Intraoperative surgical stress was higher under LA and was blunted by carotid shunting under both LA and GA. Within 2 hours after surgery the anesthetic modality no longer had any impact on surgical trauma. The stress response to CEA, regardless of the type of anesthesia, was abolished within 24 hours. Intraoperative stress response, namely hypercortisolemia, directly correlated with subclinical and clinical cerebral hypoperfusion/ischemia during CACC. Hence, attenuation of the stress response to CEA might decrease the incidence of cerebral ischemic events.

remifentanil as a supplement to regional anaesthesia for carotid endarterectomy, provides comfort and analgesia without hampering mental status evaluation.

Objective: Evaluation of the relationship between deep venous insufficiency and recurrent varicose veins (RVV). Design: Retrospective analysis of patients affected by RVV submitted to clinical examination, continuous-wave (CW) Doppler, duplex scanning and descending phlebography in cases of incompetence at groin level. Setting: Department of Vascular Surgery, Istituto Dermopatico dell'Immacolata (IRCCS), Rome. Patients: Two hundred and thirty-nine patients affected by RVV. Main outcome measures: CW Doppler ultrasound, duplex ultrasound imaging and descending phlebography to assess venous incompetence. Results: Doppler examination revealed no reflux at the groin level in 80 limbs. In the remaining 166 limbs, descending phlebography showed a superficial venous reflux in 95 limbs (related to a sapheno-femoral junction recanalization or to an inadequate previous operation) while in 69 (28% of the 246 limbs examined) deep venous reflux was present (superficial femoral vein in 38 cases, profunda femoris vein in seven cases and both veins in 24 cases); in two cases reflux came from the pelvic veins. Conclusions: Our data suggest a possible role of primary deep venous insufficiency in the development of RVV and the value of descending phlebography in the planning of further surgery.

Objective: Evaluation of the role of external banding valvuloplasty in the treatment of primary deep venous insufficiency. Design: Retrospective analysis of patients subjected to external banding valvuloplasty (EBV) with the Venocuff in relation to the evolution of venous reflux. Setting: Department of Vascular Surgery, Instituto Dermopatico dell'Immacolata, Rome, Italy. Patients: Ten patients with signs and symptoms of chronic venous insufficiency. Interventions: Application of a Venocuff to the superficial femoral vein. Main outcome measures: The correction rate of the primary deep venous reflux assessed by venography and colour duplex ultrasound. Results: In a mean follow-up period of 10 months, deep vein reflux was completely abolished in nine patients (90%). Conclusions: The Venocuff is an improvement over the previous techniques, of surgical treatment of primary deep venous insufficiency in reducing the dilated valve bulb to the correct size in a quick, standardized and precise way.

Before developing deep venous thrombosis (DVT), most patients suffering from postthrombotic syndrome (PTS) have a normal great saphenous vein (GSV). After DVT, the GSV plays a vicarious function, but many patients develop secondary varicose veins (VVs) and the previous positive contribution of the GSV vanishes. In these cases the ablative strategy is generally implemented with positive results in the short-term, but commonly with late varicose recurrences. In two cases the authors preferred a different approach to preserve and recover the GSV vicarious function by sapheno-femoral junction (SFJ) valvuloplasty. Out of 43 cases we treated with SFJ stretching valvuloplasty performed with the new OSES device (V-OSES), we proposed this operation to two patients (A and B) suffering from PTS and secondary VVs at an early stage, classified as C3 and C4 (Clinical-Etiology-Anatomy-Pathophysiology classification, CEAP). In the V-OSES operation a gentle stretching force is applied onto the apex of the opposite valve commisures so that the valve cross-section becomes oval and the cusp's length excess is retrieved. The operation was performed on the SFJ valve having incompetent, but floating cusps visible on ultrasound (US) scan. This reparative technique was undertaken under local anesthesia and was combined with disconnection of the incompetent tributaries and/or perforators. The US-duplex scanning showed that the SFJ valves were competent at month 16 (B) and 20 (A) follow-up after surgery and the GSV vicarious function was preserved. The stretching valvuloplasty operation is intended to repair the SFJ valve incompetence and preserve the GSV vicarious function. This approach may be useful in primary VVs, but especially in PTS when superficial reflux appears and secondary VVs are at early stage. The SFJ reparative operation may be combined with the conventional GSV conservative strategies, including incompetent tributaries ablation/disconnection. This approach does not seem to have been already reported in the literature and needs further confirmation.