96 research outputs found
Ultrasound guided full mechanical thrombectomy of a floating thrombus in the common femoral vein
No full textA Floating Venous Thrombus (FVT) in the deep venous system has a high potential to cause pulmonary embolization. There are no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. Catheter-directed thrombolysis is effective for treatment of venous clots, but it is associated with increased risk of bleeding. Mechanical thrombectomy currently represents a valid therapeutic option without the need for lytic therapy and with excellent short and medium-term results. We herein present a technical note through an explicative case of a patient with an FVT located in the left common femoral vein who underwent to percutaneous venous mechanical thrombectomy (ClotTriever, Inari Medical, Irvine, CA, USA) under ultrasound guidance without an intravascular ultrasound check. At the end of the treatment, venography and duplex ultrasound scan showed iliofemoral patency without residual thrombus. No further procedures were needed and the patient was discharged two days post-intervention with oral anticoagulation and compression therapy with stockings
Compensation for external iliac vein hypoplasia via an inherent suprapubic shunt
No full textA 13-year-old girl was referred to our vein center by pediatricians owing to hypertrophic superficial venous circulation in her right groin, associated with local heaviness and the presence of two enlarged superficial venous branches emerging from her right medial thigh. The patient had previously undergone numerous examinations to exclude gynecological and gastrointestinal causes. A duplex ultrasound scan revealed reflux in the right common femoral vein with competent femoral valves. Notably, the right great saphenous vein (GSV) did not show significant reflux in the calf, but a severe reflux was detected in the proximal thigh with an enlarged ascending collateral branch directed towards the suprapubic area. In the left limb, duplex ultrasound examination revealed common femoral vein competent valves and modulated flow. Further exploration of the abdomen led to the diagnosis of external iliac vein agenesia. To better define the anatomy, she underwent contrastenhanced magnetic resonance venography, which revealed incomplete agenesis or chronic occlusion of the left external iliac vein with aberrant venous drainage (A/Cover and B). In B, the asterisk (*) represents the left common iliac vein (CIV), and the plus sign (& thorn;) represents the right GSV merging into the left CIV through a suprapubic collateral, owing to complete right CIV agenesis. Two main branches were identified, sprouting from the left common femoral vein, and connecting respectively to the right external iliac vein and right GSV through a suprapubic collateral (C). Venous malformations can manifest as hypoplastic or hyperplastic vessels, leading to obstruction or dilation, depending on the case.1 Embryologically, iliac veins develop from the posterior cardinal veins, which progressively regress and leave remnants like the renal segment of the inferior vena cava and the iliac veins.2 External iliac vein agenesia is typically associated with KlippelTrenaunay syndrome, which shows an incidence of 8%.3,4 However, this young lady did not present with the typical associated triad of varicose veins, asymmetric limb growth, and arteriovenous malformation, increasing the likelihood of isolated left external iliac vein agenesis, presenting with an incidence of less than 0.09%.5 Remarkably, the patient did not show signs of deep vein thrombosis; therefore, she was recommended a conservative treatment using compressive stockings, an
Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture
No full textLate formation of pseudoaneurysm related to stent fracture is rarely described in the literature. We describe a case of spontaneous 8-cm femoral superficial artery pseudoaneurysm rupture that had developed from fracture of a stent implanted 3 years previously. Surgical repair was performed with fractured stent removal and reverse saphenous vein bypass
LA DISCIPLINA DEGLI ABUSI DI MERCATO: PROSPETTIVE NAZIONALI ED EUROPEE
No full textThe present work relates to market abuse, particularly insider trading and market manipulation. The
thesis, in particular, is divided into 5 chapters. In the first chapter we examine the abusive practices
and related economic issues.
The second chapter deals with the European profile of market abuse by
the discussion of the Community acts that have influenced this matter.
The chapter three number
deals with the national legislation for the implementation of European regulations, and also focuses
on the powers of CONSOB and the disclosure obligations of companies.
Chapter four concerns in
more detail the issues relating insider trading and market manipulation.
The final chapter regards,
finally, the proposed changes in the regulations analyzed and a proposal made by the author about
ways to punish market abuse
Anterior accessory saphenous vein confluence anatomy at the sapheno-femoral junction as risk factor for varicose veins recurrence after great saphenous vein radiofrequency thermal ablation
No full textBACKGROUND: Varicose veins recurrence rate remained almost unchanged despite the constant technological advancement in its treatment. The aim of this study is to evaluate the variable accessory saphenous vein (ASV) anatomy at the sapheno-femoral junction (SFJ) as a possible risk factor for recurrent varicose vein (RVV) after great saphenous vein (GSV) radiofrequency thermal ablation (RTA). METHODS: Two-hundred consecutive patients affected by chronic venous disease (mean age 52.4±10.3 years; 187 women; CEAP C2-C6; 25.2±1.4), underwent to RTA from 2014 to 2016, at our Institute. Preoperatively all patients underwent duplex-ultrasound scanning, reporting the anatomical site, extension of reflux and the ASV anatomy at the SFJ. Duplex ultrasound and physical examination was performed postoperatively at 1, 6 and 12 months, and yearly thereafter. RESULTS: Patients were divided in two groups based on the anatomical site of reflux: group A (N.=187) including GSV and SFJ, group B (N.=82) including SFJ reflux. There was no preoperative statistical difference between the two groups. At a mean follow-up of 29.7±2.4 months, a freedom from recurrent varicose vein and GSV recanalization was: 100% and 100% at 1 month, 95.9% and 99.1% at 1 year, 93.7% and 96.7% at 3 years, respectively. A higher rate of RVV was documented for patients in group A at 3-year of follow-up (P=0.042). Cox regression analysis found, among five potential predictors of outcome, that direct confluence of ASV in SFJ (HR=1.561; 95% CI: 1.0-7.04; P=0.032) was a negative predictors of 1-year RVV. CONCLUSIONS: Sapheno-femoral junction morphology may affect recurrent varicose veins formation. In particular, a concomitant incompetence of the accessory saphenous vein or its directly confluence into the SFJ could represent an indication to simultaneous treatment by non-surgical techniques (RTA or laser) and avoid surgical ligation
Jetstream atherectomy system for treatment of femoropopliteal artery disease. A single center experience and mid-term outcomes
No full textBackground: The aim of this study is to assess our experience and mid-term outcomes using Jetstream atherectomy system for treatment of femoropopliteal artery disease (FPAD). Methods: Data of 30 patients with FPAD treated at our center between 2013 and 2016 were analyzed. Two subgroups of patients were identified: Group A included patients (n = 18) with de novo lesions; Group B (n = 12) included those with in-stent restenosis. The primary study end points assessed were technical success, perioperative mortality, and major adverse event (MAE) rate at 30 days (distal embolization, major amputation, and target lesion revascularization). Other outcomes measured were survival, primary, and secondary patency, and freedom from amputation at 1 and 3 years of follow-up, respectively. Results: Technical success was 100% for both groups. The MAE rate was 8.7%. No distal filter was adopted during intervention. Angioplasty was associated with 93.3% of cases (93.3% vs. 100%; P = 0.15), drug-eluting balloon (DEB) in 12 cases (22.2% vs. 66.6%; P = 0.008), drug-eluting stent and bare metal implantation in 1 (5.6% vs. 0%; P = 1) and 4 cases (11.1% vs. 16.7%; P = 1), respectively. The cumulative primary and secondary patency rates were 75.1% and 95.5% at 1 year, and 70.4% and 84.8% at 3 years of follow-up, respectively. The survival and freedom from amputation were 96.4% and 85.8% at 1 and 3 years of follow-up, respectively. The freedom from target lesion revascularization was 91.7% and 83.4% at 1 and 3 years from intervention. Conclusions: The use of the Jetstream appears to be safe and feasible with no distal embolization and low rate perioperative complications. Moreover, encouraging outcomes were observed when atherectomy was associated to DEB angioplasty
Management of Bell’s Palsy (Ardita) through Panchakarma - A Case Report
No full textBell\u27s palsy condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve, resulting total facial paralysis. It affects 11.5-53.3 per 100,000 individuals a year across different populations. Exact etiology of Bell\u27s palsy is unclear. As a result of inflammation of the facial nerve, blocking the transmission of neural signals or damaging the nerve. The condition normally gets better by itself within 6. In Ayurveda, Bell’s Palsy can be correlated with Ardita. Ardita is one of the Vaata Vyadhi among 80 Nanatmaj Vaata Vyadhi, it cause contracture of face, nose, eyebrow, forehead, and mandible get crooked. Here, the case presented is of a 50 yr old male patient come with complain of weakness and deviation of, inability to close an eye lid with lacrimation, drooling of saliva, difficulty to eating and drinking, pain in left upper and lower limb, face and behind the left ear, in episodic nature 2 time per week since august 2023 and its become persist in February 2024. Patient was treated with Virechana Karma, Dashmoola Taila Nasya for 7 days and Karna Purana with Dashmoola Taila for 21 days. There was noticeable improvement in physical findings and significant improvement in House Brackmann Grading for facial palsy after treatment
Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein
No full textObjective to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. Methods This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. Results A total of 60 limbs (73.3% women, mean age 54.7 +/- 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 +/- 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 +/- 2.3 days vs. OS 14.2 +/- 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. Conclusion MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS
Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?
No full textAim: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis.
Methods: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition.
Results: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days).
Conclusion: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer's instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary
Early and mid-term outcomes of open popliteal artery aneurysm repair with prosthetic grafts
No full textObjective: The aim of the present study was to assess the early and mid-term outcomes of open surgical repair (OSR) for popliteal artery aneurysms (PAAs) with prosthetic grafts. Methods: The pre-, intra-, and postoperative data for all the patients who had undergone OSR for PAAs with prosthetic grafts at our Institution between January 2009 and July 2019 were included in a prospectively maintained database, which was retrospectively analyzed. Primary patency was defined as uninterrupted flow (<50% stenosis) in the graft with no additional procedures performed. Secondary patency was defined as the restoration of graft patency. Results: A total of 82 patients had undergone OSR for 104 PAAs (median age, 71 years; interquartile range [IQR], 67-78 years; 82 men) with prosthetic grafts. Of the 104 PAAs, 72 (68%) had been asymptomatic. The median diameter was 30 mm (IQR, 24-37 mm). A medial approach was used for 35 PAAs (34%) and a posterior approach for 69 (65%). The repairs consisted of aneurysmectomy or aneurysm ligation without removal with an interposition graft placed and end-to-end anastomoses. The median operative time was 120 minutes (IQR, 103-142 minutes). The estimated blood loss was 281 mL (IQR, 150-281 mL). Only one patient treated with a posterior approach sustained a permanent peroneal nerve lesion. A second patient also treated via the posterior approach had required surgical revision for bleeding on postoperative day 2. No temporary lesions were recorded. No early amputations were required, and no perioperative deaths occurred. The median length of stay was 3 days (IQR, 3-4 days). An expanded polytetrafluoroethylene graft was used in 92 cases (88%) and a Dacron graft in 12 cases (12%). An 8-mm graft was used in 64 cases (62%). The median follow-up was 34.6 months (IQR, 8.5-62.7 months). No related mortality occurred. Of the 104 PAAs, 19 had required reintervention, with primary and secondary patency of 78% and 88% at 3 years, respectively. The median interval to reintervention was 28.3 months. Conclusions: OSR of PAAs with prosthetic grafts is safe and feasible, with good mid-term results and satisfactory primary and secondary patency at 3 years
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