What is postthrombotic venous obstruction and how can it be avoided?

What is postthrombotic venous obstruction and how can it be avoided? Anthony J. COMEROTA, MD, FACS, FACC Director, Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA; Adjunct Professor of Surgery, University of Michigan Abstract Postthrombotic venous obstruction is part of the pathophysiology of a postthrombotic syndrome. When the obstruction occurs in the iliofemoral segment, postthrombotic morbidity is often severe. In a recent study, the intraluminal contents of chronically occluded postthrombotic common femoral veins were analyzed. Approximately 80% to 90% of the tissues analyzed were composed of type I collagen, with type III collagen comprising the remainder. Vascular endothelial growth…

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A quality of life tool kit in chronic venous disorders

A quality of life tool kit in chronic venous disorders Robert Launois REES France, 48, rue d’Assas, 75006, Paris, France Abstract Individual preferences are now at the center of the medical decision-making process. Different experimental methods are used to determine preferences. Psychometricians use direct observation of a subject’s reaction in a particular pathological situation: patients are asked to arrange the intensity of the impacts on numerical ordinal scales, but an actual metrical measure is not yet available. Traditionally, economists believe that in a market, only the consumer’s choices enable us to estimate his or her level of satisfaction. In the…

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Endovenous management of venous leg ulcers

Raju S, Kirk OK, Jones TL. J Vasc Surg Venous Lymphat Disord. 2013;1:165-173. Reviewed by: Ramesh K Tripathi and Himanshu Verma Narayana Institute of Vascular Sciences, Bangalore, India This is an important paper highlighting the various modalities of treatment that come into play in the treatment of venous leg ulceration due to chronic venous insufficiency. The authors apparently were able to follow-up on 192 limbs that had failed conservative therapy and then underwent endovascular treatment that included 39 endovenous laser ablation (ELVA ) of superficial axial veins, 99 iliac vein stents and 59 using both procedures in combination. The numbers…

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Operative treatment in postthrombotic syndrome: an update

Oscar MALETI1, Marzia LUGLI2, Michel PERRIN3 1. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy Interuniversity Center of Phlebolymphology. 2. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy. 3. Associate Professor of Surgery Grenoble and for Institution Unité de Pathologie Vasculaire Jean Kunlin, Clinique du Grand Large, Chassieu, Lyon, France. ABSTRACT Postthrombotic deep vein obstruction and/or incompetence can lead to severe chronic venous insufficiency in a significant number of cases. Postthrombotic lesions are essentially of two types: (i) obstruction of various degrees; and (ii) valve destruction with subsequent reflux. These two elements are variously present at different levels. The most…

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Prevalence of venous leg ulcer: the importance of the data collection method

Olle NELZEN Skaraborg Leg Ulcer Centre & Dept of Vascular Surgery Skaraborg Hospital/KSS Skövde, Sweden ABSTRACT Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. A proper prevalence assessment is not easily done and requires time and effort. Most studies have just focused on prevalence of leg ulcers of all causes and only a few have really validated the leg ulcer diagnosis objectively by use of hand-held Doppler, color Doppler ultrasound, or plethysmography. There are many pitfalls in performing a prevalence study of venous leg…

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Neovalve reconstruction in postthrombotic syndrome. Technique, indications, and results

Oscar MALETI Marzia LUGLI Department of Cardiac, Thoracic, Vascular Surgery Hesperia Hospital Modena, Italy ABSTRACT Patients with leg venous ulcer (C6 patients according to the CEAP classification) affected by deep venous reflux often fail to respond to conservative therapies, and the presence of non-healing or recurrent ulcers may lead one to consider surgery. However, even if surgery is properly indicated, traditional techniques such as femoral transposition and valve transplantation are not always suitable, and in these cases a de novo valve reconstruction represents a surgical opportunity. Our neovalve reconstruction technique consists in creating an intimal flap by performing a wall…

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