Both methods of endovenous ablation effectively reduce symptoms of superficial venous insufficiency. EVL is associated with greater bruising and discomfort in the perioperative period but may provide a more secure closure over the long-term than RFA.

On the basis of the USI data alone, a prediction of arteriographic findings was possible at the 95% level for occlusion and severe stenosis and for ruling out hemodynamically significant stenosis. The addition of velocity data improved prediction in borderline degrees of stenosis. USI was effective for quantifying clinically significant degrees of stenosis.

No abstract

Patients with acute deep vein thrombosis involving the iliofemoral venous system experience the most severe postthrombotic sequelae. Treatment designed to reduce or eliminate the postthrombotic syndrome must necessarily remove thrombus to eliminate obstruction. Unfortunately, currently published guidelines do not recommend venous thrombectomy and actually recommend against its use because of the poor results initially reported. However, recent reports of venous thrombectomy and the long-term results of a large randomized trial confirm the significant benefit compared with anticoagulation alone. The technique of contemporary venous thrombectomy follows basic vascular surgical principles and offers patients the opportunity for complete or nearly complete thrombus extraction, thereby avoiding the significant morbidity of their anticipated postthrombotic syndrome. The techniques described herein represent the authors' approach to patients with few alternatives to clear the venous system. Because the patient benefit is well established, vascular surgeons should include contemporary venous thrombectomy as part of their routine operative armamentarium, offering this procedure to patients with extensive deep vein thrombosis involving the iliofemoral venous system, especially if other options are not available or have failed.

Historically, patients with mild to moderate neurologic deficits lasting longer than 24 hours were believed to have sustained a completed stroke. They were followed up for 4 to 6 weeks and cerebral angiography was performed if indicated. CT scanning has identified a subset of these patients who have sustained a reversible ischemic neurologic deficit (RIND) rather than a completed stroke. The timing for angiography and surgery for this group has not been established. In an earlier study we found that 21% (4 of 19 patients) suffered a second stroke during the 4- to 6-week waiting period. To avoid this high rate of recurrence, we instituted an aggressive program of CT scan evaluation and surgical therapy for all "stroke patients" with negative CT scans. Two hundred forty-five patients were seen with a persistent neurologic deficit between July 1980 and December 1983. These patients underwent CT scans 1 and 5 days after the initial event. Of these 245 patients, 171 patients (70%) were found to have negative CT scans. Appropriate carotid lesions were found by arteriography in 110 (64%) of the negative CT scan group. There were 61 (55%) men and 49 (45%) women in this group. Eighty-five patients (77%) had previous neurologic symptoms or a cerebrovascular accident. Hypertension was present in 52% and diabetes mellitus in 30%. All 110 patients underwent carotid endarterectomy within 14 days (mean 10 days) of the initial onset of their neurologic deficit; these were all done with shunt protection. No patient suffered another neurologic deficit in the same territory within 30 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic deep venous insufficiency remains a major health problem in the United States and worldwide. Selected patients benefit from direct deep vein valve repair or valve transplantation; however, most are not candidates for these procedures. Experience with the bovine monocusp venous valve surgically inserted into the common femoral vein (CFV) demonstrates potential benefit and good long-term patency. A venous valve placed distal to the CFV via percutaneous access has great appeal and potential for further improving venous hemodynamics, as well as reducing ambulatory venous hypertension and ulceration. Two patients were treated with a percutaneous venous valve bioprosthesis as part of a Phase I trial. The primary objective was to evaluate the safety, patency, and efficacy of the percutaneous venous valve bioprosthesis to restore competency to the deep venous system.

Small vessel networks were detected adjacent to or in connection with most of the radiofrequency ablation-treated GSVs. SFJ ligation was associated with fewer small vessel networks and proximal GSV recanalization. Most below-knee untreated GSV segments remained patent, and most exhibited reflux.

Gender bias exists in use of ultrasonography for diagnosis of DVT. The greater incidence of women undergoing venous ultrasonography is not explained by higher prevalence of DVT risk factors or of higher occurrence of positive ultrasound examination results. Further investigation is needed to determine whether these differences indicate underuse of ultrasonography in men or overuse in women.