Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.
Summary. We report a prospective study analysing whether possible factors predisposing to degenerative spondylolisthesis (DS) must be present concomitantly in order to cause vertebral slipping. Standard and flexion-extension radiographs were obtained from 27 patients with DS and 27 without spondylolisthesis. The level of the intercrestal line, the lumbosacral angle, the presence of sacralization of L5 and vertebral motion at the L4 ± L5 level were assessed. Facet joint orientations were measured on CT scans. Only facet joint orientation and vertebral motion at the spondylolisthetic level were significantly different in patients with DS compared with controls. Facet joints were oriented more sagittally both at the spondylolisthetic level and at the levels above and below. An inverse linear correlation was found between the sagittal orientation of facet joints and the mobility of the slipped vertebra. Abnormal sagittal orientation of facet joints and hypermobility of the spondylolisthetic vertebra appear to play major roles among possible factors predisposing to DS. Both factors should be considered in the planning of surgical treatment.
GSV treatment by means of CFS and adjuvant PST + ISI, combined with phlebectomy of varicose tributaries, proved to be safe and effective in terms of clinical and duplex based outcomes at short/mid-term follow-up.
Re: 'Catheter-directed Foam Sclerotherapy of Great Saphenous Veins in Combination with Pre-treatment Reduction of the Diameter Employing the Principals of Perivenous Tumescent Local Anesthesia' We read with interest the article by Devereux et al. 1 The authors report no benefit in terms of venous occlusion using peri-saphenous ultrasound guided tumescence infiltration (UGTI) in addition to long catheter foam sclerotherapy (LCFS) of great saphenous veins (GSV). The positive role of tumescence in foam sclerotherapy, to decrease vein size, blood content, and inflow in the target vein, has been highlighted previously. 2,3 At the 2012 EVF meeting, we presented a prospective comparative study, which demonstrated better outcomes when UGTI was added to LCFS of the GSV 4 (82.4% occlusion rate after 14 months vs. 71% in patients treated without UGTI). Firstly, the authors acknowledge adrenaline was not included in the tumescent solution (because of legal issues). In our experience with UGTI, adding a vasoconstricting agent increases and prolongs GSV calibre reduction, and this may explain our own better outcomes. Furthermore, the statistical value of the study is possibly biased by the quite small number of patients and by the five patients (20%) and two patients (8%) not available for 12-month follow-up in the non-UGTI/UGTI groups, respectively. We acknowledge that the positive effect of adding tumescence to foam sclerotherapy has to be validated through future studies on larger cohorts.
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