We report our experience of 93 patients with recurrent varicose veins. Doppler ultrasound and ascending phlebology were routinely performed, with descending or popliteal phlebography in some patients, as a means of evaluating recurrence. Early recurrence was found in a few cases due to incorrect diagnosis. Late recurrence, in the majority of cases, was due to incorrect surgery or the overlooking of gastrocnemius vein incompetence. In some cases deep reflux, soleal arch compression or left iliac vein compression was found to be a possible cause of recurrence. Extensive evaluation of the venous disorder and the ligation of every site of deep to superficial reflux are the first steps in preventing recurrence. The rules and pitfalls of surgical treatment are stressed. On recurrence, Doppler ultrasound is accurate in deep venous assessment and in demonstrating leaking perforators. Ascending phlebography is the method of choice in the investigation of the deep veins and in confirming perforating vein incompetence. We have used popliteal phlebography to demonstrate incompetence of the LSV junction, SSV junction, gastrocnemius vein and mid-thigh and popliteal fossa perforators. When necessary, surgery for recurrent varicose veins must be carefully carried out according to certain basic principles.
WHAT THIS PAPER ADDSThis analysis of the ENDURANT France registry provides five year outcomes from a French population treated under real life conditions. Patients experienced a 69.9% AE 3.5% KaplaneMeier overall survival, 97.6% AE 1.2% freedom from aneurysm related mortality, low rates of type IA endoleaks, few secondary procedures, and showed positive signs of remodelling. These outcomes are similar to other recent global registries and better than the outcomes with earlier generation devices. With the current focus on managing costs and reimbursements, these five year outcomes of a French specific cohort provide further evidence of the long term durability and success with the Endurant stent graft system.Objective: Endovascular repair is the preferred method of treatment for infrarenal abdominal aortic aneurysms with numerous publications from multiple geographic regions showing excellent patient outcomes. Since the original ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) randomised control trial, studies of French specific population have also contributed significantly to the body of evidence in support of endovascular abdominal aortic repair. Methods: In the ENDURANT France registry, 180 patients were consecutively enrolled from 20 French centres starting in 2012. Investigational sites included public and private practice and differing centre volumes to be as representative of real world French experience as possible. The aim of this study was to present the five year outcomes from this registry. Results: Instructions for use (IFU) were respected in 97.8% (176/180) of patients. At five years, the KaplaneMeier overall survival was 69.9% AE 3.5% and the freedom from aneurysm related death was 97.6% AE 1.2%. The freedom from Type IA endoleaks was 94.5% AE 1.7%, freedom from endoleaks of any type was 70.1 AE 3.4%, and freedom from secondary endovascular procedure 90.4% AE 2.6%. In addition, 61.6% (45/73) of patients exhibited sac shrinkage at five years. Conclusion: In this five year report of the Endurant France registry, survival, re-intervention, and freedom from endoleak rates were comparable to recent EVAR registries and there was a high sac shrinkage rate. Secondary procedure and aneurysm rupture were lower than those of ACE, the French RCT which included older generation devices. This prospective registry demonstrates favourable five year outcomes of the Endurant stent graft used within IFU.
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