BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. The full text is available from: http://dx.doi.org/10.1002/14651858. CD005624.pub2.The abstract is also available in the Portuguese, French and Spanish languages from: http://summaries.cochrane.org/pt/CD005624/ablacaoendovenosa-por-radiofrequencia-e-laser-e-escleroterapia-com-espumaversus-cirurgia-convencional-para-o-tratamento-de-varizes. COMMENTSWith the advent of new techniques for treating varicose veins, many studies are needed in order to compare the new procedures with the gold-standard treatment, i.e. conventional surgery with removal of either the great or the small saphenous vein and excision of tributaries presenting insufficiency. In this review, many data were flawed or did not lead to a conclusion that would be capable of showing significant details regarding the best technique. It can be expected that treatments with laser, radiofrequency or foam sclerotherapy may lead to recanalization of the treated veins, since these do not remove the veins but only stop the flow of blood through the lumen. Recurrence of varicose veins within four months suggests that there was an error in marking out the varicose veins before the operation and failure of the planned removal of the saphenous vein or the dilated tributaries. Some technical details of the surgery may differ, such as segmental removal of the great saphenous vein under general anesthesia. This procedure is not customary in many centers, and complete removal of the saphenous vein with intrathecal or regional blockade is preferred. Other extremely necessary data include comparison of the costs of the fiber laser and radiofrequency equipment, costs of procedures and costs of hospitalization when necessary.
When comparing the recurrence rate and overall complication rate and symptoms relief, surgery was not inferior to endovenous procedures. Reported follow up periods for the endovenous procedures were relatively short.
Introduction: Computed tomography angiography (CTA) is the gold standard follow-up modality after endovascular aneurysm repair (EVAR). A potential alternative noninvasive and less expensive modality is duplex ultrasound scanning (DUS). Methods: We studied 314 follow-up paired scans (DUS and CTA) in 59 patients with EVAR. Results: Endoleak-Endoleak was detected in 23.7% patients. The sensitivity and specificity rates of DUS were 54% and 95.3%, respectively. All 9 endoleaks that needed secondary intervention were detected on DUS. Eight of those were identified within a year after EVAR. Sac size-The mean difference in maximum diameter between the DUS and CTA was 5 mm in 84.5% of cases and 10 mm in 97.1%. Graft patency-There was 100% agreement between CTA and DUS. Conclusions: Duplex ultrasound scanning was reliable as it detected all the leaks that needed reintervention after EVAR. Duplex ultrasound scanning showed similar results to CTA in detecting sac size and patency.
Summary. Background: Adverse morphological features of the proximal aortic neck have been identified as culprits for late failure after endovascular aneurysm repair (EVAR). Our objective was to investigate the prognostic role of wide proximal aortic neck in EVAR. Methods: We conducted a review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing outcomes of EVAR in patients with large versus small proximal aortic neck. A meta-analysis of time-to-event data was performed with the inverse-variance method and the results were reported as summary hazard ratio (HR) and 95 % CI. We applied random-effects models of meta-analysis. Results: We identified 9 observational studies reporting on a total of 7,682 patients (1,961 with large diameter and 5,721 with small diameter neck). The hazard of death (HR 1.57, 95 % CI 1.23–2.01; P = 0.0003), aneurysm-related reintervention (HR 2.06, 95 % CI 1.23–3.45; P = 0.006), type Ia endoleak (HR 6.69, 95 % CI 4.39–10.20; P < 0.001), sac expansion (HR 10.07, 95 % CI 1.80–56.53; P = 0.009), aneurysm rupture (HR 2.96, 95 % CI 2.00–4.38; P < 0.0001), and neck-related adverse events (HR 10.33, 95 % CI 4.95–21.56; P < 0.0001) was higher in patients with large diameter proximal aortic neck than in those with small neck. Conclusions: Patients with a large proximal aortic neck were found to have poorer outcomes than those with small neck. This finding has implications in decision making when selecting methods for aneurysm treatment and in EVAR surveillance for aneurysm-related complications in this cohort of patients.
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