Technique and results of cryo-stripping in the treatment of varicose veins of the lower limbs

Stripping of varicose veins, a reference method, causes postoperative pain and sometimes dysesthesia due to saphenous nerve damage. Ankle wound healing is sometimes painful and often unaesthetic. Invaginated stripping eliminates some of the drawbacks, but keeps the lower wound and must be left in the case of recurrent saphenous rupture. Those two techniques do not allow total saphenous resection in the case of infected ulcers. Cryosurgery can be used regardless of the state of the ankle skin. It allows a complete invaginated stripping without ankle wound. METHODS: Over a 9-year period, 6157 limbs (3255 patients) underwent cryosurgery for varicose veins. The indication in 88% of cases was based on functional or aesthetic reasons and in 7% of the cases, hypodermitis, in 3% ulcerations and in 2% superficial venous thrombosis. RESULTS: Postoperatively, a single case of sural phlebitis was observed. Frequency and intensity of pain and hematomas are decreased. Thanks to this technique, the lower incision can be avoided thus giving better aesthetic results. CONCLUSION: Cryosurgery for varicose veins can be used in any circumstances. It has a similar efficacy to the stripping technique. Aesthetic and functional results are better. It is an important improvement especially in case of ulceration.     

Sympathectomy by phenol infiltration in the treatment of chronic obliterative arteriopathies of the lower limbs. Comparison between 60 statistical cases and 35 surgical sympathectomies (author's transl)

The authors compare the results obtained by the use of two different lumbar sympathectomy techniques in patients with chronic obliterative arterial disease of the lower limbs. Surgical resection was employed in 35 cases, and infiltration with phenol under radiological control in 60 cases. The proportion of successful results was about the same in both groups, best results being obtained in younger patients with less advanced disease. No mortality occurred in the group treated by phenol infiltration. Transient neuralgia was reported in some cases, but hospital stay was reduced by an average of 10 days, and many cases could be treated as out-patients. More than half of the patients did not require operation or amputation after phenol infiltration, which is, therefore, a very valuable associated therapeutic measure, especially in the elderly.     

Superficial veins of the lower limbs

This study, limited to the superficial veins of 123 limbs (108 normal and 15 suffering from frank varicose disease) and only vessels with a caliber of at least 2 mm, reveals a certain degree of constancy of anatomical pattern. The initial network is defined embryologically and subsequent haemodynamic phenomena model the final veins. In particular, the topography of the main perforating veins is relatively fixed. Due to their double antihypertensive valve and aspirating pump function while walking, these vessels drain into saphenous veins. They are beneficial when they return reflux into the deep vessels. Conversely, perforator incompetence contaminates the superficial network in the case of deep reflux. The perforating vessels also have a relatively fixed position in relation to other structures: the main saphenous collateral veins, their duplicated branches, their communicating veins and the main valves. This results in large junctions typically associating a saphenous valve, one or several collateral veins, one or several communicating veins, and one or several perforating veins. Typical examples are the garter junction for the long saphenous vein, and the junction of the tip of the calf for the short saphenous vein. Other haemodynamic levels are situated at various sites, particularly in the leg, reflecting the existence, in some cases, of symmetrical "mirror", medial and lateral perforating veins. Morphological analysis of 15 limbs with obvious varicose veins of the trunk of the long saphenous vein defined the routes of transmission of reflux to the leg. Finally, the authors present several technical considerations which they hope will be useful for Doppler operators and surgeons.     

Surgical treatment of chronic pancreatitis. Indications and early results

A report is given on 28 resections on patients with chronic pancreatitis with a high frequency of severe destructive lesions in the head of the pancreas. Pseudocysts, single, multiple or extrapancreatic were present in almost 50%. Strictures of the Ductus Wirsungianus were found in 24 cases and 50% had multiple pancreatic stones. In these cases 12 partial and 9 total duodenopancreatectomies and 7 distal resections were performed. All patients with distal resections survived. Only one patient died in the group with partial and total duodenopancreatectomy, which accounts for a postoperative letality of 4.8%. Postoperative there were 4 reoccurrences of pancreatitis, due to further alcohol abusus, 1 patient died from alcohol intoxication. Patients with total seemed to do better than with partial pancreatectomy at a survey 18 months after operation.     

Complications in surgical treatment of varicose veins of the lower limbs and their prevention]

To prevent hemorrhage and hematomas in the bed of subcutaneously removed large saphenous vein after Babcock the authors somewhat modified tactically the order of manipulations during the operative procedure. This method was employed while operating 42 patients with primary and secondary venous varices. It was feasible to prevent hemorrhage and hematomas along the vascular bed in every case. The suggested tactical modification of the removal of venous varices wound improve the postoperative course and shorten the terms of patients' stay at the hospital postoperatively.     

Fat grafting of the buttocks and lower limbs

This article presents the senior author's experience in fat grafting for the treatment of contour deformities of the buttocks and lower limbs. This method has been termed liposculpture and consists in removal of adipose tissue by cannula and syringe and cleaning of the aspirated material with saline. All external contact is thus carefully avoided, preventing contamination. Fat grafting is done in multiple tunnels in a deep plane. Total of 140 patients were treated over the last 5 years and results were considered uniformly satisfactory. Fat absorption was estimated by clinical evaluation to be less than 20% volume. A low rate of complications (less than 3%) supports the authors' opinion that this is an efficient and safe procedure to correct or enhance contour deformities of the lower limbs.     

Sulodexide versus calcium heparin in the medium-term treatment of deep vein thrombosis of the lower limbs

Thirty adult patients with distal, monolateral deep vein thrombosis of the lower limbs were randomly treated for sixty days either with subcutaneous Ca-Heparin or with Sulodexide, administered IM for ten days and orally for fifty days. The thrombus accretion above the knee, the venous pressures of the affected leg, the clinical symptomatology, and some laboratory coagulative tests were monitored throughout the administration period. Local tolerability of the two treatments was also evaluated. The two applied treatments evidenced a net antithrombotic activity, preventing thrombus accretion above the knee, improving with the same efficacy the venous pressures in the affected legs, and similarly reducing clinical symptoms, with a quick and statistically significant trend toward normalization. Blood fibrinogen was significantly lowered by both drugs, while only Ca-heparin yielded a prolongation of activated partial thromboplastin time. Local tolerability of treatments was better for the mainly oral Sulodexide administrations, while subcutaneous Ca-heparin often induced small, though transient, hematomas.     

Intravascular surgery in the treatment of peripheral arteriopathies: our experience

The Authors, through a review of their vascular surgery experience in the treatment of PAOD at the III General Surgery Institute directed by Prof. G. Di Matteo (University, of Rome), focus their attention on endovascular surgery. Initially considered as an effective complement to "traditional surgery" rapidly its role has grown as an effective alternative for a number of vascular patients.     

Use of vazaprostan in the treatment of multifocal peripheral obliterating lesions of arteries of the lower limbs

Vazaprostan was prescribed to 13 patients with the lower limbs obliterating atherosclerosis and the coronary arteries atherosclerotic lesion (first group) and in 17--with obliterating atherosclerosis and endarteritis of the lower limbs vessels (second group). The treatment was found to be effective one in all of the patients of the first group and in 13--of the second. The authors consider vazaprostan application to be expedient in patients with the lower limbs obliterating lesions as a supplement to operative intervention and also in coincidence of this pathology with the ischemic heart disease.