Servier – Phlebolymphology

Chairpersons: P. BALAS (Greece), D. L. CLEMENT (Belgium),
A. SCHIRGER (USA), A. STRANO (Italy)

Winners: Circulatory changes in CVI patients after different
treatments: evaluation with noninvasive methods

C. L. L. PORTO, A. N. N. MILHOMENS, S. AMARAL, F. F. A. FERNANDES, C. E. PIRES,
S. X. SALLES, D. A. BOTTINO, E. BOUSKELA (Brazil)

Changes in venous diameters (by duplex scanner), microcirculation (by the orthogonal polarized system Cystoscan®) and calf volume were evaluated in 52 women, before and after 28 days of Cirkan® (Ruscus aculeatus hesperidine methilcalcone + vitamin C), or elastic compression (Venosan®, 30 to 40 mm Hg) without any medication. They were 25 to 65 years old, C2S or C 3S in the CEAP, and healthy except for CVI. Improvement on the venous score (C3 to C2) was significant in the stocking group. Popliteal diameter improved significantly in the Cirkan® group compared with controls. Great saphenous vein diameter improved significantly in both groups compared with controls. Leg diameters improved only in the stocking groups compared with Cirkan® or control groups. Cytoscan® showed a reduction in edema and an increase in the capillary density in both groups. Although stockings are considered to be the most effective medical treatment for CVI, Cirkan® showed an improvement on CVI symptoms in terms of popliteal and GVS diameters or CEAP classification.

Noninvasive evaluation of endothelial function in patients
with Anderson-Fabry disease

D. PUCCIO, E. CORRADO, G. COPPOLA, I. MURATORI, G. PISTONE, M. ARICO, S. NOVO (Italy)

Fabry disease is an X-linked recessive disease with a deficit in á-galactosidase A, implicated in the glycosphingolipid metabolism. Cardiovascular involvement of Fabry disease (myocardial hypertrophy, prolapse or thickening of the valves, conduction system involvement, etc) is one of the main causes of death in the 6th decade with renal failure. Endothelial function was studied in 6 cases of Fabry disease and 12 controls. Using high-resolution ultrasound, the brachial vasodilatator responses were assessed, after reactive hyperemia by flow-mediated vasodilatation (FMD; endothelium dependent) and sublingual nitroglycerin (endothelium-independent). No difference was observed between the two groups at baseline for clinical or laboratory markers, homocysteine concentration, and brachial artery diameter. Only inflammatory factors were significantly increased in the Fabry group. After nitroglycerin administration, no significant difference was observed between the groups. After reactive hyperemia, FMD change was significantly higher in the Fabry group, These results suggest an endothelial dysfunction in Fabry disease patients, which may be responsible for the cardiovascular involvement of the disease.

Anti-inflammatory effects of defibrotide as measured in
various pathologic states

J. FAREED, D. A. HOPPENSTEADT, M. LASEEN, J. MADDINENI, O. IQBAL (USA)

Defibrotide is a polydeoxyribonucleotide-derived drug known to release fibrinolytic mediators, tissue factor pathway inhibitor (TFPI) and inhibit the platelet activation process. Patients with peripheral arterial disease, post bone marrow transplantation, veno-occlusive disease, and post orthopedic surgery prophylaxis for thrombosis showed an upregulation of inflammatory markers: C-reactive protein, soluble CD 40 ligand, monocyte chemotactic protein (MCP-1), soluble thrombomodulin, and plasminogen activator inhibitor PAI-1. Upon defibrotide treatment time, dependent decrease was seen in all groups of patients, mostly in CD 40-L and PAI-1, with high dosages of IV defibrotide.

Chairpersons: J. FERNANDES E FERNANDES (Portugal),
P. GLOVICZKI (USA), A. N. NICOLAIDES (Cyprus), H. RIEGER (Germany)

High wall shear stress measured by magnetic resonance
is a predictor of restenosis in the femoral artery after
balloon angioplasty

B. AMANN-VESTI, S. KOZERKE, E. KRIEGER, P. BOESIGER, R. KOPPENSTEINER (Switzerland)

Wall shear stress (WSS) has been implied in the pathogenesis of restenosis. This project presents a possible way to determine WSS in superficial femoral artery from MRI and duplex ultrasonography in healthy controls and in patients after superficial femoral artery PTA. WSS was assessed by calculating the slope of velocity profiles at the vessel wall from data obtained with velocity-encoded cine MR and with duplex using the formula: WSS=4x blood viscosity x peak blood velocity /internal diameter. They studied 17 patients the day after superficial femoral artery PTA to determine WSS, and 6 months later to determine restenosis rate. They observed that patients who developed restenosis were those with higher WSS determined the day after PTA. They suggest that this is a good way to determine WSS in a vessel and use it as a predictive factor after PTA.

Arterial wall remodeling mathematically described
by standardized intima-media thickness frequency
distribution curves

E. DE GROOT, A. ZWINDERMAN, A. WIEGMAN, A. SMIT, J. KASTELEIN (The Netherlands)

The intima-media thickness (IMT) in different populations exposed to different extents of cardiovascular risk was determined by means of B-mode ultrasound. Then IMT frequency dirtribution curves were created for all populations: control adolescents, control adults, control seniors, young adolescents with familial hypercholesterolemia, patients with coronary artery disease, and adults with familial hypercholesterolemia. IMT curves that deviated from the IMT normal distribution curve were defined as lesions. They observed local differences in increase in wall thickness and increase of lesion formation with age and cardiovascular risk.

Effects of dobutamine on left ventriculoarterial coupling and
mechanical efficiency in acutely ischemic pigs

P. KOLH, B. LAMBERMONT, A. GHUYSEN, V. TCHANA-SATO, P. GERARD, J. DOGNE, V. D’ORIO,
L. PIERARD, R. LIMET (Belgium)

Although dobutamine is a drug which is widely used, it is not yet clear what its effects are on left ventriculoarterial coupling and mechanical efficiency in the ischemic heart. The author performed the experiment in 12 pigs in which coronary occlusion was produced; vascular properties were estimated with a windkessel model. They observed that in ischemic pigs dobutamine restored ventriculoarterial coupling through an increase in left ventricular contractility and decrease in arterial elastance, due to peripheral vasodilatation. However, myocardial oxygen consumption was increased and efficiency impaired.