Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins

Application of femoral nerve block combined with modified swelling anesthesia in high ligation and stripping of great saphenous vein

Background

To analyze and explore the clinical efficacy of ultrasound guided femoral nerve block combined with modified swelling anesthetic solution in high ligation and stripping of the great saphenous vein.

Methods

90 patients with varicose great saphenous vein of lower limbs undergoing high ligation and stripping of great saphenous vein were randomly divided into group A (femoral nerve block combined with modified swelling anesthesia), group B (simple swelling anesthesia) and group C (epidural anesthesia), with 30 patients in each group. The serum CRP level, operation duration, intraoperative blood loss, postoperative hospitalization time, total hospitalization cost, postoperative VAS score, preoperative and postoperative VCSS score, intraoperative mean arterial pressure and heart rate, postoperative related complications, and patients, satisfaction with diagnosis and treatment were compared among the three groups.

Results

There was no significant difference in operation duration, intraoperative blood loss, postoperative complications, and preoperative and postoperative VCSS scores among the three groups (P > 0.05). The postoperative hospitalization time, postoperative VAS score and total hospitalization cost of patients in group A and B were lower than those in group C, and the postoperative hospitalization time and postoperative VAS score in group A were more significant (P < 0.05). Compared with group B, the fluctuation range of intraoperative mean arterial pressure and heart rate, and postoperative serum CRP level in group A and C were lower, especially in group A (P < 0.05). The three groups of patients were followed up regularly after surgery. The results showed that the number of postoperative complications in group A was lower than that in the other two groups (P < 0.05), and the postoperative complications of the three groups were effectively relieved after symptomatic treatment (dressing change, anti-infection, taking drugs to improve circulation, etc.). The satisfaction of patients in group A was significantly higher than that in groups B and C (P < 0.05).

Conclusions

Ultrasound guided femoral nerve block combined with modified swelling anesthetic solution applied in high ligation and stripping of the great saphenous vein can significantly improve postoperative inflammatory stress reaction of patients, effectively ensure the safety and reliability of surgical progress, help to improve analgesia effect and accelerate physical rehabilitation, and has short hospitalization time, low medical cost, and high satisfaction of patients' diagnosis and treatment, which is worthy of widespread clinical promotion and reference.

Contrast-Enhanced High-Frame-Rate Ultrasound Imaging of Flow Patterns in Cardiac Chambers and Deep Vessels

Cardiac function and vascular function are closely related to the flow of blood within. The flow velocities in these larger cavities easily reach 1 m/s, and generally complex spatiotemporal flow patterns are involved, especially in a non-physiologic state. Visualization of such flow patterns using ultrasound can be greatly enhanced by administration of contrast agents. Tracking the high-velocity complex flows is challenging with current clinical echographic tools, mostly because of limitations in signal-to-noise ratio; estimation of lateral velocities; and/or frame rate of the contrast-enhanced imaging mode. This review addresses the state of the art in 2-D high-frame-rate contrast-enhanced echography of ventricular and deep-vessel flow, from both technological and clinical perspectives. It concludes that current advanced ultrasound equipment is technologically ready for use in human contrast-enhanced studies, thus potentially leading to identification of the most clinically relevant flow parameters for quantifying cardiac and vascular function.

Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019

Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.

Vector Flow Imaging Compared with Digital Subtraction Angiography for Stenosis Assessment in the Superficial Femoral Artery - A Study of Vector Concentration, Velocity Ratio and Stenosis Degree Percentage

Purpose

Stenosis of the superficial femoral artery (SFA) induces complex blood flow with increased velocities. Disease assessment is performed with Doppler ultrasound and digital subtraction angiography (DSA), but Doppler ultrasound is limited by angle dependency and DSA by ionizing radiation. An alternative is the vector flow imaging method based on transverse oscillation (TO), an angle-independent vector velocity technique using ultrasound. In this study, flow complexity and velocity measured with TO were compared with DSA for the assessment of stenosis in the SFA.

Materials and Methods

The vector concentration, a measure of flow complexity, and the velocity ratio obtained from the stenosis and a disease-free adjacent vessel segment, were estimated with TO in 11 patients with a total of 16 stenoses of the SFA. TO data were compared with the corresponding stenosis degree percentage obtained with DSA.

Results

The correlation between the vector concentration and DSA was very strong (R=0.93; p<0.001; 95% confidence interval (CI): 0.81-0.98), while only moderate for velocity ratio and DSA (R=0.50; p<0.07; 95% CI: 0.00-0.80). The correlation coefficients that were found were significantly different (p<0.005) without overlapping CI.

Conclusion

The study indicated that flow changes in the SFA induced by stenosis can be quantified with TO, and that stenosis grading may be improved by estimation of flow complexity instead of velocity ratio. TO is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease.