Abstract
Haemodynamic changes at the saphenofemoral junction during the application of a below-knee graduated compression stocking
C R Lattimer, M Azzam, E Kalodiki and G Geroulakos
Dermatol Surg 2012.
The authors tested their hypothesis that a stocking pull-up manoeuvre would increase flow in the great saphenous vein. The aim was to quantify this using duplex ultrasound. Twelve consecutive patients with primary varicose veins were studied. A below-knee 23–32 mmHg graduated elastic compression stocking was placed over the foot, leaving a cuff of redundant stocking around the ankle. Duplex ultrasound over the saphenofemoral junction was used to measure peak velocity (PV) and volume flow (VF) before and while the stocking was being pulled up. The application of compression hose caused a median 17.7 times increase in PV from 7.6 cm/seconds to 150.5 cm/seconds and a 9.4 times increase in VF from 50.9 mL/minutes to 458.7 mL/minutes.
The authors conclude that these forces could be avoided by the partial application of a stocking to knee level before foam injection.
Compression for preventing recurrence of venous ulcers
E A Nelson and S E Bell-Syer
Cochrane Database Syst Rev 2012;
To assess the effects of compression (socks, stockings, tights, bandages) in preventing the recurrence of venous ulcers with regard to compression strength, length, etc. For this update we searched The Cochrane Wounds Group Specialized Register (searched 1 March 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2); Ovid MEDLINE (1950 to February Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, February 29, 2012); Ovid EMBASE (1980–2012 Week 08); and EBSCO CINAHL (1982–1 March 2012). The review included only randomized controlled trials evaluating compression bandages or hosiery for preventing the recurrence of venous ulcers. Four trials (979 participants) were eligible for inclusion.
The authors conclude that there is evidence from one trial that compression hosiery reduces rates of reulceration of venous ulcers compared with no compression. Results from one trial suggest that recurrence is lower in high-compression hosiery than in medium-compression hosiery at three years while another trial found no difference at five years. Rates of patient intolerance of compression hosiery were high. There is insufficient evidence to aid selection of different types, brands, or lengths of compression hosiery.
Relationship between patients’ reports of complications and symptoms, disability and quality of life after surgery
K Grosse Frie, J van der Meulen and N Black
Br J Surg 2012;
The authors’ objectives of this observational study of patients in England who underwent hip replacement (68,391), knee replacement (77,705), inguinal hernia repair (48,199) or varicose vein surgery (16,535) during 2009–2011 were to explore the validity of patient-reported complications and to determine their influence on patients’ reports of the benefits of surgery (health gain). Patients with three or more co-morbid conditions reported more complications, whereas age, sex and socioeconomic status (adjusted for co-morbidity) had little, or no association. Complications were strongly associated with re-admission and further surgery.
The authors conclude that patients’ reports of complications can be used for statistical comparisons of surgical departments.
Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein
N Shadid, R Ceulen, P Nelemans, C Dirksen, J Veraart, G W Schurink, P van Neer, J vd Kley, E de Haan and A Sommer
BJS 2012;
The authors in a multicentre randomized controlled non-inferiority trial compared the effectiveness and costs of ultrasound-guided foam sclerotherapy (UGFS) (230 patients) and surgery (200 patients) for incompetent great saphenous treatment.
The two-year probability of recurrence was similar in the UGFS and surgery groups: 11.3% and 9.0%) respectively (P = 0.407). At five years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35.0%) than in the surgery group (21.0%) (P = 0.003). Hospital costs per patient over two years were more than two times higher for the surgical treatment group.
The authors conclude that at two-year follow-up, UGFS has the potential to be a cost-effective approach; UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest.
Adjunctive use of the superficial femoral vein for vascular reconstructions
S Brahmanandam, D Clair, J Bena and T Sarac
J Vasc Surg 2012;
The authors reviewed their patency and complication results related to the use of the superficial femoral vein during major venous reconstructions of central veins, repair of infected grafts and during lower extremity arteriovenous (AV) fistula creation. Between 1999 and 2011, 42 patients underwent surgical bypass or thigh AV fistula (31 arterial, 4 central venous, 6 AV fistulas and 1 common carotid to vertebral artery bypass). Primary, primary assisted and secondary patency rates at three years were 66.4%, 89% and 89% respectively. Complications occurred in 22 patients (52%) and included the following: wound complications 45%, deep vein thrombosis in 4.8% and compartment syndrome in 4.8%.
Costochondral calcification, osteophytic degeneration and occult first rib fractures in patients with venous thoracic outlet syndrome
G G Sheng, Y M Duwayri, B B Emery, A M Wittenberg, C T Moriarty and R W Thompson
J Vasc Surg 2012;
The purpose of this investigation was to determine the incidence of costochondral calcification (CC), osteophytic degeneration (OD) and occulty first rib fractures (FRFx) in patients presenting with venous thoracic outlet syndrome. Thirty-seven patients over 12 months were operated on for venous thoracic outlet syndrome. FRFx were observed in 16 of 37 patients (43%). All fractures were small, linear and non-displaced fractures located within an area of the CC in association with OD. The authors concluded that a high percentage of patients with venous thoracic outlet syndrome have concomitant first rib fractures.
Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers
I K Y Wong, A Andriessen, D T F Lee, D Thompson, L Y Wong, D V K Chao, W K W So and M Abel
J Vasc Surg 2012;
Compression therapy for venous leg ulcers apparently is not common in Hong Kong. The authors compared the efficacy of four layer compression bandaging, short stretch bandaging and wet to dry dressing changes for venous ulcer healing over a 24-week period. Primary endpoint was time to ulcer healing. Of the 321 randomized patients 14% did not complete the study. The authors noted that compression was superior to saline wet to dry dressings and that short stretch bandaging healed ulcers faster than four layer bandaging.