Objectives To evaluate histological and immunohistochemical changes in the great saphenous vein after endovenous laser ablation at two different wavelengths (1470 vs. 1940 nm) and linear endovenous energy density values (50 vs. 100 J/cm). Method Segments were obtained from the conventional eversion removal of great saphenous vein and divided into a control group and four groups for ex vivo irradiation (control group; A: 1470 nm, 50 J/cm; B: 1470 nm, 100 J/cm; C: 1940 nm, 50 J/cm; D: 1940 nm, 100 J/cm). Fifty venous segments ( n = 10/group) were analyzed. Changes were classified into low-temperature changes, moderate-temperature changes, high-temperature changes, and very high-temperature changes. Results In the intima, low-temperature changes + moderate-temperature changes were significantly more prevalent in group A (65.4%) than in D ( p = 0.001). In the media, low-temperature changes + moderate-temperature changes were achieved mostly in groups A and C (77.4% and 75.0%, respectively). In adventitia fragments, 100% of changes in group A were low-temperature changes + moderate-temperature changes. Conclusions The 1940-nm laser wavelength with linear endovenous energy density of 100 J/cm was excessively destructive to the intima and media causing a high rate of high-grade thermal damage. These findings corroborate the possibility of using lower linear endovenous energy densities with 1940-nm devices to achieve effective occlusion with less high grade thermal damage to the intima and media, as well as to prevent damages to the adventitia and perivenous tissues, including venous perforation and its attendant clinical consequences.

Background: Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective: To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods: This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results: Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions: Tumescence proved useful for preventing minor neurological injuries, but didn't have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

PURPOSE:To develop an ex vivo model for the analysis of macroscopic, histological and immunohistochemical changes after experimental endovenous laser ablation (EVLA) of the great saphenous vein (GSV). METHODS:We describe a model produced with glass tubes and introducer sheaths to mimic the physiological conditions of EVLA procedures, such as tumescence and blood flow. A pilot study was conducted to evaluate an ex vivo procedure of EVLA of an incompetent GSV segment using a 1470-nm radial fiber diode laser (7 W power) and an automatic pull-back device. The vein segment was analyzed macroscopically and by hematoxylin & eosin staining, elastic fiber histochemistry, Gomori's trichrome staining, and alpha-smooth muscle actin immunohistochemistry. RESULTS:No perforations were observed macroscopically. No muscle cell adhesion was observed in the central part of the ablated vein, showing tissue disruption. There was low labeling for elastic fibers, disruption of muscle fibers, and a reduced expression of the specific marker for this cell type. CONCLUSION:This ex vivo endovenous laser ablation model is a low cost alternative to in vivo experiments, providing standardized experimental conditions.

There are few data on endovascular treatment of anterior nutcracker syndrome and pelvic varices in patients with anterior and posterior renal veins. Our objective is to report a case, identify occurrences and compare diagnosis and treatments. A 42-year-old woman presented with flank and pelvic pain and hematuria. She had anterior nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein. A successful complete endovascular approach was done with stent implantation in the anterior renal vein and left gonadal vein embolisation. After 12-month follow-up, the patient remained asymptomatic with good results on CT. Only two case reports of patients with nutcracker syndrome with anterior and posterior renal veins were identified. In both, a self-expanding stent was implanted in the anterior renal vein. In conclusion, endovascular treatment represents a safe and successful option in patients with nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein.

Resumo A agenesia de carótida interna é uma anomalia rara. Na maioria dos casos, é assintomática devido às anastomoses que podem estar presentes, mas pode estar associada a complicações, principalmente quando evidenciada a presença de outras alterações anatômicas ou doença aterosclerótica grave. Relatamos o caso de uma paciente feminina de 63 anos, hipertensa e diabética, com história de cirurgia prévia para clipagem de aneurisma cerebral. Na investigação através de eco-Doppler e angiotomografia de carótidas e vertebrais, foi evidenciada agenesia unilateral da artéria carótida interna esquerda. Este relato objetiva chamar atenção para a importância de se suspeitar de malformações vasculares durante a investigação de quadros neurológicos. A agenesia de carótida interna tem uma importante associação com aneurismas intracerebrais, e é possível poupar o paciente de graves complicações quando estes são identificados a tempo.

This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.

Objectives To describe saphenous reflux patterns in patients classified as CEAP C2 by analysis of 2027 vascular ultrasound examination reports. Methods A total of 2027 venous mapping studies were reviewed and 1196 patients classified as CEAP C2 were selected. Patients were classified according to patterns of reflux for the great saphenous vein and for the small saphenous vein, and rates of great saphenous vein and small saphenous vein reflux were analyzed for both sexes. Results The overall prevalence of saphenous vein reflux was 45%. Males had significantly higher great saphenous vein reflux prevalence than females ( p < 0.001). The most common great saphenous vein reflux pattern in females was segmental reflux and the most common pattern in males was proximal reflux. Conclusions Saphenous vein reflux is common in C2 patients and is more frequent in males. Standardization of classifications of reflux patterns is very important for correct management of the disease.