized flavonoid fraction containing 90% diosmin and 10% hesperidin, acts favorably in venous ulcer treatment by inhibiting the synthesis of prostaglandins and free radicals. It decreases bradykinin-induced microvascular leakage and may act favorably to inhibit leukocyte activation, trapping, and migration. Clinically, edema is reduced, ulcer healing is accelerated, and leukocyte trapping diminished. The action of micronized purified flavonoid fraction is beginning to be better understood, and as further knowledge is gained, better pharmacologic control of CVI is a tantalizing promise.
- Published
- 2001
- Full Text
- View/download PDF
45. Internal to external carotid artery transposition to repair recurrent stenosis after carotid artery stenting.
- Author
-
Kumins NH, Sparks SR, Bergan JJ, and Owens EL
- Subjects
- Angiography, Carotid Stenosis diagnostic imaging, Humans, Male, Middle Aged, Recurrence, Anastomosis, Surgical, Angioplasty, Balloon, Carotid Artery, External surgery, Carotid Artery, Internal surgery, Carotid Stenosis surgery, Stents
- Abstract
Recently, carotid artery stenting (CAS) has emerged as a treatment option for carotid artery stenosis. Since the procedure is new, management of its complications is not standardized. This case report describes one method of arterial reconstruction after failed CAS. A 64-year-old male underwent CAS of his right internal carotid artery (ICA) for an asymptomatic 65% stenosis. Seven months later the stented area had narrowed to 95%. Arteriography revealed that the common and external carotid arteries (ECA) were free of disease so we elected to perform a transposition of the distal ICA onto the proximal ECA. The ECA and its branches were completely mobilized and the ascending pharyngeal and lingual arteries divided. The ICA was divided distal to the stent. Transection of the occipital artery provided an arteriotomy for an end ICA to side ECA anastamosis, thus preserving ECA flow. Postoperative surveillance after 8 months has revealed no recurrent stenosis. Operative repair of restenosis after CAS may be challenging if standard endarterectomy is not possible. Other options for reconstruction are feasible but if the common and external carotid arteries are disease-free, an ICA to ECA transposition provides a simple all-arterial repair that avoids bypass and prosthetic material.
- Published
- 2001
- Full Text
- View/download PDF
46. Treatment of varicose veins: proximal saphenofemoral ligation comparing adjunctive varicose phlebectomy with sclerotherapy at a military medical center.
- Author
-
Brethauer SA, Murray JD, Hatter DG, Reeves TR, Hemp JR, and Bergan JJ
- Subjects
- Ambulatory Surgical Procedures, California, Female, Femoral Vein surgery, Follow-Up Studies, Hospitals, Military, Humans, Ligation, Male, Middle Aged, Recurrence, Saphenous Vein surgery, Sclerotherapy, Time Factors, United States, Varicose Veins therapy
- Abstract
There is no consensus as to the single best approach to the treatment of varicose veins. There has been a trend toward less invasive procedures to reduce the number of incisions and provide more selective ablation of varicosities. Ultimately, therapeutic decisions have depended on surgeon preference and the patient population. The active duty military population presents a unique challenge in the treatment of varicose veins. This mobile and active population requires a treatment method that provides maximum relief with the lowest possible morbidity and rapid recovery. The authors previously reported their experience with 104 patients who underwent saphenofemoral ligation combined with perforator point ligation and staged sclerotherapy. This group was compared to 103 patients who underwent saphenofemoral ligation, point perforator ligation, and stab avulsion phlebectomy as a single procedure. Follow-up for the sclerotherapy group included patient satisfaction surveys and documentation of recurrent varicosities. All ambulatory phlebectomy patients responded positively with respect to symptomatic and cosmetic results. Overall satisfaction was favorable and there was no significant difference in patient satisfaction between the ambulatory phlebectomy and sclerotherapy groups. Twelve per cent of the sclerotherapy patients developed true recurrences or new varicosities compared to 11% in the ambulatory phlebectomy group. The most common complication was superficial thrombophlebitis (20% ambulatory phlebectomy, 16% sclerotherapy) which was mild in all cases. All but three patients in the ambulatory phlebectomy group returned to work within 7 days and 75% returned to full duty within 72 hours. Completion of therapy was accomplished in a much shorter period for the ambulatory phlebectomy group. Overall patient satisfaction was achieved for both ambulatory phlebectomy and sclerotherapy patients. Completion of therapy was achieved in a shorter period with fewer clinic visits in the ambulatory phlebectomy group and this has become our procedure of choice for active duty military patients.
- Published
- 2001
- Full Text
- View/download PDF
47. Defining the role of extended saphenofemoral junction ligation: a prospective comparative study.
- Author
-
Chandler JG, Pichot O, Sessa C, Schuller-Petrović S, Osse FJ, and Bergan JJ
- Subjects
- Adult, Aged, Analysis of Variance, Female, Follow-Up Studies, Humans, Ligation methods, Male, Middle Aged, Prospective Studies, Reference Values, Severity of Illness Index, Statistics, Nonparametric, Treatment Outcome, Ultrasonography, Doppler, Duplex, Varicose Veins diagnostic imaging, Varicose Veins surgery, Vascular Patency, Balloon Occlusion methods, Femoral Vein, Saphenous Vein, Varicose Veins therapy
- Abstract
Objective: This study explores the added effect of extended saphenofemoral junction (SFJ) ligation when the greater saphenous vein (GSV) has been eliminated from participating in thigh reflux by means of endovenous obliteration. GSV obliteration, unlike surgical stripping, can be done with or without SFJ ligation to isolate and study SFJ ligation's specific contribution to treatment results., Methods: Sixty limbs treated with SFJ ligation and 120 limbs treated without high ligation were selected from an ongoing, multicenter, endovenous obliteration trial on the basis of their having primary varicose veins, GSV reflux, and early treatment dates., Results: Five (8%) high-ligation limbs and seven (6%) limbs without high ligation with patent veins at 6 weeks or less were excluded as unsuccessful obliterations. Treatment significantly reduced symptoms and CEAP clinical class in both groups (P =.0001). Recurrent reflux developed in one (2%) of 49 high-ligation limbs and eight (8%) of 97 limbs without high ligation by 6 months (P =.273). New instances of reflux did not appear thereafter in 57 limbs followed to 12 months. Recurrent varicose veins occurred in three high-ligation limbs and four limbs without high ligation by 6 months and in one additional high-ligation limb and two additional limbs without high ligation by 12 months. Actuarial recurrence curves were not statistically different with or without SFJ ligation (P >.156), predicting greater than 90% freedom from recurrent reflux and varicosities at 1 year for both groups., Conclusion: These early results suggest that extended SFJ ligation may add little to effective GSV obliteration, but our findings are not sufficiently robust to warrant abandonment of SFJ ligation as currently practiced in the management of primary varicose veins associated with GSV vein reflux.
- Published
- 2000
- Full Text
- View/download PDF
48. Left iliac vein occlusion: its clinical spectrum.
- Author
-
Murray JD, Brennan FJ, Hall LD, Berry JM, Hatter DG, Hemp JR, Reeves TR, Velling TE, and Bergan JJ
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Iliac Vein, Thrombosis diagnosis
- Abstract
The cases reported here demonstrate the variability of the clinical manifestations of left common iliac venous occlusive disease. In each instance, therapy must be adjusted to meet the symptomatic needs of the individual patient. The experience reported here should reinforce the fact that occlusions even 25 months or longer in duration may be reopened. Continuing patency can be enhanced by stent placement.
- Published
- 2000
- Full Text
- View/download PDF
49. Expression of adhesion molecules and cytokines on saphenous veins in chronic venous insufficiency.
- Author
-
Takase S, Bergan JJ, and Schmid-Schönbein G
- Subjects
- Adult, Aged, Antigens, CD biosynthesis, Antigens, Differentiation, Myelomonocytic biosynthesis, Chronic Disease, Endothelium, Vascular metabolism, Female, Humans, Intercellular Adhesion Molecule-1 biosynthesis, Male, Middle Aged, Cell Adhesion Molecules biosynthesis, Cytokines biosynthesis, Venous Insufficiency metabolism
- Abstract
The objective of this study was to assess the relationship of signaling molecules to monocyte/ macrophages as a precursor to venous valve and venous wall dysfunction in patients with varicose veins. One of the hallmarks of venous dysfunction is destruction of venous valves with subsequent reflux and elevation of distal venous pressure. We recently observed that monocytes/macrophages migrate into the venous walls and valves of patients with venous insufficiency. There, they may play a role in the pathogenesis of primary venous insufficiency. If so, an important element in their performance would be the interaction between the monocytes and the endothelium as a precursor of damage to venous valves and the venous wall. To explore this interaction, immunohistochemistry was carried out to detect adhesion molecules and cytokines in surgical specimens removed during surgical therapy. Twenty-four surgical specimens consisting of proximal saphenous vein and subterminal valve were obtained using minimally traumatic technique in 6 males and 18 females who ranged in age from 31 to 79 years. Reflux was confirmed preoperatively by duplex technique, and severity was classified by the CEAP classification of the American Venous Forum. Ten patient limbs were class 2, eight were class 3, four were class 4, and two were class 6. The venous specimens were labeled using monoclonal antibody against ICAM-1, E-selectin, IL-1alpha, and TNF-alpha. CD68 was used for detection of monocytes/macrophages. Our results indicate that not only luminal venous endothelium but also endothelium in the vasa vasora of refluxing saphenous veins is activated, as indicated by the up-regulation of ICAM-1. However, IL-1alpha and TNF-alpha were increased in only selected specimens and are mainly detected in the vein wall. The factors that serve as trigger mechanisms to activate cells in the pathogenesis of primary venous dysfunction remain to be explored.
- Published
- 2000
- Full Text
- View/download PDF
50. Extensive tissue necrosis following high-concentration sclerotherapy for varicose veins.
- Author
-
Bergan JJ, Weiss RA, and Goldman MP
- Subjects
- Adult, Aged, Female, Humans, Leg, Male, Necrosis, Sclerosing Solutions administration & dosage, Sodium Tetradecyl Sulfate administration & dosage, Sclerotherapy adverse effects, Varicose Veins therapy
- Abstract
Background: Tissue necrosis after sclerotherapy has been observed, but is unexplained., Objective: To present the complication of extensive tissue necrosis following high-concentration sclerotherapy for varicose veins., Methods: Cases coming to the attention of the authors are presented briefly with commentary and discussion to explain the mechanisms of tissue destruction., Results: Although the complication of extensive tissue necrosis has been ascribed to intra-arterial injection, in fact, careful study of the cases described here shows that intravenous injection was present in each case. A theory of distribution of the sclerosant into the arterial arborization is proposed. This theory would explain the distribution of sclerosant into the arterial tree and would also explain the causation of extensive tissue necrosis. Mention is made of experimental work in which intra-arterial injection was not the mechanism of causation of tissue necrosis., Conclusion: Extensive tissue necrosis following high-concentration sclerotherapy may be rare, but its occurrence is serious and its treatment may be incomplete.
- Published
- 2000
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.