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Objective Endovenous laser ablation (EVLA) of great (GSV) and small saphenous vein (SSV) chronic insufficiency with 1470-nm diode laser and radial fiber yields good short-term results. The aim of this study was to assess its efficacy after at least 12 months of follow-up. Methods We performed a prospective interventional cohort study in an ambulatory care/day surgery setting. Consecutive patients with chronic, symptomatic GSV or SSV insufficiency were treated by EVLA with a 1470-nm diode laser and a radial fiberoptic. Patients were recruited between 2008 and 2011, and the follow-up was completed in 2012. All patients underwent clinical and echo color Doppler evaluations during follow-up. The primary outcome was the incidence of echo color Doppler-confirmed failures during follow-up. We also investigated potential associations between failures and patients' characteristics, echo color Doppler findings, or surgical features. The secondary outcome was the postoperative pain course. Results The planned 12-month follow-up was completed in 372 patients. Echo color Doppler-confirmed failures occurred in 37 (12%) of 310 patients with GSV insufficiency, whereas none of 62 patients with SSV insufficiency experienced a failure. Multiple Cox proportional hazards regression analysis showed a significant association of failures with a Clinical, Etiologic, Anatomic, and Pathologic class C ≥4 and a mean confluence of the superficial inguinal veins diameter ≥9 mm in patients with GSV insufficiency. Postoperative pain course was favorable. More than two thirds of the patients were asymptomatic at 7 days. Conclusions EVLA with 1470-nm diode laser and radial fiberoptic is effective for treatment of GSV and especially SSV insufficiency and is well tolerated by the patients.

Rationnelle Le but de cette etude est d’evaluer les resultats echo-doppler de l’ablation endoveineuse par laser dans le traitement de l’incontinence des veines grande saphene (VGS) et petite saphene (VPS) avec un suivi d’au moins un an. Methodes Un registre retrospectif a ete utilise par 11 centres en Europe et en Amerique, organise par le International Endovenous Laser Working Group. Les donnees de 1,020 membres chez des patients presentant une incontinence de la VGS et/ou de la VPS, traites par laser endo-veineux (LEV), ont ete rassemblees. Les echecs de LEV definis l’echo-doppler comme l’existence d’un reflux confine a la jonction sapheno-femorale ou sapheno-poplitee, d’un reflux confine au tronc principal de la saphene, ou d’un reflux de la jonction et du tronc principal (veine saphene totalement permeable) ont ete analyses a une ou plusieurs annees postoperatoires. Resultats L’âge moyen des patients etait de 54 ± 5 ans (extremes : 18-91 ans). L’index de masse corporelle moyen etait de 25. Il y avait peu de complications graves : un cas de brulure de peau du troisieme degre, six patients avec thrombose veineuse profonde post-chirurgicale (0,6%), et 27 cas de lesions de nerf sensitif (2,7%). A un an, le taux d’occlusion complete du tronc de la saphene etait de 93,1%. Il y avait 79 cas d’echecs du traitement comme demontre par l’echo-doppler : 22 echecs de jonction isoles (2,2%), 44 echecs isoles du tronc (4,4%), et 13 permeabilite complete des veines (1,3%). Les resultats d’echo-doppler a deux ans ont ete rapportes pour 329 membres avec identification de 19 nouveaux cas d’echec. Aucun nouveau cas d’echec n’a ete rapporte au suivi de trois ans sur 130 membres. Les taux cumules d’echec par analyse de Kaplan-Meier etaient de 7,7% a un an et de 13,1% a 2 et 3 ans. Conclusions Sur la base d’un echo-doppler realise au moins un an apres traitement, ce registre multicentrique confirme la surete et l’efficacite du procede du LEV dans le traitement du reflux des VGS et des VPS. Vu que le taux d’echec rapporte dans la presente etude, un suivi annuel par echo-doppler est recommande dans les 2 ans apres LEV.

Recurrent varices after surgery are a complex problem. Many studies regarding the causes of recurrence and the best procedures that can be used to study them have been conducted but few studies on the natural history of the operations performed for recurrence.To evaluate the efficiency of reintervention in controlling the varicose disease, its symptoms, and patient satisfaction.Of 71 patients operated on for surgical recurrence related to an inguinal cavernoma between 1996 and 2004, 51 were reassessed in May 2006 with a clinical and Duplex examination. Surgical and anesthesiological data were collected.The average follow-up after reintervention for the 51 of the 71 treated patients who came to the examination was 5.8 years; 38 (74.5%) of the patients were very satisfied, and one patient (2%) was dissatisfied. Thirty-five (68.6%) of the patients still had varices, but only 17 of these had real varices at the original site; 18 patients showed persistent or residual varices (3 patients, 5.8%) or a progression (15 patients, 29.9%) of the varicose disease.Surgical intervention on an outpatient basis may have a significant role in controlling the varicose disease with few complications.

BACKGROUND Recurrent varices after surgery are a complex problem. Many studies regarding the causes of recurrence and the best procedures that can be used to study them have been conducted but few studies on the natural history of the operations performed for recurrence. OBJECTIVES To evaluate the efficiency of reintervention in controlling the varicose disease, its symptoms, and patient satisfaction. MATERIALS AND METHODS Of 71 patients operated on for surgical recurrence related to an inguinal cavernoma between 1996 and 2004, 51 were reassessed in May 2006 with a clinical and Duplex examination. Surgical and anesthesiological data were collected. RESULTS The average follow-up after reintervention for the 51 of the 71 treated patients who came to the examination was 5.8 years; 38 (74.5%) of the patients were very satisfied, and one patient (2%) was dissatisfied. Thirty-five (68.6%) of the patients still had varices, but only 17 of these had real varices at the original site; 18 patients showed persistent or residual varices (3 patients, 5.8%) or a progression (15 patients, 29.9%) of the varicose disease. CONCLUSIONS Surgical intervention on an outpatient basis may have a significant role in controlling the varicose disease with few complications.

The evidence of the important two-way clinical correlation between cancer and venous thromboembolism (VTE) dates back to Trousseau's time. Over time it has been established that cancer patients not only exhibit a higher risk of developing VTE when compared with noncancer patients, but also that VTE, especially in its idiopathic presentation, sometimes acts as an epiphenomenon of a hidden cancer, offering possible chances for anticipated diagnosis of the pathology. Research has contributed greatly to the progression of this field through the identification of VTE risk factors in this setting, and through the assessment of the most adequate thromboprophylaxis and treatment modalities as well as secondary prophylaxis management. Anticoagulant drugs appear to be an attractive strategy in cancer treatment because there is growing evidence for their possible benefits in terms of cancer prognosis and patient survival.

Purpose: This study assessed the impact of varicose veins (VV) on quality of life (QOL) and patient-reported symptoms. Methods: A cross-sectional population-based study was held in 166 general practices and 116 specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec), France, and Italy. Study subjects included a sample of 259 reference patients without VV (CEAP class 0 or 1) and 1054 patients with VV who were classified as having VV alone (367; 34.8%), VV with edema (125; 11.9%), VV with skin changes (431; 40.9%), VV with healed ulcer (100; 9.5%), and VV with active ulcer (31; 2.9%). The main outcome measure was generic and disease-specific QOL, as measured by means of the Short-Form Health Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reported symptoms as measured by the VEINES-SYM scale. Results: In patients with VV, age-standardized mean SF-36 physical (PCS) and mental (MCS) scores were 45.6 and 46.1 in men and 44.2 and 43.2 in women, respectively, compared with population norms of 50. PCS scores decreased according to increasing severity of concomitant venous disease, with the lowest mean scores of 37.3 and 35.5 found in patients with VV and active ulcer. However, adjusted analyses showed no statistically significant differences between patients with VV alone and patients without VV for PCS (0.0), MCS (1.0), VEINES-QOL (–0.1), or VEINES-SYM (0.0) scores. In comparison with patients without VV, the largest differences were seen in patients with VV and edema (PCS, VEINES-QOL, and VEINES-SYM score differences of –1.8, –2.5, and –2.9, respectively) and in patients with VV and ulceration (differences of –3.3, –3.4, and –2.7, respectively). The high prevalence of major symptoms of venous disorders in patients in CEAP class 0 or 1 being treated for venous disorders (76.1% of patients had heaviness, aching legs, or swelling) might have contributed to the impairment of QOL in the reference group. Conclusion: Results indicate that impairment in physical QOL in patients with VV is associated with concomitant venous disease, rather than the presence of VV per se. Findings concerning QOL in patients with VV can only be reliably interpreted when concomitant venous disease is taken into account. In patients with VV alone, the objectives of cosmetic improvement and the improvement of QOL should be considered separately. (J Vasc Surg 2001;34:641-8.)

Objective Treatment of chronic venous insufficiency of the great saphenous veins by endovenous laser ablation yields good short- and medium-term results, as assessed clinically and technically by echo-color-Doppler. At present, scarce data are available on the long-term results of endovenous laser ablation. We wanted to assess the long-term efficacy of endovenous laser ablation. Methods We performed a prospective 6-year follow-up cohort study, with recruitment between 2003 and 2004, and the follow-up completed in 2010. The setting was an ambulatory care/day surgery. Of 209 consecutive patients who underwent endovenous laser ablation at our institution during the recruitment period, five (2.4%) did not complete the procedure due to technical reasons. Of 204 patients who successfully completed the intervention, 14 (6.8%) were lost for follow-up, and 190 completed the planned 6-year follow-up. The intervention was an endovenous laser ablation using a 980-nm laser diode. Clinical and echo-color-Doppler evaluations were regularly scheduled for all patients during the planned follow-up period. The incidence of clinical and echo-color-Doppler confirmed endovenous laser ablation failures over a 6-year follow-up period. Potential associations between failures and patients’ characteristics, echo-color-Doppler findings, or surgical features were also investigated. Results Symptomatic clinical endovenous laser ablation failures occurred in 22 (11.6%; 95% confidence interval [CI], 7.4-17.0%) patients; while 57 (30.0%; 95% CI, 23.6-37.1%) had echo-color-Doppler-confirmed failures. Only two patients (1.1%; 95% CI, 0.1%-3.8%) had both symptomatic clinical and echo-color-Doppler-confirmed failures. Three features of the great saphenous vein: an “atypical” junction, a junction diameter ≥8 mm, and a mean trunk diameter ≥8 mm, were independently associated with echo-color-Doppler-confirmed failures on multivariate logistic regression analysis. Conclusions Six years after endovenous laser ablation, most patients were improved on clinical grounds, and more than two-thirds had no saphenous insufficiency at echo-color-Doppler. Only a minority had both clinical and echo-color-Doppler-confirmed failures. Anatomical features of the junction and the saphenous diameter both at the junction and at the trunk independently predicted echo-color-Doppler-confirmed failures.

Background The goal of this study was to evaluate the duplex results of endovenous laser ablation in the treatment of incompetent great saphenous veins (GSV) and small saphenous veins (SSV) with at least 1-year follow-up. Methods A retrospective registry was entered by 11 centers from Europe and America, organized by the International Endovenous Laser Working Group. Data concerning 1,020 limbs in patients with incompetence of the GSV and/or SSV, treated with the Endovenous Laser Ablation (EVLA) procedure, were collected. EVLA failures were defined on duplex imaging as reflux confined to the saphenofemoral or saphenopopliteal junction, reflux confined to the main saphenous trunk, or reflux of both junction and main trunk (totally patent saphenous vein) were analyzed at one or more years postoperatively. Results The mean age of patients was 54 ± 5 years (range: 18-91 years). The average body mass index was 25. There was a paucity of severe complications: One case of third-degree skin burn, six patients with postsurgical deep vein thrombosis (0.6%), and 27 cases of sensory nerve damage (2.7%). At 1-year, the rate of complete occlusion of the saphenous trunk was 93.1%. There were 79 cases of treatment failures as evidenced by duplex: 22 isolated junction failures (2.2%), 44 isolated trunk failures (4.4%), and 13 totally patent veins (1.3%). Two-year duplex results were reported for 329 limbs with the identification of 19 new cases of failure. No new cases of failure were reported at 3-year follow-up of 130 limbs. Cumulative failure rates estimated by Kaplan–Meier analysis were 7.7% at 1-year and 13.1% at 2- and 3-year follow-up. Conclusions On the basis of a duplex scan performed at least 1-year post-treatment, this multicenter registry confirms the safety and efficacy of the EVLA procedure in the treatment of GSV and SSV reflux. Considering the continued failure rate documented in the present study, an annual follow-up by duplex is recommended to 2 years after EVLA.

To prevent sensory impairment in the cutaneous distribution of the saphenous nerve (S.N.) caused by stripping of the long saphenous vein (L.S.V.).

Traditional sclerotherapy can be incomplete when treating fat legs or impalpable small veins or because the doctor prefers not to inject in some area at risk ( for example groin or popliteal fossa).

Sclerotherapy of varicose veins of the lower limbs is a technique widely used in clinical practice for the past several years now.

Objective: To test the Jobst ulcer care system (JUCS), a combination of two elastic stockings and a dressing, for the treatment of venous ulcers. Design: Cohort study. Setting: Therapy was performed at home by the patient with weekly visits to the outpatient clinic at the teaching hospital of the University of Padua. Patients: Thirty-one consecutive ambulatory patients with confirmed venous ulcer. Treatment: Patients were instructed to wear the low-compression stocking (liner) day and night and the higher compression stocking (therapeutic stocking with zipper) during the day. The wound dressing (Cutinova foam) was changed as judged by the patient. Main outcome measures: Healing of the ulcer, and tolerance, safety and ease of using the JUCS by the patient. Results: Twenty-four patients completed the study; 23 Patients showed complete healing of the ulcer within 16 weeks and in the 24th patient the healing was completed in 18 weeks. The mean healing time was 5.8 weeks. Conclusions: The Jobst ulcer care system is effective in achieving ulcer healing and the elastic stockings showed no significant side-effects and were easy to use.

CA 19-9 (Centocor, Malvern, PA) and carcinoembryonic antigen (CEA), two recently developed immunoradiometric assays utilizing monoclonal antibodies, were evaluated in the sera of 139 subjects in order to assay their individual and combined value in pancreatic cancer diagnosis and to assess the influence of jaundice. Sensitivity, specificity, and accuracy in detecting pancreatic cancer were 69%, 85%, and 54% for CA 19-9; and 28%, 78%, and 6% for CEA, respectively. Combined evaluation gave the highest specificity (95%) when both, and the highest sensitivity (79%) when at least one, gave pathologic results. The receiver-operating characteristic curves demonstrated that CA 19-9 is more discriminating than CEA, for any serum value. A correlation between serum bilirubin and CA 19-9 was demonstrated in pancreatic and extrapancreatic disease. CEA determination, performed using monoclonal antibodies, seems to be unsatisfactory as compared to CA 19-9 in pancreatic cancer diagnosis, and combined assessment does not improve the results of CA 19-9 alone. Jaundice may influence serum CA 19-9 in pancreatic and extrapancreatic diseases.

Serum ferritin, described as increased in patients with pancreatic cancer, was studied in 109 subjects by an immunoradiometric technique in order to assess its reliability in detecting pancreatic malignancy. A significant increase of serum ferritin was found in pancreatic cancer as compared to controls (p

Trypsin/creatinine clearance ratio--a recently proposed screening test for pancreatic cancer--was assessed in 45 subjects (17 control subjects, 15 patients with pancreatic cancer, and 13 with chronic pancreatitis). A statistically significant increase of the ratio was detected not only in pancreatic cancer, but also in chronic calcifying pancreatitis. Thus, the previously reported clinical usefulness of the test in pancreatic cancer diagnosis was not substantiated by the present data. Although not fully investigated as yet, reasons for an abnormal ratio are probably independent of the neoplastic or inflammatory nature of the pancreatic disease. Science renal enzyme excretion (alpha-glucosidase, gamma-glutamyltranspeptidase, leucine aminopeptidase) was not found to be invariably elevated when trypsin/creatinine clearance ratio was increased, tubular damage cannot be assumed as constituting the only reason for an altered clearance ratio.

The behavior of trypsin/creatinine clearance ratio (Ctr/Ccr) and serum immunoreactive trypsin (IRT) was evaluated in a total of 168 subjects with pancreatic cancer, chronic pancreatitis and non-pancreatic digestive diseases. Amylase/creatinine clearance ratio (Cam/Ccr) and serum amylase levels were also evaluated in order to establish their possible relationship with Ctr/Ccr and IRT values. Elevated Ctr/Ccr and IRT values were observed in several patients with pancreatic cancer and chronic pancreatitis. Abnormal IRT and Ctr/Ccr values were found in 28.2 and 4% of non-pancreatic digestive diseases, respectively. IRT and amylase serum levels showed consensual modifications, while Ctr/Ccr showed a behavior different from that of Cam/Ccr. Liver damage seems to play a role in increasing serum IRT levels of patients without pancreatic involvement, while the increased Ctr/Ccr seems to depend on other factors, for instance renal tubular dysfunction.

We report our experience in the treatment of varicose veins of the lower limbs in the day surgery clinic of the 2nd Department of General Surgery of the University of Padova. From October 1990 to October 1996, 1522 cases of lower limb varicose veins were treated in our day-surgery clinic. Super-selective subarachnoid anesthesia was used in 94% of the cases. In all cases in which the incompetence of the saphenous trunk was demonstrated, crossectomy was associated with long or short stripping. There were no intra- or post-operative deaths and only limited morbidity. Post-operative hospitalization was required in four patients (three for headache and one for precordial pain). In conclusion, the out-patient treatment of varicose veins involves the same techniques as in-patient treatment. Therefore, the risks associated with surgery and anesthesia are very limited in a specialized center.