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Purpose To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. Materials and Methods A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. Results The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. Conclusion Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. Level of Evidence Level 4, Retrospective study.

T he appearance of varicose veins in the lower extremities is a prevalent condition associated with a wide range of lower limb symptoms such as pain, heaviness, night cramps, itchiness, swelling, and numbness (1-3). It is commonly caused by chronic venous insufficiency in superficial venous system, and great saphenous vein (GSV) comprises most of the superficial venous insufficiencies (82.7%), followed by small saphenous vein insufficiencies (10.9%) (4). Superficial venous insufficiency shows segmental involvement as demonstrated by previous studies (5). However, a standardized anatomical classification of superficial venous insufficiencies based on Doppler ultrasonography mapping is not readily available.Venous insufficiency mapping is important to decide the treatment planning for an individual patient. The main aim of the current treatment in venous insufficiency is to alleviate the complaints of the patients and to prevent future complications and recurrences. Treat- PURPOSEThis study aims to establish a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency and to evaluate the relationship between this classification, the demographics, and severity of clinical findings. METHODSThis is a retrospective study from prospectively collected data of 503 patients who had the complaint of varicose vein. All patients had complete physical examination and their medical history was recorded. Lower limbs of all patients were examined with Doppler ultrasonography. A total of 787 limbs with great saphenous vein insufficiency were included in the analysis. The reflux patterns of great saphenous vein insufficiency were classified into 4 types as: type 1, great saphenous vein reflux without involvement of malleolar region and saphenofemoral junction (SFJ); type 2, reflux involving malleolar region with competent SFJ; type 3, reflux involving SFJ with competent malleolar region; and type 4, reflux involving both the SFJ and the malleolar region. We evaluated the association between the classification of great saphenous vein insufficiency and age, sex, body mass index (BMI), disease duration, clinical, etiological, anatomical and pathophysiological elements (CEAP) classification and venous clinical severity score (VCSS). RESULTSThe mean age of the patients was 45.3±11.7 years, with a male-to-female ratio of 2:3. The most common reflux pattern in patients with great saphenous vein insufficiency was type 3 (48.9%), while 14.8% of patients had type 1, 10.4% had type 2, and 25.7% had type 4. Patients with type I reflux pattern were younger in age (p = 0.002), had lower BMI (p = 0.002), fewer number of children (p = 0.008), as well as milder clinical severity score (p = 0.002) compared to other reflux types. Duration of disease symptoms was not significantly correlated with the reflux patterns, but VCSS increased with the involvement of malleolar region as in type 2 compared to type 1 (2.82±1.67 vs. 2.74±2.31), and further increased with the involvement of SFJ as in type 3 (4.13±2...

Our results show that pre-procedure diameter of the GSV is the single risk factor for recanalization after RFA.

Background and Aims: Trans-arterial chemoembolization (TACE) has become a widely accepted treatment in unresectable hepatocellular carcinoma (HCC). We aimed at comparing the efficacy of Degradable Starch Microspheres (DSMs)-TACE with 50 ± 7 µm versus 300-500 μm Drug Eluting Beads (DEB)-TACE in terms of initial clinical and radiological treatment response parameters. Material and Methods:A total of 54 patients with unresectable HCC who underwent DEB-TACE (n = 25) or DSMs-TACE (n = 29) were included in this retrospective study. Baseline demographic and clinical characteristics, duration of follow-up, local recurrence and survival status, as well as treatment outcome including treatment response via modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria, viable and total tumor diameter and serum alpha-fetoprotein (AFP) levels were analyzed in both study groups.Results: No significant difference was noted between the two groups in terms of local recurrence (31.6 vs. 16.7%) or mortality (73.9 vs. 85.7%) rates after 36-month and 12-month follow-up, respectively. DSMs-TACE vs. DEB-TACE was associated with significantly higher complete response rate (27.6 vs. 0.0%, p = 0.011) and significant decrease in serum AFP levels (p = 0.013). Conclusion:Both DSMs-TACE with 50 ± 7 µm microspheres and 300-500 μm DEB-TACE are effective for local control of unresectable HCC. Our findings revealed superiority of DSMs-TACE over DEB-TACEnin terms of initial clinical and radiological tumor response; though no significant difference was noted between the two patient groups in terms of local recurrence or mortality during follow up.

Objective Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing’s syndrome. Current guidelines recommend bilateral adrenalectomy for PBMAH, but several studies showed clinical effectiveness of unilateral adrenalectomy despite bilateral disease in selected patients. Our aim was to evaluate the gain of information which can be obtained through adrenal venous sampling (AVS) based cortisol lateralization ratios for guidance of unilateral adrenalectomy. Design We performed a retrospective analysis of 16 patients with PBMAH and clinical overt cortisol secretion in three centers Methods Selectivity of adrenal vein sampling during AVS was defined as a gradient of cortisol or a reference adrenal hormone ≥2.0 between adrenal and peripheral vein. Lateralization was assumed if the dominant to non-dominant ratio of cortisol to reference hormone was ≥4.0. Results AVS was technically successful in all patients based on absolute cortisol levels and in 13 of 16 patients (81%) based on reference hormone levels. Lateralization was documented in 8 of 16 patients. In patients with lateralization, in 5 of 8 cases this occurred toward morphologically larger adrenals, while in 3 patients lateralization was present in bilaterally identical adrenals. The combined volume of adrenals correlated positively with urinary free cortisol, suggesting that adrenal size is the dominant determinant of cortisol secretion. Conclusions In this study the gain of information through AVS for unilateral adrenalectomy was limited in patients with PBMAH and marked adrenal asymmetry.

Objective: Cortisol measurements are essential for the interpretation of adrenal venous samplings (AVS) in primary aldosteronism (PA). Cortisol cosecretion may influence AVS indices. We aimed to investigate whether cortisol cosecretion affects non-ACTH stimulated AVS results. Design: Retrospective cohort study at tertiary referral center. Methods: We analyzed 278 PA patients who underwent non-ACTH stimulated AVS and had undergone at least a 1-mg dexamethasone suppression test (DST). Subsets underwent additional late-night salivary cortisol (LSC) and/or 24-hour urinary free cortisol (UFC) measurements. Patients were studied from 2013-2020 with follow-up data of 6 months following adrenalectomy or mineralocorticoid antagonist therapy initiation. We analyzed AVS parameters including adrenal vein aldosterone/cortisol ratios, selectivity, lateralization (LI) and contralateral suppression indices and post-operative ACTH-stimulation. We classified outcome according to PASO criteria. Results: 18.9% had a pathological DST result (1.9-5 µg/dl: n=44 (15.8%); > 5 µg/dl: n=8 (2.9%)). Comparison of AVS results stratified according to the 1-mg DST (≤ 1.8 vs. >1.8 µg/dl: p=0.499; ≤ 1.8 vs. 1.8 ≤ 5 vs. > 5 µg/dl: p=0.811) showed no difference. Lateralized cases with post DST serum cortisol values > 5 µg/dL had lower LI (≤ 1.8 µg/dL: 11.11 [5.36; 26.76] vs. 1.9-5 µg/dL: 11.76 [4.9; 31.88] vs. > 5 µg/dL: 2.58 [1.67; 3.3]; p=0.008). PASO outcome was not different according to cortisol cosecretion. Conclusions: Marked cortisol cosecretion has the potential to influence non-ACTH stimulated AVS results. While this could result in falsely classified lateralized cases as bilateral, further analysis of substitutes for cortisol are required to unmask effects on clinical outcome.