1
|
Fazeli B, Poredos P, Kozak M, Pecsvarady Z, Catalano M, Al Salman MM, Altarazi L, Ali AA, Bashar AH, Bozkurt K, Cacione D, Chua B, Cvjetko I, Desai S, Erer D, Farkas K, Gaddikeri P, Geroulakos G, Guclu O, Hussein E, Ionac M, Iwai T, Karahan O, Kashani D, Kota A, Kroger K, Kubat E, Kumar PP, Lang W, Lobastov K, Malecki R, Marcoccia A, Ozbakkaloglu A, Pandey SR, Patel M, Polat A, Rajeev A, Ravari H, Samuel V, Schernthaner G, Selvaraj D, Sanri US, Sermsathanasawadi N, Sharebiani H, Stanek A, Stephen E, Szuba A, Taha W, Taheri H, Wautrecht JC, Yuwono HS, Zor MH, Liew A. Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine. INT ANGIOL 2023; 42:396-401. [PMID: 38010012 DOI: 10.23736/s0392-9590.23.05098-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.
Collapse
Affiliation(s)
- Bahare Fazeli
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Pavel Poredos
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Matija Kozak
- Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Zsolt Pecsvarady
- Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
| | - Mariella Catalano
- Inter-University Research Center on Vascular Disease, Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy
| | | | - Louay Altarazi
- Varicose Veins and Vascular Polyclinic (VVVC), Damascus, Syria
| | - Abrar A Ali
- South Surgical Department, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Abul H Bashar
- Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh
| | - Kursat Bozkurt
- Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Türkiye
| | - Daniel Cacione
- Unit of Vascular and Endovascular Surgery, Department of Surgery, Federal University of Sao Paulo (UNIFESP/EPM), Sao Paulo, Brazil
| | - Benjamin Chua
- Vascular and Interventional Center of Singapore, Novena Specialist Center, Singapore, Singapore
| | - Ivan Cvjetko
- Department of Vascular Surgery, Merkur University Hospital, Zagreb, Croatia
| | - Sanjay Desai
- Department of Vascular and Endovascular Surgery, Ramaiah Medical College Hospital, Bangalore, India
| | | | - Katalin Farkas
- Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
| | | | - Georgios Geroulakos
- Department of Vascular Surgery, National and Kapodestrian University, Athens, Greece
| | - Orkut Guclu
- Department of Cardiovascular Surgery, Medical School of Trakya University, Edirne, Türkiye
| | - Emad Hussein
- Department of Vascular Surgery, Ain Shams University, Cairo, Egypt
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya, Türkiye
| | - Daniel Kashani
- Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Albert Kota
- Vascular Surgery Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Knut Kroger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Krefeld, Germany
| | - Emre Kubat
- Department of Cardiovascular Surgery, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Prabhu P Kumar
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Werner Lang
- Department of Vascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Rafal Malecki
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Antonella Marcoccia
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, Rome, Italy
| | - Alper Ozbakkaloglu
- Department of Cardiovascular Surgery, Özel Sağlık Hastanesi, İzmir, Türkiye
| | - Sandeep R Pandey
- Department of Vascular and Endovascular Surgery, Annapurna Hospital, Kathmandu, Nepal
| | - Malay Patel
- Department of Vascular Surgery, Apollo-CVHF Hospital, Ahmedabad, India
| | - Adil Polat
- Department of Cardiovascular Surgery, University of Health Sciences, İstanbul Bagcilar Research and Training Hospital, Istanbul, Türkiye
| | | | - Hassan Ravari
- Vascular Surgery Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vimalin Samuel
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Gerit Schernthaner
- Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
| | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Umut S Sanri
- Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hiva Sharebiani
- Support Association of Patients of Buerger's Disease (Buerger's Disease NGO), Mashhad, Iran
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Edwin Stephen
- Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Andrzej Szuba
- Department of Angiology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wassila Taha
- Non Invasive Vascular Lab, Al Salam Hospital, Cairo, Egypt
| | - Hossein Taheri
- Department of General Surgery, Farabi Hospital, Mashhad, Iran
| | - Jean-Claude Wautrecht
- Service of Vascular Pathology, Erasme Hospital, Free University of Brussels, Brussels, Belgium
| | - Hendro S Yuwono
- Department of Vascular Surgery, School of Medicine, Islamic University of Bandung, Bandung, Indonesia
| | - Mustafa H Zor
- Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Aaron Liew
- University of Galway & Portiuncula University Hospital, Saolta University Health Care, Galway, Ireland -
| |
Collapse
|
2
|
Kakkos S, Kirkilesis G, Caprini J, Geroulakos G, Nicolaides A, Stansby G, Reddy D. Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
3
|
Kontopodis N, Tavlas E, Ioannou C, Giannoukas A, Geroulakos G, Antoniou G. Prognosis Systematic Review and Meta-Analysis of Outcomes of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Hostile vs. Friendly Aortic Anatomy. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Lattimer C, Rudolphi P, Recke A, Geroulakos G, Kalodiki E, Kahle B. Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency. J Vasc Surg Venous Lymphat Disord 2020. [DOI: 10.1016/j.jvsv.2019.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Mohamed N, Galyfos G, Anastasiadou C, Sachmpatzidis I, Kikiras K, Papapetrou A, Giannakakis S, Kastrisios G, Papacharalampous G, Geroulakos G, Maltezos C. Fenestrated Endovascular Repair for Pararenal or Juxtarenal Abdominal Aortic Aneurysms: a Systematic Review. Ann Vasc Surg 2020; 63:399-408. [DOI: 10.1016/j.avsg.2019.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
|
6
|
Papakonstantinou NA, Antonopoulos CN, Baikoussis NG, Kakisis I, Geroulakos G. Frozen Elephant Trunk: An Alternative Surgical Weapon Against Extensive Thoracic Aorta Disease. A Three-Year Meta-Analysis. Heart Lung Circ 2019; 28:213-222. [DOI: 10.1016/j.hlc.2018.04.306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 10/14/2022]
|
7
|
Nicolaides A, Giannopoulos A, Kakkos S, Griffin MB, Geroulakos G, Tsalikakis D. Mortality risk stratification in patients with asymptomatic carotid stenosis. Vasc Invest Ther 2019. [DOI: 10.4103/vit.vit_10_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. J Vasc Surg 2019; 69:269-279.e7. [DOI: 10.1016/j.jvs.2018.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
|
9
|
Roussopoulou A, Tsivgoulis G, Krogias C, Lazaris A, Moulakakis K, Georgiadis GS, Mikulik R, Kakisis JD, Zompola C, Faissner S, Chondrogianni M, Liantinioti C, Hummel T, Safouris A, Matsota P, Voumvourakis K, Lazarides M, Geroulakos G, Vasdekis SN. Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2018; 26:673-679. [PMID: 30472766 DOI: 10.1111/ene.13876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0-2 days) in comparison to early (3-14 days) CEA in patients with sCAS. METHODS Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. RESULTS A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%-17.7%) and early (4.4%; 95% confidence interval 2.4%-7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4-6) vs. 10 days (interquartile range 7-14); P < 0.001]. CONCLUSIONS Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.
Collapse
Affiliation(s)
- A Roussopoulou
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G Tsivgoulis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Krogias
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Lazaris
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Moulakakis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G S Georgiadis
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - R Mikulik
- Department of Neurology, St Anne's University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - J D Kakisis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Zompola
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S Faissner
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Chondrogianni
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Liantinioti
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - T Hummel
- Department of Vascular Surgery, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Safouris
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece.,Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - P Matsota
- Second Department of Anaesthesiology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Voumvourakis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - M Lazarides
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G Geroulakos
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S N Vasdekis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| |
Collapse
|
10
|
Papakonstantinou NA, Antonopoulos CN, Baikoussis NG, Kakisis I, Geroulakos G. Aortic Arch Reconstruction: Are Hybrid Debranching Procedures a Good Choice? Heart Lung Circ 2018; 27:1335-1349. [DOI: 10.1016/j.hlc.2018.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/12/2018] [Indexed: 11/27/2022]
|
11
|
Cesarone MR, Belcaro G, Nicolaides AN, Geroulakos G, Bucci M, Dugall M, De Sanctis MT, Incandela L, Griffin M, Sabetai M. Increase in Echogenicity of Echolucent Carotid Plaques after Treatment with Total Triterpenic Fraction of Centella asiatica: A Prospective, Placebo-Controlled, Randomized Trial. Angiology 2018. [DOI: 10.1177/000331970105202s05] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate whether total triterpenic fraction of Centella asiatica (TTFCA), was effective in modulating collagen production over 12 months, by producing an increase in echogenicity in echolucent carotid plaques. Part I was a pilot study aimed at evaluating the effects of TTFCA on different types of plaques. Part II was a prospective, randomized, placebo-controlled trial aimed at evaluating the effects of TTFCA on hypoechoic-echolucent plaques. The sonographic examination of carotid plaques was made with high-resolution ultrasound. Capturing, digital image processing, and normalization were standardized, interobserver, intrascanner, gain-level variability were standardized using as reference blood (black) for the most echolucent parts of the plaque and the adventitia (white) as the most echogenic part. Normalization of echo texture was obtained and plaque characterization differentiated echo-texture of plaque associated with events and those that did not cause embolization, thrombosis, or cardiovascular events. After identifying plaques at higher risk, patients were treated with TTFCA (oral tablets, 60 mg, thrice daily for 12 months) to evaluate whether this compound, by modulating collagen synthesis, could increase the echogenicity and therefore the stability of echolucent plaques. Part II was aimed at evaluating the effects of TTFCA on hypoechoic-echolucent plaques. Asymptomatic patients with echolucent plaques (GSM < 18) were treated with TTFCA (60 mg, oral tablets three times daily for 12 months) or with comparable placebo after informed consent. All patients were also treated with antiplatelet agents. In part I, at inclusion the GSC in the hypoechoic group was 15 (range, 12–18) while in the hyperechoic group it was 26 (range, 24–31); at 6 months it was increased in the hypoechoic group and at 12 months the increase was significant (19.5; p<0.05). There was a minor increase in GSM in the hyperechoic group (30; ns). In part II in the treatment group there was a significant difference in GSM (increase) at 12 months (p<0.05), improvement in texture (p<0.05) and a nonsignificant decrease in stenosis. No changes were observed in the placebo group. Events were observed in 6.5% of patients in the TTFCA group and in 11% in the control group (p<0.05). In conclusion these observations suggest a positive action of TTFCA on the stabilization of hypoechoic, low-density carotid plaques.
Collapse
Affiliation(s)
- M. R. Cesarone
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - G. Belcaro
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - A. N. Nicolaides
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - G. Geroulakos
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Bucci
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Dugall
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. T. De Sanctis
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - L. Incandela
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Griffin
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Sabetai
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| |
Collapse
|
12
|
Cesarone MR, Belcaro G, De Sanctis MT, Incandela L, Cacchio M, Bavera P, Ippolito E, Bucci M, Griffin M, Geroulakos G, Dugall M, Buccella S, Kleyweght S, Cacchio M. Effects of the Total Triterpenic Fraction of Centella asiatica in Venous Hypertensive Microangiopathy: A Prospective, Placebo-Controlled, Randomized Trial. Angiology 2018. [DOI: 10.1177/000331970105202s04] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to demonstrate whether total triterpenic fraction of Centella asiatica (TTFCA), was effective in improving the microcirculation in venous hypertension and microangiopathy. Forty patients with severe venous hypertension, ankle swelling, lipodermatosclerosis were included, After informed consent, patients were randomized into a treatment and a placebo group: those in the treatment group received TTFCA (tablets, 60 mg, twice daily for 8 weeks). The two groups of subjects were comparable for age and sex distribution. The mean age was 48 years (SD 9; M:F = 11:11) in the treatment group (22 patients) and 47.6 (SD 7; M:F = 10:8) in the placebo group (18 patients). There were no differences between placebo and treatment group at inclusion; there was no change between inclusion and measurements at 8 weeks in the placebo group. A decrease (p<0.05) in RF (flux at rest) and RAS (rate of ankle swelling) were observed in the treatment group. The decrease in capillary filtration was associated with improvement in signs and symptoms (p<0.05). The difference in flux, signs and symptoms, and filtration was clinically important at 8 weeks. No side effects were observed. In conclusion venous microangiopathy was improved by TTFCA treatment.
Collapse
Affiliation(s)
- M. R. Cesarone
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - G. Belcaro
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. T. De Sanctis
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - L. Incandela
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Cacchio
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - P. Bavera
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - E. Ippolito
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Bucci
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Griffin
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - G. Geroulakos
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Dugall
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - S. Buccella
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - S. Kleyweght
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| | - M. Cacchio
- Irvine2 Vascular Laboratory and Physiology, Department of Biomedical Sciences, Chieti University, San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
- Irvine Vascular Laboratory, St Mary's Hospital and Imperial College, Vascular Unit, Ealing Hospital, London, UK
| |
Collapse
|
13
|
Incandela L, Belcaro G, Nicolaides AN, Cesarone MR, De Sanctis MT, Corsi M, Bavera P, Ippolito E, Griffin M, Geroulakos G, Sabetai M, Ramaswami G, Veller M. Modification of the Echogenicity of Femoral Plaques after Treatment with Total Triterpenic Fraction of Centella aslatica: A Prospective, Randomized, Placebo-Controlled Trial. Angiology 2018. [DOI: 10.1177/000331970105202s13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate whether TTFCA (total triterpenic fraction of Centella asiatica), was effective, by modulating collagen production, in a period of 12 months, increasing the echogenicity of echolucent plaques at the femoral bifurcation. Hypoechoic atherosclerotic plaques have been found to be associated with an increased evidence of cerebrovascular events. In this type of plaques stromal composition is limited as the collagen component is generally very low; the plaque composition is mainly due to lipid accumulation or thrombosis. The aim of this study was the evaluation of echogenicity of hyperechoic plaques and how it could be modified by a drug acting on the modulation of collagen synthesis. Antiplatelet agents were used in all patients; cholesterol-lowering agents were used in 34% of patients in the treatment group and in 36% in the placebo group. TTFCA was used at the dose of 60 mg thrice daily (oral tablets). Of the 60 included subjects 26 completed the study in the treatment group and 24 in the placebo group. At inclusion the average GSM in the treatment group was 14 (SD 3) and 14.3 (SD 3) in controls. At 12 months GSM was increased up to 22.8 (SD 4) in the treatment group and it was 15 (SD 3) in controls. Considering texture no significant changes were observed in controls while a qualitative increase in homogenicity was observed in the TTFCA group. Plaque size measured at the beginning and at the end of the study showed a median increase in size, in controls (23%; range 0%–44%); it was unchanged in the TTFCA group (variation 7%; 4%–26%). In conclusion in the treatment group plaques increased in echogenicity and in homogenicity; size and stenosis remained unchanged. Modulating the scarring process within echolucent plaques (low echogenicity, high echolucency, with a very low collagen/stromal component), possibly by collagen modulation, makes plaques more stable. This has been achieved and documented in the present study by an increase in the gray-scale median (plaques become more echogenic, more ‘white’). The variation in GSM is generally associated with a lower risk of wall thrombosis, rupture and embolization. These observations indicate a positive action of TTFCA on the stabilization of hypoechoic, low-density femoral plaques
Collapse
Affiliation(s)
- L. Incandela
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - G. Belcaro
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - A. N. Nicolaides
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. R. Cesarone
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. T. De Sanctis
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. Corsi
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - P. Bavera
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - E. Ippolito
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. Griffin
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - G. Geroulakos
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. Sabetai
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - G. Ramaswami
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| | - M. Veller
- Irvine2 Vascular Laboratory, Department of Biomedical Sciences, Chieti University and San Valentino Vascular Screening Project, Vascular Surgery, University of Milan, Italy
| |
Collapse
|
14
|
Lazaris AM, Moulakakis K, Mantas G, Poulou K, Alexiou E, Vasdekis S, Geroulakos G. Hepatorenal Revascularization Enables Endovascular Aneurysm Repair on a Patient with Abdominal Aortic Aneurysm and an Ectopic Right Renal Artery. Ann Vasc Surg 2018; 52:316.e1-316.e5. [PMID: 29886214 DOI: 10.1016/j.avsg.2018.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 10/14/2022]
Abstract
In last 30 years, the endovascular aneurysm repair (EVAR) has become the standard method of treatment of abdominal aortic aneurysms (AAAs). Nevertheless, the method has limitations mainly based on the anatomic characteristics of the specific aneurysm. In these cases, a combination of endovascular and open techniques can be used. We describe a case of a patient with an infrarenal AAA and an ectopic right renal artery emerging from within the aneurysm sac. The patient was treated with a combination of endovascular and open techniques. In particular, he underwent a hepatorenal revascularization followed by a standard EVAR procedure, with a successful final outcome. For the treatment of AAA disease, the combination of open and endovascular procedures can overcome difficulties, where a standard EVAR cannot be an option.
Collapse
Affiliation(s)
- Andreas M Lazaris
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece.
| | - Konstantinos Moulakakis
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgios Mantas
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Katerina Poulou
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Evangelos Alexiou
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Spyros Vasdekis
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgios Geroulakos
- Vascular Surgery Department, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| |
Collapse
|
15
|
Kakisis J, Antonopoulos C, Mantas G, Moulakakis K, Sfyroeras G, Geroulakos G. Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Kakkos SK, Tsolakis IA, Geroulakos G. Commentary on "Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, Ankle Brachial Index and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial". Eur J Vasc Endovasc Surg 2017; 53:695. [PMID: 28318998 DOI: 10.1016/j.ejvs.2017.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, 26 504, Greece.
| | - I A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, 26 504, Greece
| | - G Geroulakos
- Department of Vascular Surgery, National and Kapodestrian University of Athens, Greece and Vascular Surgery Group, Imperial College London, London, UK
| |
Collapse
|
17
|
Sfyroeras G, Antonopoulos C, Mantas G, Moulakakis K, Kakisis J, Brountzos E, Lattimer C, Geroulakos G. A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
18
|
Kakisis J, Antonopoulos C, Moulakakis K, Schneider F, Geroulakos G, Ricco J. Protamine Reduces Bleeding Complications without Increasing the Risk of Stroke after Carotid Endarterectomy: A Meta-analysis. Eur J Vasc Endovasc Surg 2016; 52:296-307. [DOI: 10.1016/j.ejvs.2016.05.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
|
19
|
Lattimer C, Kalodiki E, Azzam M, Geroulakos G. Haemodynamic Performance of Low Strength Below Knee Graduated Elastic Compression Stockings in Health, Venous Disease, and Lymphoedema. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
20
|
Abstract
Objective: To determine the role of liquid crystal thermography (LCT) in preoperative marking of varicose veins and incompetent perforating veins. Design: Single patient group study comparing techniques. Setting: Teaching hospital vascular laboratory. Patients: Two hundred patients (265 legs) referred to St Mary's Hospital Vascular Laboratory for preoperative varicose vein marking. Methods: Patients were studied using LCT and duplex ultrasonography to identify calf perforating veins. Results: In part I of the study LCT identified 47 ‘areas at risk’, 42 of which were demonstrated to contain incompetent perforating veins on duplex examination (positive predictive value 89%). Thirty-eight of these 42 patients were explored at operation and 36 (95%) were confirmed as incompetent. The remaining two perforating veins could not be located. In part II of the study LCT identified 327 ‘areas at risk’, 299 of which were demonstrated to contain incompetent perforating veins on duplex examination (positive predictive value 91%). Conclusion: LCT is useful in the identification of incompetent perforating veins, it is easy to perform, less time consuming, cheaper and can replace duplex scanning.
Collapse
Affiliation(s)
- E. Kalodiki
- Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, St Mary's Hospital Medical School, Imperial College of Science Technology and Medicine, London W2, UK
| | - L. Calahoras
- Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, St Mary's Hospital Medical School, Imperial College of Science Technology and Medicine, London W2, UK
| | - G. Geroulakos
- Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, St Mary's Hospital Medical School, Imperial College of Science Technology and Medicine, London W2, UK
| | - A. N. Nicolaides
- Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, St Mary's Hospital Medical School, Imperial College of Science Technology and Medicine, London W2, UK
| |
Collapse
|
21
|
|
22
|
Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. Haemodynamic Performance of Low Strength Below Knee Graduated Elastic Compression Stockings in Health, Venous Disease, and Lymphoedema. Eur J Vasc Endovasc Surg 2016; 52:105-12. [PMID: 27161999 DOI: 10.1016/j.ejvs.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the in vivo haemodynamic performance of graduated elastic compression (GEC) stockings using air-plethysmography (APG) in healthy volunteers (controls) and patients with varicose veins (VVs), post-thrombotic syndrome (PTS), or lymphoedema. Responsiveness data were used to determine which group benefited the most from GEC. METHODS There were 12 patients per group compared using no compression, knee-length Class 1 (18-21 mmHg) compression, and Class 2 (23-32 mmHg) compression. Stocking/leg interface pressures (mmHg) were measured supine in two places using an air-sensor transducer. Stocking performance parameters, investigated before and after GEC, included the standard APG tests (working venous volume [wVV], venous filling index [VFI], venous drainage index [VDI], ejection fraction [EF]) and the occlusion plethysmography tests (incremental pressure causing the maximal increase in calf volume [IPMIV], outflow fraction [OF]). Results were expressed as median and interquartile range. RESULTS Significant graduated compression was achieved in all four groups with higher interface pressures at the ankle. Only the VVs patients had a significant reduction in their wVV (without: 133 [109-146] vs. class1: 93 [74-113] mL) and the VFI (without: 4.6 [3-7.1] vs. class1: 3.1 [1.9-5] mL/s), both at p <.05. The IPMIV improved significantly in all groups except in the PTS group (p <.05). The OF improved only in the controls (without: 43 [38-51] vs. class1: 50 [48-53] %) and the VVs patients (without: 47 [39-58] vs. class1: 56 [50-64] %), both at p <.05. There were no significant differences in the VDI or the EF with GEC. Compression dose-response relationships were not observed. CONCLUSION Patients with varicose veins improved the most, whereas those with PTS improved the least. Performance seemed to depend more on disease pathophysiology than compression strength. However, the lack of responsiveness to compression strength may be related to the low external pressures used. Stocking performance tests may have value in selecting those patients who benefit most from compression.
Collapse
Affiliation(s)
- C R Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK.
| | - E Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - M Azzam
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK
| | - G Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK
| |
Collapse
|
23
|
Lazaris AM, Moulakakis K, Vasdekis S, Geroulakos G, Lattimer CR. Re: 'Management of Chronic Venous Disease. Clinical Practice Guidelines of the European Society for Vascular Surgery'. Eur J Vasc Endovasc Surg 2016; 51:609. [PMID: 26860257 DOI: 10.1016/j.ejvs.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A M Lazaris
- Vascular Surgery Department, Attikon Teaching Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - K Moulakakis
- Vascular Surgery Department, Attikon Teaching Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Vasdekis
- Vascular Surgery Department, Attikon Teaching Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Geroulakos
- Vascular Surgery Department, Attikon Teaching Hospital, National and Kapodistrian University of Athens, Athens, Greece; Josef Pflug Vascular Laboratory and the Vascular Unit, Ealing Hospital, Department of Vascular Surgery and Imperial College London, London, UK
| | - C R Lattimer
- Josef Pflug Vascular Laboratory and the Vascular Unit, Ealing Hospital, Department of Vascular Surgery and Imperial College London, London, UK
| |
Collapse
|
24
|
Giannopoulos A, Kakkos S, Abbott A, Naylor A, Richards T, Mikhailidis D, Geroulakos G, Nicolaides A. Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Shaydakov E, Porembskaya O, Geroulakos G. The May—Husni Procedure: A Reappraisal. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
Abstract
OBJECTIVES The May-Husni procedure is a rarely used saphenofemoral venous bypass because of the small number of patients with post-thrombotic segmental femoral vein obstruction alone and the lack of validated selection criteria. There are only a few institutional series reporting the use of this technique. The purpose of this report is to present the author's experience and critically review the literature. METHODS Within a 13 year period 12 patients with venous claudication, skin pigmentation, and severe pain and swelling of their legs underwent the May-Husni procedure. Their median age was 57 years (41-69 years). Imaging showed segmental venous obstruction of the femoral vein in all patients and poor or no inflow from the deep femoral vein. Two patients were lost to follow up and the remaining 10 patients were reviewed with a median follow up of 60 months (26-72 months). RESULTS The saphenopopliteal bypass remained patent in all patients at follow up. The development of reflux of the saphenous conduit in four patients did not affect the clinical improvement. Venous claudication resolved, hyper-pigmentation improved, and pain was relieved in all patients. Recanalization of the femoral vein 3 years following thrombosis was followed by recurrence of the post-thrombotic symptoms in two patients. CONCLUSIONS These results indicate that a highly selected subgroup of patients with severe symptomatic post-thrombotic syndrome secondary to chronic segmental obstruction of the femoral vein do well after the May-Husni procedure. In order to refine the criteria for the selection of patients who may benefit from this operation, there is a need for more studies that use a combination of hemodynamic and validated scales that diagnose and grade the severity of post-thrombotic syndrome.
Collapse
Affiliation(s)
- E Shaydakov
- Institute of Experimental Medicine for Research and Clinical Work, Clinic of Russian Academy of Medical Sciences, St. Petersburg, Russia.
| | - O Porembskaya
- Institute of Experimental Medicine for Research and Clinical Work, Clinic of Russian Academy of Medical Sciences, St. Petersburg, Russia
| | - G Geroulakos
- Pflug Vascular Laboratory, Ealing Hospital, and Department of Vascular Surgery, Northwick Park Hospital, Middlesex, United Kingdom; Department of Vascular Surgery, Imperial College, London, United Kingdom
| |
Collapse
|
27
|
Kalodiki E, Fareed J, Syed D, Geroulakos G, Hoppensteadt D, Lattimer CR. Blood Sampled Directly from Varicose Veins Reveals Activation of Inflammatory Processes. J Vasc Surg Venous Lymphat Disord 2015; 3:119. [PMID: 26993700 DOI: 10.1016/j.jvsv.2014.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Kalodiki
- Josef Pflug Vascular Laboratory, Imperial College London, London, United Kingdom, and Thrombosis and Hemostasis Research Laboratory, Loyola University Medical Center, Maywood, Ill
| | - J Fareed
- Thrombosis and Hemostasis Research Laboratory, Loyola University Medical Center, Maywood, Ill
| | - D Syed
- Thrombosis and Hemostasis Research Laboratory, Loyola University Medical Center, Maywood, Ill
| | - G Geroulakos
- Josef Pflug Vascular Laboratory, Imperial College London, London, United Kingdom
| | - D Hoppensteadt
- Thrombosis and Hemostasis Research Laboratory, Loyola University Medical Center, Maywood, Ill
| | - C R Lattimer
- Josef Pflug Vascular Laboratory, Imperial College London, London, United Kingdom
| |
Collapse
|
28
|
Lattimer C, Azzam M, Kalodiki E, Geroulakos G. Quantifying Saphenous Recirculation in Patients With Superficial Venous Insufficiency. J Vasc Surg Venous Lymphat Disord 2015; 3:133. [DOI: 10.1016/j.jvsv.2014.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Nicolaides A, Clark H, Labropoulos N, Geroulakos G, Lugli M, Maleti O. Quantitation of reflux and outflow obstruction in patients with CVD and correlation with clinical severity. INT ANGIOL 2014; 33:275-281. [PMID: 24861564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Chronic venous disease (CVD) is the result of venous reflux, obstruction or a combination of both. So far, attempts to correlate venous hemodynamic measurements with symptoms and signs of CVD have produced poor to moderate results, probably because of lack of methods to quantitate obstruction and combine measurements of reflux and obstruction. Our hypothesis is that the combination of quantitative measurements of (a) overall reflux (superficial and deep) and (b) overall outflow resistance i.e. including the collateral circulation would provide a hemodynamic index that should be related to the severity of the disease. METHODS Twenty-five limbs with chronic venous disease and 1 limb from a healthy volunteer (VCSS 0-13) were studied. The clinical CEAP classification was C0 in one limb, C1 in 2 limbs, C2 in 10 limbs, C3 in 3 limbs, C4 in 1 limb, C5 in 6 limbs and C6 in 3 limbs. Air-plethysmography was used to measure reflux (VFI in mL/s) when the subject changed position from horizontal to standing. Subsequently, with the subject horizontal and the foot elevated 15 cm, simultaneous recordings of pressure and volume were made on release of a proximal thigh cuff inflated to 70 mmHg. Pressure change was recorded with a needle in the foot and volume change with air-plethysmography. Flow (Q in mL/min) was calculated at intervals of 0.1 seconds from tangents on the volume outflow curve. Outflow resistance (R) was calculated at 0.1 second intervals by dividing pressure by the corresponding flow (R=P/Q). R increased markedly at pressures lower than 25 mmHg due to decrease in vein cross-sectional area, so resistance at 25 mmHg (R25) was used in this study. RESULTS In a multivariable linear regression analysis with VCSS as the dependent variable, both VFI and R25 were independent predictors (P<0.001). Using the constant (0.595) and regression coefficients, the regression equation provided a Hemodynamic Index (HI) or estimated VCSS=0.595 + (VFI x 0.41) + (R25 x 98). Thus, HI could be calculated for every patient by substituting VFI and R25 in the equation. HI or calculated VCSS was linearly related to the observed VCSS (r=0.86). CONCLUSION The results indicate that the combination of quantitative measurements of reflux and outflow resistance provide a hemodynamic index which is linearly related to the VCSS. These findings need to be confirmed in larger series.
Collapse
Affiliation(s)
- A Nicolaides
- Vascular Surgery, Imperial College, London, UK -
| | | | | | | | | | | |
Collapse
|
30
|
Lattimer C, Kalodiki E, Kafeza M, Azzam M, Geroulakos G. Quantifying the Degree Graduated Elastic Compression Stockings Enhance Venous Emptying. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2013.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
31
|
Lattimer C, Geroulakos G, Kalodiki E. Thigh Compression Significantly Improves Venous Emptying After Deep Vein Thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 2:111. [DOI: 10.1016/j.jvsv.2013.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
32
|
Lattimer C, Kalodiki E, Azzam M, Geroulakos G, Fareed J, Hoppensteadt D. Regional and Systemic Prothrombotic Biomarkers in Varicose Vein Patients and Healthy Controls. J Vasc Surg Venous Lymphat Disord 2014; 2:114. [DOI: 10.1016/j.jvsv.2013.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Lattimer CR, Kalodiki E, Azzam M, Makris GC, Somiayajulu S, Geroulakos G. Interim results on abolishing reflux alongside a randomized clinical trial on laser ablation with phlebectomies versus foam sclerotherapy. INT ANGIOL 2013; 32:394-403. [PMID: 23822942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The early results of a randomised clinical trial comparing local anaesthesia endovenous laser ablation (EVLA) with concurrent phlebectomies versus ultrasound-guided foam sclerotherapy (UGFS) into the great saphenous vein (GSV) revealed that laser was more expensive but the results on abolition of reflux were similar. The interim results at 15 month follow-up are reported. METHODS Evaluations included ultrasound, the venous clinical severity score (VCSS), the Aberdeen varicose vein questionnaire (AVVQ) and the saphenous treatment score (STS). The global absence of reflux defined technical success. Adjuvant sclerotherapy to areas of reflux was administered on patient choice. RESULTS Occlusion of the GSV was more effective with EVLA at 42/44 (95.5%) versus 31/46 (67.4%) for UGFS. However both techniques were equally effective at abolishing global venous reflux. The number of legs (N.=100) with total reflux abolition, above-knee, below-knee or combined reflux and loss to follow-up was 18, 6, 12, 8, 6 with EVLA and 20, 8, 11, 7, 4 with UGFS, respectively. The VCSS, AVVQ and STS reduced compared to baseline (P<0.0005), but there was no statistical difference between the groups. The AVVQ remained unchanged between 3-15 months (P=0.601). Also during this time, 19/46(41%) UGFS versus 9/44(20%) EVLA legs received adjuvant treatment (2.1 times increase). However, overall, adjuvant foam was given 4.7 times more frequently in the UGFS patients. CONCLUSION EVLA and UGFS are equally effective at abolishing global venous reflux with overall success of 41% and 43%, respectively. The high reflux rate was not related to deterioration in quality of life indicating that this reflux was largely asymptomatic.
Collapse
Affiliation(s)
- C R Lattimer
- Department of Medicine, Science and Technology, Imperial College, London, UK.
| | | | | | | | | | | |
Collapse
|
34
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Key Questions to be Answered. Clin Appl Thromb Hemost 2013. [DOI: 10.1177/1076029612474840x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
35
|
Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. Reflux time estimation on air-plethysmography may stratify patients with early superficial venous insufficiency. Phlebology 2013; 28:101-8. [DOI: 10.1177/0268355513476205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives It has been suggested that quantification of haemodynamic parameters of venous disease may complement clinical assessment and may help identify a group of patients with severe venous disease or alternatively patients with early venous disease. However, there has been very little work to prove this hypothesis. The venous filling index (VFI) of air-plethysmography (APG) can quantify severity and treatment effect but has limited discriminatory value. However, the components of the VFI, total venous volume (VV) and time to reach 90% of VV (VFT90), have never been fully studied. The aim was to investigate the contribution of VV and VFT90 to an elevated VFI and determine their relationship to great saphenous vein (GSV) diameter and clinical severity scoring. Method Ninety-three consecutive patients/legs (22–78 years) with primary GSV reflux (>0.5 seconds) awaiting endovenous treatment were recruited. CEAP (clinical, aetiological, anatomical and pathological elements) assessments were: 33 (35.5%) C2, 14 (15.0%) C3, 29 (31.2%) C4a, 5 (5.4%) C4b, 7 (7.5%) C5 and 5 (5.4%) C6. The median venous clinical severity score (VCSS) was 6 (2–20) and the averaged GSV diameter at three sites was 7.5 mm (4–12). The VFI, VV and VFT90 were recorded using APG. Results There was no correlation between the VV and the VFT90 ( r = −0.103, P = 0.324). The VFI, VV and VFT90 significantly correlated ( P < 0.0005, Spearman) with the GSV diameter: r = 0.623, r = 0.567, r = −0.432, respectively, and the C of CEAP ( P < 0.05): r = 0.4, r = 0.225, r = −0.343, respectively. None of the 25 (26.9%) patients with a VFT90 > 25 seconds were among the 17 (18.3%) patients in categories C4b–6 or with a VCSS > 9 ( P = 0.005, Fisher's exact test, corrected odds ratio: 17.3). Conclusions The VFT90 complements the VFI as a marker of severe superficial venous insufficiency. However, in contrast to the VFI, it may have discriminatory value in stratifying patients with early disease into two groups based on the severity of haemodynamic impairment.
Collapse
Affiliation(s)
- C R Lattimer
- Ealing Hospital & Imperial College, London SW7 2AZ, UK
| | - E Kalodiki
- Ealing Hospital & Imperial College, London SW7 2AZ, UK
| | - M Azzam
- Ealing Hospital & Imperial College, London SW7 2AZ, UK
| | - G Geroulakos
- Ealing Hospital & Imperial College, London SW7 2AZ, UK
| |
Collapse
|
36
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Periprocedural Management of Antithrombotic Therapy and Use of Bridging Anticoagulation. Clin Appl Thromb Hemost 2013; 19:220-3. [DOI: 10.1177/1076029612474840v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
37
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Cost-Effectiveness of Prevention and Treatment of VTE. Clin Appl Thromb Hemost 2013; 19:224-5. [DOI: 10.1177/1076029612474840w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Introduction. Clin Appl Thromb Hemost 2013; 19:118-20. [DOI: 10.1177/1076029612474840a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
39
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Burns. Clin Appl Thromb Hemost 2013; 19:161. [DOI: 10.1177/1076029612474840g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
40
|
Nicolaides AN, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GD, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Prevention and treatment of venous thromboembolism--International Consensus Statement. INT ANGIOL 2013; 32:111-260. [PMID: 24402349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this document is to provide a clear and concise account of the evidence regarding efficacy or harm for various methods available to prevent and manage venous thromboembolism (VTE).
Collapse
|
41
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. The Problem and the Need for Prevention. Clin Appl Thromb Hemost 2013; 19:121-2. [DOI: 10.1177/1076029612474840b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
42
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Heparin-Induced Thrombocytopenia. Clin Appl Thromb Hemost 2013; 19:208-13. [DOI: 10.1177/1076029612474840s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
43
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Diagnosis and Anticoagulant Treatment. Clin Appl Thromb Hemost 2013; 19:187-98. [DOI: 10.1177/1076029612474840n] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
44
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Prevention and Treatment of Venous Thromboembolism. Clin Appl Thromb Hemost 2013; 19:116-8. [DOI: 10.1177/1076029612474840] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
45
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Thrombolytic Therapy. Clin Appl Thromb Hemost 2013; 19:198-204. [DOI: 10.1177/1076029612474840o] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
46
|
Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, Myers K, Samama M, Fletcher J, Kalodiki E, Bergqvist D, Bonnar J, Caprini JA, Carter C, Conard J, Eklof B, Elalamy I, Gerotziafas G, Geroulakos G, Giannoukas A, Greer I, Griffin M, Kakkos S, Lassen MR, Lowe GDO, Markel A, Prandoni P, Raskob G, Spyropoulos AC, Turpie AG, Walenga JM, Warwick D. Surgical Thrombectomy. Clin Appl Thromb Hemost 2013; 19:205-6. [DOI: 10.1177/1076029612474840q] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
47
|
Makris G, Lattimer C, Lavida A, Geroulakos G. Availability of Supervised Exercise Programs and the Role of Structured Home-based Exercise in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2012; 44:569-75; discussion 576. [DOI: 10.1016/j.ejvs.2012.09.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022]
|
48
|
Makris G, Lattimer C, Lavida A, Geroulakos G. Availability of Supervised Exercise Programs and the Role of Structured Home-based Exercise in Peripheral Arterial Disease. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
49
|
Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. Responsiveness of individual questions from the venous clinical severity score and the Aberdeen varicose vein questionnaire. Phlebology 2012. [DOI: 10.1258/phleb.2012.012080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The venous clinical severity score (VCSS) and the Aberdeen varicose vein questionnaire (AVVQ) improve after treating chronic venous insufficiency (CVI). The aim was to examine how and why they improve by evaluating the change in each individual question. Methods This was an analysis on prospectively collected data from a clinical study on 100 patients (58% female) with CVI (C2 = 34, C3 = 14, C4a = 29, C4b = 9, C5 = 7, C6 = 7) who were randomized to endovenous laser ablation ( n = 50) or foam sclerotherapy ( n = 50). The change scores (performance) of each question of the VCSS (questions 1–10) and the AVVQ (questions 1–13) were calculated by subtracting the score at three weeks, and three months, from the pre-treatment score. Results Both the median, interquartile range (IQR), VCSS and the AVVQ scores improved from 6 (4) and 21.4 (15.1) at baseline to 3 (4) and 18.6 (12.1) at three weeks ( P < 0.0005, P = 0.031) to 2 (3) and 8.8 (13.6) at three months, ( P < 0.0005, P < 0.0005), respectively. The performance of the first three questions of the VCSS (pain, extent of varicosities, oedema) were the most contributory to the overall score. Questions 5, 7, 8, 9 on ulceration improved the most individually but did not contribute significantly to the overall score. Questions 5, 9 of the AVVQ on stocking use and ulceration failed to contribute statistically to the overall improvement at three months. Conclusion The majority of the individual questions of the VCSS and AVVQ responded to change. However, the cause of a poor response was multifactorial with statistical dilution playing a significant role. Stratification of patients according to ulceration may allow better comparisons.
Collapse
|
50
|
Lattimer CR, Azzam M, Kalodiki E, Geroulakos G. Venous filling time using air-plethysmography correlates highly with great saphenous vein reflux time using duplex. Phlebology 2012; 29:90-7. [DOI: 10.1258/phleb.2012.012042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|