Arteriovenous supercharging: A novel approach to improve reliability of the distally based sural flap

Complex soft-tissue defects of the distal third of the leg, foot and ankle with exposed bones/joints, tendons and implants need a flap for their closure. Distally based sural flap is commonly used, but it has a high partial necrosis rate due to venous insufficiency. We addressed this issue with AV supercharging by dorsalis pedis artery with short saphenous vein. Eight patients (seven males, mean age 34.12 years) with post traumatic lower limb defects over heel and foot were included. All flaps survived and healed although four flaps developed superficial partial epidermolysis. Average healing time was 20.12 days. Closure of the AV fistula was not required in any of the patients. At mean follow-up of two months, all patients were ambulatory with well settled flap. Arteriovenous supercharging of distally based sural flap through short saphenous vein improves the distal arterial perfusion in the flap and prevents distal flap necrosis.

Endovenous (minimally invasive) procedures for treatment of varicose veins

Thermal ablation of saphenous vein varicosis has developed into a standard procedure for treatment of varicose veins. The clinical success of the endovenous thermal procedure is comparable to high ligation and stripping operations and a significant difference between these groups could not be detected in long-term analyses. The only difference is in the genesis of saphenofemoral recurrence detected by duplex ultrasound: neoangiogenesis occurs after high ligation and stripping operation and after endovenous ablation of the great saphenous vein a recurrence occurs predominantly via a residual anterior accessory saphenous vein (AASV). Reduction of costs by an increase in endovenous procedures carried out in an outpatient setting in comparison to stripping operations, which are still frequently carried out in Germany (in comparison to other countries) as an inpatient procedure, have meanwhile been confirmed. An endovenous crossectomy (i.e., high ligation) should be strived for. Nonthermal endoluminal catheter procedures are predominantly reserved for treatment of the short saphenous vein.

Recurrence of Primary Vascular Leiomyosarcoma Five Years after Initial Diagnosis in the Lower Extremity

Primary leiomyosarcomas of vascular origin are rare tumors. They frequently arise within the inferior vena cava; however, the peripheral vein was also affected. To date, only a few hundred cases have been reported in the world literature. Although it is an extremely aggressive tumor, the symptoms may be unspecific, especially in the lower extremities. In this report, we present a case of primary vascular leiomyosarcoma, arising from the short saphenous vein, with symptoms mimicking thrombus in the initial diagnosis. The diagnosis of leiomyosarcomas was confirmed by standard H&E staining and immunohistochemical staining. Recurrence of the tumor has been observed five years after surgical treatment. Due to its rarity, experience in the management of this type of tumor is limited. The mainstay of treatment for these tumors is complete surgical resection. The purpose of the presented case is to discuss the clinicopathological features and management options of this tumor, under the light of the most recent literatures.

In Situ Popliteal–Tibial Bypass With the Short Saphenous Vein Through a Posterior Approach for Limb Salvage

A 69-year-old female patient was admitted to our hospital with gangrene of her left first and second digits. Angiography showed a diffuse occlusive lesion from the external iliac artery to the crural arteries. Endovascular therapy to the external iliac artery, above-knee femoropopliteal bypass with a polytetrafluoroethylene graft, and popliteal–tibial bypass through a posterior approach with the short saphenous vein graft were performed in 3 stages because the length of the great saphenous vein that was suitable for grafting was insufficient. Vascular surgeons should be aware of the posterior approach as an effective alternative procedure for infragenicular revascularization.

ClariVein™ – One year results of mechano-chemical ablation for varicose veins in a multi-ethnic Asian population from Singapore

Objectives This study assessed the effectiveness and patient experience of ClariVein for varicose veins and chronic venous insufficiency (CVI) in a multi-ethnic Asian population from Singapore. Methods A total of 121 patients underwent mechano-chemical ablation. Patients were reviewed at an interval of one week, and at 3, 6 and 12 months post procedure and underwent Duplex ultrasound with patient satisfaction assessment. Results At three months of follow-up, the great saphenous vein and short saphenous vein occlusion rates were 90.8% and 96.0%, respectively. At six months of follow–up, the GSV and short saphenous vein occlusion rates were 86.9% and 90.9%, respectively. At one year, great saphenous vein and short saphenous vein occlusion rates were 84.8% and 94.3%, respectively. Conclusions Early results are similar to what is described so far in the mechano-chemical ablation literature but recurrences are more than expected at one year. This is disappointing but is tempered by the fact that the majority of patients were asymptomatic and required no reintervention.

Surgical Outcomes of Varicose Veins at Universal College of Medical Sciences, Bhairahawa, Nepal

INTRODUCTION: This study was conducted to analyse the surgical outcomes of varicose vein at Universal College of Medical Sciences (UCMS), Bhairahawa. MATERIALS AND METHODS: A hospital based prospective study done at UCMS, Bhairahwa, Nepal over the period of one year, where all the patients who had lower limb varicose vein underwent surgery were analyzed. RESULTS: A total of 25 cases of varicose vein were operated at UCMS from August 2015 to July 2016. The post-operative complications like pain, wound abscess, aching, itching were minimal. CONCLUSION: Surgical treatment by SFJ ligation with stripping long and short saphenous vein is an established effective treatment of varicose vein in our center with minimal post-operative complications. Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14, page: 14-16