European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
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Eur J Vasc Endovasc Surg · Mar 2012
Randomized Controlled Trial Comparative StudyProspective randomised comparative study of visual foam sclerotherapy alone or in combination with ultrasound-guided foam sclerotherapy for treatment of superficial venous insufficiency: preliminary report.
The aim of the study is to compare ultrasound-guided foam sclerotherapy (UGFS: injection of foam sclerosant under ultrasound guidance) of the great saphenous vein (GSV) combined with visual foam sclerotherapy (VFS: injection of foam sclerosant under visual control) for varicose tributary veins and VFS alone in the treatment of GSV reflux. ⋯ These results show that UGFS + VFS and VFS are equally effective for the treatment of GSV reflux, despite the lower volume of foam used for VFS alone.
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Eur J Vasc Endovasc Surg · Mar 2012
ReviewCatheter-based radiofrequency renal-nerve ablation in patients with resistant hypertension.
This review aims to describe the role and the results of catheter-based renal nerve ablation for the treatment of resistant hypertension. Despite the availability of multiple classes of orally active antihypertensive treatments, resistant hypertension remains an important public health issue in 2012 due to its prevalence and association with target-organ damage and poor prognosis. The failure of purely pharmacological approaches to treat resistant hypertension has stimulated interest in invasive device-based treatments based on old concepts. ⋯ The available evidence suggests a favourable blood pressure-lowering effect in the short term (6 months) and a low incidence of immediate local and endovascular complications. This follow-up period is, however, too short for the detection of rare or late-onset adverse events. For the time being, the benefit/risk ratio of this technique remains to be evaluated, precluding its uncontrolled and widespread use in routine practice.
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Eur J Vasc Endovasc Surg · Mar 2012
Comparative StudyOutcomes after open surgery and endovascular aneurysm repair for abdominal aortic aneurysm in patients with massive neck atheroma.
We retrospectively analysed surgically treated abdominal aortic aneurysm (AAA) in patients with massive atheroma in the aneurysmal neck and compared the outcomes of endovascular aneurysm repair (EVAR) and open surgery (OS) to determine an appropriate strategy for massive neck atheroma cases. ⋯ Compared to OS patients, EVAR patients with massive neck atheroma tend to develop late-phase complications possibly related to cholesterol crystal embolisation. The clinical features of massive neck atheroma patients receiving EVAR should be carefully monitored even after hospital discharge.
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To analyse the incidence of stroke after thoracic endovascular aortic repair (TEVAR) for aortic arch disease. ⋯ Stroke after TEVAR is not infrequent especially when the arch is involved. Careful patient selection together with a strategy to reduce embolisation such as occlusion of supra-aortic trunks before EG deployment may play a beneficial role.
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The unit cost for crossmatching blood is £137.22 (€158.94). A maximum surgical blood order schedule for elective EVAR does not exist. We studied the crossmatch to transfusion ratio in our series to establish this recommendation. ⋯ The maximum surgical blood order for elective EVAR should be a group and save (type and screen) sample because of the high crossmatch to transfusion ratio. Intraoperative transfusion is rarely required (<1%) but often necessitates large transfusion quantities. In this circumstance each hospital is required to have an emergency protocol to manage massive blood loss. Applying these principles across all surgical specialities may lead to significant financial savings, improve efficiency and reduce wastage.