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![recommend the use of risk assessment tools to help identify individuals Fundoscopy has been forgotten last years in hypertension clinics.
at «high» risk, who could benefit from therapeutic intervention, before However, recent papers have indicated that the image seen by visual
making clinical management decision. However, the term global risk inspection, can be digitised and fed into the computer providing very
estimation is perhaps a misnomer, as no system accommodates all well quantifiable information.
known risk factors. Furthermore, many evidences indicate that the non Conclusion: total cardiovascular risk is regularly defined by risk factors
invasive evaluation of signs of preclinical atherosclerosis could help to or organ damage. Sub clinical organ damage could bring in a lot of
better define the pattern of risk in asymptomatic subjects. The risk of new information on long term prognosis. This is particularly the case
CV events in patients with preclinical atherosclerotic lesions is higher when several bits of sub clinical changes occur together. Analysis of
than in the controls. The preclinical ATS is, indeed, an early stage of these changes could open the way for much earlier prevention and
this process: it is characterized by a minimal damage (then potentially treatment.
susceptible to correction) and, above all, indicates a multifocal disease.
In these regards, the ultrasound evaluation of Intima-media thickness Sy4-4 atHerOSCLerOSiS aNd VeNOUS tHrOm-
and/or asymptomatic plaque of carotid arteries it’s a high sensitive and bOSiS tHe Same diSeaSe eNtity WitH tWO diF-
specific method. In a recent study we aimed at determining the effects FereNt FaCeS
of including carotid IMT and ACP evaluation on the accuracy of CV P. POREDOS1, M. K. JEZOVNIK1
prediction. Our intention was to investigate if a new model of risk 1 University Clinical Centre Ljubljana, Department of Vascular
stratification incorporating the IMT/ACP beyond the risk variables of Diseases, Zaloska 7, SI-1000, Ljubljana
the «Progetto Cuore» could more accurately predict the GCVR in 454
[215 male and 239 female] asymptomatic subjects. After a five-year In past decades studies have indicated that there is an association
follow-up, overall CV major events occurred in the 13% of subjects between atherosclerotic and venous thrombembolic disease (VTE).
(n=62) and none of the traditional RF evaluated was alone able to This presumption is supported by similar or identical risk factors for
predict events. We reported a strong association between presence of both diseases and common pathogenetic mechanisms. Some studies
preclinical carotid ATS and rate of events. In more details, in the group have shown also that patients with VTE are at increased risk for
of subjects at GCVR < 20% total events occurred in the 8% of subjects atherosclerotic thrombembolic events.
with normal ultrasound findings, in the 13% (n=14) with increased We investigated if in patients with idiopathic VTE the prevalence
IMT and in the 15% (n=23) with ACP (p < 0.012). We showed that of preclinical indicators of atherosclerosis (increased intima-media
in managing subjects at «low-intermediate risk» (that currently has thickness-IMT, number of atherosclerotic plaques is higher than in
poor propabilities to receive complete informations and therapies for healthy subjects. Further we studied flow mediated endothelium
cardiovascular prevention), the evidence of signs of asymptomatic dependent (FMD) vasodilatory response of brachial artery in both
IMT or ACP, could provide further informations in improving their risk groups of investigated subjects. Forty-nine patients with idiopathic
prediction. Similarly, in another study (enrolling 558 asymptomatic VTE of both sexes (mean age 52.3 ± 14.3) and 48 age-matched healthy
patients) after a ten-year follow-up we reported that although the overall controls were included. Using ultrasound carotid and femoral arteries
incidence of a first CV event reflected the different risk profiles (4, 14, were investigated and IMT as well as the presence of atherosclerotic
and 20%, respectively), the rate of events increased to 35, 46, and 63%, plaques and their thickness were determined. Flow mediated
respectively in those patients with baseline evidences of preclinical vasodilatory response was studied by the determination of changes of
ATS. Furthermore, at the multivariate analysis asymptomatic carotid the diameter of brachial artery during reactive hyperaemia.
lesions significantly influenced the incidence of events. According to Intima-media was on average and in all investigated beds significantly
our and other similar results, the carotid pre-ATS could be a marker of thicker in patients than in controls (0.94 mm ± 0.29 mm vs 0.71±0.15
«additional» risk. mm, p< 0.001). In patients with VTE a higher prevalence of
atherosclerotic plaques was registered. Furthermore, total plaque
Sy4-3 earLy marKerS iN HyperteNSiON: OFteN thickness was significantly higher in patients than in controls.
OF VaSCULar OriGiN! Compared to the control group FMD was significantly reduced in the
D. L. CLEMENT1 group of patients: 4.9% (95%CI 1.1-8.7%) vs. 12.7% (95%CI 7.8-
1 University of Ghent, Ghent, Belgium 17.6%), p<0.001. Patients with VTE had also significantly reduced
endothelium independent dilation of the brachial artery. Functional
The reappraisal of the 2007 guidelines on the management of and morphological deterioration of arterial wall were interrelated.
Hypertension have emphasised the importance of estimating total Furthermore, FMD was related to circulating indicators of endothelial
cardiovascular risk. Even minor blood pressure elevation, can become dysfunction.
a major treat in case also other risk factors are present. The findings of our study show a close interrelationship between
Last years reflections along this line has gone even further. Even minor the presence of the idiopathic VTE and preclinical atherosclerotic
degree of organ damage, when added to other risk factors or minor deterioration of the peripheral arteries. This means that patients with
disease, can lead to a seriously total increased risk. This reasoning has VTE have simultaneous deterioration of the arterial and venous wall
focused all attention in hypertension to organ damage, even when it has and that there is a close relationship in the development of both
not yet come to a clinically level; therefore the term of «subclinical» diseases.
organ damage is being used.
Microalbuminuria is a good marker of early changes in kidney Sy 5 - therapeutic education of the vascular patient
function. The test is quite easy and normal limits rather well defined.
Cost effectiveness score is excellent and there is good correlation to Sy5-1 tHerapeUtiC edUCatiON OF tHe patieNt
prognosis. However, clinicians still underuse the technique. WitH peripHeraL arteriaL diSeaSe
The electrocardiogram is largely alike at the level of the heart. ECG P. H. CARPENTIER1
is cheap and very easy to perform. Recent information shows that 1 Department of Vascular Medicine, Grenoble University Hospital,
prognostic information can be obtained even when amplitude of R F-38043 Grenoble cedex, France
waves is falling in between «normal» values.
Ankle brachial artery pressure index (ABI) is to be seen in the same Patients with peripheral arterial disease are expected to control their risk
context. Besides its diagnostic capacities, it has a very strong correlation factors, to be compliant with non symptomatic long term treatment and
to long term prognosis. Recent data point out the value of ABI also to be able to detect any warning sign for a complication. This cannot
when it falls just around normal limits. be achieved only by the usual information delivered by the physician
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![microcirculation working group and from the French microcirculation Therefore, NVC represents the safest method to analyze microvascular
society. The aim was to propose recommendations on the first-line abnormalities in SSc, and enables the early differential diagnosis
statement of Raynaud’s. between primary and secondary Raynaud phenomenon.
Three steps were considered: defining the kind of acrosyndrome, In addition, abnormal findings on NVC at baseline together with the
differentiating etiologica factors from factors that impact on Raynaud’s presence of SSc-specific autoantibodies indicate a very high probability
clinical expression, and defining assessment that needs to be relevant, (over 80%) of developing definite SSc, whereas their absence rules out
reasonable and not to be anxiogenic this outcome.
Clinical assessment can identify .Raynaud’s suspect of revealing a Early diagnosis of SSc could enable the early start of treatment, which
patholological process such as connective tissue disease or apparently could slow disease progression and clinical complications.
primary Raynaud’s. In the absence of signs of associated disease, the References:
clinical factors that lead to consider Raynaud’s as suspect are severe De Angelis R, Grassi W, Cutolo M. Arthritis Rheum. 2009 15;61:405-10
crisis (several times a day, no summer remission, all fingers concerned, Herrick AL, Cutolo M. Arthritis Rheum. 2010 May 5. [Epub ahead of print]
unexplained aggravation. When these factors are present, one needs to Cutolo M, Sulli A, Smith V. Nat Rev Rheumatol. 2010 Aug 10. [Epub ahead
of print
follow up the patient.
When Raynaud’s seems to be primary, nailfold capillaroscopy and
Sy12-3 rayNaUd pHeNOmeNON: tHe OCCUrreNCe
antinuclear antibodies (ANA) need to be performed. Then no follow
OF diGitaL ULCerS CHaNGeS eVerytHiNG!
up is believed to be necessary. If capillaroscopy or ANA are positive,
P. CARPENTIER1
then annual follow up is mandatory because 40% patients will have
1 Clinique Universitaire de Médecine Vasculaire, Centre Hospitalier
other characteristics of systemic sclerosis. Literature does not give the
Universitaire de Grenoble, France
answer on the extend of assessment to be performed in that case.
Finally a patient suffering from Raynaud’s needs careful clinical
Raynaud phenomenon is a vascular acrosyndrome that is widespread
assessment, nailfold capillaroscopy and ANA. Other investigations and
in the general population and most often primary, without significant
follow-up depend on associated clinical signs.
influence on the health status and quality of life. But when this
phenomenon is associated with digital ulcers, the situation becomes
Sy12-2 CLiNiCaL USeFULNeSS OF CapiLLarOSCOpy
quite different:
M. CUTOLO1
- A benign primary Raynaud can be ruled out in front of these associated
1 Research Laboratory and Academic Unit of Clinical Rheumatology,
trophic changes, and the underlying disease is most often a systemic
Department of Internal Medicine, University of Genova, Genova,
sclerosis, with or without additional clinical features, requiring a
Italy
diagnostic work-up and a specific management with both local and
systemic therapeutic targets. The hypothenar hammer syndrome is the
Nailfold videocapillaroscopy (NVC) represents the best and safest
second etiology to be called in mind in this situation, and although the
method to detect and to analyze morphological microvascular
recurrence of this occupational disease is rare, it requires a specific
abnormalities, especially in presence of secondary Raynaud’s
medical and medico-social approach.
phenomenon. In normal conditions or in primary Raynaud phenomenon
- Digital ulcers related to systemic sclerosis are difficult to heal (mean
(but not during the cold-exposure test), the nailfold capillaroscopic
duration > 100days), result in a significant alteration of the quality of
pattern shows regular disposition of capillary loops along the nailfold
life and hand disability in everyday life, often show multiple recurrences
bed and no abnormal enlargements or capillary loss.
(66%), and can end up in tissue loss or even digital amputations
In patients with primary Raynaud phenomenon, however, one or more
(1.2%).
abnormal capillaroscopic findings, should alert the physician to the
- Their treatment is difficult, with no clearly efficient treatment
possibility of secondary Raynaud phenomenon, owing to the presence
demonstrated in therapeutic trials, and the prevention of recurrences,
of a previously undetected connective autoimmune disease, for example
which has been found more easily achievable, is therefore one main
systemic sclerosis (SSc).
therapeutic goal.
Morphological markers of microvascular damage include giant
capillaries, microhemorrhages, loss of capillaries, the presence
Sy12-4 tHe tHerapeUtiC CHaLLeNGe OF diGitaL
of avascular areas and angiogenesis; these features characterize
ULCerS iN SyStemiC SCLerOSiS
more than 95% of patients with overt SSc even if are not obesrved
P. PRIOLLET1
concomitantly.
1 Department of Vascular Medicine, Groupe Hospitalier Paris-Saint
These sequential and dynamic capillaroscopic changes are typical of
Joseph, 75014 Paris, France
the microvascular involvement in SSc, and can be described by the
term ‘SSc pattern’ .
Digital ulcers(DU) are a major complication in the course of systemic
Most importantly, imaging with NVC enables the early differentiation
sclerosis(SSc). DU occur up to 60% of patients with limited or diffuse
between primary and secondary Raynaud phenomenon by identifying
SSc. These lesions lead to substantial morbidity (reduce quality of
morphological patterns specific to various stages of SSc (patterns
life, pain, disability and disfigurement) that can escalate to gangrene
‘early’, ‘active’ and ‘late’); the inclusion of these NVC patterns could
and amputation. Management of DU remains a challenge. It involves
increase the sensitivity of classification criteria for SSc.
non-pharmacologic and pharmacologic modalities for treatment and
Reduced capillary density on NVC correlates with a high risk of
prevention of these lesions. Non -pharmacologic therapies include
developing digital skin ulcers and the presence of pulmonary arterial
avoidance of cold exposure, emotional stress, nicotine exposure,
hypertension, and can therefore be used as a marker of SSc severity
trauma or vasoconstricting drugs. Supporting therapies include
and progression.
pain medications, antibiotics and occlusive dressings. Agents to
Therapies targeting underlying vascular disease in SSc improve
treat Raynaud’s phenomenon are often used for the treatment and
symptoms of Raynaud phenomenon and reduce ischemic injury to
prevention of DU in SSc. Direct vasodilatating drugs such as calcium
involved tussue/organs; however, targeted treatment of fibrosis remains
channel blockers, alpha-adrenergic inhibitors, angiotensin converting
a challenge.
enzyme inhibitors, angiotensin receptors blockers, nitrates and
Immunesuppressive tharapies still of efficacy in the modulation of
intravenous prostacyclins are used with variable degrees of efficacy.
the immune response underlying SSc and generally characteriwing
Placebo-controlled study using an oral endothelin receptor antagonist,
all connective tissue diseases (i.e. Cyclophosphamide, Rituximab,
bosentan, demonstrated a 48% reduction in the mean number of new
Ciclosporin).
ulcers during the treatment period; however, there was no difference
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![Conclusions: Prevalence of a low ABI is elevated in hypertensive approaches, with close collaboration with non-European Countries.
patients. The use of ABI screening may improve cardiovascular risk The Biobank is a project from VAS, European Scientific Association,
prediction and the treatment can be modified according to the guidelines a large no-profit-Network of qualified researchers, clinicians, Centres
for high risk patients. Cardiovascular morbidity and mortality data and Institutions of 23 European Countries, operating since 1991 in the
will be evaluated after the 5 years long prospective phase of the ERV area of Angiology/Vascular-Medicine funding on the triad Research-
program. Education-Clinics.
Keywords: Peripheral arterial disease, Ankle-brachial index, methods: The Biobank on Vascular has subprojects activated in
Hypertension succession.The first ongoing is on PAD (Vas-EBPp), high-risk disease
for acute events/mortality, since the asymptomatic stage. The qualified
OC2-4 CrONOCOL impLaNt redUCeS SUrGiCaL patient selection, data and sample collection procedure are standardised
Site iNFeCtiON aNd imprOVeS FiNaL OUtCOme iN for participating Centres. Once the informed consent is signed the
iSCHemiC patieNtS blood-samples are sent to the centralized biorepository in Milan after
C. COSTA ALMEIDA1, L. REIS1, L. CARVALHO1, the researchers have filled in an anonymized detailed online-clinical-
C. COSTA ALMEIDA1 questionnaire on the patient. The quality certified organization is fully
1 Centro Hospitalar de Coimbra, Coimbra, Portugal centralized making the participation free and easy.
results: The VAS-European-Biobank is already recognised in the
Surgical site infection (SSI) in an ischemic patient after implantation of European Network of Biobank of excellence for working with common
a prosthetic by-pass is a complication that can have catastrophic impact methodologies (BBMRI, ISS), with the final aim to improve knowledge
in the by-pass permeability and in the future of the limb, and it can and health in a near future. Short-term results: allowing biobanking to
happen after administration of prophylactic systemic antibiotic. Using enter the everyday clinical practice of qualified Centres, strengthening
a Cronocol implant (collagen matrix impregnated with gentamicin) in their excellence in the triad Clinic-Research-Education; make European
the groin incision of patients submitted to femoro-popliteal by-pass can patients active in researches for future generations.
be a viable option to reduce SSI. Conclusions: A wide call to join the European-Biobank on Vascular
Objective: to compare SSI rate in patients operated on of femoro- Disease has been launched.(www.vas-int-org/vas@unimi.it )
popliteal prosthetic by-pass in whom a Cronocol implant was applied Keywords: Biobanking, Peripheral arterial diseases,Research
in the groin incision intra-operatively, with SSI rate in a control group
operated on without that implant. OC2-6 aSSeSSmeNt OF COLLateraL bLOOd
Methods: in a group of 40 non-diabetic patients with lower limb ischemia FLOW iN iSCHemiC LOWer Limb
with indication for femoro-popliteal by-pass graft (PTFE supported O. ALBAZDE1
grafts were used), all treated with piperacilin plus tazobactam as 1 Imperial College, London, United Kingdom
systemic infection prophylaxis, 20 (chosen at random) had a Cronocol
implant applied in the groin incision. All patients in both groups were Raised athermanous plaques are common in the lower abdominal aorta
operated by the same team. SSI signs and symptoms were evaluated by early adult life. Progressive diseases at this site and in the vessels
during the first 30 days pos-op, and the results compared. distal to it occur mainly in the second half of life, but usually remain
Results: SSI rate (no severe infection in none, but edema, redness, asymptomatic. When symptomatic, patients usually present to the
local pain, some pus around stitches) in the control group was 25 % (5 clinician with intermittent claudication. Several risk factors have been
patients), while in the Cronocol group there were no signs of SSI. No implicated in the progression of such disease, diabetes mellitus has
allergic reactions, either local or systemic, were noticed. been found to magnify the disease process, causing greater morbidity,
Conclusions: by using a Cronocol implant intra-operatively it (and mortality) in the form of macrovascular and microvascular
seems possible to reduce SSI rate in these operations, carrying no complications.
complications related to its use. These preliminary results are very In order to quantitatively assess the contribution of the collateral
favourable to the prophylactic efficacy of Cronocol implants towards circulation to the lower limb blood flow and to assess capillary filtration
SSI, and that is why we are presenting them. More randomized studies a total of 80 subjects were subjected to popliteal artery blood flow
and a larger group of patients in ours are needed, before its routine use measurement, (using Duplex ultrasound) and total limb blood flow
can be advised in operations where a local infection can be disastrous. measurement using opto-electronic plethysmography.
Keywords: Surgical Site Infection, Cronocol implant,PTFE prosthesis These subjects included 20 patients with peripheral arterial disease
by-pass (PAD), [diagnosed by DSA as having occlusion of the superficial
femoral artery without popliteal disease and with ABPI < 0.9] 20
OC2-5 eUrOpeaN biObaNK ON VaSCULar patients with PAD and NIDDM, 20 patients with PAD and IDDM and
diSeaSeS 20 control subjects of comparable age and risk factors.
M. CATALANO1, VAS-Scientific Team1, VAS-Biobank Working There was a significant difference in the means (P<0.05) of total limb
Group1-2 blood flow and popliteal artery blood flow in patients with PAD, which
1 Vas-Vascular-Independent Research and Education-European can be attributed to the development of their collateral circulation. The
Organization, Milan, Italy mean values for total limb blood flow and popliteal artery blood flow
2 Research Center on Vascular Diseases and Angiology Unit were not markedly different in all other study groups. This means that
University of Milan-H Sacco, Milan, Italy in patients with NIDDM and IDDM, the popliteal artery is the main
contributor to the blood flow to the lower limb and these patients have
Objectives: Advances in medicine and the discovering of how genetic little collateral circulation blood flow.
variation influences disease can be achieved only by research on The measurements for capillary filtration revealed that patients with
big numbers of available samples, properly collected and stored by IDDM and PAD have a markedly reduced rate compared to the other
Biobanks. Vascular Diseases and their socio-economic impact are study groups.
spreading mainly because of the increase in average-age. To improve Keywords: Assessment of total blood flow, To ischemic lower limb
the knowledge through a secure access to clinical data and biological
resources which are essential in health-related researches the VAS- OC2-7 COmparatiVe StUddiNG OF HemOrHeOLO-
European-Biobank on Vascular Patients was defined. Besides the GiCaL iNdeXeS iN patieNtS WitH CritiCaL Limb
Biobank aims to contribute to increase research’s scientific excellence iSCHemia
and efficacy in life sciences linking both clinical and biomolecular N. ABUSHOV1, E. ZAKIRJAYEV1, Z. ALIYEV1, G. ZEYNALOVA1
46 ~](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-46-320.jpg)
![1 Scientific Center of Surgery after M. TOPCHBASHOV, Baku, results: 86.5% of DCVT patients and 76.7% of MCVT patients were
Azerbaijan treated with anticoagulant drugs during the whole follow-up (P=0.003).
MCVT was significantly more associated with localized pain than
introduction: Successful treatment of patients with critical limb DCVT (30.4% vs 22.4%, P=0.02) and less associated with swelling
ischemia (CLI) is the one of the difficulty problem of contemporary (47.9% vs 62.7%, p<0.001). MCVT and DCVT patients exhibited the
angiosurgery. The aim: to analyze the influence of alterations in same risk factors profile (except recent surgery slightly more associated
hemostasis system to clinical course. with DCVT: OR= 1.70 [1.06 – 2.75]) and were equivalent in terms
material and methods: The hemorheological status (fibrinogen of co-morbidities (evaluated thanks to their Charlson index). At three
concentration, fibrinolytic activity, prothrombin index, blood months, there was no difference in terms of death, VTE recurrence and
coagulation time, deformability of erythrocytes) in 25 patients with major bleeding between MCVT and DCVT (3.8% vs 4.1%; 1.5% vs
CLI was studied. The main group (n=15) was performed by patients 1.4%; 0% vs 0.5% respectively, all statistically not significant).
with thromboangiitis obliterans (TAO), aged from 22 to 51 (median Conclusion: isolated symptomatic MCVT and DCVT populations
40,0±0,7), control group (n=10)-arteriosclerosis obliterans, aged exhibit different clinical symptoms at presentation but affect the same
from 47 to 72 (median 61,0±0,5). The diagnosis of TAO is based on 5 population. Under anticoagulant treatment and in the short term,
criteria of Shionoya (smoking history, onset before the age of 50 years, isolated distal DVT constitute a homogeneous entity. Therapeutic trials
infrapopliteal arterial occlusive disease, either upper limb involvement are needed in order to determine a consensual mode of care of MCVT
or phlebitis migrans, and absence of atherosclerotic risk factors other and DCVT.
than smoking). Microcirculation was studied by transcutaneous oxygen Keywords: Distal deep-vein thrombosis, Muscular calf vein
pressure (tcpO2) for estimate the dependence of clinic-functional thrombosis, Deep calf vein thrombosis
infringements in ischemic leg from hemostasis system.
results: Main group (TAO) had a most tendency to hypercoagulation OC3-2 bLeediNG COmpLiCatiONS iN patieNtS
and aggravation of the blood hemorheological features as compared WitH CaNCer reCeiViNG aNtiCOaGULaNt tHerapy
with control group. In basic group prothrombin index was improved FOr VeNOUS tHrOmbOembOLiSm. FiNdiNGS
median on 11,6±1,1% (ð<0,05), deformability of erythrocytes was FrOm tHe riete reGiStry
reduced median on 1,23±0,2 un. (p<0,05). Blood coagulation time was A. VISONÀ1, P. DI MICCO2, J.A. NIETO3, J. TRUIJLLO SANTOS4,
decreased in main group (2,1±0,4 vers. 3,1±0,3 min., ð<0,01). There R. QUINTAVALLA5, P. PRANDONI6, M. MONREAL7
were no significantly differences in indexes of fibrinogen concentration 1 Angiology Unit Castelfranco Hospital, Castelfranco Veneto, Italy
and fibrinolytic activity. Comparative analysis of tcpO2 was revealed 2 Internal Medicine Ospedale Buonconsiglio Fatebenefratelli, Naples,
the more clinic-functional infringements in ischemic leg at patients Italy
with TAO (22,1±2,2 vers. 27,4±1,6 mmHg, p<0,05). 3 Department of Internal Medicine Hospital Virgen de la Luz, Cuenca,
Conclusion: We consider, that medicamental therapy of hemorheologic Spain
abnormalities in patient with TAO and CLI must be direct to correction 4 Department of Internal Medicine Hospital Universitario Santa
of abnormalities in all hemocoagulation system components. The best Maria de Rosell, Cartagena, Spain
results of complex surgical treatment were recorded by combined 5 Department of Internal Medicine Azienda Ospedaliera Universitaria,
employment of surgical operations (arterial reconstructions or lumbar Parma, Italy
sympathectomy), prolonged epidural analgesia and complex rheological 6 Germans Trias I Pujol Hospital, Badalona, Spain
therapy in perioperative period. 7 Department of Cardiothoracic and Vascular Sciences University of
Keywords: Critical limb ischemia, Thromboangiitis obliterans, Padua, Padua, Italy
Hemostasis system
Background: Cancer patients with acute venous thromboembolism
OC3 - Venous thromboembolic disease (VTE) have an increased incidence of anticoagulant related bleeding
complications compared with those without cancer.
OC3-1 COmpariSON OF tHe CLiNiCaL HiStOry methods: Using data from RIETE, an ongoing registry of consecutive
OF SymptOmatiC iSOLated mUSCULar CaLF VeiN patients with acute VTE, we assessed risk factors for fatal bleeding
tHrOmbOSiS VerSUS deep CaLF VeiN tHrOmbOSiS among consecutive patients with active cancer and symptomatic acute
J. GALANAUD1, M.A. SEVESTRE2,3, C. GENTY3,4, J.P. LAROCHE1, deep venous thrombosis (DVT) or pulmonary embolism (PE).
V. ZYZKA5, I. QUERE1,6, J.L. BOSSON3,4 results: Up to December 2009, 25,022 patients with acute VTE had
1 CHU Montpellier, Montpellier, France been enrolled in RIETE, of whom 4,921 (20%) had active cancer.
2 CHU Amiens, Amiens, France Of these 212 patients did not receive anticoagulant therapy, or it was
3 TIMC, Grenoble, France stopped earlier than day 90 for reason other than bleeding. Thus, 4,709
4 CIC, Grenoble, France received anticoagulant therapy during the first three months and were
5 Cabinet de médecine vasculaire, Fort de France, France considered for the purpose of this study.
6 EA 2992, Montpellier, France During the first three months of anticoagulant therapy, 200 (4,4%)
patients developed major bleeding. Then, 38 (0.8%) further patients
Objective: half of all lower limbs deep vein thromboses (DVT) are bled beyond the first 90 days of therapy, 3 bled after withholding
distal DVT that are equally distributed between muscular calf vein anticoagulant therapy. The most common sites of bleeding were the
thromboses (MCVT) and deep calf vein thromboses (DCVT). Despite gastrointestinal tract (118 patients, 49%), genitourinary system (43
their high prevalence, MCVT and DCVT have never been compared patients, 18%) and the brain (27 patients, 11%). In all 160 patients
so far, which prevents from a possible modulation of distal DVT (66%) died within 30 days after bleeding: 88 (55%) died of bleeding, 3
management according to the kind of distal DVT (MCVT or DCVT). (1,9%) died of recurrent pulmonary embolism.
Our objective is to compare the clinical history of DCVT versus Conclusions: Major bleeding is a frequent and severe complication in
MCVT. cancer patient with VTE, even beyond the third month. One in every
design and methods: using data from the French, multicenter, three patients who bled died of the bleeding event. This information has
prospective observational OPTIMEV study, we compared the clinical to be validated in further studies in order to help clinicians to weigh the
presentation, risk factors of 268 symptomatic isolated DCVT and 457 risk and benefits of prescribing anticoagulant therapy in an individual
symptomatic isolated MCVT and the three-month outcomes of the 222 patient.
DCVT and 390 MCVT followed up. Keywords: Bleeding, Cancer, Anticoagulant Therapy
www.iua-eurochap2010.eu ~ 47](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-47-320.jpg)
![(SVD) (24.6%, of which 38.3% were symptomatic), coronary heart OC5-4 COmpUted tOmOGrapHiC aNGiOGrapHy
disease (CHD) (40.4%, of which 19.4% had myocardial infarction and FOr tHe eVaLUatiON OF CarOtid artery SteNOSiS
67.4% 3-vessel disease), peripheral artery disease (PAD) (34.2%, of F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2
which 26.0% had chronic ischemia) and visceral artery disease (1.7%). 1 Department of Vascular Surgery, University of Naples, Naples, Italy
After paraclinical evaluation, >2 vascular territories were involved 2 Department of Interventional Radiology, Bari, Italy
in 85.0%. Vascular risk factors profiles were: previous tobacco
use (65.7%), current tobacco use (10.6%), hypertension (64.3%), aim: Stroke is the third leading cause of mortality in the word and
hypercholesterolemia (75.4%), diabetes (25.8%), overweight (43.8%) the stenosis degree is considered a fundamental parameter for the
and obesity (25.2%). LDL cholesterol was >2.58 mmol/L (>100mg/ definition of the therapeutic approach. With the development of
dL) for 38.2% of patients and for 29.2% of those treated with a statin. multi-detector-Row CT (MDCTA) scanner, computed tomography
HbA1c levels were >6.5% for 16.9% of patients and for 53.8% of has become a widely used imaging technique for categorizing carotid
diabetic patients. Patients were undertreated with antiplatelet agents artery stenosis degree. The purpose of this paper is to compare two CT
(86.1%), statins (73.2%), renin-angiotensin system inhibitors (61.1%), post-processing procedure, maximum intensity projection (MIP) and
and triple combination of at least an antiplatelet agent, a statin and a multi planar reconstruction (MPR) in order to evaluate their sensitivity
renin-angiotensin system inhibitor (45.1% for PAD, 48.1% for SVD and inter technique agreement.
and 65.9% for CHD among patients included after June 2006). With methods: For the purpose 45 patients (35 males and 10 females),
a mean follow-up of 22.3+/-10.8 months, primary and secondary that underwent MDCTA for carotid artery evaluation, have been
outcomes were higher for PAD (11.3%, p=0.012; 47.4%, p<0.001), retrospectively evaluated. Data set were processed with the study
diabetic patients (11.6%, p=0.021; 36.8%, p=0.001), HbA1c >6.5% group’s workstations, by using MPR and MIP algorithms. Each patient
(14.5%, p=0.004; 35.8%, p=0.016). Secondary outcome was higher was assessed for stenosis degree by using North American Symptomatic
in hypertensive patients (30.1%, p=0.036) and those with >2 involved Carotid Endarterectomy Trial method. Statistic analysis was performed
territories (31.9%, p=0.002). to determine the sensitivity of the used procedure. The Cohen Kappa
Conclusions: Even at the time of revascularisation, medical test was applied to assess the level of intra-observer agreement. Image
management of ATD was not optimal. The need for clinical education quality was also evaluated.
of physicians and patients remains necessary to improve prognosis of results: MPR sensitivity was 87.8%(95% confidence interval [CI]81-
ATD. 94.5%) and MIP sensitivity was 91.1% (95%CI85.2-97%). Agreement
Keywords: Atherosclerosis, Real-world evaluation, Medical in MPR was 0.792 with a standard error (SE) of 0.066, and agreement
management in MIP was 0.836, with a SE of 0.072.
Conclusion: Results of the study indicate the MIP algorithms is more
OC5-3 maNaGemeNt OF VeSSeL WaLL diSeaSe iS sensitive than MPR. Best intra-observer agreement and image quality
better tHaN tHe maNaGemeNt OF riSK FaCtOrS results were also observer in the MIP. Data suggest also that MIP
G. H. R. RAO1,2, V. SRIRAM2, G. MURALIDHARA2, A. FENSTER3 should be the post-processing procedure to be utilized in the evaluation
1 Lillehei Heart Institute, University of Minnesota, Minneapolis, of carotid artery stenosis degree, when using MDCTA. Presence of
Minnesota, USA big calcified plaque can determine difficulties in MIP evaluation of
2 South Asian Society on Atherosclerosis and Thrombosis, USA stenosis degree.
3 Robarts Research Institute, University of Western Ontario, London, Keywords: Carotid stenosis
Ontario, Canada
OC5-5 perCUtaNeOUS treatmeNt WitH drUG-
Objective: Framingham Studies provided evidence to support the eLUtiNG SteNt iN diabetiC patieNtS
role of risk factors such as increased blood pressure and altered blood F. POLLICE1, P. POLLICE1, T. GROVER1, I. CHRISTENSEN1
lipids, for promoting acute vascular events. Based on these results, 1 Department of Cardiology, Leiden University Medical Center, Leiden,
management strategies for these risk factors were developed. Recent Netherlands Antilles
studies with Computerized Tomography (CT) providing calcium
scoring for coronary arteries and Magnetic Resonance Imaging (MRI) Background: Recent pivotal randomised clinical trials underscored
giving vessel volume measurements, have demonstrated that using the salutary effects of drug-eluting stents (DES) in diabetics who
conventional methods for monitoring risk, may exclude more than 30% underwent percutaneous-coronary revascularization (PCR). These
of the individuals from further screening for high-risk. trials documented lower incidence of adverse cardiovascular events
design and method: One such new methodology for monitoring and angiographic restenosis with DES usage in comparison with bare
quantitative measurements of the progression (or regression) of carotid metal stents. Although these enthusiastic results, it should bear in mind
plaque is the use of 3D ultrasound. that clinical trials do not reflect real clinical practice as they enrol
results: Studies from the Robarts Research Institute at London highly selected patients with relative non-complex lesions.
Ontario, have demonstrated that similar to total intima media thickness aim: The aim of the current study is the evaluation of clinical outcomes
(IMT) measurements, total plaque volume (TPV) or total plaque area in unselected diabetic patients usually encountered during everyday
(TPA) measurements, also could be used to monitor the progress of interventional cardiology practice who underwent coronary stenting
atherosclerosis. Furthermore, they have demonstrated that aggressive with drug-eluting stent(DES)implantation.
lipid lowering with drugs such as Lipitor, could reduce the TPV methods: 878 patients (1451 lesions)underwent PCR with DES
significantly in as short a period as three months. This methodology implantation. Patients were classified into three groups according to
has been shown to be sensitive enough, to monitor the diet-induced diabetes mellitus(DM)status:1) No-DM (578 patients/937 lesions); 2)
changes in the total vessel volume. 3D Ultrasound studies also have non-insulin requiring DM(No.IrDM) (171 patients/301 lesions); 3)
demonstrated that even after significant lowering of blood lipids the insulin requiring DM (iRDM)(129 patients/213 lesions).
progression of TPV may still be persistent, suggesting the need for results: Procedural success was high overall. In-hospital myocardial
further aggressive treatment. infarction (MI) was higher inIrDM than in no—IrDM patients(10.9%,
Conclusion: Evidence from recent studies suggests, that monitoring 4.1%, 2.6%, respectively; p<0.001). IrDM patients showed higher in-
the progression or regression of the disease is far superior to the hospital cardiac death than no-IrDM and no-DM patients (3.9%, 0.6%,
management of known conventional risk factors. 0.5%, respectively; p=0.002). one year target lesions revascularization
Keywords: Risk, IMT (TLR) and target vessel revascularization (TVR) rates were not
statistically different. IrDM patients compared with both No-IrDM
52 ~](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-52-320.jpg)
![and NO-DM patients showed lower one-year survival (92.3%, 97.1%, was 4,12 + 0,85 g/L. Multivariate analysis showed F value has been
98.4% respectively; p=0.002%), lower one-year event-free survival(71., determinate with non HDL - cholesterol (â = 1,093, p = 0,027). Linear
80.2%, 86.3% respectively: p=0.001), and higher incidence of one-year regression analysis defined F as predictor for minimal value of ABI,
MI (15.5%, 6.4%, 3.9%, respectively; p<0.001) multivariate analysis found at the end of investigation (â = 0,469, p = 0,007). Value of CRP
demonstrated that DM was an independent predictor of one-year MI determinate change of minimal value of ABI and change of mean ABI
and one-year MACE. per year (ABImin and ABIx/y).
Conclusion: Despite the positive effects of DES on TLR, diabetics, Conclusion: Our results indicate that plasma determination of fibrinogen
especially IrDM, as compared with No-DM, showed worse immediate and CRP has clinical utility in defining the process of progression of
and long-term clinical outcomes. peripheral atherosclerosis in type 2 diabetic population.
Keywords: Diabetes 2 Keywords: ABI, CRP, Fibrinogen
OC5-6 LOW aNKLe braCHiaL iNdeX iS a riSK OC6 - rare vascular diseases and progress in vascular diagnosis
FaCtOr FOr reVaSCULariZatiON iN COrONary
patieNtS OC6-1 a NeW diaGNOStiC CriteriON WitH
M. MAUFUS1, J. B. GUITTON1, G. VANZETTO2, L. BELLE3, OLOUr dUpLeX SCaNNiNG iN pUdeNdaL NeUraLGia
B. IMBERT1, P. CARPENTIER1, G. PERNOD1 by eNtrapmeNt
1 Department of Vascular Medicine, CHU Grenoble, Grenoble, M. MOLLO1, E. BAUTRANT1, J. EGGERMONT1,
France A. K. ROSSI-SEIGNERT2
2 Department of Cardiology, CHU Grenoble, Grenoble, France 1 Pelvi-perineal Rehabilitation Dpt, Private Med Centre L’Avancee,
3 Depatment of Cardiology, CH Annecy, Annecy, France Aix-en-Provence, France
2 Physical and Readaptation Physical Med Dpt, Pays d’Aix Hospital
Objective: Peripheral Artery Disease defined as an Ankle Brachial Centre, Aix-en-Provence, France
Index (ABI) < 0,90 is associated with high risk of Coronary Artery
Disease (CAD), stroke and mortality. The aim of our study was to assess Objective: to confirm diagnostic accuracy of a new Colour Duplex
the positive predictive value of the ABI regarding CAD requiring a Scanning (CDS) criterion, the Pudendal Artery Ratio (PAR) described
revascularization procedure. by Mollo et al*, in Pudendal Neuralgia by Entrapment (PNE).
design and methods: We conducted a prospective monocentric study. design and methods: a prospective study on a consecutive series
All patients admitted in the cardiology unit for suspected CAD requiring brought up-to-date to 667 unselected patients, all evaluated by both
a coronary artery angiography were consecutively included. Patients CDS and Neurological Criteria (NC) (Diagnostic Score (DS) and
were assessed for cardiovascular risk factors, claudication history, rest Electroneuromyography (ENMG)) and, when surgery was indicated,
pain or ulcer, and ABI was calculated. Patients were divided into two by an Intra-Operative Score (IOS). CDS examinations were performed
groups (ABI < 0.90 or 0.90 < ABI < 1.30). The primary endpoint was by an operator who was unaware of NC and IOS, and in the same way,
the number of coronary artery revascularization procedure (CARP), NC and IOS established by practitioners unaware of CDS findings.
coronary artery bypass graft of percutaneous transluminal coronary Inadequate examinations were neither repeated nor removed from the
angioplasty, according to ABI group. analysis. Results of CDS were compared to those of NC and of IOS for
results: 171 patients were consecutively included during 4 months. surgical cases (Student t test) and diagnostic values (Sensitivity and
109 patients (63.7%) had CAD, and 50 (29.3%) had an ABI < 0.90. Specificity) were evaluated.
Among the 50 patients with ABI < 0.90, 43 (86%) needed a CARP. results: in this consecutive series, CDS exploration showed a 99.6%
Among the 121 patients with 0.90 < ABI < 1.30, 66 (54.5%) needed a Feasibility. PNE was diagnosed with NC in 217 patients. For 115,
CARP. The Odd ratio for CAD revascularization among patients with surgery was finally indicated, since the first stage of treatment was not
ABI < 0.90 is 5.12 [95% CI; 2.13 to 12.28, p < 0.001]. sufficient for recovery. Comparative study was based on 154 operated
Conclusions: Our prospective study has shown that among patients nerves (76 unilateral, 39 bilateral). Of the 154 PNE identified by NC,
with suspected CAD, an ABI < 0,90 is associated with a 5,12 relative 137 Pudendal Vascular Entrapment (PVE) were detected by CDS.
risk for CARP. Thus ABI is a useful non-invasive non-expansive tool Comparison with IOS obtained during surgical procedures led to a
that identifies a subgroup of patients at risk to require a CARP. 95.5% Sensitivity and a 66.7% Specificity, for diagnosis of PNE.
Keywords: Peripheral vascular disease, Coronary arteyr disease, Ankle Conclusions: this study validates our new CDS criterion, the PAR, very
brachial index strong at diagnosing PNE, involving a great advance in the patients’
care for this pathology.
OC5-7 prOGreSSiON OF peripHeraL arteriaL (*) Mollo M. et al. Evaluation of diagnostic accuracy of Colour Duplex
diSeaSe iN type 2 diabetiC patieNtS: iNFLUeNCe Scanning, compared to electroneuromyography, diagnostic score and
OF FibriNOGeN aNd Crp surgical outcomes, in Pudendal Neuralgia by entrapment: A prospective
M. BOSEVSKI1, L. J. GEORGIEVSKA-ISMAIL1 study on 96 patients. PAIN; 142: 159-63 (2009).
1 University Cardiology Clinic, Faculty of Medicine, Skopje, Keywords: Pudendal Neuralgia, Pudendal Nerve Entrapment, Alcock’s
Makedonija Canal Syndrome
The aim of study was to determinate the influence of inflammatory OC6-2 LONG term FOLLOW-Up OF GiaNt CeLL
markers: fibrinogen (F) and C-reactive protein (CRP) on the progression arteritiS-reLated Upper/LOWer Limb VaSCULitiS.
of peripheral atherosclerosis in type 2 diabetic pts. a SerieS OF 36 patieNtS
patients and methods: 62 pts with type 2 diabetes and diagnosed C. ASSIE1, A. JANVRESSE1, D. PLISSONNIER1, H. LEVESQUE1,
coronary artery disease were enrolled in a cohort prospective study. I. MARIE1
We measured in them, at all, progression of peripheral arterial disease, 1 Département de Médecine interne, CHU Rouen, 76031 Rouen Cedex,
defined as change of ankle-brachial index (ABI) after 36 months. France
Multiple linear regression analysis was built to define predictivity
of continuous variables: F, CRP, lipid fraction, urea, creatinin, fast introduction: The aims of this retrospective study were to evaluate
glycemia, duration of diabetes, age on to ABI value. clinical features and long-term outcome of patientswith giant cell
results: Study population was on age 60,28 + 27 years and mean arteritis (GCA) exhibiting upper/lower limb vasculitis.
diabetes duration of 8,58 + 6,17 years. Mean plasma fibrinogen level methods: 36 consecutive patients received a diagnosis of symptomatic
www.iua-eurochap2010.eu ~ 53](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-53-320.jpg)
![2 University Hospital Olomouc - Department of Clinical Biochemistry,
Olomouc, Czech Republic
3 University Hospital Olomouc - Department of Hematooncology,
Olomouc, Czech Republic
Objective: The aim of this study was to evaluate the plasma levels
Conclusion: Endothelial function expressed as parameters that present of prothrombotic markers: von Willebrand factor (vWF), plasminogen
arterial elastic properties ( beta index, AI and PWV) could significantly activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) in
differentiate healthy population from symptomatic patients with asymptomatic subjects with dyslipidemia.
coronary artery disease. design and methods: Asymptomatic subjects with dyslipidemia and
Keywords: CAD,e-tracking,endothel their relatives (n=234) were assessed for lipids and prothrombotic
markers. Individuals were divided into four dyslipidemic phenotypes
pS1-4 riSK prOFiLe OF CardiOVaSCULar diSeaSeS (DLP) according to apolipoprotein B (apoB) and triglycerides (TG):
aNd SUbCLiNiCaL atHerOSCLerOSiS iN HiV pOSitiVe DLP1 (n = 58, apoB < 1.2g/l and TG < 1.5mmol/l), DLP2 (n = 47,
pOLiSH patieNtS apo B < 1.2g/l and TG > or = 1.5mmol/l), DLP3 (n = 31, apoB > or =
W. KWIATKOWSKA1, B. KNYSZ2, M. CZARNECKI2, 1.2g/l and TG < 1.5mmol/l) and DLP4 (n = 98, apoB > or = 1.2g/l and
J. GASIOROWSKI2, J. DRELICHOWSKA-DURAWA1, TG > or = 1.5mmol/l). Associations between prothrombotic markers
M. BUBALA3, J. KWIATKOWSKI3, W. WITKIEWICZ1, and risk factors for atherosclerosis, markers of insulin resistance, and
A. GLADYSH2 the intima-media thickness of the common carotid artery (IMT) were
1 Regional Specialist Hospital, Research and Development Centre, assessed too.
Dpt of Angiology, Wroclaw, Poland results: Significant differences in PAI-1 between normolipidemic
2 Department of Infectious Diseases Wroclaw Medical University, phynotype - DLP1 (62.5 [35.9-82.9] ng/ml) and hypertriglyceridemic
Wroclaw, Poland phenotypes - DLP2 (82.2 [61.1-122.1] ng/ml, p<0.01) and DLP4
3 Wroclaw University of Technology, Wroclaw, Poland (91.4 [63.5-111.8] ng/ml, p<0.001) after adjustment for age, sex and
body mass index, were found. Levels of t-PA were different only
Objective: The aim of the study was to evaluate the independent between DLP1 and DLP4 (1.9 [0.9-3.3] ng/ml versus 5.3 [2.5-8.6] ng/
risk factors of CVD and early atherosclerosis in HIV positive Polish ml, p<0.05). There were no significant differences of vWF between
subpopulation. DLPs. PAI-1 and t-PA correlated with lipid parameters, markers of
design and method: We assessed risk factors for CVD and carotid insulin resistance, blood pressure and obesity. VWF was independently
intima media thickness (cIMT) of common carotid artery/bulb by associated with IMT, which was increased in DLP4.
ultrasound (LOGIQ 7) in 72 HIV(+) mostly treated with ARV and Conclusions: Individuals with hypertriglyceridemic phenotypes
24 control individuals matched for age and sex without pre-existing showed increased levels of PAI-1 in comparison with normolipidemic
CVD. subjects. The elevation of t-PA was presented only in patients with
results: CVD was diagnosed in 5% of HIV (+) patients. In HIV (+) simultaneously elevated TG and apoB. The significant increase of
patients the prevalence of heavy cigarette smoking is more frequent IMT confirmed in the patients with DLP4 reveals individuals with the
(62,5% vs. 37,5%), they are significantly: less obese (BMI 23,6 vs.25,6, highest risk for atherosclerosis manifestation.
p=0,0019) with higher waist/hip ratio (0,92 vs. 0,84, p=0,0006), with Supported by grant IGA MZCR NS/10284-3
significantly lower: LDL-C (100,9 vs.116,8 mg/dL, p=0,0034), HDL-C Keywords: Von Willebrand factor, Tissue plasminogen activator,
(56,8 vs. 65,0mg/dL, p=0,005), fibrinogen (2,49 vs. 3,04g/l, p=0,0001), Intima-media thickness
with significantly higher: triglicerydes (169,2 vs. 113,0mg/dl p=0,005),
and homocysteine (13,9 vs 11,0µmol/l, p=0,001) concentrations. Mean pS1-6 SOLUbLe iNterCeLLULar CeLL adHeSiON
cIMT was 0,703mm +/- 0,183 and 0,523mm +/- 0,095 respectively in mOLeCULe-1 aNd VaSCULar CeLL adHeSiON
HIV (+) and control group (p=0,0001). In HIV (+) vs. control - mean mOLeCULe-1 iN aSymptOmatiC dySLipidemiC
bulb cIMT value was 0,800mm vs. 0,578mm and common carotid SUbJeCtS
cIMT 0,606mm vs.0,470mm (p=0,0001). Carotid plaques > 1,5mm D. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D.
were observed in 28 HIV positive patients vs. 1 participant of control JACKULIAKOVA1, D. NOVOTNY2, J. LUKES2
group. 1 University Hospital - 3rd Department of Internal Medicine,
Conclusions: In HIV positive patients more extensive atherosclerosis Olomouc, Czech Republic
measured by cIMT was observed. The strongest classical risk factor 2 University Hospital - Department of Clinical Biochemistry,
of CVD in Polish HIV(+) patients is cigarette smoking. Constitution Olomouc, Czech Republic
features and biochemical profile of these patients tend to metabolic
syndrome. Both, HIV infection and antiretroviral therapy are important Objective: The plasma levels of soluble intercellular cell adhesion
predictive factors of premature atherosclerosis. Further longitudinal molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule-1
studies in the field of subclinical atherosclerosis in Polish HIV positive (s-VCAM-1) were assessed in clinically asymptomatic subjects to
population are necessary. compare them between normolipidemic and various dyslipidemic
Supported by European Regional Development Fund, Polish phenotypes. The associations between soluble cell adhesion molecules
Government (Operational Programme Innovative Economy 2007- (s-CAMs) and risk factors for atherosclerosis, markers of insulin
2013),under the grant “WROVASC - Integrated Cardiovascular resistance, and the intima-media thickness of the common carotid
Centre” artery (IMT) were evaluated, too.
Keywords: Atherosclerosis, IMT, HIV infection, Risk factors design and methods: 234 asymptomatic subjects were divided into
four dyslipidemic phenotypes (DLP) according to apolipoprotein B
pS1-5 eNdOtHeLiaL prOtHrOmbOtiC marKerS iN (apoB) and triglycerides (TG): DLP1 (n = 58, apoB < 1.2g/l and TG <
dySLipidemiC patieNtS 1.5mmol/l), DLP2 (n = 47, apoB < 1.2g/l and TG > or = 1.5mmol/l),
D. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D. DLP3 (n = 31, apoB > or = 1.2g/l and TG < 1.5mmol/l) and DLP4
JACKULIAKOVA1, D. NOVOTNY2, L. SLAVIK3 (n = 98, apoB > or = 1.2g/l and TG > or = 1.5mmol/l). DLP1 (normo-
1 University Hospital Olomouc - 3rd Department of Internal Medicine, apoB /normo-TG) served as a control group.
Olomouc, Czech Republic results: A significant difference in s-ICAM-1 between DLP1 (502.0
www.iua-eurochap2010.eu ~ 59](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-59-320.jpg)
![[457.1-568.2] ng/ml) and DLP4 (567.9 [502.8-692.1] ng/ml, p<0.001) associated with more impaired basic and instrumental ADL.
was found. No significant differences in s-VCAM-1 between DLPs Keywords: White matter changes, Dementia, Activities of daily
were apparent. S-ICAM-1 was independently predicted by HDL- living
cholesterol, non-HDL-cholesterol, proinsulin, C-peptide, waist,
systolic and diastolic blood pressure. S-VCAM-1 was predicted only pS1-9 SimULtaNeOUS eVaLUatiON OF COrONary
by age and systolic blood pressure. Both s-CAMs were detected as artery diSeaSe aNd aOrtiC atHerOSCLerOSiS USiNG
independent predictors for IMT, which was significantly increased in mULtideteCtOr Ct iN aCUte iSCHemiC StrOKe
DLP 4. patieNtS
Conclusions: The elevation of s-ICAM-1 was presented only in patients H. KIM1, H. CHO1, J. LEE1, Y. KIM1
with simultaneously elevated TG and apoB (DLP4) in comparison with 1 Department of Neurology, Konkuk University Hospital, Seoul,
normolipidemic subjects. Patients with DLP 4 had significantly increased South Korea
IMT, which was independently predicted by levels of s-ICAM-1 and of
s-VCAM-1. These findings pointed out DLP4 subjects as individuals Backgrounds: Coronary artery disease (CAD) is a major determinant
with the highest risk for early manifestation of atherosclerosis. of the outcome in ischemic stroke patients. Aortic atherosclerosis
Supported by grant IGA MZCR NS/10284-3. (AA) is a potential embolic source in ischemic stroke patients. We
Keywords: Soluble cell adhesion molecule, Intima-media thickness, investigated effectiveness of simultaneous evaluation of CAD and AA
Dyslipidemia in acute ischemic stroke patients with multiple vascular risk factors.
methods: We simultaneously evaluated CAD and AA using 64-slice
pS1-7 HyperteNSiON iN patieNtS WitH SyStemiC MDCT with single sequence in consecutive acute ischemic stroke
LUpUS erytHematOSUS (SLe) patients with multiple vascular risk factors admitted Konkuk university
M. BOUCELMA1, H. CHAUDET, A. BERRAH hospital from March, 2008 to November, 2009. More than 50% stenosis
1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, in one or more coronary arteries on MDCT was defined as having CAD.
Algeria AA was classified into AA in proximal aorta (ascending aorta including
2 Statistical Department, North Hospital, University of Aix Marseille, arch) or descending aorta by location, and simple or complicated by
Marseille, France plaque nature. Complicated aortic plaque (CAP) was defined as plaque
thickness more than 4mm, mobile or ulcerated plaque in proximal
Mortality in SLE patients is increasing due to cardiovascular disease. aorta. Individual vascular risk factors and Framingham Risk Scores
Objectives: To determine the prevalence of hypertension in our SLE (FRS) were evaluated.
patient cohort, and to establish the factors which contribute to their results: Of 274 patients (male 165, mean age 66.2 year-old), CAD was
development of hypertension. found in 61 (22.3%) of patients. For CAD, CAP (OR: 2.39, 95% CI:
patients and methods: We studied 150 SLE patients (149 women, 4 1.14-4.97) was independent predictor. AA was found in 209 (76.3%)
men).Blood pressure was mesured in all patients three times, with a patients including 147 (53.6%) patients with plaque in proximal aorta
separation of 5 minutes. We inquired about cardiovascular risk factor and 59 (21.5%) patients with CAP. For CAP, CAD (OR: 2.69, 95%
and treatment (immunosuppressives drugs, corticoids). CI: 1.22-5.90), previous history of ischemic stroke (OR: 2.30, 95% CI:
Results: The mean age was 37±10 years and the mean duration of 1.00-5.28), and stroke subtype (OR: 0.25, 95% CI: 0.08-0.72) were
SLE was 11.3±6.2 years.35.2% of patients suffered hypertension, 5% independent predictors. FRS was also modest predictor for both CAD
diabetes, 48% hypercholesterolemia, 42.5% moderate hyperhomo- (OR: 1.04, 95% CI: 1.01-1.06) and CAP (OR: 1.02, 95% CI: 0.99-
cysteinemia. 87% had taken corticoids. From hypertensive patients 1.04).
59.2% had a renal flare and at the time of study renal function was Conclusion: Simultaneous evaluation of CAD and AA using MDCT
normal. Hypertension was significantly linked to nephritis (p < 0.02), in acute ischemic stroke patient with multiple risk factors was useful.
and cumulative dose of corticosteroids (p < 0.001). CAD or CAP was independent predictor to either. FRS was also
Keywords: Systemic lupus erythematosus, Hypertension, Vascular usefulness in predicting presence of CAD or CAP in acute ischemic
event stroke patients.
Keywords: Ischemic stroke, Coronary artery disease, Aortic
pS1-8 impaCt OF WHite matter CHaNGeS ON atherosclerosis
aCtiVitieS OF daiLy LiViNG iN miLd tO mOderate
demeNtia pS1-10 StrOKe iN tHe yOUNG: reLatiON WitH
S. MOON1, D. L. NA2 tHrOmbOCytemia
1 Ajou University School of Medicine, Suwon, South Korea M. BOUCELMA1, S. LASSOUAOUI1, D. ZEMMOUR1,
2 Samsung Medical Center, Seoul, South Korea H. BOUDJELIDA1, N. OUADAHI1, A. BERRAH1
1 Department of internal medicine, Mohamed Lamine Debaghine
We investigated the association between white matter changes and Hospital, Bd Said Touati, Algiers, Algeria
activities of daily living (ADL) in a large, well-defined cohort of
patients with mild-to-moderate dementia (either Alzheimer’s disease or introduction: One of the hematological causes of stroke is essential
subcortical vascular dementia). We divided a total of 289 patients into thrombocythemia (ET). It is one of the proliferative syndromes of
three groups (140 mild, 99 moderate, and 50 severe) depending on the the hematopoietical system. Patient with ET have an increased risk
degree of white matter changes on their brain MRIs and analyzed the of thrombosis and/or hemorrhage of veins and arteries. Few clinical
three groups’ performances on basic and instrumental ADL. The degree reports have been published describing the clinical onset of ET in the
of white matter changes was associated with greater age, hypertension, clinical onset of ET in the form of a vascular accident.
previous history of stroke, higher Hachinski Ischemic Score, worse Case report: A 46 year old man, smoker, with no known hematological
global cognitive status and functional status, and more impaired basic pathology, was admitted for investigation of left common carotid
ADL and IADL. The severe group’s more impaired performance on both thrombosis. In his past medical history, we noticed a high blood
the basic and instrumental ADL remained significant after adjustment pressure since 06 months and a transient ischemic stroke. Clinical exam
for age and hypertension. Tasks involving physical activities were most were normal. Monitoring ECG, transoesophagal echocardiography,
significant. This is the first study investigating the association between chest-Xrays, abdominal ultrasonography show no abnormalities.
white matter changes and ADL in a large, well-defined dementia cohort. Platelet count was high: 1000.000/mm3.Marrow biopsy describes a
The present study suggests that severe white matter changes might be hyperplastic megacaryocytopoiesis.
60 ~](https://image.slidesharecdn.com/eurochap2010finalprogram-100916033047-phpapp01/85/Eurochap2010-final-program-60-320.jpg)
![with peripheral artery disease (PAD). If the WIQ questionnaire is to be pS2-10 VariabiLity aNd SHOrt-term deter-
completed without medical supervision, in order to avoid any influence miNaNtS OF WaLKiNG CapaCity iN patieNtS WitH
of the physician on patient’s answers, a potential issue is its relative iNtermitteNt CLaUdiCatiON
complexity. We aimed to estimate the difficulties encountered by the P. ABRAHAM1, A. LE FAUCHEUR2, B. NOURY-DESVAUX2,
patients to self-complete the WIQ. G. MAHE1, T. SAUVAGET2, J. L. SAUMET3, G. LEFTHERIOTIS1
methods: We prospectively studied 73 patients with claudication. 1 University Hospital, Angers, France
The French version of the WIQ was self-completed by the patients 2 IFEPSA, Le sponts de Cé, France
at arrival with a blue or black pen and then corrected with a red pen 3 University Cl Bernard, Lyon, France
by a technician or a nurse in case of missing (no answer), duplicate
(multiple answers to a single question) or paradoxical answers (e.g.: Objective: Global positioning system (GPS) recordings can provide
lower difficulty for a higher task level) on each of the three sub-scale valid information on walking capacity in patients with peripheral
questionnaires: distance (D), Speed (S), climbing stair capacity (C). arterial disease (PAD) and intermittent claudication (IC) during
Thereafter patients performed a constant load treadmill walking tests community-based outdoor walking. This study used GPS to determine
(maximized to 750 m) blinded to the results of the WIQ questionnaire. the variability of the free-living walking distance between two stops
results: Half of the questionnaires (37 out of 73) had to be corrected (WDBS), induced by lower-limb pain, which may exist within a single
for missing (n=23, 24 & 24), duplicate (n=3, 0 & 1) or paradoxical stroll in PAD patients with IC and the potential associated parameters
(n=5, 6 & 1) answers within the D, S & C sub-scales respectively. obtained from GPS analysis.
Median [25-75°centiles] distance on treadmill was 171 m [109-376]. methods: This cross-sectional study of 57 PAD patients with IC was
Once the questionnaire corrected, the coefficient of correlation of the conducted in a university hospital. The intervention was a 1-hour free-
WIQ-score (mean of the 3 subscale) to treadmill maximal walking living walking in a flat public park with GPS recording at 0.5 Hz.
distance was r=0.652; p<0.05. GPS-computed parameters for each patient were WDBS, previous
Conclusion: The WIQ correlates fairly with objective estimation of stop duration (PSD), cumulated time from the beginning of the stroll,
maximal walking distance. It is a useful tool to estimate self-reported and average walking speed for each walking bout. The coefficient of
exercise capacity in the clinical or research context but it is hardly self- variation of each parameter was calculated for patients with the number
completed by the patients. It is quite complex with 14 questions and a of walking bouts (NWB) >5 during their stroll. A multivariate analysis
choice among 5 possible answers (70 boxes). Supervised administration was performed to correlate WDBS with the other parameters.
of the WIQ appears necessary in most cases. results: Mean (SD) maximal individual WDBS was 1905 (1189) vs
Keywords: Questionnaires, Maximal walking distance 550 (621) meters for patients with NWB <5 vs NWB > 5, respectively
(P < .001). In the 36 patients with NWB > 5, the coefficient of variation
pS2-9 reLatiONSHip OF SymptOmS WitH NON-abi for individual WDBS was 43%. Only PSD and cumulated time were
HemOdyNamiC iNVeStiGatiONS ON treadmiLL iN statistically associated with WDBS in 16 and 5 patients, respectively.
patieNtS WitH SUSpeCted CLaUdiCatiON Conclusions: A wide short-term variability of WDBS exists and
P. ABRAHAM1, G. MAHE1, N. OUEDRAOGO1, G. LEFTHERIOTIS1, likely contributes to the difficulties experienced by patients with IC to
M. VASSEUR1 estimate their maximal walking distance at leisurely pace. Incomplete
1 University Hospital, Angers, France recovery from a preceding walk, as estimated through PSD, seems to
dominantly account for the WDBS in patients with IC.
Background: We aimed to study the relationship between symptoms Keywords: Global positioning system, Claudication, Community
on treadmill and a hemodynamic parameter, different from ABI, based recordings
independent from arterial stiffness and that can detect both proximal
and distal regional blood flow impairment (RBFI) respectively: pS3-peripheral arterial disease (2)
exercise-induced transcutaneous oxygen pressure (tcpO2)-changes.
When concordant with pain location on treadmill, RFBI can provide pS3-1 mOrtaLity aNd ampUtatiON rate OF tHe
objective evidence for the arterial origin of exercise-induced pain. CONSerVatiVe pHarmaCOLOGiCaL treatmeNt iN
methods: ABI at rest was defined as a 9-category variable. The San patieNtS WitH CritiCaL LeG iSCHemia UNSUitabLe
Diego Claudication Questionnaire assessed both proximal (hip, thigh, FOr reVaSCULariSatiON
buttock) and distal (calf) exertional leg pain experienced on treadmill R. MARTINI1, R. CORDOVA1, G. M. ANDREOZZI1
and analysed with the results of exercise tcpO2 for each ABI caterogy. 1 U.O.C. Angiologia - Azienda Ospedaliera-Università di Padova,
Exercise-related vascular-type pain was considered of vascular origin Padova, Italy
when underlying concordant RFBI was observed.
results: We studied 600 patients suspected of claudication. Of these, In spite of the recent progress in revascularization and in
81 were treated for diabetes, 203 had a past history of lower limb anaesthesiology procedures, today in vascular centres there are still
peripheral arterial surgery or angioplasty. ABI could not be measured patients considered not suitable for revascularization. In these patients
in 10 legs due to arterial incompressibility. Among the 1190 studied non interventional treatment such as pain treatment, prostanoids, spinal
legs, the proportion of legs with pain of vascular origin decreased in cord stimulations or hyperbaric oxygen treatment associated or not
a stepwise manner from 84.1 % for ABIs 0.50-&-lower down to 8.1 with wound management treatment are used to avoid amputation. In
% for ABIs in the 1.21-to-1.30 intervals. For ABIs 1.31-&-over, the this work we describe the natural history of a group of 90 patients with
proportion of legs with pain assumed of vascular origin increased to Critical Limb Ischaemia, considered not suitable for revascularization,
40.9 %. treated not interventionally. The rate of amputation and mortality were
Conclusions: There is no abrupt ABI cut-off point to predict the observed over a 24-month period. Patients with CLI and end-stage
concordance of pain at exercise to underlying exercise-induced RBFI general conditions, or needing immediate primary amputation were
in patient with suspected PAD. The proportion of concordant pain and excluded from this study. Sixteen patients were not revascularized
underlying RBFI decreases linearly with the increase in ABI up to an because of poor functional status (37.7%); seventy-six patients
ABI ranging 1.21-to-1.30 and increases when ABI further increases. (64.4%) had inadequate outflow vessels. Among classical risk factors
The relationship of ABI categories to pain associated with concordant for amputation and mortality in CLI, the level of independence, i.e. the
exercise-induced RBFI, follows the expected U-shaped pattern. capacity of the patients to have an independent life, was assessed. Toe
Keywords: Exercise, Transcutaneous oxygen pressure, Ankle to amputations or other foot-sparing surgical procedures were performed
brachial index during treatment in 13% of limbs. Revascularisation was attempted in
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![12 patients (10.6%) within 8 months because a significant worsening of significantly higher plasma homocysteine (Hcy) levels than unaffected
CLI. Major amputation was necessary in 8 patients (9.3%): 4 patients controls. Restenosis continues to be a frequent complication of
had primary amputation and 4 had secondary amputation after a failed percutaneous revascularisation (PR) of the femoropopliteal artery
revascularization attempt. Twenty-one patients (23.2%) died during (FPA) despite the initial technical success. The objectives of this study
the 24-month period four of these had needed revascularization. The were to determine whether elevated Hcy level can predict restenosis in
logistic regression showed that restricted level of independence (RLI) patients with claudication undergoing PR of FPA for total occlusions.
was independently associated with amputation and death at 24 months design and method: 113 pts [males=67(59%), mean age 77(range 53-
(P< 0.001). In conclusion our study reports that in patients, with not 95)] underwent PR to FPA. Plasma Hcy levels were measured 12-24
limb or life threatening skin lesions, if treated in specialised vascular hours prior to PR. All pts had total occlusions (range 2cm-40cm) of
centres, made possible to achieve good result in terms of amputation FPA and >2 vessel infrapopliteal runoff. Clinical restenosis requiring
ad death rate. repeat PR was defined by a >75% stenosis on duplex ultrasound and/
Keywords: Critical leg ischemia, Peripheral arterial disease or recurrent disabling claudication with a fall in ABI. Follow-up was
attained at 6 months.
pS3-2 Crp LeVeLS aS a prediCtOr OF reSteNOSiS results: Mean baseline Hcy level was 11.8±3.2mmol/L (7.6mmol/
FOLLOWiNG SFa reVaSCULariSatiON L–19.2mm/L). Baseline resting ABI’s ranged from 0.53 to 0.79.
P. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3, No restenosis or only minimal intimal hyperplasia was observed in
A. KELLY4 76(67%)pts at 6 months. Restenosis requiring repeat PR was observed
1 Department of Vascular Medicine, Mater Hospital, Sydney, in 37(32%). Restenosis was independent of length of occlusion. Hcy
Australia level was significantly higher in the restenosis group (16.5±1.5mmol/L,
2 Department of Vascular Surgery, Mater Hospital, Sydney, p<0.005).
Australia Conclusions: These results indicate that an elevated homocysteine level
3 Department of Anaesthetics, Mater Hospital, Sydney, Australia may predict restenosis that requires repeat revascularisation following
4 Sydney Endovascular Specialists, Sydney, Australia PR of FPA total occlusions. Studies investigating strategies to lower
homocysteine levels in patients with PAD are underway and may result
Objective: Superficial femoral artery (SFA) stenosis represents one of in reduced restenosis rates at 6 months for PR of FPA occlusions.
the most common sites of peripheral vascular obstruction. Restenosis Keywords: Homocysteine, Restenosis, SFA
continues to be a frequent complication of angioplasty (PTA) at this
site despite the initial technical success. C-reactive protein (CRP) is an pS3-4 SterNaL WOUNd aNGiOGeNeSiS iN diabetiC
acute phase reactant and pts with elevated basal levels of CRP are at aNd NON diabetiC patieNtS UNderGOiNG CardiaC
an increased risk of cardiovascular disease.The objectives of this study VaLVe repLaCemeNt SUrGery
were to determine whether CRP levels could be utilised as a predictor P. BHASKARAN1, N. J. STANDFIELD1, T. GOURLAY2
of restenosis in patients with claudication undergoing SFA PTA. 1 Hammersmith Hospital, Imperial College, London, United
design and method: 100 pts [males=65 (65%), mean age 64 (range 34- Kingdom
80)] underwent PTA to SFA alone (n=75) or in combination with PTA to 2 University of Strathclyde, Glasgow, United Kingdom
popliteal (n=25). CRP levels were measured 12-24 hours prior to PTA.
All pts had target stenoses of 70 to 100% and >2 vessel infrapopliteal Background: In this study we propose to assess the sternal wound
runoff. Clinical restenosis was defined by a >50% stenosis (increase in healing process following cardiac valve replacement patients.
flow velocity by > 100%) on duplex. Average follow-up attained was Pathological and mechanical factors affect the collateral vessel
12 months. formation and angiogenesis. In diabetic patients acute and chronic
results: Baseline resting ABI’s ranged from 0.60 to 0.83 and post- arterial changes prolong the recovery process from the insult. There is
exercise ABI’s ranged from 0.27 to 0.70. CRP levels pre-procedure no interruption of arterial blood supply in these patients as the internal
were <1mmol/L (35%), 1-2mmol/L (32%) and >2mmol/L (33%). thoracic arteries are not mobilised in these patients.
No restenosis or only minimal intimal hyperplasia was observed in aim: To establish the difference in healing process of sternal wound
75 (75%) at 12 months. Revascularization was required in 25 (25%) following diabetic and non diabetic cardiac valve replacement patients
pts (PTA=5, PTA/stent=20) for clinical restenosis. Of pts requiring using Laser Doppler Imager.
revascularisation CRP levels were 1-2mmol/L (25%) and > 2mmol/L methods: Sternal area of diabetic and non diabetic patients were
(95%). scanned at 5 time points (pre-induction and 72 hours after surgery)
Conclusions: These results may be cautiously interpreted to indicate by measuring doppler shift of laser light caused by blood cell
that elevated CRP levels prior to SFA intervention may be used as movements.
a predictor of restenosis following SFA PTA. Further strategies to results: The neovascularisation and wound healing were steady
decrease restenosis can thereby be implemented. and faster in non diabetic patients. The tissue perfusion was steadily
Keywords: Restenosis, CRP, Superficial femoral artery increased thorough out on both sides of sternum. There was a decreased
perfusion on left side compare to right side.
pS3-3 pLaSma HOmOCySteiNe LeVeL prediCtiVe In diabetic patients the perfusion was dropped slightly following surgery
OF pOteNtiaL FOr reSteNOSiS aFter SFa and increased after 24 hours. At 48 hours the process of angiogenesis
reVaSCULariSatiON FOr OCCLUSiVe FemOrO- was decreased below the baseline and increased after that.
pOpLiteaL diSeaSe Here we established the difference in the process of formation collaterals
P. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3, and angiogenesis in diabetic and non diabetic patients, which is steady
A. KELLY4 in nature through out.
1 Department of Vascular Medicine, Mater Hospital, Sydney, Summary: There was a reduced neovasculirisation process following
Australia cardiac valvular surgical patients secondary to chronic pathological
2 Department of Vascular Surgery, Mater Hospital, Sydney, arterial changes in diabetic patients.
Australia Keywords: Angiogenesis, Diabetic, Non diabetic
3 Department of Anaesthetics, Mater Hospital, Sydney, Australia
4 Sydney Endovascular Specialists, Sydney, Australia pS3-5 aSSeSSmeNt OF SterNaL WOUNd HeaLiNG
FOLLOWiNG diabetiC aNd NON diabetiC COrONary
Objective: Patients with peripheral arterial disease (PAD) have artery bypaSS GraFt SUrGiCaL patieNtS USiNG
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![0.02, Mann-Whitney U test). There were no other complications. results: New lesions were seen on the postintervantional DW-MRI in
Conclusion: Superficial femoral arterial stents have an adequate 28.0% (7/25) of the proximal EPD group versus 32.6%(6/19) of those
patency rate at 6 months with patients achieving symptomatic with a distal filter (p=NS). The majority were clinically silent. The
improvement. Further research is required to evaluate the long term new lesions in the vascular territory of the stented carotid artery in the
patency of these stents. group as a whole and per patient were fewer in the proximal EPD group
Keywords: Endoluminal stenting, Superficial femoral artery (p=NS). No significant differences were noted in the T2 appearance of
the new lesions or the number of new lesions observed away from the
pS5-3 eNdOLUmiNaL reVaSCULariZatiON OF NON vascular territory of the stented artery.
embOLiC iLiaC OCCLUSiON FOr iNFeriOr Limb aCUte Conclusion: Proximal embolus protection devices show a nonsignificant
iSCHemia: aN aLterNatiVe tO SUrGery trend toward fewer embolic events, which warrants large-scale studies.
F. MERCIER1, A. AYMARD1, H. BENAMER1, X. GUILLOTTE1, Furthermore, proximal protection devices can be useful to control and
E. LOUVARD1, R. MAGUEMOUN1, M. C. MORICE1 treat acute in-stent thrombosis.
1 Hôpital Européen de Paris la Roseraie, 120 av. de la République, Keywords: Stenosis
Aubervilliers, France
pS5-5 iNFLUeNCe OF aGe UpON COmpLiCatiON OF
Endoluminal revascularization is proposed in grade D iliac occlusion CarOtid artery SteNtiNG
of TASC II classification, rather than a surgical approach usually F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2
approved, for acute ischemia of inferior limb. 1 University of Naples, Department of Vascular Surgery, Naples,
Procedures were performed in three patients with moderate (2) or severe Italy
(1) ischemia in stade IIb Rutherford classification. Patients had a past 2 Department of Interventional Radiology, Bari, Italy
medical history of claudication stade IIb in Fontaine classification (3),
no cardiac embolic etiology, smoking (3), HTA (3). Intervals between introduction: To asses the impact of age on technical success and
symptoms and interventions were one day (1) and two weeks (2). All complications of carotid stenting in a prospective single-center cohort
patients had duplex Doppler ultrasound evaluation with ankle-brachial study.
pressure index (< 0,6), angiographic computed axial tomography (1), methods: One hundred eleven consecutive patients (74 men;
angiographic magnetic resonance imagery (1). Femoral catheterisms median age 70 years) with >- 70% symptomatic(n=33) or >-90%
were ispilateral (3) with introducer 6F, hydrophilic 0.035 guide asymptomatic(n=78) internal carotid artery(ICA) stenosis underwent
wire, nitinol stents (7 mm x 80 mm and 8 mm x 100 mm), balloon carotid artery stent implantation. Primary technical success and peri-
expandable stents (7 mm x 58 mm), balloon (6 x 80 mm, 7 x 40 mm), procedural complications were compared in patients aged>75 years
pigtail 5F. Endoluminal iliac position was controlled by visualisation (n=28) to patients <75 years (n=83).
of the opening of the nitinol stent. Complementary balloon inflation for results: Patient groups below and above 75 years compared well with
iliac artery stenosis was mandatory in all patients. respect to baseline demographic and clinical data. Successful stenting
All iliac arteries were revascularized. One clot migration occured in an was achieved in 108 (97%) patients. The combined neurological
ipsilateral profunda femoral after inflation of balloon expandable stent. complication rate was 7% (n=8), with 1(1%) major stroke, 1 (1%) minor
To avoid it and control the endoluminal position it was choosed after stroke, and no 30-day mortality. Technical angiographic complications
the first case that the nitinol stent should be gently opened before any occurred in 8(7%) patients. No significant differences between patients
inflation. One calf aponevrotomia was mandatory Length of stay were > 75 years and those <75 years were observed for primary success rates
2, 7and 21 days. Permeability was controlled clinically and with duplex (100% [28/28] versus 96% [80/83];p=0.8), overall complications (14%
Doppler at 6 months. [4/28] versus 16% [13/83]; p=1.0), neurological complications (7%
Endoluminal revascularization is a possible alternative to surgery in [2/28] versus 7% [6/83]; p=0.6).
acute grade D iliac artery occlusion and treats simultaneously occlusion Conclusion: Elective carotid stenting can be performed safely in older
and underlying iliac stenosis. Main risk is migration of the recent iliac patients with several comorbidities. Patients age does not seem to be an
clot during the recanalization. The permeability at long term should be independent risk factor for poor outcome after endovascular treatment
compared to chronic iliac grade D subintimal revascularization. of internal carotid artery stenosis.
Keywords: Endoluminal revascularisation, Iliac artery occlusion, Keywords: Stenosis
Acute inferior limb ischemia
pS5-6 iNterNaL CarOtid aNd biLateraL
pS5-4 CarOtid aNGiOpLaSty. deteCtiON OF VertebraL arterieS diSSeCtiON: a CaSe repOrt
embOLiC SiGNaLS dUriNG aNd aFter tHe M. BOUCELMA1, T. BOUNZIRA1, D. BENSALAH1, D. HAKEM1,
prOCedUre A. BERRAH1
F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers,
1 University of Naples, Department of Vascular Surgery, Naples, Algeria
Italy Cervicocerebral arterial dissections (CAD) are an important cause of
2 Department of Interventional Radiology, Bari, Italy strokes in younger patients accounting for nearly 20% of strokes in
patients under the age of 45 years. Extracranial internal carotid artery
purpose: To evaluate and compare the efficacy of proximal versus distal dissections comprise 70%- 80% and extracranial vertebral dissections
embolus protection devices (EPD) during carotid artey angioplasty/ account for about 15% all CAD. Aetiopathogenesis of CAD is
stenting (CAS) based on diffusion-weighted magnetic resonance incompletely understood, though trauma, an underlying arteriopathy
imaging (DW-MRI). are considered important. We report a case of 39 years old woman
methods: Forty-four patients (31 men; mean age 68 years, range 48- suffered a dissection of her left internal carotid artery and bilateral
85) underwent protected CAS and had DW-MRI before and after the cervical vertebral arteries after facial plastic surgery. This observation
intervention. The cohort was analyzed according to the type of EPD discusses recent developments in understanding of the epidemiology,
used:a proximal EPD was deployed in 25 (56,8%) patients (17 men) the pathogenesis, the methods of diagnosis and the approaches to
mean age 66 years, range 48-85) and a dstal filter in 19 (14men;mean treatment.
age 70 years, range 58-79). Fifteen (60.0%) patients with proximal Keywords: Stroke, Young patients, Vertebral artery dissection
protection were symptomatic of the target lesion; in the distal protection
group, 10 (52,6%) were symptomatic.
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![pS6-3 LOW adHereNCe tO aNtitHrOmbOtiC pS6-5 mULtiFaCtOriaLtreatmeNt eFFeCtiVNeSS
iNdiCatiONS aNd GeNder diFFereNCeS iN aSpiriN OF dySLipidemia, type 2 diabeteS meLLitUS aNd
USe iN patieNtS WitH preViOUS miNOr bLeediNG arteriaL HyperteNSiON iN patieNtS WitH CHd
A. MATTIOLI1, A. FARINETTI2, R. LONARDI2, S. PENNELLA1,3, K. KAPANADZE1, N. N. KIPSHIDZE1
G. TAZZIOLI2, G. MATTIOLI3 1 Acad. Nodar Kipshidze National Center of Therapy, Tbilsi,
1 University of Modena and Reggio Emilia, Department of Sc, Georgia
Modena, Italy
2 University of Modena and Reggio Emilia, Department of Surgery, The aim of the study was to estimate multifactorial treatment
Modena, Italy effectiveness of dyslipidemia, type 2 diabetes mellitus and arterial
3 Istituto Nazionale di Ricerca Cardiovascolare, Modena, Italy hypertension.
materials and methods: We studied 58 patients (mean age 49±14,
Aspirin is use in widely mode to prevent cardiovascular disease. Patients male/female 26/32) with dyslipoproteinemia, type 2 diabetes mellitus
(pts) presenting a previous episode of minor bleeding have high risk and arterial hypertension II (JNC VII). Their mean indices of T-C,
for recurrence. The aim of the study was to evaluate the adherence to HDL-C, LDL-C and TG were: 247.28±26.1 mg/dl, 29.09±4.1mg/dl,
guideline in aspirin prescription in pts with previous minor bleeding. 158.25±22.8mg/dl and 225.9±19.8mg/dl respectively), HbA1c varied
design and method: Data were analyzed from 1.100 patients: from 6.5% to 7.0% and the levels of creatinine varied from 120 to 150
[504 men (45.8%) and 596 women (54.2%), mean age 54 ± 12 yrs] µmol/l. Patients were randomly assigned and divided into two groups
referred for minor hemorrhage. All patients were followed for 1 (Gr.): Gr.1 patients received hypolipidemic drugs (statin), hypotensive
year. The use of aspirin was evaluated: dose, time, other bleeding drugs (ACE inhibitors, Ca-antagonists, duretics) and metmorphine,
episodes (major and minor), and indication according to guidelines and gliclazide during 8 weeks. And Gr.2 patients received only hypotensive
gender. Cardiovascular and hemorrhagic risk factors were assessing. and antidiabetic drugs.
We found 131 pts treated with aspirin and 89 pts treated with oral results: In the Gr.1 target levels of lipid profile, glucose levels and
anticoagulants; 65 pts had a previous episode of atrial fibrillation and / arterial presure were reached in 62%, 65% and 70% respectively. As
or a myocardial infarction. The daily aspirin dosage ranges from 80 to for Gr.2 lipid profile did not change in 84%, and target levels of arterial
500 mg. Hemoglobin was significantly lower in patients taking ASA pressure and glucose concentrations were reached in 50% and 52%,
and anticoagulants (9.8 ± 3.5 vs 14 ± 4.1). respectively.
results: We evaluate adherence to guideline in prescription aspirin in Conclusion: As a result, all patients with type 2 diabetes, should be
cardiac patients with previous minor bleeding: 456 patients had cardiac treated with the above mentioned scheme at the early stage of the
indication for aspirin and/or anticoagulants (including atrial fibrillation) disease, in order to reach target levels of lipid profile. Treatment
but only 238 of them (52.19%) were treated, women were less likely must be aimed not only at dyslipidemia, but the risk factors of type
to be treated with aspirin (30% vs 67%). Recurrence of hemorrhage 2 diabetes and arterial hypertension as well as these conditions create
was higher in pts taking aspirin (42% versus 23% in control), with a vicious circle and aggravate one another. Multifactorial treatment of
trend to even greater incidence in pts taking high dosage of aspirin and the above mentioned pathologies facilitates their management and
anticoagulants (40% vs 60%). provides better prognosis.
Conclusions: A previous minor bleeding discourages the use of aspirin Keywords: Dyslipoprotenemia, Ttype 2 diabetes mellitus, Arterial
although indicated to guideline and that women were under treated with hypertension
respect to men. Aspirin was associated with a higher rate of recurrences
of minor bleeding, without important hemodynamic effects. Pts taking pS6-6 HyperbariC OXyGeN tHerapy iN reFraC-
high dosage of aspirin or anticoagulants were more likely to develop tOry iSCHemiC CUtaNeOUS LeSiONS iN VaSCULitiS
bleeding aNd CONNeCtiVe VaSCULar diSeaSe
Keywords: Aspirin, Bleeding C. BELIZNA1, D. HENRION2, V. SOUDE3, B. BIENVENU4,
F. MAILLOT5, E. ANDRES6, C. LAVIGNE1, A. GHALI1,
pS6-4 tHe pHarmaCOGeNetiC apprOaCH tO tHe A. MERCAT3, P. ASFAR3
aNtiCOaGULaNt tHerapy 1 Angers CHU, Internal medicine, Angers, France
Y. NOVIKOVA1, A. SHEVELA1, G. LIFSHITZ1, K. SEVOSTYANOVA1, 2 Inserm 771, Angers, France
E. VORONINA1 3 Angers CHU, Medical reanimation, Angers, France
1 Institut de biologie chimique et medecine fondamentale, Novosibirsk, 4 Caen CHU, Internal medicine, Caen, France
Russia 5 Tours CHU, Internal medicine, Tours, France
6 Strasbourg CHU, Internal medicine, Strasboug, France
purpose: to study the frequency of occurrence of the warfarin
metabolism gene in patients with deep venous thrombosis, to determine Hyperbaric oxygen therapy is currently used in ischemic cutaneous
the optimal dosage of the drug depending on the genotype. arterial ulcers resistant to classical therapy.
methods: a study of CYP2C9 and VKORC1 genes with the help of Nowadays, only few data have been reported concerning the use of this
PCR/RFLP method of diagnostics was conducted on 159 patients form of treatment in ischemic lesions found in vasculitis and connective
with deep venous thrombosis in lower extremities. Results: «Poor» vascular disease.
metabolizers with the gene CYP2C9*2 variant Ñ/Ñ among patients in the We present the retrospective experience of few medical centers that
research group were found in 108 ( 68%) of cases, whereas CYP2C9*3 currently employ hyperbaric oxygen.
variant A/A -was found in 157 (98,7%) and the heterozygous variant Data from patients with vasculitis and connective vascular disease
of polymorphism CYP2C9*3 C/T was registrated in 2 (1,3%) of the presenting with ischemic cutaneous ulcers and that have received
patients. The polymorphous variant CYP2C9*2 C/T was detected in hyperbaric oxygen therapy have been retrospectively recorded (2005-
50 (31,4%), whereas the gene CYP2C9*2 substitution T/T – only in 1 2009).
(0,6%) of the cases. Measures of transcutaneous oxymetry (TcpO2) have been performed in
While investigating the frequency of occurrence of different these patients before starting the treatment based on hyperbaric oxygen,
polymorphous variations of the VKORC1 gene it was discovered, that in order to detect local ischemia. The classical treatment programme
among patients the heterozygous C/T variation is found more often consisted in a two times a day hyperbaric oxygen therapy every day, 5
than the “wild type days per week for a total length of treatment of three weeks.
Keywords: Pharmacogenetic, Warfarin, Personolized therapy 18 patients, mean age 56.5 years old, have been treated with hyperbaric
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![8/10 had an underlying venous disease, 7/10 an arterial disease. line treatment of low-flow vascular malformations. This study reports
In half of patients (5/10), hydroxyurea was purchased and leg ulcers the treatment experience by echosclerosis polidocanol foam in low-
healed in 4/5 patients. In half of patients, hydroxyurea was stopped and flow malformations of Vascular Medicine Department of Grenoble.
leg ulcers healed in 2/5. Design: Retrospective single-center series
2 to 6 skin grafts by patient were performed. 2/10 patients had an materials and methods: The records of all patients with symptomatic
arterial revascularization and 1/10 a venous crossectomy. vascular malformation type low-flow veno-venous or lymphatic or
Finally, 60% of the patients healed their ulcers and 40% were improved. complex type Klippel-Trenaunay syndrome (KTS) echosclerosis
100% were painless. treated between January 2006 and December 2009 were analyzed.
Conclusion: Leg ulcer is a polyfactorial disease which require a The therapeutic indication was always previously validated by the
complete cardiovascular assessment and a vascular global management. Consultative Committee of vascular malformations of the University
An exhaustive vascular checking is necessary. Skin grafts are efficient Hospital of Grenoble. All vascular malformations were classified
in this indication, leading to 60% healing in our experience. according to the Classification of Hamburg. The sclerosant polidocanol
Keywords: Leg Ulcer, Hydroxuurea, Skin graft was used as a foam.
results: 24 patients 7-78 years were treated (19 venous malformations,
pS7-6 prediCtOrS OF tHe pOSt-tHrOmbOtiC 3 venous malformations KTS and 2-nodes). The concentrations of
SyNdrOme dUriNG LONG-term treatmeNt OF polidocanol used ranged from 0.25 to 3%. The average number of
prOXimaL deep VeiN tHrOmbOSiS sitting was 2.3 [1-16]. After a median follow-up of 9.5 months [1-58],
F. POLLICE1, P. POLLICE1, B. DI RENZO1 23 of 24 patients notaient a decrease in pain in 9 cases, a reduction of
1 L’Aquila University, Department of cardiology, L’Aquila, Italy over 50% of the initial volume was obtained and 58.3% reduction less
than 50% of original volume. Two minor side effects were reported.
Summary: Background. The post-thrombotic syndrome is a chronic, Conclusions: Treatment with echosclerosis using polidocanol foam
poorly understood complication of deep venous thrombosis(DVT). seems to be well tolerated. This treatment will improve the symptoms
Objectives: To evaluate predictors of the post-thrombotic syndrome, of abnormalities in slow flows without the risk of more aggressive
including intensity of long-term anticoagulation, and to assess the sclerosing products such as ethanol.
impact of the post thrombotic syndrome on quality of life. Keywords: Vascular malformation, Foam sclerotherapy
patients and methods: The setting was 10 italian hospitals. One
hundred and forty-five patients with an unprovoked episode of pS7-8 iNteNSiVe reHabiLitatiON prOGram FOr
proximal DVT who were initially treated with 3 months of conventional LympHedema: ONe Or tWO WeeKS?
intensity warfarin then participated in a trial comparing two intensities B. VILLEMUR1, F. VELLUT, J. Y. BOUCHET, B. BUCCI, V. EVRA,
of long-term warfarin therapy. Post-thrombotic syndrome was assessed M. P. DE ANGELIS, A. MARQUER, D. PERENNOU
at the end of the trial using a validated clinical scale generic and 1 CHU Grenoble, Cliqnue MPR, Vascular rehabilitation unit,
venous disease-specific quality of life was compared inpatients with Echirolles 38434, France
and without the post-thrombotic syndrome. Multivariable regression
analyses were performed to identify predictors of the post-thrombotic introduction: Severe lymphoedema responds very well to an intensive
syndrome and of its severity. rehabilitation program performed in a vascular rehabilitation unit
results: After an everage follow-up of 2.2years, the prevalence of (Gironet et al 2004). Such programmes usually consist in: manual
post-thrombotic syndrome was 37% and of severe post-thrombotic lymphatic drainage, intermittent pneumatic compression, multi-layer
syndrome was 4%. Quality of life was worse in patients with the post- inelastic and elastic bandaging, patient education and physical exercise.
thrombotic syndrome compared with patients who did not have it. The The optimal duration of these programs remains to be determined.
presence of factor(F)V Leiden or the prothrombin gene mutation was Objectives: Quantifying the efficiency of an intensive vascular
an independent predictor of both a lower risk (P=0.006) an reduced rehabilitation program for the treatment of lymphoedema. Testing the
severity (P=0.045) of the post-thrombotic syndrome. Intensity of hypothesis that 2 weeks is more efficient than one week.
anticoagulation did not influence the risk of developing the post- method: Twenty female patients (62,6±5,6 years) with idiopathic
thrombotic syndrome. (7) or secondary (13) lymphedema of the upper (10) and the lower
Conclusion: The post-thrombotic syndrome is a frequent and (10) limb were recruited for this study, and assessed before treatment
burdensome complication of proximal DVT, even among patients (W0), after one week (W1) or two weeks(W2) of inpatient treatment.
maintained on long-term oral anticoagulation. While the presence of Three criteria were used: an index of limb circumference (average of 8
FV Leiden or prothrombin gene mutation appears to be associated different circumferential measurements for the same limb), the range of
with a reduced risk of post-thrombotic syndrome, this findings requires motion for passive flexion of elbow and knee; an ad hoc test of active
further evaluation in prospective studies. mobility. Non parametric statistics were used.
Keywords: Diabetic results: If an efficiency was obtained after one week, this efficiency
was better after 2 weeks of intensive rehabilitation: decrease of limb
pS7-7 treatmeNt OF LOW-FLOW VaSCULar circumference = 2 cm at W1 and 2,6 cm at W2 (p<0.001) ; the gain
maLFOrmatiONS by eCHO-SCLerOtHerapy WitH of passive flexion was 10° at W1 and 13° at W2 (p=0.01);the active
pOLidOCaNOL FOam: 24 CaSeS aNd LiteratUre mobility test was increased to 2,6 at W1 and 3,6 at W2 (p=0,03).
reVieW Conclusion: A program of two weeks of intensive lymphoedema
S. BLAISE1, M. CHARAVIN-COCUZZA1, H. RIOM2, M. BRIX3, rehabilitation is more efficient than a one-week program.
C. SEINTURIER1, J. M. DIAMANT4, G. GACHET5, Bibliographie: 1. Gironet N et al. Lymphedema of the limb: predictors
P. H. CARPENTIER1 of efficacy of combined physical therapy. Ann Dermatol Venereol
1 CHU Grenoble, Vascular Medicine Department, Grenoble, France 2004;131:775-9
2 Vascular Office, Grenoble, France Keywords: Lymphedema, Intensive rehabilitation
3 CHU Grenoble, Maxillo Facial Surgery Department, Grenoble,
France pS7-9 prOGNOStiC VaLUe OF LympHOSCiNti-
4 Vascular Office, Grenoble, France GrapHy FOr prediCtiON OF pOStmaSteCtOmy
5 Vascular Office, Voiron, France LympHedema
M. MYASNIKOVA1, N. GORDEEV1
Objectives: Treatment with sclerotherapy has been suggested as first 1 Pavlov’s State Medical University, Saint-Petersburg, Russia
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![Objectives: Development of postmastectomy lymphedema of the
upper limb is usually explaned by certain risk factors such as axillary pS8-Varicose veins
surgery, radiotherapy, obesity, venous outflow obstruction, delayed
wound healing, and infection. According to published reports, the pS8-1 VeiN – term CLaSSiFiCatiON/ VeNOUS reFLUX
incidence of lymphedema of the arm in patients with breast cancer after patterNS aNd Great SapHeNOUS VeiN SpariNG
radical surgery varies from 5 to 50%. The purpose of the carried study F. TOSCANO1, C. PEREIRA ALVES1, J. NEVES1, A. FORMIGA1
was to evaluate efficiency of lymphoscintigraphy for identifying those 1 Hospital Santo António dos Capuchos, Lisbon, Portugal
risk factors that may result in secondary lymphedema after surgical
treatment for breast carcinoma in a large patient series. Objective: Detailed analysis of reflux patterns of 94 consecutive
design and method: Using dynamic lymphoscintigraphy we performed patients operated on by the same surgical team following the VEIN
intravital visualization of functionally active lymph collectors of 600 Term Classification criteria.
upper extremities: 300 in healthy subjects, 80 in patients with breast methodology: Computer registry of CEAP, Reflux patterns (Axial
cancer before treatment, 70 in operated patients without postmastectomy [Ra]/Segmental [Rs]), type of surgery (Axial reflux= classic surgery;
edema, and 150 – in patients with postmastectomy edema. Segmental reflux= GSV sparing)
results: Three variants of normal lymph flow pattern were revealed results: 35 patients classified as Axial reflux;
in healthy subjects: collector (62%), diffuse (18%) and nodular (20%). 59 patients classified as Segmental reflux.
In patients that undergone mastectomy collector pattern was found 3 different patterns of segmental reflux were considered.
in 56,2% and edema was very seldom in these patients; diffuse – in R(S1;S2;S3)
10% of patients without edema and in 42% of the patients with edema; S1- involving superficial varicose veins only - 17 patients
nodular – in 25% of patients without edema and practically never in S2- involving varicose branches plus adjacent segments of GSV -
patients with edema. 13 patients
Conclusions: Diffuse pattern of lymph flow could be estimated as an S3- involving varicose branches plus the SFJ and a shorter or
unfavorable prognostic sign. In these patients complex conservative longer segment of GSV – 29 patients
treatment should be started in advance, before clinical appearance of CEAP distribution: Ra: C2 – 17; C4a – 6; C4b – 8; C5 – 4
the edema. Rs: C2 – 41; C4a – 13; C4b – 3; C5 - 2
Keywords: Postmastectomy lymphedema Clinical follow-up showed no recurrence so far. 10 - S3 sub group
randomized patients were subjected to pos-op eco-doppler monitoring
pS7-10 eFFeCtiVeNeSS OF mULtiLayer baNdaGe iN revelling recovery of normal flow of previously refluxive GSV
HeaLiNG VeNOUS ULCerS segments.
F. FERRARA1, I. MURATORI1, F. MELI1, C. AMATO1, Conclusions:
M. LUNETTA2, R. ALCAMO1, S. NOVO2 1- Segmental reflux was frequent, 63% of patients.
1 Division of Angiology, Palermo, Italy 2- Preservation of GSV even if a refluxive segment existed (but with no
2 Division of Cardiology, Palermo, Italy continuous involvement) doesn’t seem to conditionate recurrence but
instead is followed by recovery of normal GSV function.
The multi-layer high compression system is described as the current 3- Our CEAP data confirmed more severe clinical classes among axial
gold standard for treating venous ulcers. A recent meta-analysis of than segmental refluxes.
bandaging systems found that multi-layer compression bandages Keywords: Varices, Saphenous, Sparing
appeared to be superior to single-layer bandages in promoting venous
ulcer healing. pS8-2 CLiNiCaL eXperieNCe OF SaLem eNdOtHe-
The aim of this study is to compare the in patients with chronic venous LiaL StrippiNG OperatiON FOr tHe SUrGiCaL
ulceration compared to standard short stretch (SS) compression treatmeNt OF primary VariCOSe VeiNS OF tHe
bandaging. LOWer LimbS
An open, randomized, prospective, single-center study was performed M. SALEM1, A. SALEM2, T. SALEM3
in order to determine the healing rates of VLU when treated with 1 Faculty of Medicine, Department of Vascular Surgery, Alexandria,
different compression systems and different sub-bandage pressure Egypt
values. Patients aged at least 18-years-old with leg ulceration of 2 Medical Research Institute, Department of Surgery, Alexandria,
suspected venous etiology were screened for inclusion in the trial. Egypt
Before inclusion in the study, all patients underwent a color Duplex scan 3 Faculty of Medicine, Department of Internal Medicine, Alexandria,
(CS) examination and ankle-brachial pressure index measurements. Egypt
Patients were randomized into two groups: 30 patients who were treated
using a heel-less, open-toed, elastic class III compression device knitted Objective: New instrument Salem Stripper & operation Salem
in tubular 30 patients treated with a multi-layer bandaging system Endothelial Stripping Operation are described. The operation & the
comprised of single stretch compression bandage and inelastic bandage Stripper were invented & designed by the first author for the surgical
impregnated with oxide paste and coumarin. Group A patients were treatment of primary varicose veins of the lower limbs to avoid the
medicated every two days while group B patients were medicated every complications of vein stripping operation.
ten days. Of the 63 patients, 60 completed the protocol. Two patient design & method: 500 patients with primary varicose veins of the
received multi layer bandage had local allergic reaction, and one patients lower limbs were studied. All cases were collected at random in 14
with stretch bandage discontinued the study for poor compliance. After years (from Jan. 1991 – Jan.2005). The diagnosis was done by history
12 weeks in patients in group A was not observed a complete recovery, & clinical examination. No patient gave past history of deep vein
while all patients in group B had achieved complete ulcer healing. The thrombosis.Routine laboratory investigations were done. Duplex
results obtained in this study indicate that better healing results are Ultrasound was done to all cases. All cases were treated surgically by
achieved with multi-component compression systems than with single- Salem Operation using Salem Stripper.
component compression systems and that a compression system should results & conclusions: The age incidence was between 20 -56 years
be individually determined for each patient according to individual with a mean of 32 years. Female sex represented 58%. The most
characteristics of the leg and Calf Circumference. common presentations of primary varicose veins of the lower limb
Keywords: Venous ulcers, Multi-layer compression system, Short were: varicosities, heaviness of the limb, dull aching pain, burning
stretch compression pain & disfigurement. The great saphenous vein was affected in all
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![aim of this study was to determine the incidence of AAGSV reflux in days [1 - 21], p = 0.134).
this patient population and to assess the efficacy of endovenous laser Conclusions: We have shown in this pilot study significant advantages
ablation (EVLT) of AAGSV. of CDT-UGFS versus EVLT in a background of a comparable
methods: From December 2006 to June 2008, patients with obliteration of the main trunk of the GSV (>8mm diameter).
symptomatic varicose veins underwent clinical evaluation and venous Keywords: Foam, Laser, Quality of life
duplex scanning. AAGSV reflux was treated by EVLT with tumescent
anesthesia. Patients with GSV and AAGSV reflux underwent pS8-8 perSONaL eXperieNCe iN preSerViNG tHe
simultaneous ablation of both veins. Post procedure follow-up included Great SapHeNOUS VeiN
venous duplex ultrasound and clinical evaluation. If necessary, I. BIHARI1
sclerotherapy or stab phlebectomy of symptomatic varicose veins was 1 A + B Clinic, Budapest, Hungary
staged in the follow-up period.
results: A total of 313 limbs in 255 patients had reflux involving the aim: What is the aim of great saphenous vein preservation? Was it
GSV, AAGSV and Small Saphenous Veins. The incidence of AAGSV successful over the last 30 years?
reflux was 11.5% (36 limbs, 35 patients). EVLT ablations (n=36) of the Methods: Sapheno-femoral junction ligature, plasty, wrapping, distant
AAGSV were performed in these patients (30 women, 5 men, mean sclerotherapy.
age=51.8 yrs). Six patients had previous EVLT of the ipsilateral GSV results: Wrapping and distant sclerotherapy gave good results only
and ten patients had prior GSV stripping in the ipsilateral leg. The for two years, ligature and plasty were efficient for 5 years. After this
remaining 20 limbs had a competent GSV which was not treated. The time patients require varicose vein surgery because of recurrency. Two
incidence of concomitant AAGSV and GSV reflux was 1.6% (5 limbs). successful coronary bypass operations were performed with saved
Post procedure venous duplex ultrasound showed complete ablation great saphenous veins.
of 100% of treated AAGSVs at 9 months. Subsequent sclerotherapy Conclusion: The aim of great saphenous vein preservation is for it to
for residual symptomatic varicose veins was required in 11 of 36 be used later as a bypass material. Any debate centres on the femoral
treated limbs in 35 patients (30.6%). No significant complications were part of the great saphenous vein, because the crural part in most cases
observed. is healthy and should be saved intact. It seems that the time span, about
Conclusion: Isolated incompetence of the AAGSV occurs in 20 years between varicose vein and bypass surgery, is too long to save
approximately 10% of patients with symptomatic varicose veins. a non-healthy vein in a patient who is prone to varicose vein disease.
EVLT of the AAGSV efficacious and is associated with minimal In many cases the saphenous vein requires further operations in order
complications. to maintain the necessary quality for bypass surgery. We recommend
Keywords: Anterior Accessory Saphenous, Endovenous Laser femoral part preservation if the patient’s atherosclerosis is known at the
Ablation, Venous Insufficiency time of varicose vein surgery.
Keywords: Great saphenous vein, Preservation, Bypass material
pS8-7 a piLOt raNdOmiSed triaL OF CatHeter
direCted FOam SCLerOtHerapy WitH tUmeSCeNCe pS8-9 iNCOmpeteNt perFOratOrS - tHe UNSeeN
VerSUS LaSer abLatiON iN patieNtS WitH LarGe ViLLaiN
SapHeNOUS diameterS: a N C. STUCKEY1, C. BARBIERI1, A. MARTIN2,1, K. MCDONALD3,2,1,
C. R. LATTIMER1, E SHAWISH1, E. KALODIKI1, M. AZZAM1, C. CONROY2,1, R. MARTIN1, D. ROLLINS4
G. GEROULAKOS1 1 ACP, Overland Park, USA
1 Ealing Hospital and Imperial College, Department of Vascular 2 RVT, Overland Park, USA
Surgery, SW7 2AZ London, United Kingdom 3 RDMS, Overland Park, USA
4 ORT, Overland Park, USA
Objective: Ultrasound-Guided Foam Sclerotherapy (UGFS) alone is
less effective in obliterating veins in patients with Great Saphenous Phlebologists have accepted the role of incompetent perforators in
Vein (GSV) diameters at or above 8mm when compared to Endovenous the development of venous stasis ulcers. With the advent of portable,
Laser Therapy (EVLT). We propose Catheter-Directed Tumescence- high resolution duplex ultrasound, the identification of the elusive
assisted Ultrasound-Guided Foam Sclerotherapy (CDT-UGFS) as a incompetent perforators has been greatly facilitated. Given the
new technique to improve GSV obliteration by reducing saphenous minimally invasive nature of the radiofrequency endovenous ablation,
calibre and controlling foam deployment. the villain can now be seen and treated. This presentation analyzes
design and method: Twenty-six symptomatic patients were only the results of treatment of incompetent perforators, in a private
randomized into CDT-UGFS (mean venous diameter 9.1mm, range phlebology practice, over a 30 month period (05/17/07 - 11/17/09). In
8mm - 12mm) or EVLT (mean venous diameter 9.7mm; range 8.3mm our practice, all radiofrequency endovenous ablations accomplished
- 12mm). Assessments were performed before and at three weeks after at one setting constitute an intervention. The 415 patients treated,
treatment (23 legs) using: The Aberdeen Varicose Vein Questionnaire required 1322 interventions to ablate 3381 incompetent perforators
(AVVQ) and a full duplex examination. Time to return to normal (2.6 Pi/intervention). During the first 20 months analyzed, 2041 Pi
activities, treatment times and seven-day post-procedural visual were treated with an average time of 14.6 minutes/Pi. Over the last 10
analogue pain scores were also recorded. months, 1340 Pi were treated and required an average of 12.2 minutes/
results: In the CDT-UGFS group GSV obliteration was complete in Pi. This reduction of requisite treatment time represents a 16.4%
10/11 patients, with one patient demonstrating an incomplete occlusion reduction in time, and a commensurate improvement in the efficiency
with mild reflux. In the EVLT patients, obliteration of the vein was of our practice. It also demonstrates the learning curve associated with
complete in 11/12 patients while in one there was GSV patency but the radiofrequency endovenous ablation procedure. Our initial ablation
without reflux. Post-procedure morbidity in the EVLT group included rate remains greater than 99.75%, and the sustained ablation rate,
a thrombophlebitis requiring admission, a groin haematoma and a 30% evolving from this treatment period of 30 months, remains over 99.5%.
non-occlusive femoral vein thrombosis. In the CDT-UGFS group there As the number of patients increases, the number of Pi per patient has
was less average post-procedural pain (31/100 [2-99/100] vs 9/100 [1- decreased from 10.1per patient, down to 8.1 Pi per patient.
80 /100], p = 0.012), a trend towards improved median quality of life Keywords: Radiofrequency endovenoua abla, Incompetent perforator,
(12.0 [5.5 – 34.5] vs 18.6 [10.6 – 66.9], p = 0.106), shorter median Intervention
treatment times (48min [35 – 60] vs 90 min [65 – 132], p <0.001) with
a trend towards earlier return to normal activities (2 days [0 – 21] vs 7
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![contraindication to anticoagulation therapy were abstracted from the pS9-8 deep VeiN tHrOmbOSiS iN iNtraVeNOUS
Registry of 10 italian hospitals. drUG USerS FrOm eXperieNCe OF aNGiOLOGiC Ward
results: Ninety-nine patients (49 men, 50 women) with a mean age of aNd OUtCLiNiC
58 years were included in the study. New metastases occurred in 55% W. KWIATKOWSKA1, D. KOTSCHY1, J. PRZYTULSKA1, J.
of patients, and 12% of patients had a history of VTE before cancer DRELICHOWSKA-DURAWA1, L. MASLOWSKI1,
diagnosis. Corticosteroid agents were used during therapy in 48% of W. WITKIEWICZ1, M. CZARNECKI2, J. GASIOROWSKI2,
patients. Acute VTE was present in 52% of patients at cancer diagnosis, B. KNYSZ2
and in 34% of patients VTE was associated with new metastases. 1 Regional Specialist Hospital, Research and Development Centre,
Recurrent VTE occurred in 40% of patients, and significant risk factors Wroclaw, Poland
included presence of new metastases (odds ratio [OR], 3.3; 95% 2 Medical University of Wroclaw, Department of Infectious Diseases,
confidence interval[CI], 1.16-9.09; P=.02) and history of VTE (OR, Wroclaw, Poland
10.6; CI, 1.98-57.2; P=.006). Whereas a single episode of neutropenia
did not reach significance (OR, 1.1; CI, 0.97-1.35; P= .11), multiple Objective: In the 90thies the number of intravenous drug users (IDUs)
neutropenic episodes were significantly associated with recurrent VTE has increased. Main etiopathogenetic factors for DVT (Deep Vein
(P=.04). Smoking, hormone replacement therapy, decreased mobility, Thrombosis) among IDUs are: multiple vein injuries, unsterilized
post-surgical state, and obesity were not independently associated with injection needles, intravenous intake of insoluble particles. IDUs are up
increased risk. Mean survival in this series was 30 months, and was to 21% of all of the patients admitted to hospitals with DVT diagnosis
significantly worse in patients with VTE at cancer diagnosis and with and 50% in group under 40 years of age. Since 2004 we treated 5 young
inability to tolerate anticoagulant therapy in conjunction with VCF. patients-IDUs diagnosed for DVT, 3 of them in the last year. We present
Conclusion: Patients with malignant disease may be at increased risk 2 cases of IDUs (heroine) with the proximal DVT.
for recurrent VTE after development of new metastases or multiple design and method: presentation of cases.
episodes of neutropenia, especially those patients with a history of 28 years old female, 8 years of addiction, HCV and HIV positive,
VTE. admitted to ward with symptoms of DVT, after treatment of right
Keywords: Diabetic groin fistula. In physical examination: no fever, traces of punctures
on extremities including plantar side of feet, scar from groin fistula,
pS9-7 VaLidatiON OF a deep VeiN tHrOmbOSiS miscolored string-like veins, skin ulcerations, oedema and cyanosis of
prediCtiON rULe iN primary Care right lower limb. High D-dimer concentration, femoral vein thrombosis
M. MAUFUS1, J. L. BOSSON2, C. GENTY2, A. DELLUC3, confirmed in ultrasound examination.
P. IMBERT4, P. GAGNE5, C. ROLLAND2, L. BRESSOLLETTE3, 29 years old male, 5 years of addiction, HCV-positive, admitted with
G. LE GAL3 symptoms of DVT. In physical examination: fever, massive oedema
1 Universite Europeenne de Bretagne; EA3878 IFR 148; Departement and cyanosis of left lower limb, traces of vein punctures, groin
de medecine interne, pneumologie et medecine vasculaire, Brest, lymphadenopathy, skin ulcerations and abscesses of both lower limbs.
France High D-dimer concentration. Thrombosis of iliac, femoral, popliteal
2 CHU Grenoble, Centre Investigations Cliniques, Grenoble, and superficial veins confirmed in ultrasound examination, femoral
France artery pseudoaneurysm filled with clots. In both cases Low Molecular
3 CHU de la Cavale Blanche, Universite Europeenne de Bretagne; Weight Heparin (LMWH), antibiotics and compression therapy were
INSERM CIC 05-02, IFR148, Brest, France administered. The patients were discharged with advise to continue
4 Universite Joseph Fourrier, Departement de Medecine Generale, treatment with LMWH.
Grenoble, France Conclusions: Taking into account medical reports, escalation of
5 Private medical office, Plaintel, France addiction and observed DVT cases in IDUs, in spite of lack of
EBM data, addiction from intravenous drugs should be taken under
Objective: Suspected Deep Vein Thrombosis (DVT) of Lower Limbs consideration as a risk factor for DVT in young patients. Lack of
(LL) may require different tools to rule out or confirm the diagnosis. therapeutic guidelines for this group is also a problem to solve.
Clinical probability provides help to select useful tests, interpret their Supported by European Regional Development Fund, Polish Govern.
results, and decide to treat the patient meanwhile. Prediction rule that the grant WROVASC Integrated Cardiovascular Centre, Wroclaw,
risk stratifies patient with suspected DVT are validated for inpatients, POLAND
such Wells’score, but not for outpatients. We previously derived and Keywords: Deep vein thrombosis, Intravenous drug users
internally validated such a prediction rule: Brest’score. The aim of this
study is to externally validate this score. pS9-9 FaCtOrS iNFLUeNCiNG tHe deVeLOpmeNt
design and methods: Brest’score was applied to OPTIMEV OF tHe pOSt-tHrOmbOtiC Limb
outpatients with suspected LL-DVT, and without suspected pulmonary F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2
embolism. Sensitivity and specificity were calculated for proximal and 1 University of Naples, Department of Vascular Surgery, Naples,
distal DVT, according to each score. The area under the ROC curve Italy
was calculated for each kind of DVT, in order to assess the validity of 2 Department of Interventional Radiology, Bari, Italy
Brest’score on pedicting the presence or absence of DVT.
results: Among 3 523 outpatients prospectively included in the purpose: This study was designed to determine whether patients
OPTIMEV study for suspected LL DVT, overall prevalence of DVT having underlying venous disease in their contralateral limbs indicates
was 29.7% (n = 1046), ranging from 21.7% in the non-high Brest’score a more severe long-term clinical outcome in the ipsilateral limb after a
probability, to 61.4% in the high Brest’score probability. The area under deep vein thrombosis (DTV) and to determine what other factors may
the ROC curve was 0.7870 [CI 95%; 0.7713 - 0.8028]. With subgroup influence the long-term outcome.
analysis, the area under curve was 0.8340 [CI 95%; 0.8162 - 0.8518] methods: An acute DVT was initially diagnosed by means of duplex
for proximal DVT (n=465), and 0.7494 [CI 95%; 0.7284 - 0.7705] for ultrasound scanning. Follow-up clinical examinations and bilateral
distal DVT (n=581). duplex reflux studies were performed for a mean period as long as 3
Conclusions: Brest’score reliably identifies outpatients with LL DVT, years. The patients were divided into two groups: group I, those with
weather proximal or distal. no history of a contralateral DVT, and group II, those with a history of a
Keywords: Deep Vein Thrombosis, Primary health care, Diagnosis contralateral DVT. The patients were classified at their final examination
according to the Clinical, Etiology, Anatomic, Pathophysiologic,
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Eurochap2010 final program
- 1.
- 2. IN CONJUNCTION WITH 9th World Congress for Microcirculation Maison de la Chimie, September 26-28, 2010 9th Annual Congress of the « Société Française de Médecine Vasculaire » La Villette, September 23-25, 2010 UNDER THE AUSPICES OF Société Française de Médecine Vasculaire (SFMV) Société de Chirurgie Vasculaire de Langue Française (SCVLF) Société Française d’Angiologie (SFA) Collège Français de Pathologie Vasculaire (CFPV) Collège des Enseignants de Médecine Vasculaire (CEMV) ACKNOWLEDGMENTS The International Union of Angiology thanks for their participation Ad Rem Technology 2~
- 3. WELCOME ADDRESS Dear Participant, On behalf of the European Chapter of the International Union of Angiology, and the French societies of vascular medicine and surgery, I am very pleased to offer you a warm welcome to the 19th Eurochap! The special position of this additional congress allowed us to experiment some specific features, organized in a compact form with only two parallel rooms: - short lectures keeping time for discussions are organized in thematic symposia addressing the changes in concepts and practices in the different vascular fields; - specific postgraduate sessions based on clinical case solving and decision making will use electronic votes in addition to the comments of experts, in order to increase interactivity; - and the “Forum of Vascular Initiatives”, which will be an occasion to share the richness of the initiatives of the IUA and its members for the teaching of vascular medicine and surgery, the quality of care for the vascular patients and the promotion of patients associations and even humanitarian actions. The innovations also take a great part, since our congress attracted many proposals from which we were able to select 150 abstracts organized in seven oral and ten poster sessions with discussion rounds; furthermore the last congress day will be shared with the 9th World Congress for Microcirculation that follows in the same location. As you can see, everything has been thought in order to promote and facilitate scientific exchange in a positive and friendly atmosphere. Many top scientist and physicians invited from all over Europe and abroad accepted to play the game with you according to these principles, and we need you to be as active as possible in order to get as much as you can from the feast! As the congress takes place in the Maison de la Chimie, in the historical center of Paris, we hope it will also be for you the occasion to enjoy the cultural wealth of Paris. For the Organizing Committee, Professor Patrick Carpentier, President SUMMARY Synopsis .................................................................................... 4 Scientific Program Friday, September 24 ............................................................. 7 Saturday, September 25 ......................................................... 14 Sunday, September 26 ........................................................... 20 Congress Map and Exhibition Plan ......................................... 24 Abstracts Symposia .............................................................................. 26 Oral Communications ......................................................... 43 Posters ................................................................................. 58 Authors’ Index .......................................................................... 85 General Information ................................................................. 89 www.iua-eurochap2010.eu ~ 3
- 4. sYNOPSIS Friday, September 24, 2010 From 07:45 registration Hall 28 bis 08:30-09:20 amphithéâtre Lavoisier Plenary lecture the 2010 milestones of the vascular surgeon J. Fernandes e Fernandes 09:30-11:00 amphithéâtre Lavoisier petit amphithéâtre SY1 - Symposium SY2 - Corporate Symposium SIGVARIS abdominal aortic aneurysms: an update Efficient compression therapy to treat venous diseases: scientific, medical and practical key factors 11:00-11:30 Coffee break - Posters and Exhibition visit Room 8 11:30-13:00 amphithéâtre Lavoisier petit amphithéâtre SY3 - Symposium OC1 - Free communications Carotid stenosis: moving concepts and practices Vascular surgery: arteries 13:00-14:00 Break - Posters and Exhibition visit Room 8 14:00-15:30 amphithéâtre Lavoisier petit amphithéâtre room 8 SY4 - Symposium OC2 - Free communications poster Sessions early detection peripheral arterial disease pS1 to pS5 of the high vascular risk subjects 15:30-16:00 Coffee break - Posters and Exhibition visit Room 8 16:00-17:30 amphithéâtre Lavoisier petit amphithéâtre SY5 - Symposium OC3 - Free communications Therapeutic education of the vascular patient Venous thromboembolic disease 17:30-18:30 amphithéâtre Lavoisier petit amphithéâtre SY6 - Corporate symposium SY7 - Symposium Cook Medical New insights about the calf muscle pump function New developments in endovascular technologies Organized thanks to an unrestricted grant from Ad Rem Technology - Veinoplus SatUrday, September 25, 2010 08:30-09:20 amphithéâtre Lavoisier Plenary lecture the 2010 milestones of the vascular physician J. Belch 09:30-11:00 amphithéâtre Lavoisier petit amphithéâtre SY8 - Symposium Postgraduate Course Venous thromboembolic disease: Leg and foot ulcers - Critical limb ischemia moving concepts and practices Organized thanks to an unrestricted grant from Eumedica 11:00-11:30 Coffee break - Posters and Exhibition visit Room 8 11:30-13:00 amphithéâtre Lavoisier petit amphithéâtre SY9 - Symposium Postgraduate Course Varicose vein treatment in the future Venous thromboembolic disease - thrombophilia 13:00-14:00 Break - Posters and Exhibition visit Room 8 14:00-15:00 amphithéâtre Lavoisier petit amphithéâtre room 8 SY10 - Symposium Postgraduate Course poster Sessions Ultrasound guided procedures Clinical microcirculation pS6 to pS9 15:00-15:30 Coffee break - Posters and Exhibition visit Room 8 15:30-17:30 amphithéâtre Lavoisier Plenary session Forum of vascular initiatives 19:30 Congress dinner at the Cercle National des Armées (under registration) Pleanary session Symposia and free communications 4~ Posters
- 5. sYNOPSIS SUNday, September 26, 2010 09:30-11:00 petit amphithéâtre room 262 SY11 - Joint Symposium with the OC4 - Free communications Italian Society of Angiology and Vascular Medicine Varicose veins physical exercise and vascular medicine 11:00-11:30 Coffee break - Exhibition visit Room 8 11:30-13:00 petit amphithéâtre room 262 SY12 - Symposium OC5 - Free communications From raynaud phenomenon to digital ulcer atherosclerosis Organized thanks to an unrestricted educational grant from Actelion Pharmaceuticals 13:00-14:00 Break - Exhibition visit Room 8 14:00-15:30 amphithéâtre Lavoisier petit amphithéâtre room 262 SY13 - Symposium SY14 - Joint Symposium with the OC6 - Free communications Critical limb ischemia Romanian Society of Angiology and rare vascular diseases and progress Organized thanks to an unrestricted grant Vascular Surgery in vascular diagnosis from Sanofi Aventis Complications of vascular procedures 15:30-16:00 Break - Exhibition visit Room 8 16:00-17:30 amphithéâtre Lavoisier room 262 SY15 - Joint Symposium EuroChap - Microcirculation OC7 - Free communications relationship between macro and microcirculation Venous disorders Pleanary session Symposia and free communications Posters www.iua-eurochap2010.eu ~ 5
- 6. ORGANIZING COMMITTEE LOCAL ORGANIZING COMMITTEE President: Patrick CArPEntIEr (IUA) Members: François-André ALLAErt (SFA) François BECKEr (CEMV) Christian BOISSIEr (IUA) Michèle CAzAUBOn (SFA) nabil ChAKFE (SCVLF) Fabien KOSKAS (SCVLF) Philippe nICOLInI (SCVLF) Gilles PErnOd (SFMV) Pascal PrIOLLEt (CFPV) Isabelle QUéré (SFMV) Michel VAySSAIrAt (CFPV) INTERNATIONAL UNION OF ANGIOLOGY Executive Board Honorary president Chapter Secretaries P. BALAS (Greece) K. KOMORI (Japan) T. KARPLUS (Australia) president P.L. ANTIGNANI (Italy) R. SIMKIN (Argentina) C. GOLDENSTEIN (Argentina) R. SHEPHERD (USA) president elect A.S. EL GATIT (Libya) K. ROZTOCIL (Czech Republic) J. PILAI (Rep. S.Africa) S. NOVO (Italy) immediate past president E. BASTOUNIS (Greece) advisors to the board F. ALLAERT - C. BAKOYIANNIS - J. BARBOSA advisors to the president F. BENEDETTI VALENTINI - G. BIASI - D. CLEMENT C. ALLEGRA (Italy) M. DE CASTRO SILVA - G. DERIU - E. DIAMANTOPOULOS N. ANGELIDES (Cyprus) K. FILIS - W.R. HIATT - A.T. HIRSCH - D. HOPPENTAEDT E. ASCHER (USA) A. MANSILHA - G. MARCUCCI - P.G. MATTHEWS P. CARPENTIER (France) L. NORGREN - Z. PECSVARADY J. FAREED (USA) M.E. RENNO DE CASTRO SANTOS - A. SCHIRGER J. FERNANDES E FERNANDES (Portugal) F. SPINELLI - A. VISONA’ - Z.G. WANG - J.H. ULLOA J. FLETCHER (Australia) S. GEORGOPOULOS (Greece) representatives of other Societies: H. GIBBS (Australia) International Union of Phlebology (IUP) P. GLOVICZKI (USA) A. SCUDERI (Brazil) Y-Q. GU (China) E. HUSSEIN (Egypt) Mediterranean League of Angiology and Vascular Surgery B.B. LEE (USA) (MLAVS) S. NOVO (Italy) CH. LIAPIS (Greece) H. PARTSCH (Austria) Central European Vascular Forum (CEVF) P. POREDOS (Slovenia) V. STVRTINOVA (Slovak Rep.) G. RAO (India) A. SCUDERI (Brazil) Latin American Venosu Forum (LAVF ) H. SHIGEMATSU (Japan) P. KOMLOS (Brazil) J. ULLOA (Colombia) I.A.S.A.C.O Vice presidents S. NOVO (Italy) Y-Q. GU (China) P. VALE (Australia) International Society of Vascular Surgery (ISVS) K. ROZTOCIL (Czech Republic) F. VEITH (UK) M. DE CASTRO SILVA (Brazil) Vascular Independent Research & Education European A. SIDAWY (USA) Organisation (VAS) E. HUSSEIN (Egypt) M. CATALANO (Italy) T. ABDOOL CARRIM (Rep. S. Africa) Secretary General: A. JAWIEN (Poland) assoc. Secretary General: P. POREDOS (Slovenia) treasurer General: J. BELCH (UK) assoc. treasurer General: G. GEROULAKOS (UK) 6~
- 7. Scientific Program -Friday, September 24, 2010 08:30 - 09:20 Plenary lecture Amphitheatre Lavoisier Chair: P. Carpentier (Grenoble, France) the 2010 milestones of the vascular surgeon J. Fernandes e Fernandes (Lisbon, Portugal) 09:30 - 11:00 SY1 - Symposium Amphitheatre Lavoisier abdominal aortic aneurysms: an update Chairpersons: P. Gloviczki (Rochester, USA), A. Jawien (Bydgoszcz, Poland) Sy1-1 s Pathogenesis of the abdominal aortic aneurysm E. Allaire (Créteil, France) Sy1-2 s Screening for abdominal aortic aneurysm J.S. Lindholdt (Viborg, Denmark) Sy1-3 s The long-term results of EVAR I trial J.T. Powell (London, UK) Sy1-4 s Medical approach to the patient with an abdominal aortic aneurysm F. Becker (Geneva, Switzerland) 09:30 - 11:00 SY2 - Corporate Symposium SIGVARIS Petit Amphithéâtre Efficient compression therapy to treat venous diseases: scientific, medical and practical key factors Chairpersons: P. Carpentier (Grenoble, France), P. Kern (Vevey, Switzerland) Sy2-1 s Compression therapy: a bright future requiring many efforts P. Carpentier (Grenoble, France) Sy2-2 s New strategies to improve compliance of compression therapy (20-36 mmHg) D. Rastel, (Grenoble, France) Sy2-3 s Compression after sclerotherapy P. Kern (Vevey, Switzerland) Sy2-4 s The effects of medical compression stockings on venous anatomy J.F. Uhl (Paris, France) 11:00 - 11:30 Coffee break - Posters and Exhibition visit Room 8 11:30 - 13:00 SY3 - Symposium Amphitheatre Lavoisier Carotid stenosis: moving concepts and practices Chairpersons: E. Bastounis (Athens, Greece), F. Becker (Geneva, Switzerland) Sy3-1 s The surgical treatment of carotid stenosis: new information from recent trials and what is required for future studies J. Fernandes e Fernandes (Lisbon, Portugal) Sy3-2 s Carotid stenosis: place of carotid stenting J.L. Mas (Paris, France) Sy3-3 s Stroke and Thrombolytic therapy: an update V. Larrue (Toulouse, France) Sy3-4 s Asymptomatic Carotid Stenosis and Risk Stratification A. Nicolaides (Nicosia, Cyprus) www.iua-eurochap2010.eu ~ 7
- 8. 11:30 - 13:00 OC1 - Free Oral Communications - Vascular surgery: arteries Petit Amphithéâtre Chairpersons: F. Koskas (Paris, France), N. Chakfe (Strasbourg, France) OC1-1 Symptomatic huge abdominal aortic aneurysms M. Salem, A. Salem, T. Salem (Alexandria, Egypt) OC1-2 Minimal incision aortic aneurysm repair: an underutilized but safe technique M. Kalra, A. Duncan, S. Cha, P. Gloviczki (Rochester, USA) OC1-3 Prevalence of abdominal aortic aneurysm in screening survey of small town’s residents in northern Poland A. Jawien, B. Formankiewicz, T. Derezinski, A. Migdalski, R. Piotrowicz, G. Jakubowski (Bydgoszcz, Poland) OC1-4 Retrograde trans-popliteal recanalization of the superficial femoral artery: the face-down technique I. Broutzos, I. Dalainas, K. Moulakakis, N. Ptohis, M. Daskalopoulos, C. Papasideris, A. Papapetrou, K. Xiromeritis, M. Moschou, E. Avgerinos, T. Giannakopoulos, N. Kelekis, C. Liapis (Athens, Greece) OC1-5 Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute lower limb ischemia V. Flis, N. Kobilica, A. Bergauer, B. Mrdza, F. Milotic, B. Stirn (Maribor, Slovenia) OC1-6 Endovascular repair of traumatic aortic rupture: single center experience N. Melas, A. Giannopoulos, N. Saratzis, A. Saratzis, I. Lazaridis, C. Trigonis, K. Ktenidis, D. Kiskinis (Thessaloniki, Greece) OC1-7 Surgical treatment principles in patients with traumatic injuries of main vessels, bone-joints of extremities N. Abushov, M. Karimov, G. Tagizade, E. Zakirjayev, E. Aliyev (Baku, Azerbaidjan) 13:00 - 14:00 Break - Posters and Exhibition visit Room 8 14:00 - 15:30 SY4 - Symposium Amphitheatre Lavoisier Early detection of the high vascular risk subjects Chairpersons: J. Belch (Dundee, UK), S. Novo (Palermo, Italy) Sy4-1 s Screening for PAD in the general population V. Aboyans (Limoges, France) Sy4-2 s Asymptomatic carotid lesions predict global cardiovascular risk beyond the cards of the risk S. Novo (Palermo, Italy) Sy4-3 s Early markers in hypertension: often of vascular origin! D. Clément (Ghent, Belgium) Sy4-4 s Atherosclerosis and venous thrombosis - the same disease entity with two different faces P. Poredos, M.K. Jezovnik (Ljubljana, Slovenia) 14:00 - 15:30 OC2 - Free Oral Communications - peripheral arterial disease Petit Amphithéâtre Chairpersons: G. Marcucci (Civitavecchia, Italy), M. Catalano (Milan, Italy) OC2-1 Function of endothelial cells in limb ischemia R. Proczka, M. Kedzior, P. Jagus, P. Bialek, M. Polanska, M. Postacchini, I. Postacchini, P. Nitkowski, J. Chorostowska-Wynimko, J. Polanski (Warsaw, Poland) 8~
- 9. OC2-2 Does really exist a high risk patient for conventional carotid endarterectomy? G. Marcucci, F. Accrocca, A. Siani, A.G. Giordano, R. Antonelli (Civitavecchia, Rome, Italy) OC2-3 High prevalence of peripheral arterial disease: results of the evaluation of ankle/brachial index in hungarian hypertensives (ERV) screening program K. Farkas, Z. Jarai, E. Kolossvary, A. Ludanyi, I. Kiss (Budapest, Hungary) OC2-4 Cronocol implant reduces surgical site infection and improves final outcome in ischemic patients C. Costa Almeida, L. Reis, L. Carvalho, C. Costa Almeida (Coimbra, Portugal) OC2-5 European biobank on vascular diseases M. Catalano, VAS-Scientific Team, VAS-Biobank Working Group (Milan, Italy) OC2-6 Assessment of collateral blood flow in ischemic lower limb O. Albazde (London, UK) OC2-7 Comparative studding of hemorheological indexes in patients with critical limb ischemia N. Abushov, E. Zakirjayev, Z. Aliyev, G. Zeynalova (Baku, Azerbaijan) 14:00 - 15:30 Posters Sessions - PS1 to PS5 Room 8 Presenting authors are requested to stand close to their poster during the guided visit. Authors will have 4 minutes to present orally their work. 14:00 - 15:30 pS1 - atherosclerosis Room 8 pS1-1 Association between serum uric acid, carotid intima-media thickness and target organ damage in hypertensive patients C. Serban, S. Dragan, I. Mozos, R. Mateescu, L. Susan, A. Caraba, A. Pacurari, G. Savoiu, I. Romosan (Timisoara, Romania) pS1-2 Arterial elasticity - Carotid artery e-tracking versus arteriograph method on brachial artery Z. Miovski, L. J. Banfic, M. Vrkic Kirhmajer (Zagreb, Croatia) pS1-3 Endothelial function in healthy individuals and patients with coronary artery disease L. J. Banfic, Z. Miovski, K. Putarek, M. Vrkic Kirhmajer, M. Strozzi (Zagreb, Croatia) pS1-4 Risk profile of cardiovascular diseases and subclinical atherosclerosis in HIV positive Polish patients W. Kwiatkowska, B. Knysz, M. Czarnecki, J. Gasiorowski, J. Drelichowska-Durawa, M. Bubala, J. Kwiatkowski, W. Witkiewicz, A. Gladysh (Wroclaw, Poland) pS1-5 Endothelial prothrombotic markers in dyslipidemic patients D. Karasek, H. Vaverkova, M. Halenka, Z. Frysak, D. Jackuliakova, D. Novotny, L. Slavik (Olomouc, Czech Republic) pS1-6 Soluble intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 in asymptomatic dyslipidemic subjects D. Karasek, H. Vaverkova, M. Halenka, Z. Frysak, D. Jackuliakova, D. Novotny, J. Lukes (Olomouc, Czech Republic) pS1-7 Hypertension in patients with systemic lupus erythematosus (SLE) M. Boucelma, H. Chaudet, A. Berrah (Algiers, Algeria - Marseille, France) pS1-8 Impact of white matter changes on activities of daily living in mild to moderate dementia S. Moon, D. L. Na (Suwon, Seoul, South Korea) pS1-9 Simultaneous evaluation of coronary artery disease and aortic atherosclerosis using multidetector CT in acute ischemic stroke patients H. Kim, H. Cho, J. Lee, Y. Kim (Seoul, South Korea) www.iua-eurochap2010.eu ~ 9
- 10. pS1-10 Stroke in the young: relation with thrombocytemia M. Boucelma, S. Lassouaoui, D. Zemmour, H. Boudjelida, N. Ouadahi, A. Berrah (Algiers, Algeria) 14:00 - 15:30 pS2 - peripheral arterial disease (1) Room 8 pS2-1 Has MRA replaced conventional angiogram in the investigation of peripheral vascular disease? A district general hospitals perspective T. Hall, J. V. Barandiaran, N. El-Barghouti, E .P. Perry (Scarborough, UK) pS2-2 Arteriomegaly in female subjects T. Hall, J. V. Barandiaran, N. El-Barghouti, E. P. Perry (Scarborough, UK) pS2-3 Different behaviour of pulse wave velocity and augmentation index in patients with peripheral arterial disease G. Scandale, G. Dimitrov, G. Carzaniga, M. Minola, M. Cinquini, M. Carotta, M. Catalano (Milan, Italy) pS2-4 Increased aortic augmentation index in peripheral arterial disease G. Scandale, A. Aceranti, G. Carzaniga, M. Minola, M. Cinquini, M. Carotta, M. Catalano (Milan, Italy) pS2-5 Metabolic drugs increase effectiveness of medical treatment in smokers with intermittent claudication M. S. Bogomolov, V. M. Sedov, G. Y. Sokurenko, L. N. Edovina, V. V. Slobodyanyuk (Saint-Petersburg, Russia) pS2-6 Influence of metabolic drugs on periferal hemodynamics of the legs in patients with intermittent claudication L. Edovina, M. Bogomolov, Y. Lukyanov, V. Slobodyanyuk (St-Petersburg, Russia) pS2-7 Intima-media thickness increase and atherosclerotic plaques in asymptomatic patients M. Cazaubon, F. A. Allaer (Paris, Dijon France) pS2-8 Self-reported maximal walking capacity in arterial claudication: can the walking impairment questionnaire be self-completed? P. Abraham, N. Ouedraogo, G. Mahe, M. Vasseur, G. Leftheriotis (Angers, France) pS2-9 Relationship of symptoms with non-ABI hemodynamic investigations on treadmill in patients with suspected claudication P. Abraham, G. Mahe, N. Ouedraogo, G. Leftheriotis, M. Vasseur (Angers, France) pS2-10 Variability and short-term determinants of walking capacity in patients with intermittent claudication P. Abraham, A. Le Faucheur, B. Noury-Desvaux, G. Mahe, T. Sauvaget, J. L. Saumet, G. Leftheriotis (Angers, Les Ponts de Cé, Lyon, France) 14:00 - 15:30 pS3 - peripheral arterial disease (2) Room 8 pS3-1 Mortality and amputation rate of the conservative pharmacological treatment in patients with critical leg ischemia unsuitable for revascularisation R. Martini, R. Cordova, G. M. Andreozzi (Padova, Italy) pS3-2 CRP levels as a predictor of restenosis following SFA revascularisation P. Vale, S. Dubenec, D. Catinella, S. Hanning, A. Kelly (Sydney, Australia) pS3-3 Plasma homocysteine level predictive of potential for restenosis after SFA revascularisation for occlusive femoropopliteal disease P. Vale, S. Dubenec, D. Catinella, S. Hanning, A. Kelly (Sydney, Australia) pS3-4 Sternal wound angiogenesis in diabetic and non diabetic patients undergoing cardiac valve replacement surgery P. Bhaskaran, N. J. Standfield, T. Gourlay (London, Glasgow, UK) 10 ~
- 11. pS3-5 Assessment of sternal wound healing following diabetic and non diabetic coronary artery bypass graft surgical patients using laser doppler imager P. Bhaskaran, N. J. Standfield, T. Gourlay (London, Glasgow, UK) pS3-6 Clinical significance of laser doppler scanner in peripheral vascular disease P. Bhaskaran, M. Aslam, N. J. Standfield, T. Gourlay (London, Glasgow, UK) pS3-7 Critical limb ischaemia in diabetes: definition, assessment, prognosis F. Pollice, P. Pollice, V. Delgado (Leiden, Netherlands Antilles) pS3-8 Association between microalbuminuria and elevated levels of proinflammatory endothelium- derived mediators in hypertensive diabetic patients C. Serban, S. Dragan, I. Mozos, R. Mateescu, L. Susan, A. Pacurari, A. Caraba, G. Savoiu, I. Romosan (Timisoara, Romania) pS3-9 Susceptibility of bacterial cultures to topical antiseptics in diabetic foot L. Maslowski, M. Bartoszewicz, K. Checka, W. Kwiatkowska, W. Witkiewicz (Wroclaw, Poland) pS3-10 Improving limb salvage in critical limb ischemia with intermittent pnuematic compression: a controlled study with eighteen months follow up S. Kavros, N. Turner, A. Voll, D. Liedl, P. Gloviczki (Rochester, USA) 14:00 - 15:30 pS4 - Vascular Surgery (1) Room 8 pS4-1 Comparison of endoluminal versus open repair in the treatment of abdominal aortic aneurysms F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy) pS4-2 Endovascular thoracic aortic aneurysm repair in a patient with severe aortoiliac disease and ectopic single kidney M. Kafeza, V. Psarros, K. Papoutsis, G. Kouvelos, A. Koutsoubelis, C. Bakoyiannis, S. Georgopoulos, C. Klonaris, E. Papalambros (Athens, Greece) pS4-3 Late secondary procedures due to aneurysm rupture after EVAR: ten years experience M. Kafeza, V. Psarros, A. Koutsoubelis, G. Kouvelos, K. Papoutsis, C. Bakoyiannis, C. Klonaris, S. Georgopoulos, E. Bastounis, E. Papalambros (Athens, Greece) pS4-4 Tissue factor pathway and thrombin-antithrombin complex in blood of patients with abdominal aortic aneurysm during stent-graft implantation R. Grendziak (Wroclaw, Poland) pS4-5 A novel suture-less device (BYFix) for vascular anastomosis - the results of preclinical and clinical studies B. Yoffe (Haifa, Israel - Klinik, Erfurt Germany) pS4-6 Spontaneous aortocaval fistula: case report and literature review H. Ravari, M. Moini, M. Vahedian, M. Aliakbarian (Mashhad, Tehran, Iran) pS4-7 The role of arterial and venous shunting in the complex vascular trauma of the arteries of the lower limbs G. Marcucci, A. Siani, R. Antonelli, A. G. Giordano, F. Accrocca (Civitavecchia, Rome, Italy) pS4-8 The percutaneous angioplasty and stenting treatment in patients with subclavian steal syndrome F. Ferrara, I. Muratori, F. Meli, C. Amato, M. Lunetta, R. Alcamo, S. Novo (Palermo, Italy) pS4-9 Diagnostic procedures: the timing of follow-up of surgical and endovascular treatment of arterial diseases P. L. Antignani, C. Allegra (Rome, Italy) www.iua-eurochap2010.eu ~ 11
- 12. pS4-10 Below the knee bypass using cryopreserved arterial homografts for critical lower limb ischaemia: long term results in a single center S. Amiot, C. Perot, R. Spear, R. Jashari, D. Massouille, J. Lancelevee, J. P. Chambon (Lille, France - Brussels, Belgium) 14:00 - 15:30 pS5 - Vascular Surgery (2) Room 8 pS5-1 Intraoperative aortic embolism after middle lobe lobectomy for renal leyomiosarcoma metastases P. Amorim, C. Rodrigues, A. Rita Matos, T. Vieira, F. Félix, J. Pereira Albino (Lisbon, Portugal) pS5-2 Endoluminal stenting for superficial femoral artery occlusion offers symptomatic improvement for patients with peripheral vascular disease J. Makanjuola, V. M. Patel, M. Mobasheri, T. Hussain (London, UK) pS5-3 Endoluminal revascularization of non embolic iliac occlusion for inferior limb acute ischemia: an alternative to surgery F. Mercier, A. Aymard, H. Benamer, X. Guillotte, E. Louvard, R. Maguemoun, M. C. Morice (Aubervilliers, France) pS5-4 Carotid angioplasty. Detection of embolic signals during and after the procedure F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy) pS5-5 Influence of age upon complication of carotid artery stenting F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy) pS5-6 Internal carotid and bilateral vertebral arteries dissection: a case report M. Boucelma, T. Bounzira, D. Bensalah, D. Hakem, A. Berrah (Algiers, Algeria) pS5-7 Surgery for carotid body tumor in patient with Eisenmenger syndrome (case report) K. Kanalikova, J. Tomka, K. Kanalikova, I. Simkova, Z. Zita, L. Pretiova (Bratislava, Slovak Republic) pS5-8 A rare carotid-jugular fistula of congenital etiology J. Pereira Albino, P. Amorim, L. Castro E Sousa, K. Ribeiro, G. Sobrinho, T. Vieira, N. Meireles, F. Pinto (Lisbon, Portugal) pS5-9 Diagnosing carotid-jugular arteriovenous fistula: is color doppler sonography enough? R. Catalini, G. Pagliariccio, L. Giantomassi, O. Zingaretti (Ancona, Italy) pS5-10 Ruptured iliac artery aneurysm after abdominal aortic aneurysm resection: a case report T. Janusauskas, E. Janusauskas, V. Kazlauskas, D. Triponiene, V. Triponis (Vilnius, Lithuania) 15:30 - 16:00 Coffee break - Posters and Exhibition visit Room 8 16:00 - 17:30 SY5 - Symposium Amphitheatre Lavoisier therapeutic education of the vascular patient Chairpersons: P. Carpentier (Grenoble, France), P. Léger (Toulouse, France) Sy5-1 s Therapeutic education of the patient with peripheral arterial disease P. Carpentier (Grenoble, France) Sy5-2 Education of the patient with venous thromboembolic disease s P. Léger (Toulouse, France) Sy5-3 s Therapeutic education of the patients with chronic venous disorders B. Satger (La Léchère, France) 12 ~
- 13. 16:00 - 17:30 OC3 - Free Oral Communications - Venous thromboembolic disease Petit Amphithéâtre Chairpersons: G. Pernod (Grenoble, France), A. Visona (Castelfranco Veneto, Italy) OC3-1 Comparison of the clinical history of symptomatic isolated muscular calf vein thrombosis versus deep calf vein thrombosis J. Galanaud, M.A. Sevestre, C. Genty, J.P. Laroche, V. Zyzka, I. Quere, J.L. Bosson (Montpellier, Amiens, Grenoble, Fort de France, France) OC3-2 Bleeding complications in patients with cancer receiving anticoagulant therapy for venous thromboembolism. findings from the RIETE registry A. Visonà, P. Di Micco, J.A. Nieto, J. Truijllo Santos, R. Quintavalla, P. Prandoni, M. Monreal (Castelfranco Veneto, Naples, Parma, Padua, Italy - Cuenca, Cartagena, Badalona, Spain) OC3-3 Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism. Findings from the RIETE registry A. Visonà, P. Di Micco, A. Niglio, M. Amitrano, M. Ciammaichella, P. Prandoni, M. Monreal, J.A. Nieto (Castelfranco Veneto, Naples, Avellino, Rome, Padua, Italy - Badalona, Cuenca, Spain) OC3-4 Venous thromboembolism in the elderly: epidemiological data overview based on the prospective OPTIMEV cohort G. Pernod, M. A. Sevestre, C. Genty, J. Labarere, P. Couturier, J. L. Bosson (Grenoble, Amiens, France) OC3-5 Thrombosis of atypical location, Mayo series: profile of local causes in organ vein thrombosis W. Wysokinski, R. Mcbane (Rochester, USA) OC3-6 Evaluation of a pneumatic device efficacy to prevent venous disorders in air travel F. Fernandez, I. Chirosa, M. Martinez, J.J. Sánchez-Cruz, E. Ros (Granada, Spain) OC3-7 Calf vein thrombosis and risk of pulmonary embolism P. L. Antignani, C. Allegra (Rome, Italy) 17:30 - 18:30 SY6 - Corporate Symposium Cook Medical Amphitheatre Lavoisier New developments in endovascular technologies Chair: N. Chakfé (Strasbourg, France) Sy6-1 s Fenestrated endografts for thoracoabdominal aortic pathologies J-P. Becquemin (Créteil, France) Sy6-2 s Future developments in Abdominal Aortic Aneurysm treatment F. Thaveau (Strasbourg, France) Sy6-3 s there a room for drug eluting stents in SFA lesions? Is N. Chakfé (Strasbourg, France) 17:30 - 18:30 SY7 - Symposium Petit Amphithéâtre New insights about the calf muscle pump function Chairpersons: P. Carpentier (Grenoble, France), A. Nicolaïdes (Nicosia, Cyprus) Organized thanks to an unrestricted educational grant from Ad Rem Technology - VEINOPLUS Sy7-1 Pathophysiology of the calf muscle pump s A. Nicolaïdes (Nicosia, Cyprus) Sy7-2 Functional anatomy of the muscular pumps of the lower limb s J.F. Uhl (Paris, France) s to improve the calf muscle function in CVD patients How A. Jawien (Bydgoszcz, Poland) www.iua-eurochap2010.eu ~ 13
- 14. Scientific Program -Saturday, September 25, 2010 08:30 - 09:20 Plenary lecture Amphitheatre Lavoisier Chair: A. Jawien (Bydgoszcz, Poland) the 2010 milestones of the vascular physician J. Belch (Dundee, UK) 09:30 - 11:00 SY8 - Symposium Amphitheatre Lavoisier Venous thromboembolic disease: moving Concepts and practices Chairpersons: I. Quéré (Montpellier, France), A. Comerota (Michigan, USA) Organized thanks to an unrestricted grant from Eumedica Sy8-1 s Medical signification of the asymptomatic venous and pulmonary embolism G. Pernod (Grenoble, France) Sy8-2 s Newer trends in the management of thrombosis. Impacts on Vascular Indications E. Kalodiki (London, UK) Sy8-3 s Superficial thrombophlebitis, a significant subset of venous thromboembolic disease I. Quéré (Montpellier, France) Sy8-4 s The concept of early thrombus removal for iliofemoral deep venous thrombosis A. Comerota (Michigan, USA) 09:30 - 11:00 Postgraduate Course Petit Amphithéâtre Leg and foot ulcers - Critical limb ischemia Moderators: P. Carpentier (Grenoble, France), M.-A. Sevestre-Pietri (Amiens, France) Experts: K. Roztocil (Prague, Czech Republic), G. Marcucci (Rome, Italy), M.C. Portilho (Brazil), P. Gloviczki (Rochester, USA) This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the end of the session, participants will understand the importance of a thorough medical diagnostic and pre-therapeutic evaluation of patients with leg or foot ulcers; they will have an increased awareness of the educational and social needs of these patients; they will be able to make the diagnosis of critical limb ischemia and will understand the need for a multidisciplinary approach of the patient suffering from this condition. 11:00 - 11:30 Coffee break - Posters and Exhibition visit Room 8 11:30 - 13:00 SY9 - Symposium Amphitheatre Lavoisier Varicose vein treatment in the future Chairpersons: M. de Castro-Silva (Belo Horizonte, Brazil), P. Nicolini (Lyon, France) Sy9-1 s Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum on 3 the Care of Patients with Varicose Veins P. Gloviczki (Rochester, USA) Sy9-2 s Future techniques for varicose vein ablation P. Nicolini (Lyon, France) 14 ~
- 15. Sy9-3 s We need to know more about the natural history of venous hemodynamics in patients with varicose veins! O. Pichot, P. Carpentier (Grenoble, France) Sy9-4 s Molecular Mechanisms for Microvascular Endothelial Apoptosis under Pressure Elevation and Therapeutic Targets G. Schmid-Schönbein (San Diego, USA) 11:30 - 13:00 Postgraduate Course Petit Amphithéâtre Venous thromboembolic disease - thrombophilia Moderators: G. Pernod (Grenoble, France), P. Nguyen (Reims, France) Experts: A. Visona (Castelfranco Veneto, Italy), M.E. Renno de Castro Santos (Brazil), M. Sprynger (Liège, Belgium) This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the conclusion of the session, attendees will have an increased awareness of the importance of the evaluation of the benefit/risk ratio for the decision about the treatment of these conditions. They will have a deeper understanding of the clinical signification of the different inherited and acquired thrombophilia and the drawbacks of their systematic evaluation. 13:00 - 14:00 Break - Posters and Exhibition visit Room 8 14:00 - 15:00 SY10 - Symposium Amphitheatre Lavoisier Ultrasound guided procedures Chairpersons: O. Pichot (Grenoble, France), E. Ascher (New York, USA) Sy10-1 Ultrasound assisted arterial procedures s E. Ascher (New York, USA) Sy10-2 Vascular access for hemodialysis s O. Pichot (Grenoble, France) Sy10-3 Ultrasound guided treatment of varicose veins s C. Hamel-Desnos (Caen, France) 14:00 - 15:00 Postgraduate Course Petit Amphithéâtre Clinical microcirculation Moderators: M. Vayssairat (Paris, France), P. Carpentier (Grenoble, France) Experts: C. Allegra (Rome, Italy), A.T. Guillaumon (Brazil), J.C. Wautrecht (Brussels, Belgium) This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the end of the session, participants will have a broader understanding of the needs of patients seeking medical help for a vascular acrosyndromes, and will be able to diagnose atypical acrosyndromes such as complicated chilblains and paroxystic finger hematoma and to manage a cost effective etiological evaluation of Raynaud phenomenon. 14:00 - 15:30 Posters Sessions - PS6 to PS9 Room 8 Presenting authors are requested to stand close to their poster during the guided visit. Authors will have 4 minutes to present orally their work. www.iua-eurochap2010.eu ~ 15
- 16. 14:00 - 15:30 pS6 - arteritis, vasculitis, therapeutic Room 8 pS6-1 Generic argatroban preparations differ in their anticoagulant and antiprotease responses in patients with liver disease. Dosing implications D. Hoppensteadt, O. Iqbal, S. Masood, J. Fareed (Maywood, USA) pS6-2 Prevalence of free methyl chloride as an impurity in generic clopidogrel preparations. Safety implications in cardiovascular patients A. Duguot, H. Belva-Besnet, C. Conocar, M. Daumas, G. Rao, I. Mohan Theti (Paris, France - Bangelore, India) pS6-3 Low adherence to antithrombotic indications and gender differences in aspirin use in patients with previous minor bleeding A. Mattioli, A. Farinetti, R. Lonardi, S. Pennella, G. Tazzioli, G. Mattioli (Modena, Italy) pS6-4 The pharmacogenetic approach to the anticoagulant therapy Y. Novikova, A. Shevela, G. Lifshitz, K. Sevostyanova, E. Voronina (Novosibirsk, Russia) pS6-5 Multifactorial treatment effectivness of dyslipidemia, type 2 diabetes mellitus and arterial hypertension in patients with CHD K. Kapanadze, N. N. Kipshidze (Tbilsi, Georgia) pS6-6 Hyperbaric oxygen therapy in refractory ischemic cutaneous lesions in vasculitis and connective vascular disease C. Belizna, D. Henrion, V. Soude, B. Bienvenu, F. Maillot, E. Andres, C. Lavigne, A. Ghali, A. Mercat, P. Asfar (Angers, Caen, Tours, Strasbourg, France) pS6-7 Digital ischemia and myeloproliferative disorders B. Imbert, N. Kherat, I. Marie, H. Desmurs-Clavel, P. Carpentier (Grenoble, Rouen, Lyon, France) pS6-8 Prophylaxis of suspected secondary Raynaud’s phenomenon C. Costa Almeida, L. Carvalho, L. Reis, J. Fortuna, C. Costa Almeida (Coimbra, Portugal) pS6-9 Abdominal aortitis and doxycyclin: case report M. Sprynger, C. Nizet, L. A. Pierard (Liege, Belgium) pS6-10 Treatment of non-healing wounds with autologous bone marrow cells, platelets, fibrin glue, and collagen matrix H. Ravari, D. Hamidi Almadrai, M. Salimifar, S. H. Bonakdaran (Mashhad, Iran) pS6-11 Association of heparin-PF4 antibodies with intima-media thickness of carotid arteries A. Mattioli, A. Farinetti, R. Lonardi, S. Pennella, G. Mattioli (Modena, Italy) pS6-12 A collaborative multi-disciplinary community approach to a streptococcus pyogenes infection G. Hancock, J. V. Barandiaran, T. C. Hall, N. El-Barghouti, E. P. Perry (Scarborough, UK) 14:00 - 15:30 pS7 - Chronic venous disorders / Lymphedema Room 8 pS7-1 Are there incurable leg ulcers? F. Zernovicky, K. Samelova, F. Zernovicky Jr. (Bratislava, Slovak Republic) pS7-2 Phlebological passport T. Alekperova, A. Truxanov, S. Musaeva, O. Alekperov (Moscow, Russia) pS7-3 Electro-stimulation with VEINOPLUS® - a new method for the treatment of chronic venous insufficiency of the lower limbs V. Y. Bogachev, O. V. Golovanova, A. H. Kuznietov, A. O. Stchekoian (Moscow, Russia) 16 ~
- 17. pS7-4 Observational study of the synergy between sclerotherapy and a grade a veinotonic in chronic venous disease of the lower limbs F. Allaert, J. P. Gobin (Dijon, Lyon, France) pS7-5 Leg ulcers and hydroxyurea: has the treatment to be discontinued? U. Michon-Pasturel, I. Lazareth, A. Bouchareb, P. Priollet (Paris, France) pS7-6 Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis F. Pollice, P. Pollice, B. Di Renzo (L’Aquila, Italy) pS7-7 Treatment of low-flow vascular malformations by echo-sclerotherapy with polidocanol foam: 24 cases and literature review S. Blaise, M. Charavin-Cocuzza, H. Riom, M. Brix, C. Seinturier, J. M. Diamant, G. Gachet, P. H. Carpentier (Grenoble, Voiron, France) pS7-8 Intensive rehabilitation program for lymphedema: one or two weeks? B. Villemur, F. Vellut, J. Y. Bouchet, B. Bucci, V. Evra, M. P. De Angelis, A. Marquer, D. Perennou (Echirolles, France) pS7-9 Prognostic value of lymphoscintigraphy for prediction of postmastectomy lymphedema M. Myasnikova, N. Gordeev (St-Petersburg, Russia) pS7-10 Effectiveness of multilayer bandage in healing venous ulcers F. Ferrara, I. Muratori, F. Meli, C. Amato, M. Lunetta, R. Alcamo, S. Novo (Palermo, Italy) 14:00 - 15:30 pS8 - Varicose veins Room 8 pS8-1 Vein - Term classification/ venous reflux patterns and great saphenous vein sparing F. Toscano, C. Pereira Alves, J. Neves, A. Formiga (Lisbon, Portugal) pS8-2 Clinical experience of Salem endothelial stripping operation for the surgical treatment of primary varicose veins of the lower limbs M. Salem, A. Salem, T. Salem (Alexandria, Egypt) pS8-3 Early results from sclerotherapy for treatment of varicose veins D. Lukanova, I. Lozev (Sofia, Bulgaria) pS8-4 Preoperative and intraoperative triplex sonography in surgical treatment of varicose veins I. Lozev, N. Smilov, P. Lozev, D. Dardanov, G. Kirov (Sofia, Bulgaria) pS8-5 Treatment of symptomatic varicose veins and small saphenous vein reflux with endovenous laser ablation does not require concomitant phlebectomy J. Laredo, J. Kwock, B. B. Lee, R. F. Neville (Washington, USA) pS8-6 Endovenous laser ablation of the anterior accessory great saphenous vein J. Laredo, S. Shin, B. B. Lee, R. F. Neville (Washington, USA) pS8-7 A pilot randomised trial of catheter directed foam sclerotherapy with tumescence versus laser ablation in patients with large saphenous diameters: A N C. R. Lattimer, E. Shawish, E. Kalodiki, M. Azzam, G. Geroulakos (London, UK) pS8-8 Personal experience in preserving the great saphenous vein I. Bihari (Budapest, Hungary) pS8-9 Incompetent perforators - the unseen villain C. Stuckey, C. Barbieri, A. Martin, K. Mcdonald, C. Conroy, R. Martin, D. Rollins (Overland Park, USA) www.iua-eurochap2010.eu ~ 17
- 18. PS8-10 Endovenous laser ablation in treatment of varicose veins M. Vakhitov, D. Semenov, A. Zsibin, Z. Ulimbasheva (St. Petersburg, Russia) PS8-11 Endovascular and surgical threatment of pelvic congestion syndrome I. Ignatyev, R. Bredikhin, E. Fomina, M. Miikhailov (Kazan, Russia) 14:00 - 15:30 PS9 - Venous thromboembolic disease Room 8 PS9-1 Venous diseases in injecting drug users M. Czarnecki, B. Knysz, W. Kwiatkowska, J. Gasiorowski, A. Gladysz (Wroclaw, Poland) PS9-2 Evaluation of outcomes following endovascular recanalization and stenting of chronically occluded iliac and common femoral veins A. Kurklinsky, H. Bjarnason (Rochester, USA) PS9-3 Importance of long term follow up of dVt recanalisation Z. Pécsvárady (Kistarcsa, Hungary) PS9-4 the genetic predicts of the deep venous thrombosis Y. Novikova, A. Shevela, K. Sevostyanova, E. Voronina (Novosibirsk, Russia) PS9-5 Clinical signs and risk factors of deep veins thrombosis of lower extremities. efficiency and safety of anticoagulant therapy V. Mishalov, E. N. Amosova, N.Y. Litvinova (Kyiv, Ukraine) PS9-6 Prevention of thrombotic disorders in cancer patients undergoing chemotherapy F. Pollice, P. Pollice, L. De Giuli (L’Aquila, Italy) PS9-7 Validation of a deep vein thrombosis prediction rule in primary care M. Maufus, J. L. Bosson, C. Genty, A. Delluc, P. Imbert, P. Gagne, C. Rolland, L. Bressollette, G. Le Gal (Brest, Grenoble, Plaintel, France) PS9-8 deep vein thrombosis in intravenous drug users from experience of angiologic ward and outclinic W. Kwiatkowska, D. Kotschy, J. Przytulska, J. Drelichowska-Durawa, L. Maslowski, W. Witkiewicz, M. Czarnecki, J. Gasiorowski, B. Knysz (Wroclaw, Poland) PS9-9 Factors influencing the development of the post-thrombotic limb F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy) PS9-10 Ivus IVc filter deployment - a method for integration of IVus into daily practice D. Kassavin, G. Constantinopoulos (Long Branch, NJ, USA) 15:00 - 15:30 coffee break - Posters and Exhibition visit Room 8 15:30 - 17:30 Plenary session Amphitheatre Lavoisier Forum of Vascular Initiatives chairpersons: R. simkin (Buenos Aires, Argentina), P. carpentier (Grenoble, France) s Vascular centers F. Benedetti-Valentini (Rome, Italy) s the adventure of running a vascular journal A. Nicolaïdes (Nicosia, Cyprus) s Building-up an e-learning vascular website P. Carpentier (Grenoble, France), C. Boissier (Saint-Etienne, France) 18 ~
- 19. s VAS (Vascular- Independent Research and Education - European Organisation): almost 20 years of stable European collaboration on Angiology/Vascular Medicine M. Catalano (Milan, Italy) s Brazilian experience on vascular teaching J.L. Nascimento Silva (Rio De Janeiro, Brazil) s Franco-Vietnamese vascular teaching cooperation P. Desouter, J.M. Diamand (Grenoble, France) s The Italian Likoni project in Kenya C. Allegra (Rome, Italy) s Fighting elephantiasis in Burkina Faso A. Cornu-Thénard (Paris, France) s IUA Eurochap 2011 in Slovenia P. Poredos (Ljubljana, Slovenia) s IUA World Congress in Prague K. Roztocil (Prague, Czech Republic) www.iua-eurochap2010.eu ~ 19
- 20. Scientific Program -Sunday, September 26, 2010 09:30 - 11:00 SY11 - Joint Symposium with the Italian Society of Angiology Petit Amphitheatre and Vascular Medicine physical exercise and Vascular medicine Chairpersons: P.L. Antignani (Rome, Italy), G.M. Andreozzi (Padova, Italy), P. Abraham (Angers, France) Sy11-1 s Effects of physical exercise on the cardiovascular system P. Abraham (Angers, France) Sy11-2 s The balance or unbalance of ATS risk factors could compromise the results of physical training in claudicants ? G.M. Andreozzi (Padova, Italy) Sy11-3 s Interval training in patients with intermittent arterial claudication B. Villemur (Grenoble, France), D. Pérennou (Grenoble, France) Sy11-4 s Physical training in patients with hypertension A. Pinto (Palermo, Italy) Sy11-5 s Physical exercise in elderly arteriopathic patients M. Prior (Verona, Italy) 09:30 - 11:00 OC4 - Free Oral Communications - Varicose veins Room 262 Chairpersons: E. Kalodiki (London, UK), C. Allegra (Roma, Italy) OC4-1 Anatomic preconditions for recurrent varices in surgical treatment of primery varicose veins M. Vakhitov, O. Bolshakov, V. Amosov, O. Kovaleva (St. Petersburg, Russia) OC4-2 Closurefast catheter endovenous ablation - a three year experience C. Stuckey, C. Barbieri, A. Martin, K. Mcdonald, C. Conroy, R. Martin, D. Rollins (Overland Park, USA) OC4-3 Treatment of superficial venous insufficiency by endovenous laser therapy: lessons from a personal trial on 1000 cases P. Sarradon, E. Slotema (Toulon, Marseille, France) OC4-4 Endovenous radiofrequency-powered segmental thermal ablation (RSTA) of the great saphenous vein: 2-year european follow-up O. Pichot (Grenoble, France) OC4-5 Clinical comparison of thigh only versus endovenous laser ablation (EVLA) in great saphenous vein insufficiency treatment R. Kikuchi, E. Arcenio, C.M. Oba (Sao Paulo, Londrina, Brazil) OC4-6 A seven fold increase in volume flow in the great saphenous vein during application of a below knee stocking: a potential hazard following foam sclero M. Azzam, C. R. Lattimer, E. Kalodiki, G. Geroulakos (London, UK) OC4-7 The role of foam sclerotherapy in elderly patient (over 70) with severe disabling CVD C. Allegra, P. L. Antignani, M. Gallucci (Rome, Italy) 11:00 - 11:30 Coffee break - Exhibition visit Room 8 20 ~
- 21. 11:30 - 13:00 SY12 - Symposium Amphitheatre Lavoisier From raynaud phenomenon to digital ulcer Chairpersons: M. Cutolo (Genova, Italy), M. Vayssairat (Paris, France) Organized thanks to an unrestricted educational grant from Actelion Pharmaceuticals Sy12-1 s Basic exploration of Raynaud’s phenomenon : a consensus of French experts J. Constans (Bordeaux, France) Sy12-2 s Clinical usefulness of capillaroscopy M. Cutolo (Genova, Italy) Sy12-3 s Raynaud phenomenon: the appearance of digital ulcers changes everything P. Carpentier (Grenoble, France) Sy12-4 s The therapeutic challenge of digital ulcers in systemic sclerosis P. Priollet (Paris, France) 11:30 - 13:00 OC5 - Free Oral Communications - atherosclerosis Room 262 Chairpersons: C. Le Hello (Caen, France), M. Cazaubon (Paris, France) OC5-1 Easy assessment of dietary pattern for atherosclerosis diseases in clinical practice G. Mahe, M. Carsin, J. P. De Bosschere, M. Zeeny (Angers, Rennes, France - Beirut, Lebanon) OC5-2 Medical management and prognosis of patients with atherothrombotic disease requiring a revas- cularisation C. Le Hello, R. Morello, S. Fradin, O. Coffin, D. Maïza, M. Hamon (Caen, France) OC5-3 Management of vessel wall disease is better than the management of risk factors G. H. R. Rao, V. Sriram, G. Muralidhara, A. Fenster (Minnesota, USA - Ontario, Canada) OC5-4 Computed tomographic angiography for the evaluation of carotid artery stenosis F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy) OC5-5 Percutaneous treatment with drug-eluting stent in diabetic patients F. Pollice, P. Pollice, T. Grover, I. Christensen (Leiden, Netherlands Antilles) OC5-6 Low ankle brachial index is a risk factor for revascularization in coronary patients M. Maufus, J. B. Guitton, G. Vanzetto, L. Belle, B. Imbert, P. Carpentier, G. Pernod (Grenoble, Annecy, France) OC5-7 Progression of peripheral arterial disease in type 2 diabetic patients: influence of fibrinogen and crp M. Bosevski, L. J. Georgievska-Ismail (Skopje, Makedonija) 13:00 - 14:00 Break - Exhibition visit Room 8 14:00 - 15:30 SY13 - Symposium Amphitheatre Lavoisier Critical Limb ischemia Chairpersons: K. Roztocil (Prague, Czech Republic), E. Emmerich (Paris, France) Organized thanks to an unrestricted grant from Sanofi Aventis Sy13-1 s A randomized, double-blind, placebo-controlled gene therapy study using NV1FGF for prevention of amputation and death in critical limb ischemia (TAMARIS). Rationale, design and baseline patient characteristics J. Belch (Dundee, UK) www.iua-eurochap2010.eu ~ 21
- 22. Sy13-2 s Pathophysiology of Critical Limb Ischemia P. Carpentier (Grenoble, France) Sy13-3 s Critical Limb Ischemia: the Limits of Revascularization E. Ascher (New York, USA) s Results of gene and cell therapy in CLI: are we close to salamander? J. Emmerich (Paris, France) 14:00 - 15:30 SY14 - Joint Symposium with the Romanian Society of Angiology and Petit Amphitheatre Vascular Surgery Complications of vascular procedures Chairpersons: A. Andercou (Cluj-Napoca, Romania), D. Olinic (Cluj-Napoca, Romania) Sy14-1 s Anastomotic aneurysms and infections after peripheral procedures A. Andercou, O. Andercou, B. Stancu, O.Budiu, O. Barbos, M. Andrei (Cluj-Napoca, Romania) Sy14-2 s Complications after interventional venous procedures M. Catalano, E. Perilli (Milan, Italy) Sy14-3 s Complications of vascular access I. Droc, V. Alexandrescu (Bucharest, Romania) Sy14-4 s Early failure of arteriovenous fistula for hemodialysis V. Popovic, J. Pasternak, J. Pfau, M. Kacanski, D. Nikolic, Z. Horvat (Novi Sad, Serbia) Sy14-5 s Interventional retrieval of fractured central venous catheter D. Olinic, C. Homorodean, M. Olinic, M. Ober (Cluj-Napoca, Romania) 14:00 - 15:30 OC6 - Free Oral communications Room 262 rare vascular diseases and progress in vascular diagnosis Chairpersons: G. Gerotziafas (Paris, France), M.L. Gloviczki (Rochester, USA) OC6-1 A new diagnostic criterion with colour duplex scanning in pudendal neuralgia by entrapment M. Mollo, E. Bautrant, J. Eggermont, A. K. Rossi-Seignert (Aix-en-Provence, France) OC6-2 Long term follow-up of giant cell arteritis-related upper/lower limb vasculitis. a series of 36 patients C. Assie, A. Janvresse, D. Plissonnier, H. Levesque, I. Marie (Rouen, France) OC6-3 Digestive arteries dissection in a retrospective monocentric series C. Belizna, A. Ghali, C. Lavigne, A. Beucher, F. Thouveny, S. Willoteaux, J. Piquet, B. Enon (Angers, France) OC6-4 Evaluation of thrombin generation assay in the monitoring of treatment with vitamin K antagonists, enoxaparin and fondaparinux G. Gerotziafas, V. Galea, M. Chaari, M. Sassi, H. Baccouche, I. Elalamy (Paris, France) OC6-5 Application of 3 tesla blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) to study oxygenation of the kidney in renovascular disease M. L. Gloviczki, J. Glockner, J. P. Grande, L. O. Lerman, S. C. Textor (Rochester, USA) OC6-6 Duplex guided angioplasty of arteriovenous fistulae for hemodialysis: retrospective study of 45 patients in a French univeristary hospital A. Dessi, C. Seinturier, O. Pichot, E. Cochet, P. H. Carpentier, C. Sessa (Grenoble, France) OC6-7 Klippel-Trenaunay-Weber syndrome and epithelioid angiosarcoma. a rare association J. Pereira Albino, A. Simas, C. Matos, G. Sobrinho, V. Brotas, N. Meireles, G. Clara (Lisbon, Portugal) 22 ~
- 23. 15:30 - 16:00 Break - Exhibition visit Room 8 16:00 - 17:30 SY15 - Joint Symposium Eurochap - Microcirculation Amphitheatre Lavoisier relationship between macro and microcirculation Chairpersons: B. Levy (Paris, France), H.A.J. Struijker-Boudier (Maastricht, the Netherlands) s The development of microvascular networks F. Le Noble (Berlin, Germany) Sy15-2 s Modulation of small artery flow: wall remodeling and perivascular adipose tissue A. Greenstein (Manchester, United Kindom) Sy15-3 s Relationship between macro- and microcirculation P. Boutouyerie (Paris, France) s Match and mismatch between large arteries and microcirculation G. London (Paris, France) 16:00 - 17:30 OC7 - Free Oral communications - Venous disorders Room 262 Chairpersons: F. Allaert (Dijon, France), M. Jezovnik (Ljubljana, Slovenia) OC7-1 Treatment of venous stasis ulcer, through cell therapy with keratinocyte autograft in patients users of micronized diosmin and hesperidin A. Guillaumon, C. Bosnardo, M. B. Puzzi, J. Rheder (Campinas, Brazil) OC7-2 Assessing mesoglycan treatment efficacy in 1483 outpatients with chronic venous insufficiency C. Allegra, P. L. Antignani (Rome, Italy) OC7-3 Clinical and haemodynamic sequelae of deep venous thrombosis F. Pollice, P. Pollice, M. Sansone (l’Aquila, Italy) OC7-4 Post-surgical vein thrombosis and onset of post-thrombotic syndrome: influence of 4G/5G polymorphism F. Ferrara, C. Amato, F. Meli, I. Muratori, M. Lunetta, I. R. Alcamo, S. Novo (Palermo, Italy) OC7-5 Anatomical description of the ostial valve in the saphenofemoral junction C. Tasch, L. Larcher, E. Brenner (Schongau, Germany - Feldkirch, Innsbruck, Austria) OC7-6 Meta-analysis approach of the effect of venoactive drug on ankle circum-ference in CVD patients F. Allaert (Dijon, France) OC7-7 Inflammation - pathogenetic mechanism of venous thrombosis M. Jezovnik, P. Poredos (Ljubljana, Slovenia) www.iua-eurochap2010.eu ~ 23
- 24. C ONGRESS MAP 24 ~
- 25. E HIBITION PLAN Stand Exhibitors N° 1 KREUSSLER PHARMA N° 2 AD REM TECHNOLOGY - VEINOPLUS N° 3 LABORATOIRES INNOTHERA N° 4 PIERRE FABRE N° 5 MINERVA MEDICA N° 6 SIGVARIS N° 7 PERIMED Stand Exhibitors N° 1 KREUSSLER PHARMA N° 2 AD REM TECHNOLOGY - VEINOPLUS N° 3 LABORATOIRES INNOTHERA N° 4 PIERRE FABRE N° 5 MINERVA MEDICA N° 6 SIGVARIS N° 7 PERIMED N° 8 DANISH MYO TECHNOLOGY A/S N° 9 WILEY BLACKWELL N° 10 ADINSTRUMENTS LTD N° 11 IMMUNDIAGNOSTIK AG N° 12 CELLIX LTD N° 13 RHEO MEDITECH, INC N° 14 MOOR INSTRUMENTS N° 15 LIVING SYSTEMS INSTRUMENTATION www.iua-eurochap2010.eu ~ 25
- 26. SympOSia at 178€ based upon all cause mortality. This is lower than 1/10 of the costs in the well-known implemented cancer programs. Sy 1 - abdominal aortic aneurysms: an update In all, offering men aged 65-74 years screening for AAA seems acceptable according to criteria from Council of Europe, however Sy1-1 patHOGeNeSiS OF abdOmiNaL aOrtiC nation-wide implementation in Europe is only ongoing in UK. aNeUrySmS E. ALLAIRE1 Sy1-3 tHe LONG-term reSULtS OF tHe eVar i 1 Department of Vascular Surgery, Henri Mondor Hospital, Créteil, triaL France J. T. POWELL1 1 Vascular Surgery Research Group, Imperial College at Charing Abdominal aortic aneurysms (AAAs) form and rupture because of Cross, St Dunstan’s Road, London W6 8RP, UK the destruction of aortic extracellular matrix digested by an excess of proteinases. Some of these proteinases are activated by the plasmin The 3 published randomised trials comparing elective endovascular pathway. Inflammatory cells infiltrating the aortic wall are important versus open repair for abdominal aortic aneurysms have been sources of proteinases. Other cells – endothelial, vascular smooth remarkably consistent in showing a 3-fold 30-day operative survival muscle cells- are other putative sources. An important specificity of benefit of endovascular aneurysm repair (EVAR)1-3. These trials AAAs is the disappearance of vascular smooth muscle cells (VSMCs) (EVAR-1, DREAM and OVER) also have reported mid-term results, in the media layer, which may impair adequate wall repair. In addition, with survival rates to between 2 and 4 years after randomisation4;5. VSMCs produce TGF-beta1 and inhibitors of proteinases, thereby However the long-term follow of the EVAR trials6;7 has yielded some protecting the aortic wall against inflammation and proteolysis. Lack surprises. of VSMCs may turn the aortic wall into a structure vulnerable to The EVAR 1 trial randomised patients with large aneurysms (at least 5.5 inflammation-driven proteolysis. cm in diameter, anatomically suitable for EVAR) to either endovascular Recent data have linked the formation of a luminal thrombus and AAA repair or open repair. After 8 years of follow-up, 54% remained alive, expansion. The surface of the thrombus promotes the recruitment of exactly the same proportion in those randomised to EVAR as in those polymorphonuclears which deliver an excess of proteases to the wall. randomised to open repair: EVAR was not associated with a long-term The atrophy of AAA wall is in fact more severe at sites of thrombus survival benefit6. Therefore, other long-term outcomes assume greater accumulation. The exact mechanisms by which AAAs rupture remains importance to more than half of the patients, particularly the new poorly documented. The accumulation of destructive factors is focal endograft-related complications reported throughout follow-up. The at site of rupture, suggesting a very local phenomenon. Recent report reporting of new endograft-related complications was highest within suggest that inflammation may not be the main feature of ruptured the first 6 months of aneurysm repair (22.9 new complications per 100- areas, but rather excessive angiogenesis. patient years of follow up), reducing to 3.4 new complications per 100- A last striking feature is that patients with AAAs associated to patient years of follow up between 6 months and 4 years, with weak atherosclerosis have generalized “atrophy” of vessels distant to the evidence that rates might start to increase again after 4 years. There is main lesion, and that other tissues of these patients heal poorly. Recent other evidence to indicate that EVAR might not be as durable as open data from our laboratory suggest that mechanisms of healing of tissues repair. There were 25 secondary ruptures after EVAR, the majority under strain are altered in these patients. This observation may help (72%) of which proved to be fatal. In contrast, there were no secondary identify new molecular and genetic factors linked to this deadly aortic ruptures reported after open repair. disease. The promotion of aortic healing represents an innovative These endograft ruptures appear to explain the erosion of the statistically approach for future treatments alternative to interventional techniques. significant 3% aneurysm-related survival benefit for EVAR versus open repair, observed during the first 4 years of follow up5. Sy1-2 SCreeNiNG FOr abdOmiNaL aOrtiC These long-term results question the durability of EVAR and for the aNeUrySmS moment there is no better evidence. Or is perhaps the durability of J. S. LINDHOLT1 EVAR acceptable but with the general aging of the population, the 1 Vascular Research Unit, Viborg Hospital, Denmark durability of the aorta is not adequate? References AAA includes an asymptomatic phase with a relatively low-risk (1) EVAR Trial Participants. Comparison of endovascular aneurysm repair with treatment, compared with the symptomatic phase, which is a good open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day argument to consider screening. However, all criteria formulated by operative mortality results: randomised controlled trial. Lancet 2004; 364:843- 848. the Council of Europe must be fulfilled; Ultrasonographic screening is (2) Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm a valid, suitable and acceptable method of screening as the estimated R et al. A randomized trial comparing conventional and endovascular repair of sensitivity and specificity is 98% and 99%, respectively, acceptance abdominal aortic aneurysms. N Engl J Med 2004; 351:1607-1618. rates are above 75%, and 95% accept control scans. The offer of (3) Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT, Jr., Matsumura JS, screening for AAA causes transient, mild reactions of fear, but repeated Kohler TR et al. Outcomes following endovascular vs open repair of abdominal screening seems only required in 5% of the initially negative findings. aortic aneurysm: a randomized trial. JAMA 2009; 302:1535-1542. Evidence based large scaled randomised trials have identified 5.5 cm (4) Blankensteijn JD, de Jong SE, Prinssen M, van der Ham AC, Buth J, van as cut point for repairing asymptomatic AAA, and survivors enjoy the Sterkenburg SM et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005; 352:2398-2405. same quality of life as the general population of the same age, and it (5) EVAR Trial Participants. Endovascular aneurysm repair versus open repair in seems that only 2-5% of patients refuse an offer of surgery. patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled Finally, the benefits of screening must outweigh the costs. All four trial. Lancet 2005; 365:2179-2186. existing randomised trials are reporting benefit of screening of men (6) The UK EVAR Trial Participants. Endovascular versus open repair of aged 65 and above, and the pooled mid-term and long term relative risk abdominal aortic aneurysm. N Engl J Med 2010; 2010;362:1863-70. reduction is both around 50%, and 2% reduction in overall mortality. (7) The UK EVAR Trial Participants. Endovascular repair of aortic aneurysm in Cost effectiveness have proven attractive in the large MASS trial, and patients physically ineligible for open repair. N Engl J Med 2010; 362:1872-80 recently the Viborg Study reported after 14 years that the number needed to screen to save one life was just 135, the frequency of emergency operations due to rupture was significantly reduced by 56%. The cost per life year gained could be calculated at 157€ and the cost per QALY 26 ~
- 27. Sy1-4 mediCaL apprOaCH tO tHe patieNt WitH Sy2-2 NeW StrateGieS tO imprOVe COmpLiaNCe aN abdOmiNaL aOrtiC aNeUrySm OF COmpreSSiON tHerapy (20-36 mmHG) F. BECKER1 D. RASTEL1, E. LE FLOCH2, B. LUN3 1 Division of Angiology and Hemostasis, Department of Internal 1 Grenoble, France Medicine, University Hospitals of Geneva, Geneva, Switzerland 2 Paris, France 3 Saint-Just Saint-Rambert, France Until recently, abdominal aortic aneurysm has only been seen through an immutable progression and a very high mortality in case of rupture. Compression therapy (CT) is one of the key treatment of deep and In this frame any AAA discovered was monitored by imaging as superficial venous disorders. CT based on Medical compression long as the surgical benefit versus risk of rupture was in favor of a stockings (MCS) is generally preferred to bandages thanks to the preventive surgery. The threshold diameter of the AAA being at better control of the delivered pressure. Nervertheless, it is admitted 50 mm. that the compliance to MCS remains insufficient due to difficulties to Nevertheless, -firstly when analyzing the causes of death of patients put on, to wear and to remove MCS. In a recent survey among French with AAA, the AAA rupture is not the main cause, it may even be the phlebologists (MCS with 20-36mmHg at the ankle; alias french class last one, -secondly the operative mortality in scheduled surgery for 3), 21.4% of patients are uncompliant, 70.4% have difficulties to put on AAA is largely due to pre-existing co-morbidities, -thirdly even if we and 25.4% feel discomfort. have no evidence-based drug to slow the progression of AAA, actions Then, new strategies of research have been conducted to improve against some reducible factors (like smoking and sedentariness) are compliance to MCS over long term periods of treatment such as it is likely to slow the AAA progression rate. required to treat post thrombotic syndrome or severe venous pathologies. Faced with a patient who has just been discovered a AAA <50 mm One of the key point for compliance is the putting on process where its AP, we must not only monitor the evolution of AAA by scheduled main parameter is fabric friction factor at the level of the instep and the ultrasound examinations, we must act on cardio-vascular risk factors ankle. So, the objectives of the strategy was to reduce friction. and on co-morbidities that are able to exacerbate the potential surgical This was driven through different studies: risk. In particular, smoking cessation, improvement of respiratory 1 - To improve our knowledges on skin-MCS interface, coefficent function, regular exercise... are probably as important as the repeated of friction and secondary skin parameters. In brief, hydration imagings. It is probably also useful to inquire about the relatives over (corneometer®), micro-structure (Visioscan®), water loss (Tewameter®), 50 years of the patient. elasticity (Cutometer®) have been measured. 2 - To optimise the ergonomic description of patients’ body movements SY 2 - Efficient compression therapy to treat venous during putting on and pulling off processes, a biomechanician approach diseases: scientific, medical and practical key factors have been considered. Muscle activities were investigated using surface (Corporate Symposium - Sigvaris) electromyography measurements. We concluded that muscle activity of the thumb is mainly involved in putting on and muscle groups of Sy2-1 COmpreSSiON tHerapy iN CHrONiC VeNOUS shoulder in removing MCS. diSOrderS: a briGHt FUtUre reQUiriNG maNy 2 - To facilitate the putting on process (slippy aspect), improvement eFFOrtS (yarns selection) and innovation (dynamic in elasticity) in MCS P. CARPENTIER1 concept and design were implemented («EXPERT» from SIGVARIS). 1 Centre de Recherche Universitaire de La Léchère (73210), France Conducted on a pannel of 30 patients in different situations (comparative test) we noticed that for 79% putting on is improved and 93% felt Although compression therapy is increasingly acknowledged as the confortable with this new MCS. cornerstone of the treatment of patients with chronic venous disorders (CVD), its use in everyday practice is far from satisfactory, and Sy2-3 COmpreSSiON aFter SCLerOtHerapy many efforts have to be developed by the manufacturers, the vascular P. KERN1 scientists, the attending physicians and the patients in order to get the 1 Private office of vascular medicine in Vevey, Switzerland potential benefit that can be drawn from this major therapeutic tool: - Patients have to appropriate their compression device, to learn how to As recommended in the guidelines of the German Society of use and to look after it, and to adapt in some way their lifestyle to the Phlebology most specialists apply compression after sclerotherapy treatment, all objectives that are nothing short of difficult and require of saphenous varicose veins and collaterals. Applying an extrinsic knowledge, skills and motivation, which means that compression selective compression associated with compression bandage after therapy requires specific therapeutic education programs. sclerotherapy of the great saphenous vein significantly enhances results - Physicians have to play their role in these therapeutic education at 2 years (echographic recanalisation 11 vs 23%, respectively)1. On programs, and already the prescription process is one first important the contrary, short term (< 6 weeks) results and incidence of side step for building motivation, insuring the adequacy of the device to effects are not influenced by compression (low grade 15-20 mmHg the vascular status of the patient and for customizing it to its personal medical compression stocking (MCS)2, or 5 days instead of one day needs: education of the physicians is also necessary. compression bandages3). - A lot of work is needed from the vascular scientists who have yet In the setting of telangiectasias, several studies demonstrated a to validate the efficacy of compression stockings in some important beneficial effect of wearing MCS after sclerotherapy. This was shown indications such as venous edema, and to define the optimal pressure for telangiectasias greater than 0.5 mm in diameter4. The best effects and stiffness for each clinical situation through adequate therapeutic were observed in patients wearing MCS 20-30 mmHg for three trials, in order to make the use of compression stockings quite an weeks5. Recently, this benefit was confirmed by a prospective study6. evidence-based practice. After one session of sclerotherapy for telangiectasias on the lateral - The acceptability (esthetics, comfort, easiness to handle) and physical aspect of the thigh (C1A or SEPASPN1), 100 patients were randomized properties of the compression have very much improved during the last either to daily 23-32 mmHg MCS for three weeks or no compression. decade. However, a lot remains to be done from the manufacturers in Objective rating of vessel disappearance was significantly better this respect, and they also have to play their role in the promotion of after compression (p= .026). Poor results were more frequent in the the therapeutic trials. no compression group (43% versus 24%). Micro-thrombi were less All these efforts, and their coordination, are necessary to make prevalent in the compression group. Finally, a subsequent study7, compression therapy more effective in real life. comparing 1 to 4 week MCS, showed a significant reduction of post- www.iua-eurochap2010.eu ~ 27
- 28. sclerotherapy pigmentations whenMCS was worn for 4 weeks. J. FERNANDES E FERNANDES1 In conclusion, even if the usefulness of MCS wearing after sclerotherapy 1 Faculty of Medicine, University of Lisbon, Hospital Santa Maria and of saphenous veins seems to be more obvious, it’s efficacy at present Lisbon Cardiovascular Institute, Lisbon, Portugal is less well documented in this indication than after sclerotherapy of telangiectasias. Severe carotid bifurcation stenosis is a major cause of stroke in the References: western population. Carotid Endarterectomy (CEA) has been shown to 1- Ferrara F, Bernbach HR, La compression écho-guidée après sclérothérapie. reduce stroke risk in stenosis >70% for symptomatic and asymptomatic Phlébologie 2009 ; 62 : 36-41 patients (ECST; NASCET, ACAS and ACST) and became the 2- Hamel-Desnos C; Guias BJ, Desnos PR, Mesgard A. Foam sclerotherapy of established procedure for the treatment of severe carotid bifurcation the saphenous veins. Randomised controlled trial with or without compression. disease, because combined mortality and neurological morbidity Eur J Vasc Endovasc Surg. 2010 Apr; 39: 500-7 3- O’Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinical trial of were inferior to best medical treatment. Reduction of surgical risk different bandage regimens after foam sclerotherapy for varicose veins. Br J and improvement on durability of CEA resulted from judicious use Surg. 2010 May; 97: 650-6. of indwelling shunts during endarterectomy and systematic use of 4- Goldman MP, Beaudoing D, Marley W, Lopez L, Butie A. Compression in patch closure. Per-operative quality control of CEA adequacy has been the treatment of leg telangiectasia: a preliminary report. J Dermatol Surg Oncol. associated with reduction of neurological events as confirmed by our 1990; 16:322-5. own experience of systematic completion assessment of CEA with per- 5- Weiss RA, Sadick NS, Goldman MP, Weiss MA. Post-sclerotherapy operative colour-flow Duplex Scan. compression: controlled comparative study of duration of compression and its Carotid Angioplasty and Stenting (CAS) a less invasive procedure, not effects on clinical outcome. Dermatol Surg 1999; 25:105-8. 6- Kern P, Ramelet A-A, Wütschert R, Hayoz D. Compression after sclerotherapy requiring surgical intervention, has been suggested as an alternative for for telangiectasias and reticular leg veins: a randomized controlled study. J Vasc treatment of carotid stenosis. Surg 2007; 45: 1212-16. Recently published RCT’s (EVA-3S, SPACE and ICSS) comparing 7- Nootheti PK, Kristian MC, MagpantayA, Goldman MP. Efficacy of graduated CAE and CAS in symptomatic >70% stenosis have provided evidence compression stockings for an additional 3 weeks after sclerotherapy treatment that CAS is associated with higher incidence of ipsilateral stroke, of reticular and telangiectactic leg veins. Dermatol Surg 2009; 35: 53-8. increased incidence of silent brain infarcts as assessed by DW NMR (ICSS) and concluded that CEA should continue as the procedure of Sy2-4 tHe eFFeCtS OF mediCaL COmpreSSiON choice for symptomatic patients. StOCKiNGS ON VeNOUS aNatOmy Asymptomatic carotid disease is a relatively benign disease with a stroke J. - F. UHL1, 2 risk of 3%/year as suggested in natural history studies and is a marker 1 URDIA research unit, EA4566 University Paris Descartes, Paris, of cardiovascular disease. Reported CAS results in asymptomatic France stenosis are constantly associated with neurological morbidity > 3%, 2 Vascular surgeon, 113 av. victor Hugo, 75116 Paris, France with non-negligible restenosis rate, thus casting doubts on its real efficacy and CEA to be really effective must have a surgical risk < 3% Objective: to study the effects of medical compression stockings (MCS) (AHA Guidelines). on both the superficial and deep veins veins of the lower limbs. Increased stroke risk in asymptomatic stenosis is associated with plaque methods: The spiral CT with 3D reconstruction of the lower limbs vulnerability as assessed by its echogenicity, plaque structure analysis (with or without injection) is an accurate method to assess the 3D shape and evidence of progressing stenosis on repeated Duplex examinations. of the leg and the diameter of the superficial/deep veins. It is possible Non-invasive evaluation of plaque activity provided by the Activity to obtain a realistic 3D model of the leg and its anatomical structures. Index was shown to identify asymptomatic stenosis with higher risk That makes possible to evaluate the interface pressure and effects due of developing neurological events thus improving selection of patients to the compression stockings. Technical limits: exposition to X rays, that will benefit of carotid interventions to prevent stroke. a venous injection is usually not advisable, and this exam is strictly Therefore, a study in asymptomatic patients at high risk of stroke is limited to the lying position. required comparing interventional procedures (CEA and CAS) with a The MRI in standing position in T2 is a more informative protocol. subgroup of patients under well established contemporary best medical The Duplex US through a stocking with a transparent window is treatment. another way to assess both the anatomical and hemodynamical effect of the MCS on the veins. Sy3-2 CarOtid SteNOSiS: pLaCe OF CarOtid results: According to the Laplace’s law, the modifications of the shape SteNtiNG of the leg i.e cross sections at different levels, give a radius for each J. L. MAS1 location, and so different interface pressures all around the limb. 1 Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, The results of these theoretical values of the interface pressure are Paris, France close to the real values measured at the same location by a probe: the compression of the saphenous veins in lying position is observed below Large randomized clinical trials (RCTs) have shown that the addition the knee providing the pressure at the ankle (B point) is at least 25 mm of endarterectomy to medical therapy is effective in reducing the risk of Hg. It is not possible to make a compression of the veins at the thigh of stroke among patients with severe carotid stenosis. At present, RCTs level without a pad. in patients with symptomatic carotid disease show inferior results of Conclusion: The Laplace law and the interface pressure work well stenting compared to surgery with regard to the risk of stroke or death regarding the superficial veins. But, in reality, the problem is much within 30 days of treatment. more complex regarding the effect of MCS on the deep veins: during Both methods of treatment seem to have similar efficacy at preventing the muscular contraction, they act like an extra aponeurosis and seem mid/long-term ipsilateral stroke after the treatment period, but with to play an important role even for a lower pressure interface. wide confidence intervals, despite a significantly higher incidence Key words: Multisclice CT - MRI - interface pressure - MCS of restenosis in patients treated with stenting. Longer follow-up is needed to assess the impact of the potentially higher rate of recurrent Sy 3 - Carotid stenosis: moving concepts and practices stenosis after stenting compared with surgery on late recurrent stroke. To improve the risk-benefit profile of stenting, it is crucial to establish Sy3-1 tHe SUrGiCaL treatmeNt OF CarOtid which factors among patient characteristics and the procedure itself SteNOSiS: NeW iNFOrmatiON FrOm reCeNt triaLS are associated with a high risk of stroke after carotid stenting. Recent aNd WHat iS reQUired FOr FUtUre StUdieS meta-analysis show a striking age-related difference with equivalent 28 ~
- 29. risks of strokeor death after stenting and surgery below the age of 70 clinical features and a model of stenosis combined with clinical and and a two-fold increase in risk of stenting over endarterectomy above plaque features were 0.59 (95% CI 0.54 to 0.64), 0.66 (0.62 to 0.72) this age. and 0.82 (0.78 to 0.86) respectively. RCTs in patients with asymptomatic stenosis have shown that the In the last model, stenosis, history of contralateral TIAs or stroke, GSM, absolute benefit of endarterectomy versus medical treatment alone is plaque area and DWA were independent predictors of ipsilateral CORI small, especially in women. In addition, there is growing evidence that events. Combinations of these could stratify patients into different the risk of ipsilateral stroke without surgery has been going down to levels of risk for ipsilateral CORI and stroke, with predicted risk close <1% per year, thanks to more effective medical therapy. If stenting to observed risk. Of the 923 patients with ?70% stenosis, the predicted is associated with an excess procedural risk of stroke (as it probably cumulative five year stroke rate was <5% in 495, 5-9.9% in 202, is), this excess risk will probably erode or nullify the small benefit of 10-19.9% in 142 and ?20% in 84 patients. revascularisation versus medical treatment alone. Therefore, the right Thus, cerebrovascular risk stratification is possible using a combination question may be whether carotid stenting (or surgery) further reduces of clinical and ultrasonic plaque features. stroke risk in patients who receive best medical therapy. SY 4 - Early detection of the high vascular risk subjects Sy3-3 StrOKe aNd tHrOmbOLytiC tHerapy. aN Update Sy4-1 SCreeNiNG FOr pad iN tHe GeNeraL V. LARRUE1 pOpULatiON 1 Department of Vascular Neurology, University Hospital of Toulouse, V. ABOYANS1 Toulouse, France 1 Vascular Unit, Dupuytren University Hospital, Limoges, France Fifteen years after demonstration of its efficacy intravenous thrombolytic Over these last 25 years, the clinical and epidemiological studies have therapy with alteplase remains the only validated treatment of acute clearly shown that PAD is a frequent condition in general population, ischemic stroke. The efficacy of treatment is strongly time dependent. and the subjects affected even by its asymptomatic form are at high risk It has been demonstrated up to 4.5h of stroke onset and efficacy rapidly of death and cardiovascular events. As for the population screening of decreases within this time frame. any life-threatening disease, screening for PAD should follow specific Safety of intravenous thrombolysis for stroke in clinical practice has conditions: the screening method should be accurate, robust, safe, been confirmed by large phase IV studies. Implementation of this well-accepted, cost-effective and it should be followed by a successful treatment is however still a challenge in many areas because it requires medical intervention to improve the prognosis in case of positive test. expertise in both clinical neurology and brain imaging interpretation. The ankle-brachial index is the most widely-used tool to detect PAD, In addition, the efficacy of intravenous thrombolysis remains uncertain because it presents the five former characteristics enlisted above. The in important subgroups such as patients over 80 years. key and unresolved issue remains the management of asymptomatic Intravenous thrombolysis with alteplase is poorly effective in patients PAD. Further studies are necessary to assess the successful strategies with large vessel occlusion. Additional or alternative therapies are which may definitely validate the population screening for PAD. currently evaluated in these patients. These include thrombolysis acceleration with transcranial ultrasound, intra-arterial administration Sy4-2 aSymptOmatiC CarOtid LeSiONS prediCt of fibrinolytics, and embolectomy with mechanical devices. GLObaL CardiOVaSCULar riSK beyONd tHe CardS OF tHe riSK Sy3-4 aSymptOmatiC CarOtid SteNOSiS aNd riSK S. NOVO1, P. CARITA1, C. VISCONTI1, E. CORRADO1, StratiFiCatiON I. MURATORI1, G. NOVO1 A. NICOLAIDES1 (for the ACSRS study group) 1 Center for the Early Diagnosis of Preclinical and Multifocal 1 Department of Biomedical Sciences - University of Cyprus, Nicosia, Atherosclerosis, Division of Cardiology, University Hosp., University Cyprus of Palermo, Italy Best evidence indicates that the annual risk of ipsilateral cerebral Atherosclerotic Cardiovascular Disease (CVD) is the biggest cause stroke in patients with moderate-severe asymptomatic internal carotid of morbidity and mortality worldwide and remains the major threats stenosis (ACS) receiving optimal medical intervention alone has to the future public health of multiple countries. Decades of research fallen to approximately 1% making routine carotid endarterectomy have determined that atherosclerosis develops insidiously, being unjustified. However, if patient subgroups with sufficiently higher advanced by the time that symptoms occur. In healthy subjects, the average risk, despite current optimal medical intervention, could be atherosclerotic process is the product of a number of genetic, social, reliably identified, then carotid surgery may still be justified. physiological and environmental factors and a comprehensive The ACSRS performed under the auspices of the IUA was a prospective, approach to prevention would address all of these. Risk Factors may multicentre, cohort study of patients undergoing medical intervention be defined as conditions casual-linked to ATS and can be divided in for vascular disease that has answered this question. Hazard ratios for traditional (modifiable and not modifiable) and emerging. Recently, stenosis, clinical features and plaque texture features associated with various biomarkers of inflammation have also been increasingly ipsilateral cerebrovascular or retinal ischemic (CORI) events were investigated as possible indicators of increased cardiovascular risk. calculated using proportional hazards models. Several seemingly modest RF may, in combination, result in a much 1121 patients with 50-99% asymptomatic ICA stenosis in relation to the higher risk than an impressively raised single factor. This means bulb (ECST method) were followed-up for 6-96 (mean 48) months. A that the RF may interact to increase risk into a logarithmic way. For total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, these reasons, risk estimation systems have been developed to assist systolic blood pressure, increased serum creatinine, smoking history clinicians to assess the effects of several risk factors combinations in of more than 10 pack-years, history of contralateral TIAs or stroke, planning cardiovascular preventive strategies. The various countries low gray scale median (GSM), increased plaque area, plaque types 1, 2 use different systems in order to respect the different populations of and 3 and presence of discrete white areas without acoustic shadowing reference, in example the Progetto Cuore (ISS) aims at estimating the (DWA) were associated with increased risk. risk in Italian population. Each score system should consider a broader ROC curves were constructed for predicted risk versus observed CORI perspective and attempt to estimate the «global» cardiovascular risk events as a measure of model validity. The areas under the ROC curves (GCVR) of developing a first adverse CV event in the following ten for a model of stenosis alone, a model of stenosis combined with years by evaluating several traditional RF. The most recent guidelines www.iua-eurochap2010.eu ~ 29
- 30. recommend the useof risk assessment tools to help identify individuals Fundoscopy has been forgotten last years in hypertension clinics. at «high» risk, who could benefit from therapeutic intervention, before However, recent papers have indicated that the image seen by visual making clinical management decision. However, the term global risk inspection, can be digitised and fed into the computer providing very estimation is perhaps a misnomer, as no system accommodates all well quantifiable information. known risk factors. Furthermore, many evidences indicate that the non Conclusion: total cardiovascular risk is regularly defined by risk factors invasive evaluation of signs of preclinical atherosclerosis could help to or organ damage. Sub clinical organ damage could bring in a lot of better define the pattern of risk in asymptomatic subjects. The risk of new information on long term prognosis. This is particularly the case CV events in patients with preclinical atherosclerotic lesions is higher when several bits of sub clinical changes occur together. Analysis of than in the controls. The preclinical ATS is, indeed, an early stage of these changes could open the way for much earlier prevention and this process: it is characterized by a minimal damage (then potentially treatment. susceptible to correction) and, above all, indicates a multifocal disease. In these regards, the ultrasound evaluation of Intima-media thickness Sy4-4 atHerOSCLerOSiS aNd VeNOUS tHrOm- and/or asymptomatic plaque of carotid arteries it’s a high sensitive and bOSiS tHe Same diSeaSe eNtity WitH tWO diF- specific method. In a recent study we aimed at determining the effects FereNt FaCeS of including carotid IMT and ACP evaluation on the accuracy of CV P. POREDOS1, M. K. JEZOVNIK1 prediction. Our intention was to investigate if a new model of risk 1 University Clinical Centre Ljubljana, Department of Vascular stratification incorporating the IMT/ACP beyond the risk variables of Diseases, Zaloska 7, SI-1000, Ljubljana the «Progetto Cuore» could more accurately predict the GCVR in 454 [215 male and 239 female] asymptomatic subjects. After a five-year In past decades studies have indicated that there is an association follow-up, overall CV major events occurred in the 13% of subjects between atherosclerotic and venous thrombembolic disease (VTE). (n=62) and none of the traditional RF evaluated was alone able to This presumption is supported by similar or identical risk factors for predict events. We reported a strong association between presence of both diseases and common pathogenetic mechanisms. Some studies preclinical carotid ATS and rate of events. In more details, in the group have shown also that patients with VTE are at increased risk for of subjects at GCVR < 20% total events occurred in the 8% of subjects atherosclerotic thrombembolic events. with normal ultrasound findings, in the 13% (n=14) with increased We investigated if in patients with idiopathic VTE the prevalence IMT and in the 15% (n=23) with ACP (p < 0.012). We showed that of preclinical indicators of atherosclerosis (increased intima-media in managing subjects at «low-intermediate risk» (that currently has thickness-IMT, number of atherosclerotic plaques is higher than in poor propabilities to receive complete informations and therapies for healthy subjects. Further we studied flow mediated endothelium cardiovascular prevention), the evidence of signs of asymptomatic dependent (FMD) vasodilatory response of brachial artery in both IMT or ACP, could provide further informations in improving their risk groups of investigated subjects. Forty-nine patients with idiopathic prediction. Similarly, in another study (enrolling 558 asymptomatic VTE of both sexes (mean age 52.3 ± 14.3) and 48 age-matched healthy patients) after a ten-year follow-up we reported that although the overall controls were included. Using ultrasound carotid and femoral arteries incidence of a first CV event reflected the different risk profiles (4, 14, were investigated and IMT as well as the presence of atherosclerotic and 20%, respectively), the rate of events increased to 35, 46, and 63%, plaques and their thickness were determined. Flow mediated respectively in those patients with baseline evidences of preclinical vasodilatory response was studied by the determination of changes of ATS. Furthermore, at the multivariate analysis asymptomatic carotid the diameter of brachial artery during reactive hyperaemia. lesions significantly influenced the incidence of events. According to Intima-media was on average and in all investigated beds significantly our and other similar results, the carotid pre-ATS could be a marker of thicker in patients than in controls (0.94 mm ± 0.29 mm vs 0.71±0.15 «additional» risk. mm, p< 0.001). In patients with VTE a higher prevalence of atherosclerotic plaques was registered. Furthermore, total plaque Sy4-3 earLy marKerS iN HyperteNSiON: OFteN thickness was significantly higher in patients than in controls. OF VaSCULar OriGiN! Compared to the control group FMD was significantly reduced in the D. L. CLEMENT1 group of patients: 4.9% (95%CI 1.1-8.7%) vs. 12.7% (95%CI 7.8- 1 University of Ghent, Ghent, Belgium 17.6%), p<0.001. Patients with VTE had also significantly reduced endothelium independent dilation of the brachial artery. Functional The reappraisal of the 2007 guidelines on the management of and morphological deterioration of arterial wall were interrelated. Hypertension have emphasised the importance of estimating total Furthermore, FMD was related to circulating indicators of endothelial cardiovascular risk. Even minor blood pressure elevation, can become dysfunction. a major treat in case also other risk factors are present. The findings of our study show a close interrelationship between Last years reflections along this line has gone even further. Even minor the presence of the idiopathic VTE and preclinical atherosclerotic degree of organ damage, when added to other risk factors or minor deterioration of the peripheral arteries. This means that patients with disease, can lead to a seriously total increased risk. This reasoning has VTE have simultaneous deterioration of the arterial and venous wall focused all attention in hypertension to organ damage, even when it has and that there is a close relationship in the development of both not yet come to a clinically level; therefore the term of «subclinical» diseases. organ damage is being used. Microalbuminuria is a good marker of early changes in kidney Sy 5 - therapeutic education of the vascular patient function. The test is quite easy and normal limits rather well defined. Cost effectiveness score is excellent and there is good correlation to Sy5-1 tHerapeUtiC edUCatiON OF tHe patieNt prognosis. However, clinicians still underuse the technique. WitH peripHeraL arteriaL diSeaSe The electrocardiogram is largely alike at the level of the heart. ECG P. H. CARPENTIER1 is cheap and very easy to perform. Recent information shows that 1 Department of Vascular Medicine, Grenoble University Hospital, prognostic information can be obtained even when amplitude of R F-38043 Grenoble cedex, France waves is falling in between «normal» values. Ankle brachial artery pressure index (ABI) is to be seen in the same Patients with peripheral arterial disease are expected to control their risk context. Besides its diagnostic capacities, it has a very strong correlation factors, to be compliant with non symptomatic long term treatment and to long term prognosis. Recent data point out the value of ABI also to be able to detect any warning sign for a complication. This cannot when it falls just around normal limits. be achieved only by the usual information delivered by the physician 30 ~
- 31. during a classicalmedical consultation. It is the aim of therapeutic and any mean able to improve the quality of life is welcome. In order education is to modify the behavior of the patient in order to obtain the to address these needs, several educational programs for voluntary required changes in lifestyle, to help him to cope with the disabilities patients were developed in French spa resorts with some improvements related to his disease or its treatment, and to make him an active partner over the years. Initially focused on the promotion of a better knowledge in the management of his disease. in venous disease by the patients, by the time the educational programs A program called “Let’s Walk” was developed by the vascular medicine developped towards a more customized approach to the needs of each teams of Grenoble and Montpellier with the collaboration of a group patient. of patients with arterial claudication. The educational course was made The first one named «Ecole de la veine» started 15 years ago in the of three face to face educational consultations and five workshops spa resort of La Léchère, with topics approached during interactive where small groups of patients were interactively informed about the work-groups. A series of patients showed improved knowledge and risk factors, the natural history and the treatments of peripheral arterial compliance to compression therapy in the short term. disease and atherothrombosis, and motivated for a better control of «Veinothermes» was developed two years ago by a multiprofessional physical activity, dietetics and other needed lifestyle modifications. A group with the help of referent patients. The program combines three preliminary evaluation of the 90 first patients showed that only two educational workshops and an individual education consultation third of the patients completed the whole educational course, but that aiming at the selection of objectives for the patient to be achieved this group experienced a significant increase of knowledge, motivation, within three months. A systematic evaluation of the first 94 patients self-perceived health status and physical activity. This program is showed significant behavioural changes, including an improvement of currently available in 12 other French centers. compliance to compression therapy and of quality of life. A third programme was experimented for persons with a recent history Sy5-2 edUCatiON OF tHe patieNt WitH VeNOUS of proximal deep vein thrombosis with a six days training course tHrOmbOembOLiC diSeaSe combining four educational workshops and a specific rehabilitation P. LEGER1 program using spa therapy. 1 Clinique Pasteur, Toulouse, France These experiments with CVD show that it can be useful for this category of chronic vascular patients, and desserve a larger application. Therapeutic patient education is a crucial factor in the therapeutic management of patients with thromboembolic disease. Sy 7 - New insights about the calf muscle pump function Education has been structured and modeled. Many recommendations regarding the role of the trainers, as well as the role and implementation Sy7-1 patHOpHySiOLOGy OF tHe CaLF mUSCLe of Education in the treatment of chronic diseases, are available. pUmp Therapeutic education of patients with thromboembolic disease is A. NICOLAIDES1 mainly focused on anticoagulation treatment. 1 Department of Biomedical Sciences - University of Cyprus, Nicosia, The objectives of Education are numerous: Cyprus - To avoid hemorrhagic and thrombotic events, - To train the patient on how to manage his treatment with VKA through The lower limb venous return consists of three muscle pumps in a comprehensive patient-centred approach series: foot, calf and thigh. Stepping on the ground empties the venous - To emphasize the «patient-actors» concept by sharing knowledge plexus of the foot into the calf (priming) and subsequent contraction and expertise with caregivers. The aim is to integrate the treatment and of the muscles to lift the heel off the ground empties the calf into the disease in the patient’s daily life and allow him to achieve an acceptable thigh; finally lifting the leg off the ground maintains contraction of quality of life. the quadriceps contributing to the emptying of the thigh. Proximal Education is best achieved by a multi-professional team, using many propagation is the result of competent valves. teaching tools and different means of transmission of knowledge. Reflux, in the superficial system allows a proportion of the expelled Role-playing situations can often help assess the patient’s knowledge. blood to flow down to the lower limb depending on rate of reflux and the Education is based on the achievement of educational diagnosis for interval of relaxation between steps. This produces a high ambulatory each patient and the set up of a therapeutic agreement with the patient venous pressure (AVP) which is worse during slow walking. Reflux followed by an action plan. Evaluation is an integral part of the activity. in the deep veins is associated with an even higher AVP and damage A minimum knowledge is required for the patient called «Safety to the microcirculation producing skin changes and oedema. Outflow agreement» is often used in the case of education of a patient treated obstruction in the presence of reflux produces the worst possible with anticoagulants. clinical condition unless the popliteal valves are competent. Thus, Recent studies confirm the importance and the efficiency of therapeutic the popliteal valves are key in maintaining the efficacy of calf muscle patient education specially, in Self-monitoring of oral anticoagulation. pump. When competent they protect the lower limb from developing A recent study showed a significant difference in favour of the group the post thrombotic sequelae. Education on the occurrence of serious bleeding complications and In clinical practice elastic compression controls oedema all the time recurrence thrombosis. OR 0.25 (95% CI 0.1 to 0.7), p <0.01. but improves the calf muscle pump function only during walking Education is effective in patients treated with anticoagulants. It reduces and contributes to lowering the average venous pressure throughout bleeding and thrombotic complications. the day. Intermittent calf compression or musle stimulation devices empty the veins at rest (during sitting) also contributing to a lower Sy5-3 tHerapeUtiC edUCatiON OF tHe patieNtS average venous pressure throughout the day. The combination of (a) WitH CHrONiC VeNOUS diSOrderS elastic compression, (b) intermittent calf compression, (c) iliofemoral B. SATGER1 recanalisation when indicated and (d) venotonic drugs offer a patient 1 Centre de Recherche Universitaire de La Léchère, 73260, France with a deficient venous pump, the best therapeutic option. What is not yet known is the quantitative contribution of each modality Chronic venous disorders (CVD) have no effective curative therapy and which combination is optimal for different clinical situations. and need long term care management. Patients have to manage their illness for a long time; a high motivation for treatment with a good Sy7-2 FUNCtiONaL aNatOmy OF tHe mUSCULar compliance to compression therapy is required, and they may have to pUmpS OF tHe LOWer Limb change their lifestyle with the importance of venous hygiene. Thus a J.-F. UHL1,2, C. GILLOT1 need for active participation of patients to their treatment is requested 1 URDIA research unit, EA4566 Laboratory of anatomy - University www.iua-eurochap2010.eu ~ 31
- 32. Paris Descartes, Paris,France 2 Vascular surgeon, 113 avenue victor Hugo, 75116 Paris, France The conventional management of thrombotic and cardiovascular disorders is based on the use of heparin, oral anticoagulants and aspirin. Objective: to study the anatomy of the muscular veins responsible for Despite remarkable progress in life sciences, these drugs still remain the venous return of the lower limb. a challenge and mystery to us, and their use is far from optimized. methods: 3 main techniques were used in this study: The anatomical The development of low molecular weight heparins (LMWHs) and dissection after Latex injection of venous network, the CT venography the synthesis of heparinomimetics, such as the chemically synthesized (MSCT in lying position with contrast injection of the foot) and the pentasaccharide, represent a refined use of heparin. Generic versions of T2-weighted MRI of the calf in different body positions (supine, prone, various branded LMWHs are also developed. Chemical and enzymatic upright). modifications of heparin and related glycosaminoglycans have also results: The 4 anatomical components of the muscular pumps are: resulted in the introduction of anticoagulants with different biologic the foot pump, the leg pump (soleus muscle), the popliteal pump actions. An anti-Xa enriched LMWH namely AVE 5026 is also (gastrocnemius muscles) and the thigh pump (semimembranosus developed for specific indications in cancer associated thrombosis. muscle). Additional drugs from this knowledge will continue to develop; Anatomy of these muscular pumps is not well-known: its main aspects however, none of these drugs will match the polypharmacology of will be demonstrated by dissections and 3D reconstruction of the heparin. Parenteral antithrombin agents such as hirudins, angiomax and venous system. argatroban have been used in the management of heparin compromised A systematization of the veins of the soleus muscle will be proposed. patients. Newer parenteral anticoagulants from both the natural and The gastrocnemius pump, the most powerful, is synchronized with the synthetic sources are also developed. A newer parenteral anti-Xa drug, thigh pump which acts like a safety valve to drain the high flow of the namely otamaxiban represents a potent anticoagulant which may be popliteal vein in the deep femoral vein. useful in various hematologic indications. A parenteral LMWH, namely Conclusion: A chain of muscles from the foot to the thigh makes a M118 is currently undergoing clinical trials and can be developed true functional unit to activate the venous return. A failure of one or for expanded indications. Among the antiplatelet drugs, aspirin still several of these pumps, activated during walk, will be responsible for a remains the leading drug in the management of thrombotic disorders. worsening of the chronic venous disease of our patients. The newer antiplatelet drugs such as ADP receptor inhibitors, GPIIb/ Key words: VenoCT - MRI - Anatomy- muscular pumps- calf pump IIIa inhibitors and other specific receptor inhibitors have limited effects and have been used in patients who have already been treated with Sy 8 - Venous thromboembolic disease: moving Concepts and aspirin. Warfarin provides a convenient and affordable approach in the practices long-term outpatient management of thrombotic disorders. Warfarin and other anticoagulant usage has been optimized by utilizing INR Sy8-1 mediCaL SiGNiFiCatiON OF tHe aSymptO- and improved monitoring approaches. The optimized use of these matiC VeNOUS aNd pULmONary embOLiSm drugs still remains as the approach of choice to manage thrombotic G. PERNOD1 disorders. The new anticoagulant targets, including specific sites in the 1 Vascular Medical unit, CHU Grenoble, Grenoble, France hemostatic network such as tissue factor, individual clotting factors (IIa, VIIa, IXa, Xa, XIIa and XIIIa), recombinant forms of serpins Pulmonary embolism (PE) is a common disorder with an estimated (antithrombin, heparin co-factor II and tissue factor pathway inhibitors), annual incidence of approximately 300,000 cases in Europe. PE is an recombinant activated protein C, thrombomodulin and site specific important cause of mortality: in the past two decades, the case fatality serine proteases inhibitors complexes have also been developed. Of rate for PE was estimated to vary from 7% to 11%. Over the last these activated protein C and thrombomodulin have been useful in years, there has been an increasing number of diagnosis of incidental, the management of disseminated intravascular coagulation (DIC) asymptomatic pulmonary emboli that are detected in patients undergoing and related syndromes. There is a major thrust on the development chest computer tomography (CT) for reasons other than the research of of orally bioavailable anticoagulant drugs (anti-Xa and IIa agents), suspected PE. With the increasing use of chest CT scans, incidental which are slated to replace oral anticoagulants. Both anti-factor Xa ( diagnoses of PE are becoming a common problem in clinical practice. rivaroxiban and apixiban) and antithrombin (dabigatran) agents have However, information on the prevalence and on the natural history been developed for oral use and have provided impressive clinical of unsuspected silent PE is extremely limited. In particular, whether outcomes in sponsored trials for the post surgical prophylaxis of the diagnosis of an unsuspected asymptomatic PE is associated with venous thrombosis; however, safety concerns related to liver enzyme increased morbidity and mortality rates remains unclear. Furthermore, elevations and thrombosis rebound have been reported with some of the optimal therapeutic strategies when asymptomatic PE is incidentally their use. For these reasons the US FDA did not approve the orally diagnosed are uncertain. In the absence of evidences on the risk to active antithrombin agent ximelagatran for several indications. While benefit ratio of an active treatment, it is currently recommended that the rivaroxiban and dabigatran are available for qualified indications same initial and long-term anticoagulation as for comparable patients in Europe and Canada these drugs are not approved in the United with symptomatic PE is prescribed. Moreover, approximately one States. The synthetic pentasaccharide (fondaparinux) has undergone third of patients with deep venous thrombosis have silent pulmonary an aggressive clinical development. Unexpectedly, fondaparinux also embolism. Silent pulmonary embolism is more frequent in patients produced major bleeding problems at minimal dosages. Fondaparinux with proximal deep venous thrombosis than in those with distal deep represents only one of the multiple pharmacologic effects of heparins. venous thrombosis, and asymptiomatic pulmonary embolism may lead Thus, its therapeutic index will be proportionately narrower. The to pulmonary hypertension. methylated pentasaccharide, namely idraparinux, is effective for The aim of this presentation was to focus on epidemiological data and long term prophylaxis, but its use is associated with bleeding. Other practical approach regarding unsuspected silent PE. forms of pentasaccharide such as the biotinylated form which can be reversed with fucoidin are also developed. The newer antiplatelet Sy8-2 NeWer treNdS iN tHe maNaGemeNt OF drugs have added a new dimension in the management of thrombotic tHrOmbOSiS. impaCtS ON VaSCULar iNdiCatiONS disorders. The favorable clinical outcomes with aspirin and clopidogrel E. KALODIKI1, J. FAREED2 have validated COX-1 and P2Y12 receptors as targets for new drug 1 Ealing Hospital & Imperial College London, SW7 2AZ & Loyola development. Prasugrel, a novel thienopyridine, cangrelor and tricoglor University, UK represent newer P2Y12 antagonists. Cangrelor and tricoglor are direct 2 USA inhibitors, whereas prasugrel requires metabolic activation. While 32 ~
- 33. clinically effective, prasugrelmay have a narrower safety spectrum alone have demonstrated that patients receiving thrombectomy have and its dosage requires further optimization. The newer parenteral and significantly better outcomes at 6 months, 5 years, and 10 years.6 oral antithrombin and anti-Xa agents may be useful in the short and Furthermore, nonrandomized reports have demonstrated patency and long term management of heparin compromised patients, in particular preservation of valve function following thrombectomy in two-thirds those who develop thrombocytopenia. These drugs may also be useful or more of patients. in specific indications, in particular the oral anti-Xa and anti-IIa agents Catheter-directed thrombolysis (CDT) has evolved as the treatment of for the long term outpatient management of thrombosis. Because of choice for the majority of patients with iliofemoral DVT. Success rates the lower molecular weigh, synthetic oral anti-Xa and anti-IIa drugs as of 80-95% are commonly reported if patients are treated within 2 weeks well as the newer antiplatelet drugs may pass through the placenta and of onset.7, 8 Nonrandomized observations of long-term patency without also pass through the blood brain barrier. These drugs cannot be used reflux and low recurrence rates have been reported.8 A cohort-controlled in pregnant women and patients with central nervous system (CNS) trial demonstrated improved QOL following CDT compared to patients disorders. Since heparins have a therapeutic effect on cancer associated treated with anticoagulation alone.9 It has recently been observed that thrombosis it’s useful in the management of hematologic malignancies. the amount of thrombus removed is directly proportional to improved The relative therapeutic value of the newer anticoagulants will remain QOL and reduced postthrombotic morbidity.10, 11 A small randomized unknown until additional clinical data becomes available. Although trial of CDT versus anticoagulation alone demonstrated improved the newer anticoagulant and antiplatelet drugs are attractive for several patency and valve function following CDT.12 Two randomized trials reasons, none of these are expected to replace the conventional drugs are currently underway to further assess the long-term benefit of CDT in poly-therapeutic approaches. The generic versions of heparin and versus anticoagulation for acute DVT.13, 14 LMWH along with other anticoagulants will also become available. Based upon available data, a strategy of thrombus removal for patients However, their safety and efficacy has to be closely watched and with iliofemoral DVT appears superior to anticoagulation alone and validated. Heparins, warfarin and aspirin will continue to play a major should be recommended to all who are active and ambulatory. role in the management of thrombosis and related vascular disorders (1) Prandoni P, Villalta S, Bagatella P, Rossi L, Marchiori A, Piccioli A, et al. beyond 2010. The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients. Haematologica 1997;82(4):423-8. (2) Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of Sy8-3 SUperFiCiaL tHrOmbOpHLebitiS, a thrombosis determine the risk of disease recurrence in patients with proximal SiGNiFiCaNt SUbSet OF VeNOUS tHrOmbOembOLiC deep vein thrombosis? Am J Med 2001;110(7):515-9. diSeaSe (3) Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in I. QUÉRÉ1 iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical 1 Vascular Medicine, Hôpital Saint Eloi, Montpellier, France status, and quality of life. Ann Surg 2004;239(1):118-26. (4) Akesson H, Brudin L, Dahlstrom JA, Eklof B, Ohlin P, Plate G. Venous Superficial venous thrombosis (SVT) is a very frequent event. Until function assessed during a 5 year period after acute ilio-femoral venous recently, the scarcity of strong epidemiological data and therapeutic thrombosis treated with anticoagulation. Eur J Vasc Surg 1990;4(1):43-8. (5) Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. trials has led to a mostly empirical and debated management. Clinically Determinants and time course of the postthrombotic syndrome after acute deep relevant superiority of any kind of treatment over another (placebo, venous thrombosis. Ann Intern Med 2008;149(10):698-707. surgery, non steroidal anti-inflammatory agents, and different regimens (6) Plate G, Eklof B, Norgren L, Ohlin P, Dahlstrom JA. Venous thrombectomy of anticoagulants) could not be demonstrated. for iliofemoral vein thrombosis--10-year results of a prospective randomised Important advances were recently realized in the epidemiological and study. Eur J Vasc Endovasc Surg 1997;14(5):367-74. therapeutic fields. In the large prospective multicenter observational (7) Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. J Vasc Surg POST (Prospective observational superficial thrombophlebitis) French 2007;46(5):1065-76. study, one out of four patients with SVT had a concurrent deep venous (8) Baekgaard N, Broholm R, Just S, Jorgensen M, Jensen LP. Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral thromboembolism (DVT, pulmonary embolism (PE)) and 10% of venous thrombosis. Eur J Vasc Endovasc Surg 2010;39(1):112-7. patients with an isolated SVT, i.e. without concurrent deep VTE at (9) Comerota AJ, Throm RC, Mathias SD, Haughton S, Mewissen M. Catheter- presentation, experienced a VTE complication (SVT, DVT, PE) at directed thrombolysis for iliofemoral deep venous thrombosis improves health- three months. Preliminary results of the international Calisto trial have related quality of life. J Vasc Surg 2000;32(1):130-7. been presented and will be discussed during this talk. (10) Grewal N, Martinez J, Andrews L, Comerota AJ. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep venous thrombosis Sy8-4 tHe CONCept OF earLy tHrOmbUS correlates with post-thrombotic morbidity. J Vasc Surg 2010;In press. remOVaL FOr iLiOFemOraL dVt (11) Grewal N, Martinez J, Andrews L, Assi Z, Kasanjian S, Comerota AJ. Objective outcome measures of patients with iliofemoral DVT treated with A. J. COMEROTA1,2 catheter-directed thrombolysis. Presented at American Venous Forum, February 1 Director Jobst Vascular Center, USA, 2010 2010 2 Adjunct Professor of Surgery, University of Michigan, USA (12) Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Anticoagulation alone is standard treatment for most patients with acute Surg 2002;24(3):209-14. deep venous thrombosis (DVT). However, patients with iliofemoral (13) Enden T, Klow NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, et DVT have increased postthrombotic morbidity1 and suffer significantly al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein higher recurrence rates compared to patients with infrainguinal thrombosis: results of an open randomized, controlled trial reporting on short- term patency. J Thromb Haemost 2009;7(8):1268-75. DVT.2 Following the natural history of iliofemoral DVT treated with (14) Comerota AJ. The ATTRACT Trial: Rationale for Early Intervention for anticoagulation alone reveals that the overwhelming majority have a Iliofemoral DVT. Perspect Vasc Surg Endovasc Ther 2010. poor quality-of-life (QOL), 15% will develop ulceration within 5 years, and at least 40% will have venous claudication. 3, 4 Sy 9 - Varicose vein treatment in the future A prospective analysis of patients treated with anticoagulation for acute DVT demonstrates that patients with iliofemoral DVT have the Sy9-1 CLiNiCaL praCtiCe GUideLiNeS OF tHe most severe postthrombotic morbidity (OR 2.23; P<.001).5 The same SOCiety FOr VaSCULar SUrGery aNd tHe ameriCaN investigators reported that common femoral or iliac vein thrombosis VeNOUS FOrUm ON tHe Care OF patieNtS WitH and the degree of postthrombotic morbidity at 1 month were the best VariCOSe VeiNS predictors of postthrombotic syndrome (P<.001). P. GLOVICZKI1 Randomized trials of venous thrombectomy versus anticoagulation 1 Mayo Clinic, Rochester, MN, USA www.iua-eurochap2010.eu ~ 33
- 34. The Society forVascular Surgery (SVS) and the American Venous Sy9-3 We Need tO KNOW mOre abOUt tHe Forum (AVF) established a committee to provide evidence based NatUraL HiStOry OF VeNOUS HemOdyNamiCS iN guidelines for treatment of patients with varicose veins (CEAP Class patieNtS WitH VariCOSe VeiNS! 2). The guidelines also included recommendation for treatment of O. PICHOT1, P. CARPENTIER2 superficial and perforator vein incompetence in patients with more 1 Centre de médecine vasculaire, Grenoble, France advanced (CEAP Class 3-6) venous disease. Recommendations of the 2 Hôpital A. Michallon, Service de médecine vasculaire, BP 217X, Guideline Committee were Strong (Grade 1), if the benefits clearly Grenoble, France outweighed risks, burden, and costs or the suggestions were Weak (Grade 2) if the benefits were closely balanced with risks and burden. The natural history of venous hemodynamics in patients with varicose The level of available evidence to support the evaluation or treatment veins is far from being understood. The classical old theoretical could be of High (A), Medium (B) and Low or Very Low (C) quality. model, lacking of objective scientific evidence, which was favoring The following recommendations were proposed: The committee the reflux hypothesis and describing a chronic vein disease progressing recommended that in patients with varicose veins a complete history downwards under the effect of the venous hyper pressure is currently and detailed physical examination is complemented by duplex challenged by the theory of a primary parietal disease of the venous scanning of the deep and superficial veins (Grade 1A). The committee reticulum. also recommended that the CEAP classification is used for patients Several observational studies using duplex ultrasound bring evidence with varicose veins and that the revised Venous Clinical Severity Score in favor of the ascending hypothesis of varicose disease progression. is used to assess treatment outcome (both Grade 1B). The committee Particularly, it has been demonstrated that primary venous reflux can suggested compression therapy for patients with symptomatic varicose occur in any superficial or deep vein of the lower limbs, suggesting that veins (Grade 2C) but recommended against compression therapy as reflux appears to be a local or multifocal process and that the typology the primary treatment if the patient is a candidate for an intervention of the reflux correlates with the age of patients as well as with the CEAP (Grade 1B). Compression therapy was recommended, however, as the clinical class. In other hand, some data suggests that reflux progression primary treatment to aid healing of venous ulceration and as an adjuvant doesn’t concern all the patients and thus that competent valves will not treatment to intervention to prevent ulcer recurrence (Grade 1B). To necessarily deteriorate overtime. decrease recurrence of venous ulcers, ablation of the incompetent Outcomes observed after minimally invasive alternative to the superficial veins in addition to compression therapy was recommended conventional high ligation and stripping have demonstrated that the (Grade 1A). For treatment of the incompetent great saphenous vein sole ablation of the saphenous trunk results in restitution of saphenous (GSV) the committee recommended endovenous thermal ablation vein termination competence and sometimes in legs varicose veins (radiofrequency or laser) over high ligation and inversion stripping disappearance and in opposite, removing the only vein reservoir of the saphenous vein to the level of the knee (Grade 1 B). The leads in about 2 thirds of cases to saphenous reflux disappearance and committee also recommended phlebectomy or sclerotherapy to treat decrease of the saphenous trunk diameter. varicose tributaries (Grade 1B) and suggested foam sclerotherapy as Actually, in an individual patient presenting with varicose veins, an option for treatment of the incompetent saphenous vein (Grade 2C). precise criteria are missing in order to determine the risk of progression The committee recommended, however, against selective treatment of of the superficial vein insufficiency. In the same time, even if a tailored perforator vein incompetence in patients with simple varicose veins treatment is usually proposed to address the patient’s complaints, the (CEAP Class 2, Grade 1B) but suggested treatment of pathologic choice of the more efficient and less invasive treatment modality is still perforators (outwards flow of > 500 ms duration, vein diameter of often non evidence based. >3.5 mm) located underneath healed or active ulcers (CEAP Class Prospective studies of superficial veins disease natural history, and 5-6, Grade 2B). The committee also recommended treatment of pelvic standardized evaluation of postoperative outcomes after the different congestion syndrome and pelvic varices with coil embolization, plugs available varicose treatments modalities are mandatory in order to or transcatheter sclerotherapy, used alone or in combination (Grade optimize therapeutic strategy. 2B) Sy9-4 mOLeCULar meCHaNiSmS FOr miCrO- Sy9-2 FUtUre teCHNiQUe FOr VariCOSe VeiN VaSCULar eNdOtHeLiaL apOptOSiS UNder preSSUre abLatiON eLeVatiON aNd tHerapeUtiC tarGetS P. NICOLINI1 G. W. SCHMID-SCHÖNBEIN1, T. ALSAIGH1, E. S. POCOCK1 1 Vascular Surgeon, Clinique du Parc, Lyon, France 1 Department of Bioengineering, University of California, San Diego La Jolla, California, 92093-0412, USA Within 10 years, crossectomy and stripping of the saphenous veins associated with stab avulsions was gradually replaced by the thermal Chronic venous hypertension is associated with markers for percutaneous techniques of destruction. The radiofrequency (RF) is microvascular inflammation, tissue restructuring, and apoptosis, but first technique (11 years), LASER is a more recent technique (8 years). the cellular and molecular mechanisms underlying these processes On the same bases as two previous ones, a new technique of thermal remain uncertain. Key signatures of inflammation in microvascular destruction with steam is in the course of evaluation. regions with elevated venous blood pressure are already evident in Some warmed sterile water is sent under pressure (600 bars) in the acute forms of venous pressure elevation. This observation suggests form of vapor (temperature from 100 to 150 ° C) to the trunk of the that acute venous pressure elevation may represent one of the trigger saphenous vein by a percutaneous approach. mechanisms for the inflammatory cascade encountered during the A prospective multicentric study began in November 2008 with progression of the disease. In the present study we examined the inclusion of 80 patients. The sx months results are superposables to hypothesis that acutely elevated venous pressure together with the those of the RF and LASER. A deep venous thrombosis was found reduction of shear stress induces elevated enzymatic activity in in the immediate post operative course without after-effects. In the venules. This activity in turn causes cleavage of surface receptors medium term we find a pigmentation and a dysethesia. promoting endothelial dysfunction. Using a rodent model for venous Subject to confirmation of the medium-term results, this technique is hypertension by repeated venular occlusions with 15 min durations, promising. It should cheaper than 2 more other technique. Furthermore microzymographic techniques for enzyme activity detection in-vivo, It also allows to treat the collateral without phlebectomy. and immunohistochemistry for receptor labeling, we found increased activity of the matrix metalloproteases (MMP-1, -8 and -9). In this short time we also observed that elevated venule pressure causes in 34 ~
- 35. some venules areduced labeling density with an antibody against the In addition to clinical examination, duplex ultrasound (DU) is the extracellular domain of the vascular endothelial growth factor receptor choice technique for assessment of arteriovenous fistulae in patients 2 (VEGFR2) while in other venules we observed an increased VEGFR2 undergoing hemodialysis. DU presents a high sensibility for a- or expression compared to the levels before venous pressure elevation. symptomatic venous stenosis diagnosis. It provides an accurate We conclude that short-term pressure elevation increases enzymatic anatomical and hemodynamic analysis of the stenosis and allows to activity in venules, which may contribute to endothelial dysfunction measure in the same time the vascular access (VA) flow even in patients associated with this disease. Supported by NIH grant HL 10881. who’s the VA is not yet used for dialysis delivery. Actually, information provided by DU is sufficient to decide to treat stenosis, and to optimize Sy 10 - Ultrasound guided procedures the choice between surgical and endovascular revision. Even in case of a clinically obvious indication of angioplasty, DU preliminary Sy10-1 ULtraSOUNd aSSiSted arteriaL examination allows to optimize practical modalities of angioplasty. prOCedUreS Recently, ultrasound guided angioplasty (UGA) has become a very E. ASCHER1 promising option. DU allows to guide every step of the angioplasty 1 Mt. Sinai School of Medicine, New York, USA procedure, including stenting if necessary, and to analyze continuously the results of the procedure in an anatomical and hemodynamic way purpose: The technique of balloon angioplasty of peripheral arteries as well. Immediate preoperative ultrasound analysis of the stenosis is and failing infrainguinal bypasses requires use of arteriography and the first step of the UGA. It allows choosing the type and the size of fluoroscopic guidance. Patients not yet on dialysis with chronic renal the balloon and the most suitable site of vascular access, which can be insufficiency (CRI) and non-maturing AV accesses present therapeutic guided by ultrasound if necessary. Introducers, guide wires, balloons problem. Because standard treatment with balloon angioplasty is and stents are easily imaged by DU. based on nephrotoxic contrast for diagnosis and treatment, we sought Compared to conventional fluoroscopic guidance, UGA presents some alternative therapies. We attempted to perform balloon angioplasty and advantages: risks related to contrast injection and X rays exposure stent placement for infrainguinal arteries, bypasses, carotid arteries are avoided; continuous monitoring of the procedure allows detecting and AV accesses under duplex guidance to avoid/minimize use of immediately occurrence of eventual complications and also recoil nephrotoxic contrast material and radiation exposure. phenomena; local hemodynamic results assessment of angioplasty and methods: Over the last 72 months, 260 patients underwent 360 duplex- intraoperative VA flow measurement demonstrates more accurately guided infrainguinal arterial balloon angioplasties (236 stenoses, 124 than the only morphological analysis the efficiency of the procedure, occlusions) for claudication and limb-threatening ischemia in 57% and especially in case of multiple stenosis; at least, UGA appears to be 43%, respectively. often easier, faster, and cheaper than fluoroscopic guidance. Additional 44 patients had attempted balloon angioplasties of 50 failing Nevertheless, UGA requires collaboration of two practitioners infrainguinal bypasses. accustomed with the use of ultrasound. Furthermore preoperative DU All arterial or graft cannulations were done under direct duplex examination is mandatory to verify ultrasound accessibility of the visualization. Fluoroscopy and contrast was employed to reach stenosis to be treated. ipsilateral CFA in cases of contralateral access (5%). Guide wire manipulation from ipsilateral CFA to a site beyond the most distal Sy10-3 treatmeNt OF VariCOSe VeiNS. stenotic lesion, selection and placement of balloons and stents were ULtraSOUNd-GUided prOCedUreS done solely with duplex scanning. C. HAMEL-DESNOS1 Forty-one patients (63% asymptomatic) with severe (>70%) carotid 1 Saint Martin Private Hospital, Caen, France stenoses (27 primary, 14 restenoses) underwent duplex-assisted carotid balloon angioplasty and stenting (CBAS). Fluoroscopy was used to The use of ultrasound imaging assistance in procedures for the assist guidewire passage into aorta and common carotid artery and treatment of varicose veins began in 1986, when the first description also to place cerebral protection device (39 cases). Catheterization of was published of ultrasound guided sclerotherapy (UGS). internal and external carotid arteries, balloon and stent deployment were Objective: The objective of this presentation is to highlight the successfully achieved with ultrasound guidance alone in all cases. importance and the contribution of duplex ultrasonography in various results: Overall technical success of infrainguinal angioplasties was procedures for treating varicose veins in the lower limbs. 95% (99.6% and 86% for stenoses and occlusions, respectively). design and method: The ultrasound guided procedures being Technical success of bypass angioplasties was 98% (49/50 cases). essentially endovenous procedures, the UGS and the thermal ablation Six-month primary patency rates for both lower extremity arterial and (TA) are tackled. bypass angioplasties were 70%. The common points and the peculiarities, according to the procedures, One ipsilateral stroke (2.4%) occurred intraoperatively during duplex- are successively described. assisted CBAS with complete clinical recovery in 4 months. results: In all cases, prior to any treatment, a clinical and duplex Conclusions: The proposed technique is an effective modality for ultrasonographic assessment is performed. The assessment makes it treatment of infrainguinal arterial occlusive disease and failing possible to study the condition and to choose the most suitable treatment infrainguinal arterial bypasses. Advantages include direct visualization for the case in question, in concertation with the patient. It also makes it of puncture site, accurate selection of balloons and stents and possible to assess more specifically any hemodynamic, anatomical and/ confirmation of technical adequacy by hemodynamic and imaging or technical difficulties that may need to be overcome. parameters. Additional benefits are avoidance of radiation exposure Afterwards, in the case of UGS, the treatment is performed entirely and contrast material. under ultrasound imaging control and comprises four stages - identifying Duplex-assisted CBAS is feasible and may reduce the need of the vein to be treated, puncturing the vein, injection of the sclerosing intraarterial contrast injection in selected patients deemed high risk for agent and checking the post-injection outcome. renal failure. In the case of TA, the veins to be treated are marked on the skin surface, a procedure performed with ultrasound imaging assistance. Then, Sy10-2 ULtraSOUNd GUided prOCedUreS: during the treatment, ultrasound scanning is used for puncturing the VaSCULar aCCeSS FOr HemOdiaLySiS vein and introducing the catheter, for positioning the fibre or applicator O. PICHOT1 correctly, for tumescent anaesthesia, and for performing a post- 1 Centre De Médecine Vasculaire, Grenoble, France procedural examination. Conclusion: For treating varicose veins in the lower limbs, the duplex www.iua-eurochap2010.eu ~ 35
- 36. ultrasonography is provingto be an essential tool. Appropriate training and safety tolerate and the patient’s motivation were excellent. More and learning the skills accurately are an indispensable prerequisite for studies will be useful to confirm these results. effective and safe endovenous treatments of all types. Sy11-2 tHe baLaNCe Or UNbaLaNCe OF atS Sy 11 - physical exercise and Vascular medicine riSK FaCtOrS COULd COmprOmiSe tHe reSULtS OF (Joint symposium with the italian Society of angiology pHySiCaL traiNiNG iN CLaUdiCaNtS? and Vascular medicine) G. M. ANDREOZZI1 1 Angiology Care Unit of University Hospital of Padua, Padua, Italy Sy11-1 eFFeCtS OF pHySiCaL eXerCiSe ON tHe CardiOVaSCULar SyStem The correction of atherosclerotic risk factors is the unavoidable P. ABRAHAM1 assumption to assure the maximal effectiveness and duration of the 1 University of Angers, Angers, France results of any therapeutic intervention (pharmacological and surgical) for the treatment of Intermittent Claudication. A normal vascular function is essential for exercise. The energetic Aim of this study has been to verify if the presence/absence of risk substrates required for the biochemical processes leading to movement, factors and the degree of their correction could compromise the as well as the oxygen used to oxidize these substrates are both provided responsiveness of claudicant patients to the supervised physical to the exercising muscle by blood. Then muscle blood flow must increase training. with exercise to fit the oxygen and metabolic requirement of the active methods: Initial (IDC), absolute (ACD) claudication distance, and muscle. As a result, the increase in the workload is linearly associated recovery time (RT) have been measured by maximal treadmill exercise to an increase in blood flow to the exercising muscles. Cardiac output in 74 claudicants. The measurements have been repeated after 18 days increases to fit the increase in muscle blood flow. Nevertheless, the of supervised physical training consisting of a daily walk reaching physiological adaptation to exercise not only includes an increase in either a distance goal of 1-2 km or a time goal of at least 30 min. The cardiac output, but a redistribution of the total flow to the different working load of each single training session has been tailored at 60- vascular beds (splanchnic, renal, cutaneous, etc…). The fraction of the 70% of the ACD measured by a non-maximal treadmill exercise. cardiac output distributed to each vascular bed is variable and depends The patients’ cohort has been stratified in seven groups and eighteen on the intensity and duration of exercise, environmental conditions sub-groups (no smokers, smokers in the past, still smokers, no-diabetics, and training status. The underlying mechanism of short term and long well balanced and unbalanced diabetes, absent, well balanced and term vascular changes induced by exercise are still subject to debate. unbalanced hypercholesterolemia, normal weight, over weight and light The presentation will review current concepts about the physiological obesity, hypertensive and no-hypertensive, with and without previous mechanisms involved in blood flow regulation in peripheral vessels myocardial infarction and TIAs or stroke). The mean and standard error during exercise. Then, the structural and functional changes induced of ICD, ACD and RT before and after 18 days of physical training have by exercise training in peripheral vessel will shortly be presented. Last, been calculated and compared with Student’s t test in each group and as an introduction to the other presentations, the different underlying sub-group. On the data before and after training of ICD, ACD and RT mechanisms, beyond the sole blood flow impairment, that may result of each group of risk factors the multivariate analysis of the variance in exercise limitation in patients showing vascular-type claudication has been carried out by ANOVA. All the analyses were considered will be analysed. These mechanisms should not be underestimated significant when the p value was less than 0.05. and should likely be accounted for to further improve the quality of results: ICD values increased from 55.12 to 121.86 m, ACD from rehabilitation programs in PAD patients. 103.16 to 191.58 m, TR reduced from 204.04 to 87.46 sec, confirming the relevant (p<0.0001) effectiveness of supervised physical training Sy11-3 iNterVaL traiNiNG iN patieNtS WitH on the walking capacity of claudicant patients. The comparison iNtermitteNt arteriaL CLaUdiCatiON between the deltas (value after minus value before) of each sub-group B. VILLEMUR1, D. PÉRENNOU1 did not show any significant difference. The multivariate analysis of 1 Unité de Rééducation Vasculaire, Clinique Universitaire de Médecine the variance (ANOVA) of before and after ICD ACD and RT of each Physique et Rééducation, Centre Hospitalier Universitaire de risk factor groups showed values relevantly lesser than 0.05, indicating Grenoble, France that risk factors did not influence the result of physical training. Conclusions: The supervised physical training is confirmed as an During controlled studies with patients with intermittent claudication effective tool for the treatment of claudicant patient. We did not find any from peripheral arterial disease, it was found that exercise training significant difference in the response to the programme related with the improved patients walking distance. The study’s objective was to presence, absence or balance degree of the risk factors, and we conclude determine the effects and the adverse events of treadmill interval that physical training effectiveness is independent from the their training with active recovery by a prospective study. presence, absence or balance degree. This statement is very important methods: Eleven patients with the second stage of peripheral arterial because highlights the physical training as the only therapeutic tool for disease took part in a rehabilitation program (aged 68,5±10,3 years)5 PAD independent from the results of the risk factors’ treatment. days a week for 2 weeks. Each day, they had to practice global physical activity, up and low lesionnel exercises, intermittent pressotherapy Sy11-4 pHySiCaL traiNiNG iN patieNtS WitH and program of treadmill walking. The interval training program HyperteNSiON consisted of treadmill exercise, 30 minutes each morning and evening A. PINTO1 with increased intensity: for the first week, speed was increased, for 1 U.O. FISIOPATOLOGIA CIRCOLATORIA - Dipartimento the second one, trend was increased. Each session of interval training Biomedico di Medicina Interna e Specialistica - AOUP «P. Giaccone», consisted of 5 cycles successively of 6 minutes. Each cycle consisted of Università degli Studi di Palermo, Italy 3 minutes of work followed of 3 minutes of active recovery. results: At the beginning of the rehabilitation program, the walking Elevated blood pressure (BP) is an extremely common and important distance was in average 610 meters (120-1930) and 1252 meters risk factor for cardiovascular disease and stroke. Because drug therapy (320-2870 at the end (p=0,033). Every patient improved their walking for hypertension effectively reduces the risk of stroke and coronary distance. No adverse event was noted. disease, efforts to control BP levels and correlated diseases have Conclusion: This study showed that the interval training with active concentrated on pharmacological therapy. Still, despite the common recovery for patients with arterial intermittent claudication was efficient use of antihypertensive medications, rates of hypertension control 36 ~
- 37. remains suboptimal (1,2). Lifestyle modifications as adjuvant therapy An update. Sports Med. 1996; 21 (5):347-383. in medication-treated hypertension are recently being recommended 12.Kelley G. Dynamic resistance exercise and resting blood pressure in adults: by guidelines (3), yet there are considerable gaps in our knowledge a meta analysis. J Appl Physiol. 1997; 82 (5):1559-1565. 13.Williams PT. Physical fitness and activity as separate heart disease risk about the effects of therapies centered on behavioural modifications. factors: a meta-analysis. Med Sci Sport Exerc. 2001; 33:754-761. Several studies of the relation between BP levels and physical exercise 14.Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the have mainly focused on exercise of the dynamic aerobic type (4-7). dose-response relation? Med Sci Sport Exerc. 2001; 33: S459-S471. This type of exercise requires a prolonged period of time and involves 15.Tanasescu M, Leitzmann MF, Rimm EB, et al. Physical activity in relation a large number of muscles. Aerobic exercise has been recognized as to cardiovascular disease and total mortality among men with type 2 diabetes. the most recommended when the issue is the promotion of general Circulation. 2003 May 20;107(19):2435-2439. Epub 2003 Apr 28. health (5,6). Recently more emphasis is being placed on resistive 16.Iwane M, Arita M, Tomimoto S, et al. Walking 10,000 steps/day or more exercise, with the same objective. Resistance or resistive training reduces blood pressure and sympathetic nerve activity in mild essential hypertension. Hypertens Res. 2000 Nov;23(6):573-580. consists of local muscle work with overloads, such as weights, bars, and clamps, performed with moderate weights, frequent repetitions, and pauses, being, therefore, characterized as discontinuous exertion. Sy11-5 pHySiCaL eXerCiSe iN eLderLy arteriO- (8-10). Resistive training is now currently used in programs of cardiac patHiC patieNtS rehabilitation; when practiced under appropriate supervision, it leads M. PRIOR1 to significant benefits with low risks (11), contributing to the reduction 1 Vascular Rehabilitation Unit - Azienda Ospedaliera Universitaria in resting BP. In a meta-analysis with normotensive and hypertensive Integrata, Verona, Italy individuals, dynamic resistance exercise has been reported to cause a mean 3% reduction in systolic blood pressure (SBP) and a 4% reduction At present, physical exercise is considered a cornerstone in the initial in diastolic blood pressure (DBP) in both groups, with no changes treatment of peripheral arterial disease (PAD). The best results are in body weight or resting heart rate (12). Development of adjuvant obtained when a supervised program of treadmill based walking therapy based on physical exercise in a great number of subjects, as exercise is used. More than 100% increases in treadmill exercise required by recent guidelines, not only entails considerable economic performance, together with significant improvements of peak oxygen investment, but also requires adequate technical support and continuing consumption, and of quality of life are described. Possible mechanisms supervision of trained physiotherapists. In addition, some pathologic underlying the training response in PAD include improvements in conditions limit or prohibit certain types of physical activity. All these leg blood flow and oxygen delivery, mostly related to incremented reasons contribute to less use of these important non-pharmacological muscle capillary density. These changes are likely mediated by an interventions both on hypertensive patients and on non-hypertensive improvement of endothelial function and nitric oxide release. Exercise high-risk subjects than expected. The benefits of physical activity training may also improve skeletal muscle metabolism, and blood centred on walking programs are well demonstrated: walking is viscosity, and reduce local and systemic inflammation. In addition to inversely associated with total mortality (13); faster walking pace was hemodynamic and metabolic mechanisms, improved biomechanics inversely associated with cardiovascular disease and total mortality of walking may contribute to increased walking ability. An elevation independently of the time spent walking (14); this inverse association of pain perception threshold, possibly induced by an increase in was not explained by other cardiovascular risk factors (13-15). endorphins release, could also be considered. All these beneficial effects Specifically in relation to walking activity on hypertensive subject, of exercise don’t seem to be age-related. Older PAD patients benefit Iwane et al. demonstrated that walking 10,000 steps/day or more, from exercise training too, given that the presence of comorbidity irrespective of exercise intensity or duration, is effective in lowering doesn’t limit their involvement in training sessions. In fact, once the BP, increasing exercise capacity, and reducing sympathetic nerve main exercise response determinants are considered, age is not «per activity in hypertensive patients (16).So, even a light/moderate aerobic se» significantly correlated to a reduced improvement of claudication physical activity program, such as fast walking, provides a significant distance upon completion of a treadmill walking program. Moreover, benefit in hypertensives, and could be prescribed added to drug therapy the lower is the initial physical fitness, the higher is the fitness increase or alone. at the same training load. Then, it is particularly important that elderly References arteriopathic patients take part to specific supervised exercise training 1.Burt VL, Cutler JA, Higgins M, et al. Trend in the prevalence, awareness, programs, given that they are usually more compromised than younger treatment, and control of hypertension in the adult US population. Hypertension. ones, in functional capabilities and in quality of life. At this regard, our 1995; 26:60-69. rehabilitation program integrates the treadmill training sessions with 2.Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood gymnastics sessions based on physical exercises specifically aimed pressure in a hypertensive population. N Engl J Med. 1998; 339:1957-1963. to enhance proprioceptive ability, joint flexibility, muscular mass 3.European Society of Hypertension-European Society of Cardiology and strength and walking mechanics. Such a program evidenced an Guidelines Committee. 2003 European Society of Hypertension-European improvement not only of walking distance, but also of the quality of Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003 Jun; 21(6):1011-1053. life scores measured with specific questionnaires. 4.Lima EG, Spritzer N, Nerkenhoff FL, et al. Noninvasive ambulatory 24 hours blood pressure in patients with high normal blood pressure and exaggerated Sy 12 - From raynaud phenomenon to digital ulcer (organized systolic pressure response to exercise. Hypertension. 1995; 26:1121-1124. thanks to an unrestricted educational grant from Actelion 5.Kelley G, McClellan P. Antihypertensive efffects of aerobic exercise: a brief pharmaceuticals) metaanalytic review of randomized controled trials. Am J Hypertens. 1994; 7:115-119. Sy12-1 baSiC eXpLOratiON OF rayNaUd’S 6.Fagard RH. The role of exercise in blood pressure control: supportive evidence. pHeNOmeNON: a CONSeNSUS OF FreNCH eXpertS J Hypertens. 1995; 13:1223-1227. 7.Kingwell BA, Jennings GL. Effects of walking and other exercise programs J. CONSTANS (Bordeaux) AND M.-A. PISTORIUS (Nantes) for the upon blood pressure in normal subjects. Med J Aust. 1993;158(4):234-238. French Working Group 8.Kelemen MH. Resistive training safety and assessment guidelines for cardiac P. CARPENTIER (Grenoble), J. DECAMPS LE CHEVOIR (Paris), and coronary prone patients. Med Sci Sports Exerc. 1989; 21 (6):675-677. J.-L. GUILMOT (Tours), J. LAUNAY (Paris), I.LAZARETH (Paris), 9.Stewart KJ. Weight training in coronary artery disease and hypertension. Prog P. LEGER (Toulouse), P. PRIOLLET (Paris), P. SENET (Paris), Cardiovasc Dis. 1992; 35 (2):159-168. P. SINTES (Paris), A. SOLANILLA (Bordeaux), L. TRIBOUT (Paris), 10.Morrissey MC, Harman EA, Johnson MJ. Resistance training modes: M. VAYSSAIRAT (Paris) specificy and effectiveness. Med Sci Sport Exer. 1995; 27:648-660. 11.Verrill DE, Ribisl PM. Resistive exercise training in cardiac rehabilitation. A consensus was made by experts from French vascular medicine society www.iua-eurochap2010.eu ~ 37
- 38. microcirculation working groupand from the French microcirculation Therefore, NVC represents the safest method to analyze microvascular society. The aim was to propose recommendations on the first-line abnormalities in SSc, and enables the early differential diagnosis statement of Raynaud’s. between primary and secondary Raynaud phenomenon. Three steps were considered: defining the kind of acrosyndrome, In addition, abnormal findings on NVC at baseline together with the differentiating etiologica factors from factors that impact on Raynaud’s presence of SSc-specific autoantibodies indicate a very high probability clinical expression, and defining assessment that needs to be relevant, (over 80%) of developing definite SSc, whereas their absence rules out reasonable and not to be anxiogenic this outcome. Clinical assessment can identify .Raynaud’s suspect of revealing a Early diagnosis of SSc could enable the early start of treatment, which patholological process such as connective tissue disease or apparently could slow disease progression and clinical complications. primary Raynaud’s. In the absence of signs of associated disease, the References: clinical factors that lead to consider Raynaud’s as suspect are severe De Angelis R, Grassi W, Cutolo M. Arthritis Rheum. 2009 15;61:405-10 crisis (several times a day, no summer remission, all fingers concerned, Herrick AL, Cutolo M. Arthritis Rheum. 2010 May 5. [Epub ahead of print] unexplained aggravation. When these factors are present, one needs to Cutolo M, Sulli A, Smith V. Nat Rev Rheumatol. 2010 Aug 10. [Epub ahead of print follow up the patient. When Raynaud’s seems to be primary, nailfold capillaroscopy and Sy12-3 rayNaUd pHeNOmeNON: tHe OCCUrreNCe antinuclear antibodies (ANA) need to be performed. Then no follow OF diGitaL ULCerS CHaNGeS eVerytHiNG! up is believed to be necessary. If capillaroscopy or ANA are positive, P. CARPENTIER1 then annual follow up is mandatory because 40% patients will have 1 Clinique Universitaire de Médecine Vasculaire, Centre Hospitalier other characteristics of systemic sclerosis. Literature does not give the Universitaire de Grenoble, France answer on the extend of assessment to be performed in that case. Finally a patient suffering from Raynaud’s needs careful clinical Raynaud phenomenon is a vascular acrosyndrome that is widespread assessment, nailfold capillaroscopy and ANA. Other investigations and in the general population and most often primary, without significant follow-up depend on associated clinical signs. influence on the health status and quality of life. But when this phenomenon is associated with digital ulcers, the situation becomes Sy12-2 CLiNiCaL USeFULNeSS OF CapiLLarOSCOpy quite different: M. CUTOLO1 - A benign primary Raynaud can be ruled out in front of these associated 1 Research Laboratory and Academic Unit of Clinical Rheumatology, trophic changes, and the underlying disease is most often a systemic Department of Internal Medicine, University of Genova, Genova, sclerosis, with or without additional clinical features, requiring a Italy diagnostic work-up and a specific management with both local and systemic therapeutic targets. The hypothenar hammer syndrome is the Nailfold videocapillaroscopy (NVC) represents the best and safest second etiology to be called in mind in this situation, and although the method to detect and to analyze morphological microvascular recurrence of this occupational disease is rare, it requires a specific abnormalities, especially in presence of secondary Raynaud’s medical and medico-social approach. phenomenon. In normal conditions or in primary Raynaud phenomenon - Digital ulcers related to systemic sclerosis are difficult to heal (mean (but not during the cold-exposure test), the nailfold capillaroscopic duration > 100days), result in a significant alteration of the quality of pattern shows regular disposition of capillary loops along the nailfold life and hand disability in everyday life, often show multiple recurrences bed and no abnormal enlargements or capillary loss. (66%), and can end up in tissue loss or even digital amputations In patients with primary Raynaud phenomenon, however, one or more (1.2%). abnormal capillaroscopic findings, should alert the physician to the - Their treatment is difficult, with no clearly efficient treatment possibility of secondary Raynaud phenomenon, owing to the presence demonstrated in therapeutic trials, and the prevention of recurrences, of a previously undetected connective autoimmune disease, for example which has been found more easily achievable, is therefore one main systemic sclerosis (SSc). therapeutic goal. Morphological markers of microvascular damage include giant capillaries, microhemorrhages, loss of capillaries, the presence Sy12-4 tHe tHerapeUtiC CHaLLeNGe OF diGitaL of avascular areas and angiogenesis; these features characterize ULCerS iN SyStemiC SCLerOSiS more than 95% of patients with overt SSc even if are not obesrved P. PRIOLLET1 concomitantly. 1 Department of Vascular Medicine, Groupe Hospitalier Paris-Saint These sequential and dynamic capillaroscopic changes are typical of Joseph, 75014 Paris, France the microvascular involvement in SSc, and can be described by the term ‘SSc pattern’ . Digital ulcers(DU) are a major complication in the course of systemic Most importantly, imaging with NVC enables the early differentiation sclerosis(SSc). DU occur up to 60% of patients with limited or diffuse between primary and secondary Raynaud phenomenon by identifying SSc. These lesions lead to substantial morbidity (reduce quality of morphological patterns specific to various stages of SSc (patterns life, pain, disability and disfigurement) that can escalate to gangrene ‘early’, ‘active’ and ‘late’); the inclusion of these NVC patterns could and amputation. Management of DU remains a challenge. It involves increase the sensitivity of classification criteria for SSc. non-pharmacologic and pharmacologic modalities for treatment and Reduced capillary density on NVC correlates with a high risk of prevention of these lesions. Non -pharmacologic therapies include developing digital skin ulcers and the presence of pulmonary arterial avoidance of cold exposure, emotional stress, nicotine exposure, hypertension, and can therefore be used as a marker of SSc severity trauma or vasoconstricting drugs. Supporting therapies include and progression. pain medications, antibiotics and occlusive dressings. Agents to Therapies targeting underlying vascular disease in SSc improve treat Raynaud’s phenomenon are often used for the treatment and symptoms of Raynaud phenomenon and reduce ischemic injury to prevention of DU in SSc. Direct vasodilatating drugs such as calcium involved tussue/organs; however, targeted treatment of fibrosis remains channel blockers, alpha-adrenergic inhibitors, angiotensin converting a challenge. enzyme inhibitors, angiotensin receptors blockers, nitrates and Immunesuppressive tharapies still of efficacy in the modulation of intravenous prostacyclins are used with variable degrees of efficacy. the immune response underlying SSc and generally characteriwing Placebo-controlled study using an oral endothelin receptor antagonist, all connective tissue diseases (i.e. Cyclophosphamide, Rituximab, bosentan, demonstrated a 48% reduction in the mean number of new Ciclosporin). ulcers during the treatment period; however, there was no difference 38 ~
- 39. between treatment groupsin the healing of existing ulcers. Other NCT00566657 agents considered for the treatment of DU include phosphodiesterase- 5-inhibitor,selective serotonin reuptake inhibitors, antiplatelet as well Sy13-2 patHOpHySiOLOGy OF CritiCaL Limb iSCHe- as anticoagulant therapies and statin. Surgical procedures may be mia required as a last resort for severe DU. Finally, patients therapeutic P. CARPENTIER1 training is essential for DU prevention in SSc. 1 Clinique Universitaire de Médecine Vasculaire, Centre Hospitalier Universitaire de Grenoble (38043), France Sy 13 - Critical Limb ischemia (Organized thanks to an unrestricted grant from Sanofi Aventis) The microvascular system is able to adapt for a large range of blood flow conditions to preserve tissular viability through adequate oxygen Sy13-1 a raNdOmiZed, dOUbLe-bLiNd, pLaCebO- cell delivery. The most crucial parameter for a proper functioning of CONtrOLLed GeNe tHerapy StUdy USiNG NV1FGF FOr this sophisticated distribution network is the arterio-venous pressure preVeNtiON OF ampUtatiON aNd deatH iN CritiCaL gradient, which explains the prognostic value of distal arterial pressure Limb iSCHemia (tamariS). measurements in patients with peripheral arterial disease, and the ratiONaLe, deSiGN aNd baSeLiNe patieNt CHaraC- well documented superiority of revascularization over vasomotor teriStiCS interventions in the situation of limb salvage. J. BELCH7, E. VAN BELLE1, S. NIKOL2, L. NORGREN3, However, when the arterial hemodynamic conditions are beyond the I. BAUMGARTNER4, V. DRIVER5, W. R. HIATT6 (Tamaris steering adaptation capability of the microcirculation, the decompensation of committee) this highly regulated system produces several pathophysiological 1 Department of Cardiology, CHRU de Lille and EA 2693, University vicious circles that have also to be taken into account in the medical Lille-Nord de France; management of the patient: 2 Department of Angiology, Askleplios Klinik St. Georg, Hamburg; - the low arterio-venous pressure gradient induces heterogeneity of 3 Department of Surgery, Orebro University Hospital, Orebro, capillary perfusion related to the non-uniformity of capillary geometry, Sweden; which results in even deeper hypoxia in some tissular areas and higher 4 Swiss Cardiovascular Center, Division of Angiology, Inselspital, risk of cellular death; Bern University Hospital, Bern, Switzerland; - this perfusion heterogeneity is further enhanced by a regional 5 Clinical Research Foot Care, Endovascular and Vascular Services, hyperviscosity related to a deficiency of the physiological hemodilution, Boston University School of Medicine and Boston University which is depending upon the arterial blood flow velocity; Medical Center, Boston; - the hypoxic vasoplegia suppress the physiological vasomotion - an 6 Division of Cardiology, University of Colorado School of Medicine, other compensatory mechanism for tissue perfusion heterogeneity – Denver, Colorado USA; 7Institute of Cardiovascular Research, and the myogenic reflex which physiologically protects the capillary (Vascular & Inflammatory Diseases Research Unit) Ninewells networks against orthostatic pressure, therefore facilitating edema Hospital and Medical School, Dundee formation; - the decrease in transcapillary pressure gradient related to poor Background: Patients with critical limb ischemia (CLI) unsuitable for capillary perfusion and edema-related interstitial hyperpressure results revascularization have a high rate of amputation and mortality (30% in capillary collapsus and further decrease in functional capillary and 25% at 1 year respectively). Local gene therapy using plasmid density. DNA encoding acidic fibroblast growth factor (NV1FGF, riferminogene The understanding of these mechanisms allow the optimization of the pecaplasmid) demonstrated an increased amputation-free survival in a adjuvant medical, pharmacological and physiotherapeutic management phase II trial. This paper provides the rationale, design and baseline of patients with critical limb ischemia in dedicated multidisciplinary characteristics of CLI patients enrolled to the pivotal phase III trial vascular centers. (EFC6145/TAMARIS). methods: An international, double-blind, placebo-controlled, Sy13-3 CritiCaL Limb iSCHemia: tHe LimitS randomized study included 525 CLI patients recruited from 170 OF reVaSCULariZatiON sites worldwide who were unsuitable for revascularization and had E. ASCHER1 non-healing skin lesions, to evaluate whether repeated intramuscular 1 Mt. Sinai School of Medicine, New York, USA administration of NV1FGF results in reduction of major amputations or deaths at 1 year. introduction: Bypasses to the infrageniculate arteries were adopted by results: Mean age of the population was 70±10 years including 70% vascular surgeons for management of critical lower extremity ischemia males and 53% diabetic patients. Fifty four percent of the population more than four decades ago. These challenging operations have proven had previous lower extremity revascularization and 22% had previous to be an acceptable alternative to major amputations, especially in minor amputation of the index leg. Ninety six percent of patients had the elderly diabetic population. Perhaps the most important factor an ankle pressure < 70 mmHg and/or a toe pressure < 50 mmHg or a determining success is the utilization of autologous vein as a conduit. TcPO2 < 30mmHg. In 94% the index leg had distal occlusive disease Herein we discuss the reported results of distal bypass to arteries in the affecting arteries below the knee. Statins were prescribed in 54% of foot and calf using non-autologous conduit. patients, and antiplatelet drugs in 80%. Variation in region of origin Prosthetic Bypasses with Adjacent Arterio-Venous Fistulas (AVF): resulted in only minor demographic imbalance. Patients with diabetes Bypasses to Infrageniculate Arteries: We recently reviewed our had more risk factors including history of coronary artery disease, but experience with 112 PTFE bypasses with complementary AVF were similar to non-diabetic patients regarding limb haemodynamics performed in 103 patients at our institution. Of these, 58 were men and vascular lesions. (56%) and 45 women (44%) with average ages 71.5 ± 9. Indications Conclusion: The clinical and vascular anatomy presentation of for surgery were limited to patients with critical ischemia: severe rest patients with CLI with ischemic skin lesions who were unsuitable for pain in 39%, non-healing ischemic ulcers in 33% and gangrene in revascularization was homogeneous with little imbalance according to 28%. Six-millimeter expanded and ringed PTFE grafts were utilized region of origin or diabetic status. The findings from this large CLI for all 112 bypasses. Lack of suitable autologous vein for the bypass cohort are important for the understanding of the epidemiology of the was the indication for the use of prosthetic material in 91 cases. In the disease. remaining 21 cases, patients were too unstable to withstand prolonged reference: This study is registered with ClinicalTrials.gov, number operations with multiple vein harvesting. www.iua-eurochap2010.eu ~ 39
- 40. The arteries used for outflow included: the anterior tibial in 53 cases material are well tolerated by the organism, but in particular situations, (45%), the posterior tibial in 26 (23%), and the peroneal in 21 (19%). they can lead to severe infections, difficult to treat. We created complementary distal anastomosis AVFs in the following materials and methods: A retrospective study were carried out in fashion: We selected the larger of the two deep veins, ligated vein which sequential cases of pseudoaneurysms and infections occured branches, mobilized the recipient artery and performed a 1-2 cm after vascular procedures between 2005 and 2009 were identified from arteriotomy, ligated adjacent deep vein and transected it at anywhere operating rooms records. Data collected included epidemiological from 0.5 to 1 cm distal to the endpoint of the arteriotomy, fashioned and characteristics of each patient, method of presentation, history of anastomosed the open end of the central vein portion to the adjacent previous vascular surgery, treatment received by each case and results artery and then performed an end-to-side anastomosis between the after treatment. distal end of the PTFE graft and the vein. Completion arteriogram was results: In these period we performed 150 reconstructions of the lower performed in all cases to evaluate the adequacy of the technique. limbs. Time from graft implantation to aneurysm formation varied from The 30-day mortality rate in our set of patients was 2.9%. All 3 patients 1 month to 3 years. Clinical signs were represented by groin swelling died from acute myocardial infarction. The overall cumulative graft associated with pain but in 2 cases only pulsatile mass in the groin patency rates for the 112 infrapopliteal bypasses were 75%, 65% and was the only sign. Treatment consisted in defect repair by direct suture 55% at 1, 2 and 3 years, respectively. Overall cumulative limb salvage or complete revision of anastomosis. Another treatment option was rates for the 112 infrapopliteal bypass cases were 81%, 76% and 73% excision of a segment of the graft and replacement with additional graft at 1, 2 and 3 years, respectively. material. Treatment of infections was both medical with large spectrum Bypasses to Pedal Vessels: Our experience with this technique consists of antibiotics and surgical by graft excision and extraantomic bypass of 20 patients who presented with very limited distal runoff with no reconstruction or arterial ligature followed by above knee amputation. autogenous vein and very small adjacent deep veins. Adjunctive turn- Conclusion: The development of an anastomotic aneurysm should down arteriovenous fistulae were constructed with great saphenous be viewed as a total failure of the anastomosis. The best therapeutic vein in 15 patients and with the small saphenous vein in 5 patients. The strategy is excision of a segment of the graft and replacement with an recipient arteries were the distal posterior tibial in 7 cases, the dorsalis interponat. In the presence of infection the only option is to bypass pedis in 7 cases and the plantar branches in 6 cases. the region through an extraanatomic procedure and eventually to cover Our technique for the saphenous turn-down fistula includes: 1) the infected site with a muscular flap. Intensive use of large spectrum transection of the greater or lesser saphenous vein in the lower leg; 2) antibiotics and a proper surgical technique can prevent appearance of circumferential mobilization of the vein down to the level of the ankle; these complications. 3) ablation of the distal valves with an antegrade valvulatome and coronary dilator; 4) subcutaneous tunneling of the free portion of the Sy14-2 COmpLiCatiONS aFter iNterVeNtiONaL vein in a gentle arc towards the paramalleolar artery; 5) anastomosis VeNOUS prOCedUreS of the peripheral end of the vein to the side of the artery and; 6) M. CATALANO1, E. PERILLI1 anastomosis of the distal end of a 6 mm PTFE ringed graft to the vein 1 Research Center on Vascular Diseases and Angiology Unit - at or near its anastomosis to the artery. University of Milan - L.Sacco Hospital, Milan, Italy Of the 20 cases with PTFE bypass and a saphenous turn-down arteriovenous fistula, 13 had a patent graft and fistula from 6 to 24 In recent years, mini-invasive procedures (laser and radio-frequency) months (mean 14 months). Five patients have had patent graft and for out-patient use have been developed, aimed at lowering the fistula for more than 2 years. Limb salvage was achieved in 14 (70 %) peri-operative morbidity of surgery but retaining the same level of of these cases from 3 to 24 months (mean 12 months). We believe that, effectiveness. despite the limited patency rates of non-autologous pedal bypasses, Complications, both major or minor, can rarely occur with these limb salvage will be achieved in a certain percentage therefore making methods (less than 3% of patients). the attempt a viable and worthwhile endeavor. According to the main data in literature on endovenous laser, the Summary: While an aggressive approach to ischemic limbs salvage incidence of major complication, (TED), is 0.12%. The occurrence using totally autogenous infrapopliteal bypasses has demonstrated of minor complications are: pain during the procedure (16.1%), encouraging results, a significant number of patients will face major bruises (60.6%), haematoma (5.5%), temporary paraesthesia (3.4%), amputation due to the insufficient vein length. In these instances, the hyperpigmentation (2.9%), superficial vein thrombosis of collateral physician must rely on using less durable grafts made of prosthetic veins (3.4%) and burns (0.2%). material. Methods developed by our group provide surgeons with Both TED (2.1%) and minor complications such as skin burns (1.2%) additional options for treatment of these challenging cases. The and paraesthesia (12.3%) are slightly more frequent with radio- cumulative patency rates are acceptable and support the value of using frequency procedures. this adjunctive technique. In order to maintain the proper safety level needed for performing this treatment on out-patients and to reduce complications it is important to Sy 14 - Complications of vascular procedures - a Symposium of pay special attention to several aspects: the romanian Society of angiology and Vascular Surgery • Rigorous personnel training • In-depth clinical investigation and ultrasonographic examination of Sy14-1 aNaStOmOtiC aNeUrySmS aNd the venous circulation to select patients iNFeCtiONS aFter peripHeraL prOCedUreS • Whole procedure must be entirely echo-guided (including the vein A. ANDERCOU1, O. ANDERCOU1, B. STANCU1, O. BUDIU1, access, the guide wire, the catheter and the optical fibre, the laser O. BARBOS1, M. ANDREI1 equipment while delivering energy). 1 University of Medicine and Pharmacy Iuliu Hatieganu, Second • Peri-venous anaesthesia (wi)th echographic monitoring). Other types Surgical Clinic, Cluj Napoca, Romania of anaesthesia increase the risk of TED and lower the likelihood of a successful outcome of the treatment. purpose: Most common and feared complications after peripheral • Antithrombotic prophylaxis with fractioned heparin, class three reconstructions are anastomotic aneurysms and local infections, which elastic compression leads to high rate of graft failure and limb loss. Anastomotic aneurysms • Echographic and clinical follow-up of the patient can be categorized into to groups: those that result from a perforation of Conclusions: Endovenous laser and radio-frequency are two safe mini- an artery by traumatic or iatrogenic injury, and those that results from invasive methods that can be considered out-patient treatments. dehiscence of a surgical vascular anastomosis. Usually, synthetic graft 40 ~
- 41. Sy14-3 COmpLiCatiONS OFVaSCULar aCCeSS avoid further complications (pulmonary infarction, endocarditis, I. DROC1, V. ALEXANDRESCU2 arrhythmia). 1 Army’s Center for Cardiovascular Diseases, Bucharest, Romania A right femoral vein 8F approach was done. A two loops snare was used 2 Princess Paola Hospital, Brussel, Belgium to capture the proximal end of the catheter, but this one was attached to the wall. A pigtail catheter was then successfully used to attach Endovascular procedures proved to be an alternative for classical the central part of the catheter, in the right atrium. By withdrawing vascular surgery. Postoperative complications are less frequent but the pigtail catheter, the bended ruptured catheter was than pooled sometimes very severe. Femoral pseudoaneurysms and retroperitoneal progressively into the inferior vena cava and the right iliac vein. hematoma are ones of the rare complications after femoral puncture, Once in the smaller diameter iliac vein, one extremity of the ruptured with local and systemic signs. That’s why the surveillance and prompt catheter was easier to capture, using the dedicated snare. Pooling back surgical treatment is very important especially for high risk patients. the snare, the bending of the ruptured catheter was abolished. Venous This is a retrospective study which was perfomed on patients aged 48- introducer, snare and captured ruptured catheter were progressively 80 years old developing complications after endovascular treatment in extracted, without venous injury. our institutions. All patients required emergency surgical treatment. The Although rare, complications of ruptured venous catheter may require diagnosis was established by clinical exam, echo-doppler and CT. The the intervention of a skilled team, with the use of dedicated extraction main risk factors were: hypertension, COPD, obesity, use of antiplatelet devices and the ability of operators to improvise. agents, periprocedural heparinisation. The maximal incidence was reported in the 7th decade. All the patients needed surgical treatment. Sy 15 - Common session eurochap - microcirculation: Postoperative evolution was favorable. relationship between macro and microcirculation After cardiac and vascular procedures, clinical and paraclinical postinterventional surveillance is mandatory in order to detect and treat Sy15-2 mOdULatiON OF SmaLL artery FLOW: major complications, which sometimes can be fatal. WaLL remOdeLiNG aNd periVaSCULar adipOSe tiSSUe Sy14-4 earLy FaiLUre OF arteriOVeNOUS FiStULa A. S. GREENSTEIN1, R. AGHAMOHAMMADZADEH1, FOr HemOdiaLySiS R.A. MALIK1, A. M. HEAGERTY1 V. POPOVIC1, J. PASTERNAK1, J. PFAU1, M. KACANSKI1, 1 Cardiovascular Research Group, School of Biomedicine, University D. NIKOLIC1, Z. HORVAT1 of Manchester 1 Clinical Centre Vojvodina, Novi Sad, Serbia The major determinant of flow through small arteries is variation in the Background: Increasing use of primary arteriovenous fistulae (pAVFs) luminal diameter. In patients with essential hypertension a reduction is a desired goal in hemodialysis patients. However, in many instances, in lumen diameter occurs by eutrophic remodeling: an inward re- AVFs fail to adequately mature due to ill-defined mechanisms. arrangement of the arterial wall. In patients with diabetes there is a Objective: To determine the factors affecting early failure and high pathological outward growth of the arterial wall with preservation, rather complication rate of AVFs than narrowing of the lumen diameter. The inability to reduce lumen methods: A retrospective study was conducted analyzing data during diameter in the context of hypertension may lead to a predisposition six year period on hemodialysis patients with previously created to target organ damage and this forms the basis of the ‘passive vascular accesses at Clinical Center in Novi Sad. Five hundred eighty pressure microcirculatory bed’ hypothesis. This pathological pattern AVFs were analyzed. There were 216 men and 188 women, with an of wall growth also been seen in patients with acromegaly, endocrine average age ranging from 21 to 82 years (mean age, 51.39 years). hypertension and recently in elderly patients with late-life depression results: The types of procedures performed included placement of where it correlates with vascular lesions seen on MR scanning. arteriovenous grafts in 12 patients, creation of AVFs in 484 patients Luminal diameter is also controlled by a fine balance between and revision of AVFs in 83 patients. endothelium mediated vasodilation and constriction of the small Conclusions: Main risk factors for early failure and high complication artery wall. Recently, it has been observed that this balance can be rate included: hypothension, diabetes mellitus, cardiac desease, previos influenced by adipose tissue which surrounds the small artery, known temporary catheter insertion. Autologous access is the best angioaccess as perivascular adipose tissue (PVAT). In health, PVAT releases soluble for dialysis also in all groups of patients and can be performed in most relaxing factors which work via both endothelial dependent (nitric patients. oxide) and endothelium independent mechisms. In obesity the anti- contractile capacity of PVAT is lost due to inflammation in adipocytes. Sy14-5 iNterVeNtiONaL retrieVaL OF FraCtUred The resultant increase in tone has been postulated to contribute to the CeNtraL VeNOUS CatHeter development of hypertension in obesity. D. D. OLINIC1, C. C. HOMORODEAN1, M. MARIA OLINIC1, M. M. OBER1 Sy15-3 reLatiONSHip betWeeN maCrO- 1 University of Medicine and Pharmacy, County Clinical Emergency aNd miCrOCirCULatiON Hospital, Cluj-Napoca, Romania P. BOUTOUYERIE1 1 Hôpital Européen Georges Pompidou, Unité de Pharmacologie Central venous catheters are often used for chemotherapy, parenteral clinique, Service de Pharmacologie nutrition and long term antibiotics. A potential complication with their use is fracture of the catheter with the intravascular fragment migrating Abstract: large arteries and small arteries properties may interact to centrally as a foreign body embolus. The incidence of this complication explain the pathophysiology of cerebrovascular diseases in many is approximately 1-2/1000. ways. First, atherosclerosis at the level of the aorta and cervical A case is presented in which the central venous catheter, implanted arteries is a major cause of stroke. Here, epidemiological evidences perioperatory in a patient with gastric neoplasia, was unfortunately are given, together with insights in the mechanical properties of the cut, during manoeuvers to withdraw the catheter. The distal part of atherosclerotic plaque. Second, cognitive impairment may result from the catheter migrated into the pulmonary artery, while the proximal vascular causes (small vessel disease, stroke), or neurodegenerative part remained in the upper vena cava. Radiology assessed the disease such as Alzheimer disease, and even more often both conditions complication, while patient remained asymptomatic. Interventionists are associated. Here, we present evidence of strong and meaningful were immediately asked to extract the ruptured catheter, in order to associations between large artery stiffness, cognitive decline and white www.iua-eurochap2010.eu ~ 41
- 42. matter lesions. Last,there is a unifying condition known as pulse wave encephalopathy, related to the transmission of pulse pressure to the brain tissue along large arteries to the microcirculation, where excessive pulsatility induces fragility and damages. Evidence for this phenomenon and its link with arterial stiffness and chronic brain damage are to be given. The efficacy of antihypertensive treatments to prevent cerebrovascular diseases may be carried by their effect on large arteries, namely arterial stiffness. Whatever the mechanisms involved, the consequences of risk factors on large and small arteries matters for the understanding of most cerebrovascular diseases and related conditions. 42 ~
- 43. Free OraL COmmUNiCatiONS compared with Pearson chi-square test, survival using Kaplan-Meier curves. EVAR patients were older and had significantly more cardiac OC1 - aortic aneurysms and pulmonary comorbidities (p=0.05). 30-day major complication and mortality rates for MIAR, OR and EVAR were 5%, 15%, 5% (p=0.15) and OC1-1 SymptOmatiC HUGe abdOmiNaL aOrtiC 1.7%, 1.6% and 1.6% (p=0.99) respectively. Median LOS for MIAR=5 aNeUrySmS:mOrbidity aNd mOrtaLity days was shorter than OR=7 days (p=0.003); longer than EVAR=2 days M. SALEM1, A. SALEM2, T. SALEM3 (p< .001). Median hospital charges were lowest for MIAR, +$1,325 1 Faculty of Medicine, Department of Vascular Surgery, Alexandria, greater for OR (p=0.32); +$15,305 for EVAR (p<0.001). The >30-day Egypt complication rate for MIAR was 5%; OR 12.5% (p=0.2). The 30 to 2 Medical Research Institute, Department of Surgery, Alexandria, 180-day and >180-day EVAR re-intervention rate for endoleak and/or Egypt migration was 4.7% (3/63) and 6.3% (4/63). Three-year survival was 3 Faculty of Medicine, Department of Internal Medicine, Alexandria, 91%, 87%, and 81% (p=0.35) for MIAR, OR and EVAR. Egypt Conclusion: MIAR is safe and results in fewer complications and shorter hospital stay compared to standard open repair. It is significantly Objective: is to evaluate the results of surgical reconstruction of more cost effective than EVAR. MIAR may become the new gold symptomatic huge abdominal aortic aneurysms (AAAs). standard for AAA repair. design & method: Twenty eight patients with symptomatic huge Keywords: Minimal incision, Open repair, Endovascular repair abdominal aortic aneurysms were studied in ten years period from 1995-2005.The diagnosis was done by: history, clinical examination, OC1-3 pr e Va L e N C e OF a b d Om i N aL aO rtiC various imaging which include: Duplex Ultrasound, CTA, MRA, DSA aNeUrySm iN SCreeNiNG SUrVey OF SmaLL tOWN’S & mid –stream aortography . Aortic reconstruction was done by using reSideNtS iN NOrtHerN pOLaNd Bifurcated Dacron graft or aneurysmorrhaphy in mycotic saccular type A. JAWIEN1, B. FORMANKIEWICZ1, T. DEREZINSKI1, (two cases). A. MIGDALSKI1, R. PIOTROWICZ1, G. JAKUBOWSKI1 results & Conclusions: The age incidence ranged from 45 -78 years 1 Collegium Medicum, University of Nicolai Copernicus, Bydgoszcz, with a mean of 64 years. Male sex was predominant than female Poland sex with M:F ratio 6:1. There was a history of Diabetes mellitus, smoking, hypertention, hypercholesterolaemia, obesity, myocardial purpose: The aim of the study was to evaluate the prevalence of infarction(7cases ) & renal impairment (two cases). The most common Abdominal Aortic Aneurysm (AAA) among asymptomatic men aged presentations of AAAs were abdominal pain, back pain, pulsating 65 years and older in the community of 14 700 citizens’ town in abdominal mass & acute abdomen (in two leaking AAAs ). The size northern Poland. of the aneurysm (diameter) ranged between 10-22 cm with a mean method: Ultrasonography was used as an assessment for abdominal of 14 cm, the size was measured by Duplex Ultrasound &CTA. aorta in a population of small town’s men over 65 years old. The criteria Postoperative. Morbidity: Lower limb ischemia due to thrombosis was for diagnosing AAA were: 1.diameter of the infrarenal aorta more than present in two cases & distal embolization in two cases, thrombectomy 30 mm or 2. diameter of infrarenal aorta 50 per cent greater than the & embolectomy were done respectively & successfully except One big diameter of suprarenal aorta. toe amputated after embolectomy. Myocardial infarction occurred in results: Among 14 700 citizens of the studied town’s population the four cases, Two of them died. Another two cases developed uraemia, men 65 of age or more accounted for 641. The screening was performed one of them died. One of the two cases presented with leaking aneurysm in 253 men, leading to the attendance rate of 39%. 23 (9.1%) out of 253 died. The over all mortality rate within thirty postoperative days was screened men had positive ultrasound results for AAA. The anterior to 14.3%, no intraoperative mortality. In conclusion, the morbidity & posterior diameter of the aorta was successfully measured in all studied mortality rates were proportional with increase in size of the aneurysm men and the size of diagnosed AAA ranged from 30 to 65mm. The & increase with the presence of preoperative cardiac, renal dysfunction mean age of men with AAA was 72,8 years. Almost 87% (20) patients & risk factors. with detected AAA were active smokers or only recently not smoking. Keywords: Aortic aneurysm,Pulsating Abdominal mass, Ischaemia of Hypertension and cardiovascular disease were respectively accounted the lower limb for 56% and 30% of another risk factors for AAA. Only 1 patient with AAA had positive familial history. Five (1.9%) patients were found OC1-2 miNimaL iNCiSiON aOrtiC aNeUrySm to have the diameter of AAA >= 55mm and all of them underwent repair: aN UNderUtiLiZed bUt SaFe teCHNiQUe elective AAA surgical reconstruction (3 patients - open repair, 2 M. KALRA1, A. DUNCAN1, S. CHA1, P. GLOVICZKI1 patients - endovascular repair). There were no postoperative mortality. 1 Mayo Clinic, Rochester, USA The progression of smaller lesions found in 19 patients (7.5%) are monitored on a regular basis by ultrasound and clinical examination. Objective: To evaluate our experience with minimal incision aortic Conclusion: The performed screening identified 23 (9.1%) patients repair (MIAR, incision <15 cm) and compare the results of abdominal previously not aware of having AAA. These findings have proven that aortic aneurysm (AAA) repair to traditional open surgery (OR) and screening for AAA is not only valuable for big populations but also for endovascular repair (EVAR). smaller communities with comparable rate of diagnosed AAA. methods: Data from consecutive patients undergoing elective MIAR Keywords: Abdominal Aortic Aneurysm, Prevalence, Screening over a 6 year period (2003-2008) were retrospectively reviewed. Patients undergoing suprarenal and/or iliac reconstruction were excluded, the OC1-4 retrOGrade traNS-pOpLiteaL reCaNaLi- remainder were compared to patients concurrently undergoing OR or ZatiON OF tHe SUperFiCiaL FemOraL artery: EVAR. tHe FaCe-dOWN teCHNiQUe results: MIAR was performed in 142 males and 30 females (mean I. BROUTZOS1, I. DALAINAS2, K. MOULAKAKIS2, age 72 years) with AAA: infrarenal (117), juxtarenal (20), with iliac N. PTOHIS1, M. DASKALOPOULOS2, C. PAPASIDERIS2, aneurysms (15) and aortoiliac occlusive disease (20). There were 10 A. PAPAPETROU2, K. XIROMERITIS2, M. MOSCHOU2, conversions; 30 day mortality was 1.7%. Median time to regular diet, E. AVGERINOS2, T. GIANNAKOPOULOS2, N. KELEKIS1, C. LIAPIS2 ICU and hospital stay (LOS) were 4,1.6 and 5 days. Infrarenal AAA repair by MIAR (n=64) was compared to OR (n=65) and EVAR (n=63). 1 2nd Department of Radiology, Athens, Greece Patient characteristics, 30-day mortality and complications were 2 Department of Vascular Surgery, Athens, Greece www.iua-eurochap2010.eu ~ 43
- 44. purpose: The aimof this prospective, single-Institution study is to documented in all patients. There were no amputations during a follow evaluate the technical success, clinical impact, and short term results of up period of 36 months and no hemorrhagic complications in early the retrograde transpopliteal recanalizzation of the superficial femoral post treatment period (within 30 days). Five patients died (28%) during artery (SFA), (face-down technique). follow up period from unrelated causes. methods: From September 2008 to April 2010, 24 patients were treated Conclusion: Findings indicate that thrombolytic treatment with with the face-down technique. Data collection and analysis, as well as intravenous rt-PA in selected patients with ALI who are unable or follow-up, were performed in a prospective manner. All patients were unwilling to undergo intra-arterial treatment is feasible. males, mean age 69 years (range 58-82). In all cases the antegrade Keywords: Intravenous thrombolysis,Tissue plasminogen recanalizzation was not possible due to impossibility of re-entry in the activator,Acute lower limb ischemia true lumen in subintimal recanalizzation attempts, or impossibility of proceeding with the antegrade access due to occlusion of the proximal OC1-6 eNdOVaSCULar repair OF traUmatiC part of the SFA. Twenty-two patients (91.7%) were classified with aOrtiC rUptUre: SiNGLe CeNter eXperieNCe TASC D lesions. The procedure started with the patient to a prone N. MELAS1, A. GIANNOPOULOS1, N. SARATZIS1, position and placement of a 5-6F introducer sheath into the popliteal A. SARATZIS1, I. LAZARIDIS1, C. TRIGONIS1, K. KTENIDIS1, artery under fluoroscopic guidance. A 0.035» hydrophilic guidewire D. KISKINIS1 was used for recanalizzation in all cases. 1 Aristotle University of Thessaloniki, Thessaloniki, Greece results: Immediate technical success was achieved in 21 of the 24 patients (87.5%). In two patients, the femoral-popliteal axis introduction: Traumatic rupture of the thoracic aorta secondary to was thrombosed immediately after the procedure. One patient blunt chest trauma is a life-threatening emergency. The endovascular underwent bellow-knee amputation, while the other an uncomplicated treatment of such pathologies is a proposed alternative to open surgery, thrombectomy of the femoral-popliteal axis. The third patient was which is typically associated with high rates of morbidity and mortality. complicated with intra-procedural dissection of the unilateral iliac- The objective of this study was to evaluate the efficacy of thoracic femoral-popliteal axis. He was immediately transferred to the operating aortic disruptions treated with thoracic stentgraft. theatre and treated with surgical fenestration and thrombectomy. The methods: 18 male patients (mean age 28.5 years) were admitted to patient restored good pedal flows after the surgical procedure. At a our institution between 2003 and 2009 due to blunt aortic trauma – mean follow-up of 6 months (range 1 to 16 months) 12 patients remain following violent motor vehicle collisions. Plain chest x-ray, spiral with patent popliteal artery and without significant restenosis. computed tomography and aortography were used for diagnosis in Conclusion: The face-down technique is a valid alternative to failed all cases. In six cases, transesophageal echocardiography was also antegrade subintimal recanalizzation of the SFA with an acceptable available. All subjects were poor surgical candidates, due to major periprocedural success rate. However, the mid-term durability of concomitant injuries and were treated using endovascular technique. the procedure is limited and therefore it should be attempted only in results: Technical success was 100%. In one case the deployment of patients with critical limb ischemia. a second cuff was necessary for exclusion of a endoleak. There were Keywords: Retrograde Recanalizzation, Subintimal Recanalizzation, no procedure related deaths. 3 patients presented with uncontrolled Face down hypertension which continued after graft deployment but subsided 3 months later. No cardiac, neurological or peripheral vascular OC1-5 iNtraVeNOUS tHrOmbOLySiS WitH reCOm- complications were noted within the 30 day post operative follow up biNaNt tiSSUe pLaSmiNOGeN aCtiVatOr (rt-pa) iN period except in one patient who presented Horner syndrome due to aCUte LOWer Limb iSCHemia subclavian artery transpotition. During late follow up (36 months) V. FLIS1, N. KOBILICA1, A. BERGAUER1, B. MRDZA1, one major complication appeared. One patient was converted to F. MILOTIC1, B. STIRN1 hybrid E-vita repair (18nth month) due to stentgraft collapse and 1 University Hospital Maribor, Maribor, Slovenia pseudoaneurysm formation. All patients are alive with no documented complication. Background: Over the past years, thrombolysis for the treatment of Conclusion(s): Endovascular repair of thoracic aortic disruption is acute limb ischemia has been the subject of intense evaluation, however technically feasible and early follow-up results are promising. most authors have attempted to address this issue by the use of intra- Keywords: Traumatic aortic rupture arterial thrombolysis. Some patients are for various reasons unable to undergo such treatment. The aim of this study was to evaluate the effect OC1-7 SUrGiCaL treatmeNt priNCipLeS iN of intravenous thrombolysis in patients with acute lower limb ischemia patieNtS WitH traUmatiC iNJUrieS OF maiN VeSSeLS, (ALI). bONe-JOiNtS OF eXtremitieS methods: In the present study we prospectively evaluated the outcome N. ABUSHOV1, M. KARIMOV2, G. TAGIZADE1, of ALI after intravenous thrombolytic treatment with 100 mg rt-PA E. ZAKIRJAYEV1, E. ALIYEV1 in patients with acute thrombosis of lower limb arteries and onset 1 Scientific Center of Surgery after M. TOPCHUBASHOV, Baku, of symptoms within 12 hours prior to treatment. During 3 years Azerbaidjan (2007-2009) eighteen patients out of 86 were included (range 65- 2 Azerbaijan Medical University, Baku, Azerbaidjan 80, 11 women). Written consent was obtained. Occlusions of in situ thromboses of native vessels and the level of ischemia between IIA and introduction: Debate continues about the choice of optimal surgical II B were accepted. Thrombosis was verified with duplex ultrasound treatment principles in patients with traumatic injuries (TI) of main examination. Thrombotic occlusions were located in external iliac vessels, bone-joints (MVBJ) of extremities. Aim: to define more artery (2), common femoral artery (2), superficial femoral artery (11) precisely the surgical treatment principles, to examine of complications and popliteal artery (3). All patients received thrombolytic treatment in the postoperative period and theirs prophylactic measures, to with100 mg rt-PA given intravenously over a period of 180 minutes. improve the immediate and remote results in patients with TI of MVBJ Standard exclusion criteria for thrombolysis treatment were applied. of extremities. Degree of lysis, patency of initially occluded vessels and clinical materials ans methods: 902 patients with vascular injuries, in side outcome including amputation-free survival (major amputations) were 855 persons with extremity vascular trauma, of these 127 (14,8%) with assessed. combined skeletal trauma. Localization of injury: upper extremity- results: Complete and partial thrombolysis was obtained in 8 (44%) 52(40,9%), lower-75(59,1%). Gunshot wounds–52 (40,9%), stab– and 6 (33%) patients, respectively, however clinical improvement was 30(23,6%), lacerated–20 (15,8%), blunt–25 (19,7%). Arteriography 44 ~
- 45. was used in 19 (14.19%) patients with stable homodynamics and OC2-2 dOeS reaLLy eXiSt a HiGH riSK patieNt FOr no establish diagnosis. Treatment methods of bone-joint injuries: CONVeNtiONaL CarOtid eNdartereCtOmy? transosseous osteosynthesis-9 (7,0%), intramedullary osteosynthesis- G. MARCUCCI1, F. ACCROCCA1, A. SIANI1, A.G. GIORDANO1, 13 (10,3%), osteosynthesis with metal pins-16 (12,7%), skeletal R. ANTONELLI1 traction-20 (15,7%), plaster immobilization-69 (54,3%). 1 San Paolo Hospital, Civitavecchia, Rome, Italy results: We consider, that prophylaxis of early infective complications in patients with TI of MVBJ (114-89,7%) depends on preferable Objective: the increasing use of carotid stenting (CAS) has been justified employment of external fixation methods; primary repair of injured in the patients at “high risk” for conventional carotid endarterectomy artery (later injured vein) for ischemia time decrease at stable fractures. (CEA). Based on our own patient population and the results reported in At unstable fractures priority should be given to osteosynthesis the literature, we try to demonstrate that CEA is a safe procedure, even before repair of injured vessels. Initial surgical correction of the in patients with high risk comorbidities. bone-joints injuries was used in 37 (29,1%), of injured vessels in design and method: we analyzed our 625 CEA interventions in 545 90 (70,9%) patients. Surgical repair of injured vessels-97 (76,4%) patients between June 2003 to June 2009. Of these patients, 59% had patients. Combined vascular and skeletal trauma was associated with a severe coronary disease, 15% had a severe pulmonary disease, 8% a higher (42(33,2%) from 127) employing of transplantat for vascular renal malfunction, 18% had a controlateral internal carotid artery reconstruction more than isolated vascular trauma (147(20,2%) from occlusion, 5% recurrent carotid stenosis or hostile neck and 37% were 728, p<0,001). Vascular ligation (11,8%) must be used only at forced more than 80 years old. circumstances. 48(37,7%) patients were presented with combined results: comparing with the “not –high risk” patients, so called “high nerve injuries. The long-term results: bad-7 (8,5%), satisfactory-53 risk” patients presented not significative differences in morbility and (64,7%), fine-22 (26,8%) patients. mortality rate (1.2% vs 1.5 % postoperative neurological events; p = Conclusion: Investigations show, that adherence of developed ns; 0.4 % mortality in both groups). In patients with redo surgery or principles promote for improvement of surgical treatment results in hostile neck, cranial nerve lesions rate was not statistically different of patients with TI of MVBJ of extremities. The long-term prognosis, on those of patients without redo surgery. In patients over 80 years of age, the whole, was connected with condition of extremity blood circulation we achieved a neurological deficit rate was 1.6% and mortality 0.2%. and reestablishment of nerve’s functions. Conclusion: our results and those from the literature show that CEA Keywords: Traumatic injuries,Main vessels, Bone-joints, Extremities is a safe procedure in patients with carotid artery disease. Coronary, pulmonary or renal disease, controlateral carotid occlusion carotid OC2 - peripheral arterial disease restenosis, hostile neck, age over 80 years are not a controindication to conventional CEA. OC2-1 FUNCtiON OF eNdOtHeLiaL CeLL iN Limb Keywords: Carotid endarterectomy, High risk patients iSCHemia R. PROCZKA1, M. KEDZIOR2, P. JAGUS2, P. BIALEK1, OC2-3 HiGH preVaLeNCe OF peripHeraL arteriaL M. POLANSKA2, M. POSTACCHINI1, I. POSTACCHINI1, diSeaSe: reSULtS OF tHe eVaLUatiON OF aNKLe/ P. NITKOWSKI1, J. CHOROSTOWSKA-WYNIMKO2, braCHiaL iNdeX iN HUNGariaN HyperteNSiVeS (erV) J. POLANSKI1 SCreeNiNG prOGram 1 2nd Department of Vascular Surgery, Warsaw, Poland K. FARKAS1, Z. JÁRAI2, E. KOLOSSVÁRY1, A. LUDÁNYI3, 2 Medical Diagnostic Laboratory, Warsaw Institute of Tuberculosis I. KISS1 and Lung Disease, Warsaw, Poland 1 Department of Angiology and Nephrology of Internal Medicine, St. Imre Teaching Hospital, Budapest, Hungary Objective: In patients with lower limb ischemia, specifically critical 2 First Department of Medicine, Semmelweis University, Budapest, limb ischemia, the local angiogenic response is unsatisfactory in Hungary maintaining adequate local perfusion. From our previous results, it is 3 EGIS Pharmaceuticals, Budapest, Hungary apparent that the level of vascular endothelial growth factor rises in this group of patients, however in patients with critical limb ischemia it Background and objective: Epidemiological data have shown that does not produce the expected biological effects. The aim of the study, clinical, but also preclinical stages of peripheral arterial disease (PAD) was to assess the impact of the patients serum on the activity of human are characterised by a high risk of cardiovascular mortality. PAD can umbilical vein cells( HUVEC) in patients with critical ischemia, be diagnosed already in the early, asymptomatic stage, with a simple, moderate ischemia and in healthy patients. noninvasive test, the ankle/brachial index (ABI). A low ABI is an method: We analysed three group of patients; with critical ischemia, indicator of high cardiovascular risk in asymptomatic patients. The moderate ischemia and healthy. In each group five patients were objective of the present study was to evaluate the prevalence of PAD in examined. 5% solution of patients serum was added to MTT and hypertensive patients. incubated for 4 hours. Absorbance was measured by 570nm wave. We patients and method: Hypertensive patients (age 50-75 years) who measured also the effect of 5% serum on elongation of vascular buds. were attended at 55 hypertension outpatient clinics from Hungary, results: The cessation of proliferative progression of HUVEC cells during a 17 month period, were included in the prospective study. All was discovered in the CLI group of patients. Furthermore, the effect of patients had a clinical history, a physical examination, a blood analysis, the examined serum on the angiogenic activity of endothelial vascular and a measurement of the ankle-brachial index. cells was analyzed. We observed enlarged total elongation of vascular results: A total of 21 892 patients (9162 males; mean age: 61.45 years), bud in patients with critical ischemia comparing to patients with were included in the study. 58 % of the subjects were at low (0-1%) moderate ischemia and to healthy ones (p<0.01, p<0.001). or moderate (2-4%) risk according to the calculated SCORE risk. The Conclusion: VEGF of patients with critical peripheral ischemia prevalence of a low ABI (<=0.9) was 14.0%. In the low, moderate and develops strong biological effect on HUVEC ! We suspect, that in high SCORE risk groups, the prevalence of low ABI was 6.5%, 9,7% critical ischemia, incompetence of VEGF receptors plays a crucial role. and 17.5% in males; 8.7%, 11.9% and 17.4% in females, respectively. Further investigations on larger group is needed. In a multivariate analysis, factors associated with a low ABI were age, Keywords: VEGF, HUVEC, CLi smoking, diabetes, hypercholesterolemia, elevated serum uric acid level, a reduced glomerular filtration rate, blood pressure >140/90 mmHg, microalbuminuria, the presence of myocardial infarction in the patient history and the presence of PAD in the family history. www.iua-eurochap2010.eu ~ 45
- 46. Conclusions: Prevalence ofa low ABI is elevated in hypertensive approaches, with close collaboration with non-European Countries. patients. The use of ABI screening may improve cardiovascular risk The Biobank is a project from VAS, European Scientific Association, prediction and the treatment can be modified according to the guidelines a large no-profit-Network of qualified researchers, clinicians, Centres for high risk patients. Cardiovascular morbidity and mortality data and Institutions of 23 European Countries, operating since 1991 in the will be evaluated after the 5 years long prospective phase of the ERV area of Angiology/Vascular-Medicine funding on the triad Research- program. Education-Clinics. Keywords: Peripheral arterial disease, Ankle-brachial index, methods: The Biobank on Vascular has subprojects activated in Hypertension succession.The first ongoing is on PAD (Vas-EBPp), high-risk disease for acute events/mortality, since the asymptomatic stage. The qualified OC2-4 CrONOCOL impLaNt redUCeS SUrGiCaL patient selection, data and sample collection procedure are standardised Site iNFeCtiON aNd imprOVeS FiNaL OUtCOme iN for participating Centres. Once the informed consent is signed the iSCHemiC patieNtS blood-samples are sent to the centralized biorepository in Milan after C. COSTA ALMEIDA1, L. REIS1, L. CARVALHO1, the researchers have filled in an anonymized detailed online-clinical- C. COSTA ALMEIDA1 questionnaire on the patient. The quality certified organization is fully 1 Centro Hospitalar de Coimbra, Coimbra, Portugal centralized making the participation free and easy. results: The VAS-European-Biobank is already recognised in the Surgical site infection (SSI) in an ischemic patient after implantation of European Network of Biobank of excellence for working with common a prosthetic by-pass is a complication that can have catastrophic impact methodologies (BBMRI, ISS), with the final aim to improve knowledge in the by-pass permeability and in the future of the limb, and it can and health in a near future. Short-term results: allowing biobanking to happen after administration of prophylactic systemic antibiotic. Using enter the everyday clinical practice of qualified Centres, strengthening a Cronocol implant (collagen matrix impregnated with gentamicin) in their excellence in the triad Clinic-Research-Education; make European the groin incision of patients submitted to femoro-popliteal by-pass can patients active in researches for future generations. be a viable option to reduce SSI. Conclusions: A wide call to join the European-Biobank on Vascular Objective: to compare SSI rate in patients operated on of femoro- Disease has been launched.(www.vas-int-org/vas@unimi.it ) popliteal prosthetic by-pass in whom a Cronocol implant was applied Keywords: Biobanking, Peripheral arterial diseases,Research in the groin incision intra-operatively, with SSI rate in a control group operated on without that implant. OC2-6 aSSeSSmeNt OF COLLateraL bLOOd Methods: in a group of 40 non-diabetic patients with lower limb ischemia FLOW iN iSCHemiC LOWer Limb with indication for femoro-popliteal by-pass graft (PTFE supported O. ALBAZDE1 grafts were used), all treated with piperacilin plus tazobactam as 1 Imperial College, London, United Kingdom systemic infection prophylaxis, 20 (chosen at random) had a Cronocol implant applied in the groin incision. All patients in both groups were Raised athermanous plaques are common in the lower abdominal aorta operated by the same team. SSI signs and symptoms were evaluated by early adult life. Progressive diseases at this site and in the vessels during the first 30 days pos-op, and the results compared. distal to it occur mainly in the second half of life, but usually remain Results: SSI rate (no severe infection in none, but edema, redness, asymptomatic. When symptomatic, patients usually present to the local pain, some pus around stitches) in the control group was 25 % (5 clinician with intermittent claudication. Several risk factors have been patients), while in the Cronocol group there were no signs of SSI. No implicated in the progression of such disease, diabetes mellitus has allergic reactions, either local or systemic, were noticed. been found to magnify the disease process, causing greater morbidity, Conclusions: by using a Cronocol implant intra-operatively it (and mortality) in the form of macrovascular and microvascular seems possible to reduce SSI rate in these operations, carrying no complications. complications related to its use. These preliminary results are very In order to quantitatively assess the contribution of the collateral favourable to the prophylactic efficacy of Cronocol implants towards circulation to the lower limb blood flow and to assess capillary filtration SSI, and that is why we are presenting them. More randomized studies a total of 80 subjects were subjected to popliteal artery blood flow and a larger group of patients in ours are needed, before its routine use measurement, (using Duplex ultrasound) and total limb blood flow can be advised in operations where a local infection can be disastrous. measurement using opto-electronic plethysmography. Keywords: Surgical Site Infection, Cronocol implant,PTFE prosthesis These subjects included 20 patients with peripheral arterial disease by-pass (PAD), [diagnosed by DSA as having occlusion of the superficial femoral artery without popliteal disease and with ABPI < 0.9] 20 OC2-5 eUrOpeaN biObaNK ON VaSCULar patients with PAD and NIDDM, 20 patients with PAD and IDDM and diSeaSeS 20 control subjects of comparable age and risk factors. M. CATALANO1, VAS-Scientific Team1, VAS-Biobank Working There was a significant difference in the means (P<0.05) of total limb Group1-2 blood flow and popliteal artery blood flow in patients with PAD, which 1 Vas-Vascular-Independent Research and Education-European can be attributed to the development of their collateral circulation. The Organization, Milan, Italy mean values for total limb blood flow and popliteal artery blood flow 2 Research Center on Vascular Diseases and Angiology Unit were not markedly different in all other study groups. This means that University of Milan-H Sacco, Milan, Italy in patients with NIDDM and IDDM, the popliteal artery is the main contributor to the blood flow to the lower limb and these patients have Objectives: Advances in medicine and the discovering of how genetic little collateral circulation blood flow. variation influences disease can be achieved only by research on The measurements for capillary filtration revealed that patients with big numbers of available samples, properly collected and stored by IDDM and PAD have a markedly reduced rate compared to the other Biobanks. Vascular Diseases and their socio-economic impact are study groups. spreading mainly because of the increase in average-age. To improve Keywords: Assessment of total blood flow, To ischemic lower limb the knowledge through a secure access to clinical data and biological resources which are essential in health-related researches the VAS- OC2-7 COmparatiVe StUddiNG OF HemOrHeOLO- European-Biobank on Vascular Patients was defined. Besides the GiCaL iNdeXeS iN patieNtS WitH CritiCaL Limb Biobank aims to contribute to increase research’s scientific excellence iSCHemia and efficacy in life sciences linking both clinical and biomolecular N. ABUSHOV1, E. ZAKIRJAYEV1, Z. ALIYEV1, G. ZEYNALOVA1 46 ~
- 47. 1 Scientific Centerof Surgery after M. TOPCHBASHOV, Baku, results: 86.5% of DCVT patients and 76.7% of MCVT patients were Azerbaijan treated with anticoagulant drugs during the whole follow-up (P=0.003). MCVT was significantly more associated with localized pain than introduction: Successful treatment of patients with critical limb DCVT (30.4% vs 22.4%, P=0.02) and less associated with swelling ischemia (CLI) is the one of the difficulty problem of contemporary (47.9% vs 62.7%, p<0.001). MCVT and DCVT patients exhibited the angiosurgery. The aim: to analyze the influence of alterations in same risk factors profile (except recent surgery slightly more associated hemostasis system to clinical course. with DCVT: OR= 1.70 [1.06 – 2.75]) and were equivalent in terms material and methods: The hemorheological status (fibrinogen of co-morbidities (evaluated thanks to their Charlson index). At three concentration, fibrinolytic activity, prothrombin index, blood months, there was no difference in terms of death, VTE recurrence and coagulation time, deformability of erythrocytes) in 25 patients with major bleeding between MCVT and DCVT (3.8% vs 4.1%; 1.5% vs CLI was studied. The main group (n=15) was performed by patients 1.4%; 0% vs 0.5% respectively, all statistically not significant). with thromboangiitis obliterans (TAO), aged from 22 to 51 (median Conclusion: isolated symptomatic MCVT and DCVT populations 40,0±0,7), control group (n=10)-arteriosclerosis obliterans, aged exhibit different clinical symptoms at presentation but affect the same from 47 to 72 (median 61,0±0,5). The diagnosis of TAO is based on 5 population. Under anticoagulant treatment and in the short term, criteria of Shionoya (smoking history, onset before the age of 50 years, isolated distal DVT constitute a homogeneous entity. Therapeutic trials infrapopliteal arterial occlusive disease, either upper limb involvement are needed in order to determine a consensual mode of care of MCVT or phlebitis migrans, and absence of atherosclerotic risk factors other and DCVT. than smoking). Microcirculation was studied by transcutaneous oxygen Keywords: Distal deep-vein thrombosis, Muscular calf vein pressure (tcpO2) for estimate the dependence of clinic-functional thrombosis, Deep calf vein thrombosis infringements in ischemic leg from hemostasis system. results: Main group (TAO) had a most tendency to hypercoagulation OC3-2 bLeediNG COmpLiCatiONS iN patieNtS and aggravation of the blood hemorheological features as compared WitH CaNCer reCeiViNG aNtiCOaGULaNt tHerapy with control group. In basic group prothrombin index was improved FOr VeNOUS tHrOmbOembOLiSm. FiNdiNGS median on 11,6±1,1% (ð<0,05), deformability of erythrocytes was FrOm tHe riete reGiStry reduced median on 1,23±0,2 un. (p<0,05). Blood coagulation time was A. VISONÀ1, P. DI MICCO2, J.A. NIETO3, J. TRUIJLLO SANTOS4, decreased in main group (2,1±0,4 vers. 3,1±0,3 min., ð<0,01). There R. QUINTAVALLA5, P. PRANDONI6, M. MONREAL7 were no significantly differences in indexes of fibrinogen concentration 1 Angiology Unit Castelfranco Hospital, Castelfranco Veneto, Italy and fibrinolytic activity. Comparative analysis of tcpO2 was revealed 2 Internal Medicine Ospedale Buonconsiglio Fatebenefratelli, Naples, the more clinic-functional infringements in ischemic leg at patients Italy with TAO (22,1±2,2 vers. 27,4±1,6 mmHg, p<0,05). 3 Department of Internal Medicine Hospital Virgen de la Luz, Cuenca, Conclusion: We consider, that medicamental therapy of hemorheologic Spain abnormalities in patient with TAO and CLI must be direct to correction 4 Department of Internal Medicine Hospital Universitario Santa of abnormalities in all hemocoagulation system components. The best Maria de Rosell, Cartagena, Spain results of complex surgical treatment were recorded by combined 5 Department of Internal Medicine Azienda Ospedaliera Universitaria, employment of surgical operations (arterial reconstructions or lumbar Parma, Italy sympathectomy), prolonged epidural analgesia and complex rheological 6 Germans Trias I Pujol Hospital, Badalona, Spain therapy in perioperative period. 7 Department of Cardiothoracic and Vascular Sciences University of Keywords: Critical limb ischemia, Thromboangiitis obliterans, Padua, Padua, Italy Hemostasis system Background: Cancer patients with acute venous thromboembolism OC3 - Venous thromboembolic disease (VTE) have an increased incidence of anticoagulant related bleeding complications compared with those without cancer. OC3-1 COmpariSON OF tHe CLiNiCaL HiStOry methods: Using data from RIETE, an ongoing registry of consecutive OF SymptOmatiC iSOLated mUSCULar CaLF VeiN patients with acute VTE, we assessed risk factors for fatal bleeding tHrOmbOSiS VerSUS deep CaLF VeiN tHrOmbOSiS among consecutive patients with active cancer and symptomatic acute J. GALANAUD1, M.A. SEVESTRE2,3, C. GENTY3,4, J.P. LAROCHE1, deep venous thrombosis (DVT) or pulmonary embolism (PE). V. ZYZKA5, I. QUERE1,6, J.L. BOSSON3,4 results: Up to December 2009, 25,022 patients with acute VTE had 1 CHU Montpellier, Montpellier, France been enrolled in RIETE, of whom 4,921 (20%) had active cancer. 2 CHU Amiens, Amiens, France Of these 212 patients did not receive anticoagulant therapy, or it was 3 TIMC, Grenoble, France stopped earlier than day 90 for reason other than bleeding. Thus, 4,709 4 CIC, Grenoble, France received anticoagulant therapy during the first three months and were 5 Cabinet de médecine vasculaire, Fort de France, France considered for the purpose of this study. 6 EA 2992, Montpellier, France During the first three months of anticoagulant therapy, 200 (4,4%) patients developed major bleeding. Then, 38 (0.8%) further patients Objective: half of all lower limbs deep vein thromboses (DVT) are bled beyond the first 90 days of therapy, 3 bled after withholding distal DVT that are equally distributed between muscular calf vein anticoagulant therapy. The most common sites of bleeding were the thromboses (MCVT) and deep calf vein thromboses (DCVT). Despite gastrointestinal tract (118 patients, 49%), genitourinary system (43 their high prevalence, MCVT and DCVT have never been compared patients, 18%) and the brain (27 patients, 11%). In all 160 patients so far, which prevents from a possible modulation of distal DVT (66%) died within 30 days after bleeding: 88 (55%) died of bleeding, 3 management according to the kind of distal DVT (MCVT or DCVT). (1,9%) died of recurrent pulmonary embolism. Our objective is to compare the clinical history of DCVT versus Conclusions: Major bleeding is a frequent and severe complication in MCVT. cancer patient with VTE, even beyond the third month. One in every design and methods: using data from the French, multicenter, three patients who bled died of the bleeding event. This information has prospective observational OPTIMEV study, we compared the clinical to be validated in further studies in order to help clinicians to weigh the presentation, risk factors of 268 symptomatic isolated DCVT and 457 risk and benefits of prescribing anticoagulant therapy in an individual symptomatic isolated MCVT and the three-month outcomes of the 222 patient. DCVT and 390 MCVT followed up. Keywords: Bleeding, Cancer, Anticoagulant Therapy www.iua-eurochap2010.eu ~ 47
- 48. OC3-3 FataL bLeediNG iN patieNtS reCeiViNG incidence, there is surprisingly little known about VTE in elderly. aNtiCOaGULaNt tHerapy FOr VeNOUS tHrOmbO- Our aim was to focus on epidemiological information regarding VTE embOLiSm. FiNdiNGS FrOm tHe riete reGiStry among old population. A. VISONÀ1, P. DI MICCO2, A. NIGLIO3, M. AMITRANO4, A total of 8256 patients suspected of VTE were included in the M. CIAMMAICHELLA5, P. PRANDONI6, M. MONREAL7, multicentre prospective cohort OPTIMEV study, among which the J.A. NIETO8 aged study population (> 75y) was 2149. A total of 655 patients 1 Angiology Unit Castelfranco Veneto Hospital, Castelfranco Veneto, (30.5%) were positive cases of VTE, including 203 isolated distal Italy DVT (31%), and 452 (69%) proximal DVT +/- PE. Compared to a 2 Internal Medicine Ospedale Buonconsiglio Fatebenefratelli, Naples, control group aged lower than 75 without VTE, bed rest (OR 1.43, Italy 95% CI 1.09 – 1.87), acute cancer (OR 1.99, 95% CI 1.47 – 2.7), 3 Internal Medicine of Second University of Naples, Naples, Italy previous history of VTE (OR 1.71, 95% CI 1.36 – 2.14), cardiac or 4 Angiology Unit San Giuseppe Moscati Hospital, Avellino, Italy pulmonary insufficiency (OR 1.91, 95% CI 1.4 – 2.62) and travel (OR 5 Medicina Urgenza S Giovanni Addolorata Hospital, Rome, Italy 3.59, 95% CI 1.31 – 9.85) were independent risk factors for all forms 6 Department of Cardiothoracic and Vascular Sciences University of of VTE. To identify potential specific risk factors in elderly, we tested Padua, Padua, Italy by logistic regression the interaction between age (more or less than 7 Department of Internal Medicine Hospital Germans Trias i Pujol, 75) and risk factors. Only male gender, lower limb immobilization and Badalona, Spain surgery were found to be significantly different risk factors for VTE 8 Hospital Virgen de la Luz, Cuenca, Spain according to age, and surprisingly, were more associated with VTE in younger patients. Our epidemiological data showed that severe medical Background: Fatal bleeding is the most serious consequence of disorders were strongly associated with the occurrence of VTE elderly. anticoagulant therapy, but the factors associated with fatal bleeding However, compared to young patients suffered from VTE, there is a during the first 3 months of treatment of acute venous thromboembolism few really specific risk factors in this old population. (VTE) are uncertain. Keywords: Venous thrombosis, Elderly, Epidemiology methods: Using data from RIETE, an ongoing registry of consecutive patients with acute VTE, we assessed risk factors for fatal bleeding OC3-5 tHrOmbOSiS OF atypiCaL LOCatiON, mayO among all patients. We then used this information to derive a clinical SerieS: prOFiLe OF LOCaL CaUSeS iN OrGaN VeiN model that would stratify a patient’s risk of fatal bleeding during the tHrOmbOSiS first 3 months of treatment. W. WYSOKINSKI1, R. MCBANE1 results: Of 24,395 patients, 546 (2.24%) had a major bleed and 1 Mayo Clinic and Foundation, Rochester, USA 135 (0.55%) had a fatal bleed. The gastrointestinal tract was the most common site of fatal bleeding (40% of fatal bleeds), followed Objectives: Organ vein thrombosis represents relatively rare but often by intracranial bleeding (25%). Fatal bleeding was independently very serious medical condition. To challenge the common notion that associated with the following factors at the time of VTE diagnosis: thrombosis of this location is associated with the general prothrombotic age >75 years (OR: 2.16), metastatic cancer (OR: 3.80), immobility§4 status, etiology of organ venous thrombosis with particular attention to days (OR 1.99), a major bleed within the past 30 days (OR: 2.64), an local causes was analyzed. abnormal prothrombin time (OR: 2.09), a platelet count <10/L (OR: patients and methods: We studied all patients with organ vein 2.23), creatinine clearance <30 mL/min (OR: 2.27), anemia (OR: 1.54), thrombosis: cerebral venous sinus thrombosis (CVST), portal, and distal deep vein thrombosis (OR: 0.39). A clinical prediction rule mesenteric, splenic, hepatic, renal, and ovarian vein thrombosis seen for risk of fatal bleeding that included 9 baseline factors was derived. at the Mayo Clinic between 1990 and 2006. Etiology of thrombotic Fatal bleeding occurred in 0.16% (95% CI: 0.11-0.23) of the low-risk, process was carefully reviewed. 1.06% (95% CI: 0.85-1.30) of the moderate-risk, and 4.24% (95% CI: results: Number of patients included, mean age±SD, contribution of 2.76-6.27) of the high-risk category. organ pathology provoking thrombosis, and the percentage of total Conclusions: Patient characteristics and laboratory variables can patients with local cause of thrombosis including those with multiple identify patients at high risk for fatal bleeding during treatment of acute potential etiologies are shown in Table. VTE. Keywords: Fatal Bleeding, Anticoagulant Therapy, Venous Thromboembolism OC3-4 VeNOUS tHrOmbOembOLiSm iN tHe eLderLy: epidemiOLOGiCaL data OVerVieW baSed ON tHe prOSpeCtiVe OptimeV COHOrt G. PERNOD1, 2, M. A. SEVESTRE1, 3, C. GENTY4, J. LABARERE1,5, P. COUTURIER1,6, J. L. BOSSON1,4 1 ThEMAS, TIMC UMR 5525 CNRS Université Joseph Fourier, Grenoble, France 2 Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France 3 Department of Vascular Medicine Unit, Amiens University Hospital, Amiens, France 4 Department of statistics, Centre of Clinical Investigation, Grenoble University Hospital, Grenoble, France 5 Quality of Care Unit, Grenoble University Hospital, Grenoble, France 6 Department of Geriatrics, Grenoble University Hospital, Grenoble, France Conclusions: With the exception of CVST, all other thromboses of organ veins are caused in the majority of cases by local factor: cancer, One of the strongest risk factor for VTE is age. Despite this high inflammation, surgery. Specific location of underlying cause determines 48 ~
- 49. specific location of thrombotic process while general predisposition is CCDU assessment is scheduled and after 3 months patients are planned less important. for a follow-up visit. 192 outpatients with objective confirmed ID-DVT Keywords: Venous thrombosis of atypical, Risk factors for were considered. 171 were eligible and were included in the study. 124 thrombosis (72.5%) presented only thrombosis of the muscular veins. 62 patients (36.2%) presented an unprovoked ID-DVT. OC3-6 eVaLUatiON OF a pNeUmatiC deViCe eF- Events during first month of treatment: Six patients showed progression FiCaCy tO preVeNt VeNOUS diSOrderS iN air thrombosis proximal deep veins (3.5%), 1 showed ID-DVT in the traVeL other leg. Six of them were unprovoked ID-DVT. There were no major F. FERNANDEZ1, I. CHIROSA2, M. MARTINEZ2, bleeding (0%); two patients (1.16%) suffered a minor bleeding. J.J. SÁNCHEZ-CRUZ3, E. ROS1 After three months: Five patients demonstrated recurrence: 4 patients 1 Hospital Universitario San Cecilio, Granada, Spain showed a proximal DVT. 2 Universidad de Granada, Granada, Spain In our study, the majority of thrombotic progression, during the 3 Escuela Andaluza de Salud Pública, Granada, Spain treatment period, was observed in patients with unprovoked ID-DVT. We need others patients to define correctly the treatment of ID-DVT Objectives: The WHO recognizes air travel related venous diseases but our results showed the usefulness of a full prolonged treatment in as a global hazard for health; it may encompass from paresthesia to unprovoked ID-DVT. oedema and in serious cases can produce deep venous thrombosis and Keywords: Deep venous thrombosis, Ultrasound, Pulmonary pulmonary emboli that can lead to fatal consequences. As causes we embolism can emphasize immobilization in static and forced situation, hypobaric hypoxia and coagulation disorder related to low humidity and low OC4 - Varicose veins pressure in cabin. In order to test the efficacy of a pneumatic device designed to prevent this pathology we have performed a randomized OC4-1 aNatOmiC preCONditiONS FOr reCUrreNt clinical essay with cross over groups. VariCeS iN SUrGiCaL treatmeNt OF primery design and methodology: 60 healthy volunteers were assigned in VariCOSe VeiNS randomized way to simulated air travel in hypoxia-hypobaric altitude M. VAKHITOV1, O. BOLSHAKOV1, V. AMOSOV1, O. KOVALEVA1 at 2.400 meters high with space and conditions similar to those of a 1 St.Petersburg State I.P.Pavlov Medical University, Department of commercial flight. We took anthropometric determinations, echography, General Surgery, St.Petersburg, Russia plethysmography and QOL questionnaire, after and before exposition and with and without induced exercise. The problem of primary varicose veins (PVV) treatment is not finally We made evaluation of weight, echographic diameters of deep and established. The high percentage of complicated forms and recurrent superficial veins, distance dermis-fascial and dermis-periostial for varices (RV) (from 20 to 80%) testifies to it. The precise mechanism of estimated oedema, venous occlusion plethysmography (venous outflow PVV development, as well as RV remains unclear. and capacitance) and qualitative questionnaires (symptomatology and It’s known, that deep veins (DV) take up to 85% of the outflow blood. QOL). Logically clear, the pathological high venous volume and pressure in results: There were no differences in venous diameter, but we found the superficial veins are an effect of inadequacy between the quantitive significant differences in oedema evaluated by malleolar echographic needs in the venous outflow and the DV capacity, caused by their distances (p<.000), clear differences in plethysmographic parameters anatomic structure. (p<.00) more acute in distal measures of venous return and there aim: To study a role of DV in varicose veins recurrence. weren´t significance in qualitative symptomatology after exposure to Materials and methods: Ultrasonography of 255 patients (339 lower flight simulated conditions. Those effects are reversible in control after limbs) with RV throughout different follow-up periods after radical two weeks. operations were made. Conclusion: Exercise mediated by pneumatic device can prevent DV structure of 53 lower extremities in anatomic material has been venous disorders caused by experimental simulated exposure to flight studied. The research included latex injection of veins and a layer- by- conditions. layer section. Keywords: Prophylaxis venous disease, Prevention based in exercise, results: In all 339 cases of RV pathologic reflux from the deep to Traveller´s thrombosis superficial veins were revealed: in 42 cases of 339 through the long stump (1,0-2,5cm) with insufficient tributaries; in 188 cases through OC3-7 CaLF VeiN tHrOmbOSiS aNd riSK OF the Anterolateral and Posteromedial tributaries. In 255 cases of 339 pULmONary embOLiSm there was reflux through the perforator veins mainly (94,5%) in the P. L. ANTIGNANI1, C. ALLEGRA1 calf. In 147 cases of 339 DV insufficiency was revealed. 1 Department of Angiology St. Giovanni Hospital, Rome, Italy In anatomic material 18 variants of venous structure were revealed, which reflect retiform, maturation stages of development and their The majority of the thrombi diagnosed by screening tests were similar forms. confined to the calf, clinically silent, without any progression or Conclusions: Morphological bases, providing adequate venous embolic complications. However, approximately 10 to 20% of calf outflow, are not the same in different individual forms of the DV thrombi extend to proximal veins. The real incidence of symptomatic structure. A lack of compensatory possibility of the DV can explain Isolated Distal Deep Vein Thrombosis (ID-DVT) is not clear, being DV hypertension, deep and perforator veins dilatation by pressure and reported in different studies between 9 and 46%. Symptomatic ID- reflux into the Great and Small Saphenous veins system, leading to DVT is associated with proximal progression, PE and post-thrombotic venous hypertension in the superficial veins and their varicosity, even syndrome more frequently than asymptomatic ID-DVT. after radical operations. Recent studies reported that the risk of PE in patients with ID-DVT is Keywords: Varicose Veins, Recurrent Varices, Deep Veins Structure similar to the risk of PE in patients with proximal DVT (24.6%). The TICT study (Treatment of Isolated Calf Thrombosis) is aimed to OC4-2 CLOSUreFaSt CatHeter eNdOVeNOUS assess the efficacy and safety of a treatment regimen of ID-DVT with abLatiON - a tHree year eXperieNCe twice-daily subcutaneous administration of full dose weight-adjusted C. STUCKEY1, C. BARBIERI1, A. MARTIN2,1, K. MCDONALD3.2.1, of LMWH for 1 week, followed by half dose of LMWH administered C. CONROY2,1, R. MARTIN1, D. ROLLINS4 once-daily for the 3 weeks. At the end of the 4 weeks of treatment a 1 ACP, Overland Park, KS, USA www.iua-eurochap2010.eu ~ 49
- 50. 2 RVT, OverlandPark, KS, USA had similar total repermeation rates (III&IV), but showed less partial 3 RDMS, Overland Park, KS, USA repermeation rates, ecchymoses, pigmentations or inflammation. 4 ORT, Overland Park, KS, USA Conclusion: This study confirms the efficacy of ELT in treatment of SVI. Subsequent studies remain necessary to determine its place among This presentation analyzes the three year experience developed in a continuously developing endoluminal techniques. private practice of Phlebology, from 05/01/2007 thrrough 04/30/2010. Keywords: Endovenous Laser Ablation, Varicose Veins,Venous In that time period we treated 359 patients (83% female), using 857 Insuffisency ClosureFast catheters to ablate 886 vessels (1.03 vessels/catheter), using radiofrequency for our energy source. The average number OC4-4 eNdOVeNOUS radiOFreQUeNCy-pOWered of ClosureFast catheters used was 2.39 catheters per patient. We SeGmeNtaL tHermaL abLatiON (rSta) OF tHe Great experienced no ClosureFast catheter failures. SapHeNOUS VeiN: 2-year eUrOpeaN FOLLOW-Up The treatment of these 886 vessels required 934 accesses (1.05 accesses/ O. PICHOT1 vessel). This larger number of accesses was primarilly the result of the 1 Service de Médecine Vasculaire CHU de Grenoble, Grenoble, failure of previous treatment (EVA with RF or EVLT) or segmental France occlusion from previous episodes of idiopathic thrombophlebitis.The vessel being treated required only one access in 804 interventions. Background: Radiofrequency segmental thermal ablation (RSTA) has Fifty six (56) vessels required two (2) assesses and on six vessels, three become a commonly used technology for occlusion of incompetent accesses were utilized. great saphenous veins (GSVs). Mid-term results and data on clinical We used 489,680 cc of tumescent analgesia in treating 45,652.2 cm parameters are still lacking. (approx 1500 yd) of incompetent refluxing varicose vein (10.73 cc/cm methods: N=295 RSTA-treated GSVs were followed for 24 months of vein). The treatment time required was 30,258 min (504.3 hrs), as in a prospective multicenter trial. Clinical control visits included flow measured from the initial injection of local anesthesia to the closing of and reflux analysis by duplex- ultrasound and assessment of clinical the access site(s). The time required for the application of the dressing parameters according to CEAP and VCSS. or compression garment was not included. We averaged 1.51 cm of results: 280 of 295 treated GSVs (94.9%) were available for 24 vein treated per minute of operative time. months follow-up. Utilizing Kaplan-Meier survival analysis, the The distribution of vessels treated was GSV (467), SSV (215), SSV + probability of occlusion was 94.5% and the probability of no reflux GIA (99), AASV (88), GIA (9) and refluxing branches (8). was 97.2% at 24 months after the intervention. In addition, 98.6% of We evaluated all of the patients throughout the three year period, and legs remained free of clinically relevant axial reflux at 24 months post- our series showed an ablation rate of greater than 99%. procedure. If occlusion was present at 12 months follow-up, the risk Keywords: Endovenous Ablation, ClosureFast, Intervention of developing new flow or reflux until 24 months follow-up was 3.7% and 2.9%, respectively. Diameters of the GSV measured 3 cm distal OC4-3 treatmeNt OF SUperFiCiaL VeNOUS iNSUF- to the SFJ reduced from 5.6 ± 2.1 mm at screening to 2.1 ± 0.9 mm FiCieNCy by eNdOVeNOUS LaSer tHerapy: LeSSONS at 24-months follow-up. The average VCSS score improved from 3.9 FrOm a perSONaL triaL ON 1000 CaSeS ± 2.1 to 0.8 ± 1.5 at 3 months follow-up (p<0.0001) and stayed at an P. SARRADON1, E. SLOTEMA2 average below 0.7 during the complete 24 months follow-up. While 1 Polyclinique les Fleurs, Toulon, France only 41.1% of patients were free of pain before treatment, at 24 months 2 Dpt. of General and Endocrine Surgery, Hôpital la Timone, Marseille, 99.3% (n=278) reported no pain and 96.4% (n=270) did not experience France pain during the 12 months before. Conclusion: RSTA showed a high and durable success rate in aim: Treatment of superficial venous insufficiency (SVI) is changing conjunction with clinical efficacy and a moderate side-effect profile. rapidly in the last decade due to innovations in endoluminal technology, Keywords: Radiofrequency rendering aggressive surgical stripping out of date. We report the results a trial of 1002 saphenous axes (SA) treated by endovenous laser OC4-5 CLiNiCaL COmpariSON OF tHiGH ONLy therapy (ELT) performed by a single surgeon and the lessons learnt to VerSUS eNdOVeNOUS LaSer abLatiON (eVLa) iN improve the technique. Great SapHeNOUS VeiN iNSUFFiCieNCy treatmeNt method: From November 2002 to May 2009, 1002 SA (84.8% great R. KIKUCHI1, E. ARCENIO2, C.M. OBA1 saphenous vein (GSV), 15.2% small saphenous vein (SSV)) were 1 Clinica Miyake, Sao Paulo, Brazil treated by ELT, using a 980nm diode laser on 745 patients (mean age 2 EVAS, Londrina, Brazil 53 years; female 78%, male 22%). In the first year (n=124) crossectomy was added to the procedure, but abandoned thereafter. The pulsed laser introduction: Recurrence of varicose veins in the leg occurs emission evolved in the third year to continuous laser emission with 1 frequently after standard EVLA technique for great saphenous vein to 2 millimeters per second retraction of the fiber. Phlebectomies were (GSV) insufficiency. The present study aims to compare efficacy and performed after the procedure if necessary. Perivenous tumescence side effects of treating GSV insufficiency with EVLA in the thigh only was carried out using a solution of xylocaine 20ml, naropène 20ml- and EVLA extended to the middle leg. bicarbonate 1.4% in 250ml. Follow-up contained clinical and methods: Forty limbs (20 patients) with GSV insufficiency, randomly ultrasound examination at one week postoperatively, 6 months and separated in two groups. The first group was submitted to EVLA yearly. Different type of repermeations were classified according to standard technique (S-EVLA), and the other group was submitted to anatomical stage and clinical grade (clinical stage of repermeation: I= EVLA extended from the thigh to the middle leg (E-EVLA). Efficacy, piecemeal II= long III= total without dilation or reflux IV= total with symptoms and side effects were assessed after 1, 4 and 8 weeks. dilation and reflux; clinical grades: A= asymptomatic B= symptomatic results: One week after procedure, hypoesthesia was present in 6/20 venous insufficiency C=varicose veins). E-EVLA group and absent in all patients of S-EVLA group. After results and discussion: With a follow-up of up to 6 years (1 to 79 two weeks only 2 of these patients still have hypoesthesia, with lower months), the success rate was 96.8%. Significant repermeation (grades intensity. Residual varicose veins were present in 6/20 of E-EVLA and II to IV) were found in 32 cases (3.2%); 6 (0.6%) lead to a surgical 16/20 of S-EVLA patients. GSV patency and skin hyperpigmentation reintervention (IIBC IVB¹C). No reperfusion was found after one year were similar in both groups. follow-up. The first group operated with crossectomy didn’t show any Conclusion: E-EVLA is more effective if compared to S-EVLA. superior outcomes to ELT only. The continuous laser therapy group E-EVLA side effects exist but are usually mild and temporary. 50 ~
- 51. Keywords: Endovenous laser, Venous insufficiency, Varicose vein after-treatment value of 4.3; VDS score improved from 2.1 to 0.6. We obtained a complete success in 53 patients, a partial success in 3 OC4-6 a SeVeN FOLd iNCreaSe iN VOLUme FLOW iN patients and 1 failure. No systemic side effects have been observed. tHe Great SapHeNOUS VeiN dUriNG appLiCatiON All patients expressed their gratitude and a high level of satisfaction; OF a beLOW KNee StOCKiNG: a pOteNtiaL HaZard especially patients with a more severe CVI (C5-C6) could achieve a FOLLOWiNG FOam SCLerO significant improvement in their quality of life (SF12). M. AZZAM1, C. R. LATTIMER1, E. KALODIKI1, G. GEROULAKOS1 Keywords: Echo guide foam sclerotherapy, Varicose veins, Elderly 1 Department of Vascular Surgery, Ealing Hospital and Imperial patients College, SW7 2AZ., London, United Kingdom OC5 - atherosclerosis Objective: Bolus foam displacement into deep veins has been associated with systemic side effects following Ultrasound Guided OC5-1 eaSy aSSeSSmeNt OF dietary patterN FOr Foam Sclerotherapy (UGFS). Since the Great Saphenous Vein (GSV) atHerOSCLerOSiS diSeaSeS iN CLiNiCaL praCtiCe is a primary target for foam sclerotherapy, the objective was to measure G. MAHE1, M. CARSIN2, J. P. DE BOSSCHERE2, M. ZEENY3 the Peak Systolic Velocity (PSV) and Volume Flow (VF) within the 1 Laboratoire d’explorations fonctionnelles vasculaires, centre GSV before and during the application of an Elastic Graduated hospitalier universitaire, Angers, France Compression Stocking (EGCS). 2 Médecine générale, Rennes, France design and method: Twelve consecutive symptomatic patients (12 3 Université Saint Joseph, Beirut, Lebanon legs, median age 47 years, range 24 - 76) with GSV reflux (> 0.5ml/ sec) were recruited. The average GSV diameter (d) in the thigh, PSV Objectives: Nutrition is one of the modifiable risk factors of and the Time Averaged Mean Velocity (TAMV) were recorded with the atherosclerosis vascular diseases. We aimed to (1) evaluate dietary patient supine. Duplex measurements were taken at baseline and during pattern associated with vascular diseases in clinical practice using a the application of the EGCS. Cross-sectional area (A) was calculated validated food frequency questionnaire (FFQ), (2) determine potential using: π x d2 / 4. The VF (ml/min) was derived using: TAMV x A. independent socio-demographic and behavioural factors that are results: The median GSV diameter was 6.9mm (range 5.0 – 9.1) which involved in such dietary. reduced to 5.8mm (range 3.5 - 8.4) after the stocking was applied (p < Design: Cross sectional study. 0.001). During the application of the EGCS there was a median 17.7 Setting: General Practitioners’ office in 2009. fold increase in PSV (range 6.0 - 42.3, p < 0.001) within the GSV and a Subjects: 250 French subjects (from 18 to 84 years old). median 7.2 fold increase in VF (range 1.9 – 12.2, p < 0.001). Main outcome measure: Vascular Dietary Score (VDS ranges from-17 Conclusions: This study demonstrates that the application of a to 19). stocking results in significant increases in VF and PSV within the GSV. results: 21% had a favourable vascular diet (VDS > or = 8), 79% If the GSV contains foam this may increase the incidence of systemic needed to improve their diet (VDS< 8) and 21% had a risky vascular diet side effects by its potential displacement into deep veins. The initial (VDS < or = -1). A step-by-step multivariate linear-regression analysis application of an EGCS up to the level of the access site is proposed with stepwise selection was performed using the VDS as the dependent before foam is injected as this could minimize complications. Validation variable. Significant variables were: age (beta=0.495, P<0.0001), men of this hypothesis with clinical endpoints will require large numbers of (beta=-0.282, P<0.0001), “Sport, > or = 1 hour/week” (beta=0.253, patients and such a study, statistically powered, in our view is unlikely P=0.001), “Walking, 20 minutes/day” (beta=0,161, P=0.012), “Former to be performed. smoker” (beta=0.118, P=0.029), and previous nutritional advice Keywords: Foam, Compression Stockings (beta=0.105, P=0.049), “Alcohol, > or = 20g/day” (-0.216, P<0.0001), “Primary school” (-0.156, P=0.010)). The R2 coefficient of this model OC4-7 tHe rOLe OF FOam SCLerOtHerapy iN was 0,347 (P<0.0001). 88.7% of subjects found the evaluation very eLderLy patieNt (OVer 70) WitH SeVere diSabLiNG interesting and 89.6% that the GPs should perform it. CVd Conclusion: Simple dietary assessment for vascular diseases prevention C. ALLEGRA1, P. L. ANTIGNANI1, M. GALLUCCI1 can be easily done in clinical practice to allow physicians to give 1 Department of Angiology - St.Giovanni Hospital, Rome, Italy objective and rapid advice for each patient. Age, educational-status, alcohol-consumption, gender, and physical-activity are associated with Factors like age, active leg ulcers and a high cost often turn into a the VDS. Compliance with such evaluation was found to be very high, limitation for conventional stripping procedure. Foam sclerotherapy, which should encourage larger dietary screening in the population in as a minimally invasive, repeatable, inexpensive and safe procedure, order to reduce the impact of vascular diseases. seems to be a promising option among this group of patients. Our study Keywords: Nutrition, Food frequency questionnaire, Atherosclerosis aimed at evaluating the efficacy, safety, patient’s satisfaction and ability to make elderly patients autonomous after such procedure. OC5-2 mediCaL maNaGemeNt aNd prOGNOSiS OF Between December 2005 and December 2009 we performed ultrasound patieNtS WitH atHerOtHrOmbOtiC diSeaSe guided foam sclero-therapy in 57 patients with C4-C6 of CVD. All reQUiriNG a reVaSCULariSatiON patients were evaluated before and after treatment (6-12-24-36 months) C. LE HELLO1, R. MORELLO1, S. FRADIN1, O. COFFIN1, through the Venous Severity Score System (VSSS) and quality of life D. MAÏZA1, M. HAMON1 questionnaire (SF12). Seventeen patients (34.6%) had been suffering 1 CHU, Caen, France from leg ulcers for an average period of 3.6 years. Eighteen patients underwent internal or external saphenous trunk treatment; as to the Objective: Real-world evaluation of medical management and remaining 31 patients, incompetent perforating veins and relapsing prognosis of patients with atherothrombotic disease (ATD) addressed collateral varices accounting for ulcers were treated. At the end of for revascularisation. treatment, all patients were followed up with objective clinical exams, design and method: Prospective observational study of 956 patients CDU, VCSS, VDS and SF12 questionnaire at 6-12-24-36 months. followed during 3 years (primary outcome: all-cause death, composite During the 6-36 months follow-up period symptoms improved or secondary outcome: cardiovascular death and major adverse vascular disappeared in all patients. Ulcer healing was observed in 12 out of events) in the University Hospital of Caen (France). 17 patients (70.5%) with an average treatment time of 2.7 months. results: During a period of 6 years, 956 patients (82.6% men, mean On average, VCSS improved from a baseline value of 12.7 to an age 64.5+/-10.1 years) were enrolled for supra-aortic vessels disease www.iua-eurochap2010.eu ~ 51
- 52. (SVD) (24.6%, of which 38.3% were symptomatic), coronary heart OC5-4 COmpUted tOmOGrapHiC aNGiOGrapHy disease (CHD) (40.4%, of which 19.4% had myocardial infarction and FOr tHe eVaLUatiON OF CarOtid artery SteNOSiS 67.4% 3-vessel disease), peripheral artery disease (PAD) (34.2%, of F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 which 26.0% had chronic ischemia) and visceral artery disease (1.7%). 1 Department of Vascular Surgery, University of Naples, Naples, Italy After paraclinical evaluation, >2 vascular territories were involved 2 Department of Interventional Radiology, Bari, Italy in 85.0%. Vascular risk factors profiles were: previous tobacco use (65.7%), current tobacco use (10.6%), hypertension (64.3%), aim: Stroke is the third leading cause of mortality in the word and hypercholesterolemia (75.4%), diabetes (25.8%), overweight (43.8%) the stenosis degree is considered a fundamental parameter for the and obesity (25.2%). LDL cholesterol was >2.58 mmol/L (>100mg/ definition of the therapeutic approach. With the development of dL) for 38.2% of patients and for 29.2% of those treated with a statin. multi-detector-Row CT (MDCTA) scanner, computed tomography HbA1c levels were >6.5% for 16.9% of patients and for 53.8% of has become a widely used imaging technique for categorizing carotid diabetic patients. Patients were undertreated with antiplatelet agents artery stenosis degree. The purpose of this paper is to compare two CT (86.1%), statins (73.2%), renin-angiotensin system inhibitors (61.1%), post-processing procedure, maximum intensity projection (MIP) and and triple combination of at least an antiplatelet agent, a statin and a multi planar reconstruction (MPR) in order to evaluate their sensitivity renin-angiotensin system inhibitor (45.1% for PAD, 48.1% for SVD and inter technique agreement. and 65.9% for CHD among patients included after June 2006). With methods: For the purpose 45 patients (35 males and 10 females), a mean follow-up of 22.3+/-10.8 months, primary and secondary that underwent MDCTA for carotid artery evaluation, have been outcomes were higher for PAD (11.3%, p=0.012; 47.4%, p<0.001), retrospectively evaluated. Data set were processed with the study diabetic patients (11.6%, p=0.021; 36.8%, p=0.001), HbA1c >6.5% group’s workstations, by using MPR and MIP algorithms. Each patient (14.5%, p=0.004; 35.8%, p=0.016). Secondary outcome was higher was assessed for stenosis degree by using North American Symptomatic in hypertensive patients (30.1%, p=0.036) and those with >2 involved Carotid Endarterectomy Trial method. Statistic analysis was performed territories (31.9%, p=0.002). to determine the sensitivity of the used procedure. The Cohen Kappa Conclusions: Even at the time of revascularisation, medical test was applied to assess the level of intra-observer agreement. Image management of ATD was not optimal. The need for clinical education quality was also evaluated. of physicians and patients remains necessary to improve prognosis of results: MPR sensitivity was 87.8%(95% confidence interval [CI]81- ATD. 94.5%) and MIP sensitivity was 91.1% (95%CI85.2-97%). Agreement Keywords: Atherosclerosis, Real-world evaluation, Medical in MPR was 0.792 with a standard error (SE) of 0.066, and agreement management in MIP was 0.836, with a SE of 0.072. Conclusion: Results of the study indicate the MIP algorithms is more OC5-3 maNaGemeNt OF VeSSeL WaLL diSeaSe iS sensitive than MPR. Best intra-observer agreement and image quality better tHaN tHe maNaGemeNt OF riSK FaCtOrS results were also observer in the MIP. Data suggest also that MIP G. H. R. RAO1,2, V. SRIRAM2, G. MURALIDHARA2, A. FENSTER3 should be the post-processing procedure to be utilized in the evaluation 1 Lillehei Heart Institute, University of Minnesota, Minneapolis, of carotid artery stenosis degree, when using MDCTA. Presence of Minnesota, USA big calcified plaque can determine difficulties in MIP evaluation of 2 South Asian Society on Atherosclerosis and Thrombosis, USA stenosis degree. 3 Robarts Research Institute, University of Western Ontario, London, Keywords: Carotid stenosis Ontario, Canada OC5-5 perCUtaNeOUS treatmeNt WitH drUG- Objective: Framingham Studies provided evidence to support the eLUtiNG SteNt iN diabetiC patieNtS role of risk factors such as increased blood pressure and altered blood F. POLLICE1, P. POLLICE1, T. GROVER1, I. CHRISTENSEN1 lipids, for promoting acute vascular events. Based on these results, 1 Department of Cardiology, Leiden University Medical Center, Leiden, management strategies for these risk factors were developed. Recent Netherlands Antilles studies with Computerized Tomography (CT) providing calcium scoring for coronary arteries and Magnetic Resonance Imaging (MRI) Background: Recent pivotal randomised clinical trials underscored giving vessel volume measurements, have demonstrated that using the salutary effects of drug-eluting stents (DES) in diabetics who conventional methods for monitoring risk, may exclude more than 30% underwent percutaneous-coronary revascularization (PCR). These of the individuals from further screening for high-risk. trials documented lower incidence of adverse cardiovascular events design and method: One such new methodology for monitoring and angiographic restenosis with DES usage in comparison with bare quantitative measurements of the progression (or regression) of carotid metal stents. Although these enthusiastic results, it should bear in mind plaque is the use of 3D ultrasound. that clinical trials do not reflect real clinical practice as they enrol results: Studies from the Robarts Research Institute at London highly selected patients with relative non-complex lesions. Ontario, have demonstrated that similar to total intima media thickness aim: The aim of the current study is the evaluation of clinical outcomes (IMT) measurements, total plaque volume (TPV) or total plaque area in unselected diabetic patients usually encountered during everyday (TPA) measurements, also could be used to monitor the progress of interventional cardiology practice who underwent coronary stenting atherosclerosis. Furthermore, they have demonstrated that aggressive with drug-eluting stent(DES)implantation. lipid lowering with drugs such as Lipitor, could reduce the TPV methods: 878 patients (1451 lesions)underwent PCR with DES significantly in as short a period as three months. This methodology implantation. Patients were classified into three groups according to has been shown to be sensitive enough, to monitor the diet-induced diabetes mellitus(DM)status:1) No-DM (578 patients/937 lesions); 2) changes in the total vessel volume. 3D Ultrasound studies also have non-insulin requiring DM(No.IrDM) (171 patients/301 lesions); 3) demonstrated that even after significant lowering of blood lipids the insulin requiring DM (iRDM)(129 patients/213 lesions). progression of TPV may still be persistent, suggesting the need for results: Procedural success was high overall. In-hospital myocardial further aggressive treatment. infarction (MI) was higher inIrDM than in no—IrDM patients(10.9%, Conclusion: Evidence from recent studies suggests, that monitoring 4.1%, 2.6%, respectively; p<0.001). IrDM patients showed higher in- the progression or regression of the disease is far superior to the hospital cardiac death than no-IrDM and no-DM patients (3.9%, 0.6%, management of known conventional risk factors. 0.5%, respectively; p=0.002). one year target lesions revascularization Keywords: Risk, IMT (TLR) and target vessel revascularization (TVR) rates were not statistically different. IrDM patients compared with both No-IrDM 52 ~
- 53. and NO-DM patients showed lower one-year survival (92.3%, 97.1%, was 4,12 + 0,85 g/L. Multivariate analysis showed F value has been 98.4% respectively; p=0.002%), lower one-year event-free survival(71., determinate with non HDL - cholesterol (â = 1,093, p = 0,027). Linear 80.2%, 86.3% respectively: p=0.001), and higher incidence of one-year regression analysis defined F as predictor for minimal value of ABI, MI (15.5%, 6.4%, 3.9%, respectively; p<0.001) multivariate analysis found at the end of investigation (â = 0,469, p = 0,007). Value of CRP demonstrated that DM was an independent predictor of one-year MI determinate change of minimal value of ABI and change of mean ABI and one-year MACE. per year (ABImin and ABIx/y). Conclusion: Despite the positive effects of DES on TLR, diabetics, Conclusion: Our results indicate that plasma determination of fibrinogen especially IrDM, as compared with No-DM, showed worse immediate and CRP has clinical utility in defining the process of progression of and long-term clinical outcomes. peripheral atherosclerosis in type 2 diabetic population. Keywords: Diabetes 2 Keywords: ABI, CRP, Fibrinogen OC5-6 LOW aNKLe braCHiaL iNdeX iS a riSK OC6 - rare vascular diseases and progress in vascular diagnosis FaCtOr FOr reVaSCULariZatiON iN COrONary patieNtS OC6-1 a NeW diaGNOStiC CriteriON WitH M. MAUFUS1, J. B. GUITTON1, G. VANZETTO2, L. BELLE3, OLOUr dUpLeX SCaNNiNG iN pUdeNdaL NeUraLGia B. IMBERT1, P. CARPENTIER1, G. PERNOD1 by eNtrapmeNt 1 Department of Vascular Medicine, CHU Grenoble, Grenoble, M. MOLLO1, E. BAUTRANT1, J. EGGERMONT1, France A. K. ROSSI-SEIGNERT2 2 Department of Cardiology, CHU Grenoble, Grenoble, France 1 Pelvi-perineal Rehabilitation Dpt, Private Med Centre L’Avancee, 3 Depatment of Cardiology, CH Annecy, Annecy, France Aix-en-Provence, France 2 Physical and Readaptation Physical Med Dpt, Pays d’Aix Hospital Objective: Peripheral Artery Disease defined as an Ankle Brachial Centre, Aix-en-Provence, France Index (ABI) < 0,90 is associated with high risk of Coronary Artery Disease (CAD), stroke and mortality. The aim of our study was to assess Objective: to confirm diagnostic accuracy of a new Colour Duplex the positive predictive value of the ABI regarding CAD requiring a Scanning (CDS) criterion, the Pudendal Artery Ratio (PAR) described revascularization procedure. by Mollo et al*, in Pudendal Neuralgia by Entrapment (PNE). design and methods: We conducted a prospective monocentric study. design and methods: a prospective study on a consecutive series All patients admitted in the cardiology unit for suspected CAD requiring brought up-to-date to 667 unselected patients, all evaluated by both a coronary artery angiography were consecutively included. Patients CDS and Neurological Criteria (NC) (Diagnostic Score (DS) and were assessed for cardiovascular risk factors, claudication history, rest Electroneuromyography (ENMG)) and, when surgery was indicated, pain or ulcer, and ABI was calculated. Patients were divided into two by an Intra-Operative Score (IOS). CDS examinations were performed groups (ABI < 0.90 or 0.90 < ABI < 1.30). The primary endpoint was by an operator who was unaware of NC and IOS, and in the same way, the number of coronary artery revascularization procedure (CARP), NC and IOS established by practitioners unaware of CDS findings. coronary artery bypass graft of percutaneous transluminal coronary Inadequate examinations were neither repeated nor removed from the angioplasty, according to ABI group. analysis. Results of CDS were compared to those of NC and of IOS for results: 171 patients were consecutively included during 4 months. surgical cases (Student t test) and diagnostic values (Sensitivity and 109 patients (63.7%) had CAD, and 50 (29.3%) had an ABI < 0.90. Specificity) were evaluated. Among the 50 patients with ABI < 0.90, 43 (86%) needed a CARP. results: in this consecutive series, CDS exploration showed a 99.6% Among the 121 patients with 0.90 < ABI < 1.30, 66 (54.5%) needed a Feasibility. PNE was diagnosed with NC in 217 patients. For 115, CARP. The Odd ratio for CAD revascularization among patients with surgery was finally indicated, since the first stage of treatment was not ABI < 0.90 is 5.12 [95% CI; 2.13 to 12.28, p < 0.001]. sufficient for recovery. Comparative study was based on 154 operated Conclusions: Our prospective study has shown that among patients nerves (76 unilateral, 39 bilateral). Of the 154 PNE identified by NC, with suspected CAD, an ABI < 0,90 is associated with a 5,12 relative 137 Pudendal Vascular Entrapment (PVE) were detected by CDS. risk for CARP. Thus ABI is a useful non-invasive non-expansive tool Comparison with IOS obtained during surgical procedures led to a that identifies a subgroup of patients at risk to require a CARP. 95.5% Sensitivity and a 66.7% Specificity, for diagnosis of PNE. Keywords: Peripheral vascular disease, Coronary arteyr disease, Ankle Conclusions: this study validates our new CDS criterion, the PAR, very brachial index strong at diagnosing PNE, involving a great advance in the patients’ care for this pathology. OC5-7 prOGreSSiON OF peripHeraL arteriaL (*) Mollo M. et al. Evaluation of diagnostic accuracy of Colour Duplex diSeaSe iN type 2 diabetiC patieNtS: iNFLUeNCe Scanning, compared to electroneuromyography, diagnostic score and OF FibriNOGeN aNd Crp surgical outcomes, in Pudendal Neuralgia by entrapment: A prospective M. BOSEVSKI1, L. J. GEORGIEVSKA-ISMAIL1 study on 96 patients. PAIN; 142: 159-63 (2009). 1 University Cardiology Clinic, Faculty of Medicine, Skopje, Keywords: Pudendal Neuralgia, Pudendal Nerve Entrapment, Alcock’s Makedonija Canal Syndrome The aim of study was to determinate the influence of inflammatory OC6-2 LONG term FOLLOW-Up OF GiaNt CeLL markers: fibrinogen (F) and C-reactive protein (CRP) on the progression arteritiS-reLated Upper/LOWer Limb VaSCULitiS. of peripheral atherosclerosis in type 2 diabetic pts. a SerieS OF 36 patieNtS patients and methods: 62 pts with type 2 diabetes and diagnosed C. ASSIE1, A. JANVRESSE1, D. PLISSONNIER1, H. LEVESQUE1, coronary artery disease were enrolled in a cohort prospective study. I. MARIE1 We measured in them, at all, progression of peripheral arterial disease, 1 Département de Médecine interne, CHU Rouen, 76031 Rouen Cedex, defined as change of ankle-brachial index (ABI) after 36 months. France Multiple linear regression analysis was built to define predictivity of continuous variables: F, CRP, lipid fraction, urea, creatinin, fast introduction: The aims of this retrospective study were to evaluate glycemia, duration of diabetes, age on to ABI value. clinical features and long-term outcome of patientswith giant cell results: Study population was on age 60,28 + 27 years and mean arteritis (GCA) exhibiting upper/lower limb vasculitis. diabetes duration of 8,58 + 6,17 years. Mean plasma fibrinogen level methods: 36 consecutive patients received a diagnosis of symptomatic www.iua-eurochap2010.eu ~ 53
- 54. upper/lower limb vasculitisrelated to GCA. Diagnosis of upper/lower a mean delay varying from 24 hours (one patient) to 6 months. limb vasculitis was made using duplex arterial ultrasonography, helical In conclusion, the correct approach of the etiological diagnosis when computed tomography (CT)-scan or angiography. dealing with digestive arterial dissection, is essential, in order to detect results: The patients were 30 women and 6 men with a median age elastic and conjonctif tissue arterial disease, and some vasculitis with of 68.5 years. Upper/lower limb vasculitis preceded the initial GCA elective tropism for digestive arteries. diagnosis in 7 patients. GCA clinical manifestations was severe Keywords: Digestive arteries, Arterial dissection resulting in ischemic complications of the limbs in 10 patients (27.8%). GCA-related large vessel involvement was located on: the upper limb OC6-4 eVaLUatiON OF tHrOmbiN GeNeratiON alone (58.3%), the lower limb alone (19.4%) and both upper and lower aSSay iN tHe mONitOriNG OF treatmeNt WitH limbs (22.2%). The distribution of arterial involvement in GCA patients VitamiN K aNtaGONiStS, eNOXapariN aNd with upper limb vasculitis was as follows: subclavian (55.6%), axillary FONdapariNUX (47.2%) and brachial (22.2%) arteries; the localization of arterial G. GEROTZIAFAS1, V. GALEA1, M. CHAARI1, M. SASSI1, involvement in GCA patients with lower limb vasculitis included: H. BACCOUCHE1, I. ELALAMY1 internal iliac artery (11.1%); common femoral artery (13.9%); superficial 1 Thrombosis Center, Service Hématologie Biologique. ER2 UPMC, femoral artery (33.3%), deep femoral artery (5.6%), popliteal and Hôpital Tenon, Paris, France anterior tibial arteries (5.6%). All patients were given steroid therapy. Reconstructive study was performed in 10 patients (27.8%): venous Background/Aim: Thrombin generation (TG) assay is sensitive bypass graft (n=6), angioplasty (n=1), thromboendarteriectomy (n=2) or but not standardized for monitoring anticoagulant treatment. We thrombectomy (n=1); two other patients with limb ischemia underwent sought to establish therapeutic ranges of thrombogram parameters amputation. The median observation time was 32 months; the outcome in patients treated with vitamin K antagonist (VKA), enoxaparin or of upper/lower limb vasculitis was as follows: 1) disappearance of fondaparinux. clinical symptoms (44.4%); 2) improvement of clinical manifestations materials and methods: We studied plasma of 234 consecutive (44.4%); and 3) deterioration of clinical manifestations (11.2%). patients receiving VKA (n= 148), enoxaparin (n=36), fondaparinux Conclusion: Our study indicates that upper/lower limb vasculitis is not (n=50) and 30 healthy individuals. Patients on VKA were stratified uncommon in GCA. Indeed, yearly clinical vascular examination may according to INR value (<2,2-3,>3) and patients on enoxaparin or be adequate to screen upper/lower limb vasculitis in GCA patients. Our fondaparinux were stratified according to the administered dose series also underlines that early diagnosis of GCA-related is crucial in (prophylactic or therapeutic). Prothrombin time (PT) was determined patients, resulting in decrease of severe ischemic complications. using human thromboplastin (Thromborel S, Dade Behring; Marbourg, Keywords: Giant cell arteritis, Upper and lower limb vsculitis, Long Germany) and anti-Xa activity using a standardized chromogenic assay term outcome (Coamatic Heparin from Chromogenix, Milan, Italy). Callibration curves were constructed by spiking normal pool plasma with enoxaparin OC6-3 diGeStiVe arterieS diSSeCtiON iN a of fondaparinux. TG was assessed in citrated platelet poor plasma with retrOSpeCtiVe mONOCeNtriC SerieS Calibrated Automated Thrombogram (CAT, Stago, France). C. BELIZNA1, A. GHALI1, C. LAVIGNE1, A. BEUCHER1, results: TG was significantly inhibited in patients receiving F. THOUVENY2, S. WILLOTEAUX2, J. PIQUET3, B. ENON3 antithrombotic treatment compared to controls. Thrombogram 1 Internal medicine, CHU Angers, Angers, France parameters showed different sensitivity to the antithrombotic effect 2 Radiology, CHU Angers, Angers, France and to the treatment intensity. A significant inter-individual variability 3 Vascular surgery, CHU Angers, Angers, France of Endogenous Thrombin Potential (ETP) and Mean Rate Index (MRI) of the propagation phase of TG was observed in VKA subgroups with Digestive arteries dissection could have sometimes a severe outcome, INR>2 as well as in patients receiving enoxaparin or fondaparinux. MRI further complicated by difficulties in performing an etiological and Peak were the most sensitive thrombogram parameters reflecting diagnosis. antithrombotic effect of enoxaparin. MRI was the most accurate tool Hence, a complete screening for etiological diagnosis allows a fast allowing the distinction of prophylactic and therapeutic fondaparinux clinical management and the scheduling of the follow-up. doses. We report a retrospective monocentric series of 47 patients diagnosed Conclusion: Each parameter of CAT thrombogram had a different during a five year period (2005-2009) in Internal Medicine and Vascular sensitivity to the antithrombotic effect depending on the type and Surgery Department. the treatment intensity. It is not correlated with the INR or the anti- methods: 47 cases could be included in the current study with the aid Xa activity. The clinical relevance of such a monitoring needs to be of two medical tools: the French medical disease coding PMSI, and prospectively investigated. informatised patient medical recording. Keywords: Thrombin generation, Fondaparinux, Low Molecular Data regarding the etiological diagnosis, treatment, outcome, follow- Weight Heparin up, could have been collected. results: Patients’ s mean age was 41 years old, and the sex ratio males OC6-5 appLiCatiON OF 3 teSLa bLOOd OXyGeN to females 2:1. LeVedepeNdeNt (bOLd) maGNetiC reSONaNCe Digestive arterial localisation was either unique: superior mesenteric imaGiNG (mri) tO StUdy OXyGeNatiON OF tHe artery (49%), or coeliac artery (42%), or concerned more than one KidNey iN reNOVaSCULar diSeaSe territory (9%). M. L. GLOVICZKI1, J. GLOCKNER2, J. P. GRANDE3, The etiological diagnosis was found as follows: Marfan syndrome L. O. LERMAN1, S. C. TEXTOR1 (3 cases), Ehler- Danlos (3 cases), panarteritis (2 cases), Wegener 1 Nephrology and Hypertension Department, Mayo Clinic, Rochester, granulomatosis (2 cases), Churg-Strauss syndrome (2 cases). Minnesota, USA Arterial dysplasia was reported in 35 patients. 2 Radiology Department, Mayo Clinic, Rochester, Minnesota, USA Mean time before performing final diagnosis was 3 months. 3 Laboratory Medicine and Pathology Department, Mayo Clinic, 22 patients had emergency surgery, and 25 had only radiological and Rochester, Minnesota, USA clinical regular follow-up. Among these 25 patients, 7 had surgery after a mean follow-up time of 6 months. Background: BOLD MRI provides noninvasive measurement of Immunosuppressive therapy allowed arterial lesional stabilisation in regional tissue oxygenation based upon the paramagnetic properties of 4/6 cases of vasculitis. Fatal outcome appeared in 10 cases (21%) after deoxyhemoglobin. We sought to examine patients with atherosclerotic 54 ~
- 55. renal artery stenosis for whom reduced blood flow to the kidneys 69% of fistulae were located in the arm, 31 % in the forearm. In 40% ultimately leads to renal tissue damage. of patients, procedure was completed with stenting.Immediat results methods: BOLD MRI evaluation was performed in 24 patients with were good. In 6 cases there was a resident moderate stenosis and in two essential hypertension, 19 patients with moderate atheromatous renal cases procedure failed. artery stenosis (ARAS) and 14 patients with severe ARAS. Studies were Conclusions: Angioplasty under duplex scan guidance is effectible and done under baseline conditions and after intravenous administration safe and rarely necessits adjunction of fluoroscopy to be performed. of furosemide (20 mg) to examine changes in R2* resulting from This technic has many advantages: less irradiation for staff and patients, suppression of oxygen consumption linked to medullary tubular solute no toxicity of iodine. Duplex scan may be considered the key exam for transport. For each kidney the hilum level was chosen for analysis, preoperative evaluation, surveillance and treatment of complications of including 3 individual segments (anterior, lateral and posterior). Each arteriovenous fistulae. segment was defined by cortical and medullary region of interest Keywords: Duplex scan, Arteriovenous fistulae, Angioplasty (ROI). results: OC6-7 KLippeL-treNaUNay-Weber SyNdrOme aNd epitHeLiOid aNGiOSarCOma. a rare aSSOCiatiON J. PEREIRA ALBINO1, A. SIMAS2, C. MATOS3, G. SOBRINHO1, V. BROTAS2, N. MEIRELES1, G. CLARA3 1 Vascular Surgery Service 2 H. Pulido Valente - CHLN, Lisbon, Portugal 2 Medicine 2 Service H. Capuchos - CHLC, Lisbon, Portugal 3 Medicine 3 Service H. Pulido Valente - CHLN, Lisbon, Portugal Klippel-Trenaunay-Weber syndrome is a rare congenital disorder of the peripheral vascular system that is characterized by haemangiomas, soft tissue and/or osseous hypertrophy, venous and lymphatic anomalies, as well as arterio-venous malformations. Although this syndrome is rarely associated with tumors sometimes this association occurs. The authors describe the case of a 22 year old black male from Guiné-Bissau who had shown signs of complications of a Klipppel-Trenaunay-Weber Moderate ARAS reduced blood flow and GFR, but was associated syndrome since the age of 14, including ulcerations an bleeding, with preserved medullary and cortical R2* as compared to essential He was referenced to our Hospital, and on arrival showed gigantic hypertension. More severe ARAS (stenosis >90%) led to elevation hemihypertrophy of his right lower limb, with multiple variegated and of cortical R2* values and changes after furosemide were smaller grape-like red, purple and firm subcutaneous nodules in the calf and for medullary ROIs. The ratio of cortical to medullary R2* after thigh, pinpoint red macules, and multiple infected skin ulcers with furosemide administration rose in severe ARAS. Many atrophic excessive bleeding. Laboratory tests revealed a ferropenic anemia. poststenotic kidneys demonstrated patchy distribution of zones with After several complementary examinations (MRI and AngioCT) elevated medullary R2*. an arteriography was performed, that revealed multiple pelvic and Conclusion: These results demonstrate substantial adaptation of lower limb arteriovenous fistulae. Because of uncontrolled bleeding kidneys to decreased blood flow, kidney volume and GFR despite of the lower right limb, he was submitted to limb disarticulation with progressive ARAS. However, tissue oxygenation and medullary controlled hypotension. The histopathologic examination of a nodule function deteriorate in more severe stenosis, consistent with results revealed an epihelioid angiosarcoma, which was also confirmed in observed after acute vascular occlusion in animal studies. Regional other nodules. Although the patient improved, the pulmonary CT scan tissue examination using 3 T BOLD MR appears to be a valuable revealed the existence of lung metastases. The patient was submitted non-invasive tool to detect the limits of renal adaptation to reduced to chemotherapy with thalidomide and doxorubicin. At the 12 month perfusion. This test may be helpful to decide which patients need renal follow-up the patient was doing well, and a PET scan revealed no revascularization. more new lesions, except in the amputation stump. However, 32 Keywords: Renal artery stenosis, Kidney, Bold MRI months after the diagnosis, the patient came back to our department with new modular lesions and more av fistulas in the stump. Tumoral OC6-6 dUpLeX GUided aNGiOpLaSty OF arteriO- dissemination was detected and he died 42 months after the diagnosis VeNOUS FiStULae FOr HemOdiaLySiS: retrOS- (3 months after new chemotherapy treatment had begun). Our case peCtiVe StUdy OF 45 patieNtS iN a FreNCH illustrates a rare association and also an unexpected survival for a UNiVeriStary HOSpitaL patient with an epithelioid angiosarcoma. A. DESSI1, C. SEINTURIER1, O. PICHOT1, E. COCHET2, Keywords: Klippel-Trenaunay-Weber S., Epithelioid Angiosarcoma P. H. CARPENTIER1, C. SESSA2 1 Vascular Medicine Department, CHU Grenoble, Grenoble, France OC7 - Venous disorders 2 Vascular Surgery Departmeent, CHU Grenoble, Grenoble, France OC7-1 treatmeNt OF VeNOUS StaSiS ULCer, Venous stenosis amount to the major part of the complication of tHrOUGH CeLL tHerapy WitH KeratiNOCyte arteriovenous fistulae for hémodialysis. Consequences are high aUtOGraFt iN patieNtS USerS OF miCrONiZed venous pressures, bleeding at the puncture point and low volume flow. diOSmiN aNd HeSperidiN Treatment of these complications are usually performed by angioplasty A. GUILLAUMON1, C. BOSNARDO1, M. B. PUZZI1, J. RHEDER1 with contrast material under fluoroscopy. This procedure may also be 1 State University of Campinas, Campinas, Brazil performed with duplex scan guidance. design and method: we describe a retrospective serie of 45 cases of introduction: The venous stasis ulcer is the most severe complication patients treated by venous angioplasty guided by duplex scan and detail of chronic venous insufficiency, affecting adults and keeping them technics and results. away from work and from normal social life. Objective: To demonstrate results: 45 patients (mean age 68) received a venous angioplasty a new therapeutic method for accelerating healing. under duplex scan guidance. 60 % were men and 47% were diabetic. methods: Twenty-five (25) patients with venous stasis ulcers, CEAP www.iua-eurochap2010.eu ~ 55
- 56. VI, who havenot healed with conventional treatments were selected 3, 6, 12, and 24 months. from the Clinic of Peripheral Vascular Diseases, Faculty of Medical results: The study include 86 leg, and the 2-year follow-up period Sciences, UNICAMP – were treated with autograft keratinocytes, was completed for 70 legs. Significantly more reflux was found in grown in the skin cell culture laboratory, CIPED-FCM – UNICAMP. previously thrombosed vein segments, with an odds ratio of 1.8 after 3 They were divided into two groups, Group I-11 patients, 10 female months, of 2.1 after 6 months, of 2.5 after 12 months, and 3.2 after 24 and 1 male, Group II-14 patients, 11 female and 3 male. Both groups months. Multiple regression results showed that the most important risk were treated with autograft keratinocytes on the clean ulcer bed, and factor for early clinical signs of PTS was superficial reflux in months group II, was also given a dose of micronized diosmin hesperidin every 3,6 and 12 (<-.02). deep reflux did not have a synergistic relationship 12 hours. All the patients were asked to take a 30-minute rest in the with superficial reflux in correlation with the clinical signs of PTS. The Trendelenburg position for two hours of usual activity. SVPT was not able to predict the development of PTS. results: After the evaluation of data with statistics methods no Conclusion: More reflux develops in previously thrombosed vein parametric Healing and/or improvement of the ulcers with significant segments. As early as after the third month, patients with superficial reduction of the bed in both groups were observed, with Group II reflux have an increased risk of development of the first clinical signs obtaining precocious results. of PTS. Within 2 years, SVPT shows no relationship with clinical signs Conclusion: This method proves to be a good therapeutic option to of PTS. help in the healing of stasis ulcers Keywords: Post thrombotic syndrome Keywords: Ulcer, Keratinocites, Venous Estatis OC7-4 pOSt-SUrGiCaL VeiN tHrOmbOSiS aNd ONS OC7-2 aSSeSSiNG meSOGLyCaN treatmeNt eFFiCa- et OF pOSt-tHrOmbOtiC SyNdrOme: iNFLUeNCe OF Cy iN 1483 OUtpatieNtS WitH CHrONiC VeNOUS 4G/5G pOLymOrpHiSm iNSUFFiCieNCy F. FERRARA1, C. AMATO1, F MELI1, I. MURATORI1, C. ALLEGRA1, P. L. ANTIGNANI1 M. LUNETTA2, I. R. ALCAMO1, S. NOVO2 1 Department of Angiology St. Giovanni Hospital, Rome, Italy 1 Divion of Angiology, Palermo, Italy 2 Division of Cardiology, Palermo, Italy Background: Mesoglycan is an antithrombotic agent, a pro-fibrinolytic drug and restores the endothelium’s physiologic selective-barrier The purpose of this study was to investigate whether the presence of a properties that include anti-edematous activity as shown by numerous Plasminogen Activator Inhibitor type 1 (PAI-1) promoter polymorphism clinical and experimental studies. 4G/5G and increase of PAI-1 activity may have a prognostic significance methods: In the present investigation we studied the effect of in patients with persistence of post-surgical vein thrombosis and in Mesoglycan in patients with chronic venous disorders (presence of onset of post-thrombotic syndrome in spite of anticoagulant treatment overt Class 2 venous disorders as defined by the CEAP guidelines for in patients with DVT. the diagnosis and therapy of vein and lymphatic disorders). The study The PAI-1 promoter polymorphism 4G/5G can induce a reduced comprised a 30-day treatment period with 50 mg b.i.d. Mesoglycan fibrinolytic activity with persistence thrombosis (Prisma, Mediolanum Farmaceutici, Milan) administered p.o., followed methods: We included in a prospective 36 months follow-up study 168 by a 30-day wash-out period. patients with post-surgical femoral and/or popliteal vein thrombosis results: Between March and August 2008, 1559 patients were enrolled subdivided in the following groups: in the study involving 98 centers. The analysis population comprised 85 patients with 4G/5G polymorphism and increase of PAI-1 activity. 1483 patients. 74.4% of patients were female and the mean age was 55.2 83 patients without 4G/5G polymorphism and normal PAI-activity years. At the end of the study, the improvements recorded from baseline We evaluated the persistence of thrombotic lesion after 3 and 12 months were statistically significant for each of the eight domains of the SF- (short-term) and the occurence of post-thrombotic syndrome after 36 36 Health Status questionnaire, indicating an improvement in patients’ months by echocolordoppler examination. general condition. Already by day 15 from the start of treatment, results: We observed that 65 patients with 4G/5g polymorphism had a pigmentation and eczema severity score and lower limb circumference persistence of deep vein thrombosis after three months and in 62 patients had fallen significantly. These changes were also confirmed at 30 days after 12 months; 61 patients presented a persistence of thrombosis and after withdrawal of Mesoglycan treatment. post-thrombotic syndrome at the end of the study (after 36 months) Conclusions: The present results show that, in patients with chronic ; while in patients without 4G/5G polymorphism 39 patients had a venous disorders, clinical manifestations of venous disease and quality persistance of deep vein thormbosis after three months and 19 patients of life improved after Mesoglycan therapy administered according to after 12 months; 14 patients shown persistence of thrombosis and the described protocol. post-thrombotic syndrome at the end of the study. From a multivariate Keywords: Treatment, Venous ulcers, Symptoms and signs analysis of data we observed that 4G/5G polymorphism was a predictor for the persistence of thrombosis after short-term analysis and for OC7-3 CLiNiCaL aNd HaemOdyNamiC SeQUeLae incidence of post-thrombotic syndrome in the following controls. OF deep VeNOUS tHrOmbOSiS Conclusion: Patients with 4G/5G genotype in the promoter of the PAI – F. POLLICE1, P. POLLICE1, M. SANSONE1 1 gene with increase of PAI-1 activity present a higher risk of persistence 1 Department of Medicine and Thrombosis - l’Aquila University, of vein thrombosis and onset of post-thrombotic syndrome. l’Aquila, Italy Keywords: Polymorphism 4G/5G, Post-thrombotic syndrome, Deep vein thormbosis Objective: Post thrombotic syndrome (PTS) develops in 40% to 60% of patients with deep venous thrombosis. Factors that are important in OC7-5 aNatOmiCaL deSCriptiON OF tHe OStiaL the development of PTS include venous reflux, deep vein obstruction, VaLVe iN tHe SapHeNOFemOraL JUNCtiON and calf muscle pump dysfunction (CMD). C. TASCH1, L. LARCHER2, E. BRENNER3 methods: Reflux and CMD in relationship to the severity of PTS were 1 Division for Surgery, Clinic Weilheim-Schongau, Schongau, evaluated in a 2-years follow-up study of patients with acute deep Germany venous thrombosis. Duplex scanning was used to measure reflux. The 2 Division for Plastic Surgery, Hospital Feldkirch, Feldkirch, Austria supine venous pump function test (SVPT) measures CMD with strain- 3 Department of Anatomy, Medical University Innsbruck, Innsbruck, gauge plethysmography. The base-line examination was performed Austria within 1 to 5 days after diagnosis. The next examination were scheduled 56 ~
- 57. Background: Venous valves have been classified into parietal and OC7-7 iNFLammatiON – patHOGeNetiC meCHaNiSm ostial valves. Most of the literature deals with the parietal valves (PVs), OF VeNOUS tHrOmbOSiS which are situated within the lumen of the veins, whereas ostial valves M. JEZOVNIK1, P. POREDOS1 (OVs) are situated directly at the confluence of two veins. OVs occur 1 Department of Vascular Disease, University Medical Centre less frequently, and they consist usually of a single cusp, sometimes Ljubljana, Ljubljana, Slovenia of two cusps. Within the common femoral vein (CFV), the most prominent PVs are the suprasaphenic and infrasaphenic valve, within Background: The role of inflammation in the pathophysiology of the great saphenous vein (GSV) these are the terminal and preterminal arterial thrombosis has been well elucidated. Little is known about the valve. Especially in French literature, this terminal valve of the GSV is relationship between inflammation and venous thrombosis. Recently, called “valvule ostiale”. While PVs were well studied, there is almost inflammation has been accepted as a possible mechanism through no literature on the OVs, especially on the OV of the GSV. which risk factors trigger thrombus formation in veins. The aim of study methods: Ninety-eight isolated specimens consisting of the CFV and was to investigate the inflammatory markers and their relationship to the attached tributary veins including the GSV, were investigated for idiopathic venous thrombosis. the presence of OVs. All specimens derived from bodies bequested by materials and methods: 49 patients with first idiopathic venous informed consent to the Division for Clinical and Functional Anatomy, thrombosis and 48 age matched control subjects were included in Medical University Innsbruck. the study. Patients were studied 2-4 months after the acute event. From these 98 specimens five possessed an OV consisting of a single Patients and control subjects did not differ in the classical risk factors cusp (5.1%), six had an OV with two cusps (6.1%); additional ten of atherosclerosis, except in body mass index. In both groups, blood specimens showed remnants of an OV (10.2%). markers of inflammation, namely high sensitive C-reactive protein (hs discussion: The distinction between PVs and OVs is not always clear CRP), interleukins (IL-6, IL-8, IL-10) and tumour necrosis factor alpha in literature, and in consequence misinterpretation may occur. Very (TNF-α), and circulating markers of endothelial dysfunction/damage often the terminal valve of the GSV, a real PV, is called “ostial valve”. namely von Willebrand factor (vWF), P-selectin and the vascular In patients presenting symptoms of chronic venous disease, saphenous adhesion molecule (VCAM-1) were measured. vein reflux is the most common haemodynamic abnormality and results: In comparison to healthy subjects patients had significantly sapheno-femoral junction involvement has been cited as responsibel higher levels of inflammatory markers: hs CRP: 2.58 mg/L (1.37-6.61), for varicose vein formation. Thus especially the competence as well as vs 1.67 mg/L (0.97-3.24) p=0.044, IL-6: 2.37 pg/mL (1.59-4.10), vs the exact location respectively correct identification of the valves of the 2.03 pg/mL (1.45-2.59), p=0.025, IL-8: 3.53 pg/mL (2.94-5.3), vs saphenofemoral junction gain in importance in ultrasound scanning. It 2.25 pg/mL (1.77-2.90) p=< 0.0001. The levels of anti-inflammatory is important to identify OVs and consequently differentiate saphenous IL-10 were significantly lower 1.81 pg/mL (1.53-2.21) vs 2.71 pg/mL from non-saphenous trunk pathology before surgical intervention with (1.84-3.65), p<0.001. Patients had higher levels of circulating markers regard to preserve the main GSV for its potential use in coronary bypass of endothelial dysfunction: vWF 150.0 g/L (121.0-195.0) vs 91.5 g/L grafting and other vascular procedures. To avoid misinterpretation our (70.5-104.0), p=<0.0001, P-selectin 39.5 pg/L (34.0-40.6) vs 34.8 pg/L anatomical data provides a clear distinction to the terminal valve of the (32.5-38.6) p=0.009. The levels of some inflammatory markers were Great Saphenous Vein. related to markers of endothelial dysfunction. Keywords: Venous Valves Conclusions: Patients with idiopathic venous thrombosis have increased levels of circulating markers of inflammation and blood OC7-6 meta-aNaLySiS apprOaCH OF tHe eFFeCt markers of endothelial dysfunction. Higher levels of investigated OF VeNOaCtiVe drUG ON aNKLe CirCUmFereNCe iN markers indicate that patients in the stable phase of the disease have CVd patieNtS an increased systemic inflammatory response and consequently F. ALLAERT1 deteriorated endothelial function. 1 Chair of medical evaluation Ceren ESC, Dijon, France Keywords: Venous thrombosis, Inflammation, Endothelial dysfunction Objectives: to describe and compare the effects of venoactive drugs on ankle circumferences in CVD patients through a meta-analysis of grade A publication issued from 1975 to 2009. methods: All papers dealing with randomized double-blind clinical trials, comparing active drug versus placebo or active drug versus active drug on ankle circumferences were extracted from Medline and checked according Jadad and Cucherat evaluation grid. results: Ten papers with a Jadad score> 3 including 1010 patients were introduced in the matanalysis. Studied drugs were MPFF, hydroxyethylrutoside, ruscus aculeatus extracts and placebo. The ankle perimeter reduction was - 0,80 ± 0,53 cm for MPFF, -0,58 ± 0,47 cm for ruscus aculeatus extracts, - 0,58 ± 0,31 cm for hydroxyethylrutoside, and -0,11 ± 0,42 cm.for placebo. Statistical comparison show that the three drugs are more active than placebo (p<0.0001), than MPFF was superior to ruscus aculeatus extracts and hydroxyethylrutoside and do not show difference between the two last one. Meta-analytic results show also that statistically oedema will be reduced of 1 cm in 35% of the patient treated with MPFF, 17% with ruscus aculeatus extracts, 13% with hydroxyethylrutoside and 2% with lacebo. Conclusion: This metanalysis confirms the grade A rank attributed to MPFF by the Sienna conference consensus through the demonstration of its predominant effect on oedema, one of the most frequent symptoms for which people presenting venous insufficiency are consulting. Keywords: Oedema, Venoactive drug, Metanalysis www.iua-eurochap2010.eu ~ 57
- 58. POSTERS on common carotid arteries. Healthy volunteers were compared with coronary patients. Coronary angiography was done to all patients with PS1 - Atherosclerosis symptom of angina pectoris while control group was not submitted to coronary angio because of ethical reasons. The aim was to establish the PS1-1 ASSOCIATION BETWEEN SERUM URIC ACID, applicability of the two similar methods used to evaluate the elasticity CAROTID INTIMA-MEDIA THICKNESS AND TARGET of the arterial wall in healthy individuals as well as in patients that ORGAN DAMAGE IN HYPERTENSIVE PATIENTS suffer from coronary artery disease (CAD). C. SERBAN1, S. DRAGAN2, I. MOZOS1, R. MATEESCU3, Methods: Prospectively were evaluated 49 individuals (20 healthy L. SUSAN4, A. CARABA4, A. PACURARI4, G. SAVOIU5, volunteers and 29 CAD patients). The average age was 28.62±9.51 I. ROMOSAN4 years for healthy individual and 61.5±8.06 years for coronary patients. 1 University of Medicine and Pharmacy Victor Babes - Both groups were subjected to two non invasive measurements of artery Pathophysiology Department, Timisoara, Romania elasticity. E-TRACKING on common carotid artery 1 to 2 centimeters 2 University of Medicine and Pharmacy Victor Babes - Preventive before the bifurcation was done by using ALOKA alfa 100 ultrasound., Cardiology and Cardiovascular Rehabilitation Clinic, Timisoara, beta index, augmentation index ( AI ) and the speed of pulse wave Romania velocity ( PWV ) were evaluated. TensioMedTM arteriograph was used 3 University of Medicine and Pharmacy Victor Babes - Physiology on brachial artery. Augmentation index of the brachial artery (AI brah), Department, Timisoara, Romania augmentation index of aorta ( AO aortic ) and the speed of pulse wave 4 University of Medicine and Pharmacy Victor Babes - IVth Medical velocity were measured thereafter in the same conditions. Clinic, Timisoara, Romania Results: 5 University of Medicine and Pharmacy Victor Babes - Anatomy, physiology and pathophysiology Department, Timisoara, Romania Objective: Clinical evidence supported the possibility that serum uric acid (SUA) may lead to hypertension. Carotid intima–media thickness (carotid IMT) measured noninvasively by ultrasonography is now widely used as a surrogate marker for atherosclerosis. The purpose of this study was to investigate the association of SUA and carotid IMT with target organ damage (TOD) in hypertensive patients. Design and method: One hundred and eighty two hypertensive patients, after underwent extensive clinical, laboratory, and ultrasonographic investigations searching for cardiac, vascular and renal TOD, were divided into four groups as follows: no TOD (Group I, n=24); 1 TOD Conclusion: Parameters given from the e-TRACKING method (Group II, n=50); 2 TOD (Group III, n=40); and > or=3 TOD (Group comparing to the results of Arteriograph discriminate healthy IV, n=48). Carotid IMT was performed using high-resolution B-mode individuals from CAD population signifi cantly better. Arteriograph ultrasonography according with Mannheim Consensus. as the method did not show any signifi cant difference in the arterial Results: Uric acid was directly associated with the number of affected wall elasticity between healthy and patient population. Nominal values organs. Uric acid was higher in the patient groups with > or=3 TOD according to the two different population exist but the difference was (Group IV: 8.38±0.31mg/dl vs Group III: 8.24±0.42 mg/dl, P<0.001), not statistically significant. 2 TOD (Group III: 8.24±0.42 mg/dl vs Group II: 7.91±0.76 mg/dl, Keywords: Arteriograph, e-tracking, CAD P<0.001) and 1 TOD as compared with patients with no TOD (Group II: 7.91±0.76 mg/dl vs Group I: 6.04±0.41, P<0.001). Carotid IMT PS1-3 ENDOTHELIAL FUNCTION IN HEALTHY was also directly associated with the number of affected organs. The INDIVIDUALS AND PATIENTS WITH CORONARY ARTERY value of carotid IMT was higher in the patient groups with > or=3 TOD DISEASE (Group IV: 1.30±0.04 mm vs Group III: 1.29±0.04 mm, P<0.001), 2 L. J. BANFIC1, Z. MIOVSKI1, K. PUTAREK1, TOD (Group III: 1.29±0.04 mm vs Group II: 1.22±0.11 mm, P<0.001) M. VRKIC KIRHMAJER1, M. STROZZI1 and 1 TOD as compared with patients with no TOD (Group II: 1 Department of Cardiovascular Diseases - University Hospital 1.22±0.11 mm vs Group I: 0.84±0.03 mm, P<0.001). We obtained a Center Zagreb, Zagreb, Croatia strong significantly correlation between SUA and carotid IMT (r=0.86, p<0.001). Introduction: Endothelial function and arterial elasticity create the Conclusions: These fi ndings suggested that increased values of new insight in vascular function with the potential for risk evaluation. SUA and IMT were associated with the number of TOD and may be Echo tracking (e-TRACKING) offers accurate evaluation of vascular considered indicators for evaluating TOD. elasticity even before atherosclerotic vessel changes occur. Aim: The investigation was designed to compare the elasticity of Keywords: Hypertension, UltraSound, Hyperuricemia carotid artery in healthy individuals and in coronary patients confi rmed by coronary angiography. Non-invasive (e-TRACKING) method was PS1-2 ARTERIAL ELASTICITY - CAROTID ARTERY used in testing arterial endothelial function and elasticity. ß index, AI E-TRACKING VERSUS ARTERIOGRAPH METHOD ON and PWV are used to evaluate arterial elasticity. BRACHIAL ARTERY Methods: 49 individuals (20 healthy volunteers and 29 coronary Z. MIOVSKI1, L. J. BANFIC1, M. VRKIC KIRHMAJER1 patients) were tested. Beta index, augmentation index (AI) and the 1 University Hospital for Cardiovascular Diseases - Zagreb, Zagreb, speed of pulse wave velocity progression (PWV) were evaluated in both Croatia groups. The endothelial function and the e-TRACKING parameters from carotid artery insonifi cations were evaluated by using Aloka 100 Introduction: The evaluation of peripheral arterial elasticity became ultrasound with the linear probe (10MHz). popular method in primary and secondary prevention of cardiovascular Results: Average age of the healthy individual was 28,62±9,5 years diseases. and in coronary artery disease group was 61.5± 8,05 years. Aim: The study was designed to compare two similar method used for arterial elastic properties evaluation ; arteriopgraph method for evaluation on brachial artery, and e-TRACKING ultrasound method 58 ~
- 59. 2 University HospitalOlomouc - Department of Clinical Biochemistry, Olomouc, Czech Republic 3 University Hospital Olomouc - Department of Hematooncology, Olomouc, Czech Republic Objective: The aim of this study was to evaluate the plasma levels Conclusion: Endothelial function expressed as parameters that present of prothrombotic markers: von Willebrand factor (vWF), plasminogen arterial elastic properties ( beta index, AI and PWV) could significantly activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) in differentiate healthy population from symptomatic patients with asymptomatic subjects with dyslipidemia. coronary artery disease. design and methods: Asymptomatic subjects with dyslipidemia and Keywords: CAD,e-tracking,endothel their relatives (n=234) were assessed for lipids and prothrombotic markers. Individuals were divided into four dyslipidemic phenotypes pS1-4 riSK prOFiLe OF CardiOVaSCULar diSeaSeS (DLP) according to apolipoprotein B (apoB) and triglycerides (TG): aNd SUbCLiNiCaL atHerOSCLerOSiS iN HiV pOSitiVe DLP1 (n = 58, apoB < 1.2g/l and TG < 1.5mmol/l), DLP2 (n = 47, pOLiSH patieNtS apo B < 1.2g/l and TG > or = 1.5mmol/l), DLP3 (n = 31, apoB > or = W. KWIATKOWSKA1, B. KNYSZ2, M. CZARNECKI2, 1.2g/l and TG < 1.5mmol/l) and DLP4 (n = 98, apoB > or = 1.2g/l and J. GASIOROWSKI2, J. DRELICHOWSKA-DURAWA1, TG > or = 1.5mmol/l). Associations between prothrombotic markers M. BUBALA3, J. KWIATKOWSKI3, W. WITKIEWICZ1, and risk factors for atherosclerosis, markers of insulin resistance, and A. GLADYSH2 the intima-media thickness of the common carotid artery (IMT) were 1 Regional Specialist Hospital, Research and Development Centre, assessed too. Dpt of Angiology, Wroclaw, Poland results: Significant differences in PAI-1 between normolipidemic 2 Department of Infectious Diseases Wroclaw Medical University, phynotype - DLP1 (62.5 [35.9-82.9] ng/ml) and hypertriglyceridemic Wroclaw, Poland phenotypes - DLP2 (82.2 [61.1-122.1] ng/ml, p<0.01) and DLP4 3 Wroclaw University of Technology, Wroclaw, Poland (91.4 [63.5-111.8] ng/ml, p<0.001) after adjustment for age, sex and body mass index, were found. Levels of t-PA were different only Objective: The aim of the study was to evaluate the independent between DLP1 and DLP4 (1.9 [0.9-3.3] ng/ml versus 5.3 [2.5-8.6] ng/ risk factors of CVD and early atherosclerosis in HIV positive Polish ml, p<0.05). There were no significant differences of vWF between subpopulation. DLPs. PAI-1 and t-PA correlated with lipid parameters, markers of design and method: We assessed risk factors for CVD and carotid insulin resistance, blood pressure and obesity. VWF was independently intima media thickness (cIMT) of common carotid artery/bulb by associated with IMT, which was increased in DLP4. ultrasound (LOGIQ 7) in 72 HIV(+) mostly treated with ARV and Conclusions: Individuals with hypertriglyceridemic phenotypes 24 control individuals matched for age and sex without pre-existing showed increased levels of PAI-1 in comparison with normolipidemic CVD. subjects. The elevation of t-PA was presented only in patients with results: CVD was diagnosed in 5% of HIV (+) patients. In HIV (+) simultaneously elevated TG and apoB. The significant increase of patients the prevalence of heavy cigarette smoking is more frequent IMT confirmed in the patients with DLP4 reveals individuals with the (62,5% vs. 37,5%), they are significantly: less obese (BMI 23,6 vs.25,6, highest risk for atherosclerosis manifestation. p=0,0019) with higher waist/hip ratio (0,92 vs. 0,84, p=0,0006), with Supported by grant IGA MZCR NS/10284-3 significantly lower: LDL-C (100,9 vs.116,8 mg/dL, p=0,0034), HDL-C Keywords: Von Willebrand factor, Tissue plasminogen activator, (56,8 vs. 65,0mg/dL, p=0,005), fibrinogen (2,49 vs. 3,04g/l, p=0,0001), Intima-media thickness with significantly higher: triglicerydes (169,2 vs. 113,0mg/dl p=0,005), and homocysteine (13,9 vs 11,0µmol/l, p=0,001) concentrations. Mean pS1-6 SOLUbLe iNterCeLLULar CeLL adHeSiON cIMT was 0,703mm +/- 0,183 and 0,523mm +/- 0,095 respectively in mOLeCULe-1 aNd VaSCULar CeLL adHeSiON HIV (+) and control group (p=0,0001). In HIV (+) vs. control - mean mOLeCULe-1 iN aSymptOmatiC dySLipidemiC bulb cIMT value was 0,800mm vs. 0,578mm and common carotid SUbJeCtS cIMT 0,606mm vs.0,470mm (p=0,0001). Carotid plaques > 1,5mm D. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D. were observed in 28 HIV positive patients vs. 1 participant of control JACKULIAKOVA1, D. NOVOTNY2, J. LUKES2 group. 1 University Hospital - 3rd Department of Internal Medicine, Conclusions: In HIV positive patients more extensive atherosclerosis Olomouc, Czech Republic measured by cIMT was observed. The strongest classical risk factor 2 University Hospital - Department of Clinical Biochemistry, of CVD in Polish HIV(+) patients is cigarette smoking. Constitution Olomouc, Czech Republic features and biochemical profile of these patients tend to metabolic syndrome. Both, HIV infection and antiretroviral therapy are important Objective: The plasma levels of soluble intercellular cell adhesion predictive factors of premature atherosclerosis. Further longitudinal molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule-1 studies in the field of subclinical atherosclerosis in Polish HIV positive (s-VCAM-1) were assessed in clinically asymptomatic subjects to population are necessary. compare them between normolipidemic and various dyslipidemic Supported by European Regional Development Fund, Polish phenotypes. The associations between soluble cell adhesion molecules Government (Operational Programme Innovative Economy 2007- (s-CAMs) and risk factors for atherosclerosis, markers of insulin 2013),under the grant “WROVASC - Integrated Cardiovascular resistance, and the intima-media thickness of the common carotid Centre” artery (IMT) were evaluated, too. Keywords: Atherosclerosis, IMT, HIV infection, Risk factors design and methods: 234 asymptomatic subjects were divided into four dyslipidemic phenotypes (DLP) according to apolipoprotein B pS1-5 eNdOtHeLiaL prOtHrOmbOtiC marKerS iN (apoB) and triglycerides (TG): DLP1 (n = 58, apoB < 1.2g/l and TG < dySLipidemiC patieNtS 1.5mmol/l), DLP2 (n = 47, apoB < 1.2g/l and TG > or = 1.5mmol/l), D. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D. DLP3 (n = 31, apoB > or = 1.2g/l and TG < 1.5mmol/l) and DLP4 JACKULIAKOVA1, D. NOVOTNY2, L. SLAVIK3 (n = 98, apoB > or = 1.2g/l and TG > or = 1.5mmol/l). DLP1 (normo- 1 University Hospital Olomouc - 3rd Department of Internal Medicine, apoB /normo-TG) served as a control group. Olomouc, Czech Republic results: A significant difference in s-ICAM-1 between DLP1 (502.0 www.iua-eurochap2010.eu ~ 59
- 60. [457.1-568.2] ng/ml) andDLP4 (567.9 [502.8-692.1] ng/ml, p<0.001) associated with more impaired basic and instrumental ADL. was found. No significant differences in s-VCAM-1 between DLPs Keywords: White matter changes, Dementia, Activities of daily were apparent. S-ICAM-1 was independently predicted by HDL- living cholesterol, non-HDL-cholesterol, proinsulin, C-peptide, waist, systolic and diastolic blood pressure. S-VCAM-1 was predicted only pS1-9 SimULtaNeOUS eVaLUatiON OF COrONary by age and systolic blood pressure. Both s-CAMs were detected as artery diSeaSe aNd aOrtiC atHerOSCLerOSiS USiNG independent predictors for IMT, which was significantly increased in mULtideteCtOr Ct iN aCUte iSCHemiC StrOKe DLP 4. patieNtS Conclusions: The elevation of s-ICAM-1 was presented only in patients H. KIM1, H. CHO1, J. LEE1, Y. KIM1 with simultaneously elevated TG and apoB (DLP4) in comparison with 1 Department of Neurology, Konkuk University Hospital, Seoul, normolipidemic subjects. Patients with DLP 4 had significantly increased South Korea IMT, which was independently predicted by levels of s-ICAM-1 and of s-VCAM-1. These findings pointed out DLP4 subjects as individuals Backgrounds: Coronary artery disease (CAD) is a major determinant with the highest risk for early manifestation of atherosclerosis. of the outcome in ischemic stroke patients. Aortic atherosclerosis Supported by grant IGA MZCR NS/10284-3. (AA) is a potential embolic source in ischemic stroke patients. We Keywords: Soluble cell adhesion molecule, Intima-media thickness, investigated effectiveness of simultaneous evaluation of CAD and AA Dyslipidemia in acute ischemic stroke patients with multiple vascular risk factors. methods: We simultaneously evaluated CAD and AA using 64-slice pS1-7 HyperteNSiON iN patieNtS WitH SyStemiC MDCT with single sequence in consecutive acute ischemic stroke LUpUS erytHematOSUS (SLe) patients with multiple vascular risk factors admitted Konkuk university M. BOUCELMA1, H. CHAUDET, A. BERRAH hospital from March, 2008 to November, 2009. More than 50% stenosis 1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, in one or more coronary arteries on MDCT was defined as having CAD. Algeria AA was classified into AA in proximal aorta (ascending aorta including 2 Statistical Department, North Hospital, University of Aix Marseille, arch) or descending aorta by location, and simple or complicated by Marseille, France plaque nature. Complicated aortic plaque (CAP) was defined as plaque thickness more than 4mm, mobile or ulcerated plaque in proximal Mortality in SLE patients is increasing due to cardiovascular disease. aorta. Individual vascular risk factors and Framingham Risk Scores Objectives: To determine the prevalence of hypertension in our SLE (FRS) were evaluated. patient cohort, and to establish the factors which contribute to their results: Of 274 patients (male 165, mean age 66.2 year-old), CAD was development of hypertension. found in 61 (22.3%) of patients. For CAD, CAP (OR: 2.39, 95% CI: patients and methods: We studied 150 SLE patients (149 women, 4 1.14-4.97) was independent predictor. AA was found in 209 (76.3%) men).Blood pressure was mesured in all patients three times, with a patients including 147 (53.6%) patients with plaque in proximal aorta separation of 5 minutes. We inquired about cardiovascular risk factor and 59 (21.5%) patients with CAP. For CAP, CAD (OR: 2.69, 95% and treatment (immunosuppressives drugs, corticoids). CI: 1.22-5.90), previous history of ischemic stroke (OR: 2.30, 95% CI: Results: The mean age was 37±10 years and the mean duration of 1.00-5.28), and stroke subtype (OR: 0.25, 95% CI: 0.08-0.72) were SLE was 11.3±6.2 years.35.2% of patients suffered hypertension, 5% independent predictors. FRS was also modest predictor for both CAD diabetes, 48% hypercholesterolemia, 42.5% moderate hyperhomo- (OR: 1.04, 95% CI: 1.01-1.06) and CAP (OR: 1.02, 95% CI: 0.99- cysteinemia. 87% had taken corticoids. From hypertensive patients 1.04). 59.2% had a renal flare and at the time of study renal function was Conclusion: Simultaneous evaluation of CAD and AA using MDCT normal. Hypertension was significantly linked to nephritis (p < 0.02), in acute ischemic stroke patient with multiple risk factors was useful. and cumulative dose of corticosteroids (p < 0.001). CAD or CAP was independent predictor to either. FRS was also Keywords: Systemic lupus erythematosus, Hypertension, Vascular usefulness in predicting presence of CAD or CAP in acute ischemic event stroke patients. Keywords: Ischemic stroke, Coronary artery disease, Aortic pS1-8 impaCt OF WHite matter CHaNGeS ON atherosclerosis aCtiVitieS OF daiLy LiViNG iN miLd tO mOderate demeNtia pS1-10 StrOKe iN tHe yOUNG: reLatiON WitH S. MOON1, D. L. NA2 tHrOmbOCytemia 1 Ajou University School of Medicine, Suwon, South Korea M. BOUCELMA1, S. LASSOUAOUI1, D. ZEMMOUR1, 2 Samsung Medical Center, Seoul, South Korea H. BOUDJELIDA1, N. OUADAHI1, A. BERRAH1 1 Department of internal medicine, Mohamed Lamine Debaghine We investigated the association between white matter changes and Hospital, Bd Said Touati, Algiers, Algeria activities of daily living (ADL) in a large, well-defined cohort of patients with mild-to-moderate dementia (either Alzheimer’s disease or introduction: One of the hematological causes of stroke is essential subcortical vascular dementia). We divided a total of 289 patients into thrombocythemia (ET). It is one of the proliferative syndromes of three groups (140 mild, 99 moderate, and 50 severe) depending on the the hematopoietical system. Patient with ET have an increased risk degree of white matter changes on their brain MRIs and analyzed the of thrombosis and/or hemorrhage of veins and arteries. Few clinical three groups’ performances on basic and instrumental ADL. The degree reports have been published describing the clinical onset of ET in the of white matter changes was associated with greater age, hypertension, clinical onset of ET in the form of a vascular accident. previous history of stroke, higher Hachinski Ischemic Score, worse Case report: A 46 year old man, smoker, with no known hematological global cognitive status and functional status, and more impaired basic pathology, was admitted for investigation of left common carotid ADL and IADL. The severe group’s more impaired performance on both thrombosis. In his past medical history, we noticed a high blood the basic and instrumental ADL remained significant after adjustment pressure since 06 months and a transient ischemic stroke. Clinical exam for age and hypertension. Tasks involving physical activities were most were normal. Monitoring ECG, transoesophagal echocardiography, significant. This is the first study investigating the association between chest-Xrays, abdominal ultrasonography show no abnormalities. white matter changes and ADL in a large, well-defined dementia cohort. Platelet count was high: 1000.000/mm3.Marrow biopsy describes a The present study suggests that severe white matter changes might be hyperplastic megacaryocytopoiesis. 60 ~
- 61. Conclusion: Myeloproliperative disorders,including ET, must be Conclusion: True arteriomegaly is predominantly a disease of males. It suspected in al stroke patients with an elevated platelet count, even in is rare in females but still causes late problems which prove difficult to those who have potential causes of reactive thrombocytosis. treat. Operative treatment in male patients proves more successful than Keywords: Hematologics disorders, Stroke endovascular procedures. Keywords: Arteriomegaly, Female PS2 - Peripheral arterial disease (1) pS2-3 diFFereNt beHaViOUr OF pULSe WaVe pS2-1 HaS mra repLaCed CONVeNtiONaL VeLOCity aNd aUGmeNtatiON iNdeX iN patieNtS aNGiOGram iN tHe iNVeStiGatiON OF peripHeraL WitH peripHeraL arteriaL diSeaSe VaSCULar diSeaSe? a diStriCt GeNeraL HOSpitaLS G. SCANDALE1, G. DIMITROV1, G. CARZANIGA1, M. MINOLA1, perSpeCtiVe M. CINQUINI2, M. CAROTTA1, M. CATALANO1 T. HALL1, J. V. BARANDIARAN1, N. EL-BARGHOUTI1, 1 Research Centre on Vascular Diseases and Angiology Unit - E.P. PERRY1 University of Milan - L. Sacco H, Milan, Italy 1 Scarborough Hospital, Scarborough, United Kingdom 2 Mario Negri Institute for Pharmacological Research, Milan, Italy introduction: Magnetic resonance angiogram (MRA) has lower rates Objective: Age-related increased arterial stiffness is facilitated by of morbidity and mortality when compared to the invasive catheter arteriosclerotic disease. Both the aortic pulse-wave velocity and the insertion required in conventional angiography. We conducted a study aortic augmentation index are used as direct and indirect markers of looking at the change of clinical practice in our departments’ initial arterial stiffness. It has not been determined whether these parameters investigation of peripheral vascular disease (PVD). exhibit the same behaviour in patients with Peripheral Arterial method: Data was collected prospectively between January 2001 Disease. and Dec 2009. Multi-disciplinary team meeting outcomes were methods: The aortic augmentation index of 43 subjects with an evaluated from our database as intervention (surgery/angioplasty) or ankle-arm pressure index of <0.9 and of 49 sex-matched controls no intervention. was measured using central pulse-wave analysis and aortic stiffness results: Data per year is shown in table 1. techniques applied to the carotid-femoral pulse-wave velocity. results: The age, height, heart rate and mean arterial pressures did not differ between the two groups (p=0.87; p=0.29; p=0.25; p=0.63). The aortic augmentation index was higher (p<0.01) in the PAD group but the aortic pulse-wave velocity did not differ as compared with the controls (p=0,36). In the univariate and multivariate regression *Surgery and/ or Angioplasty analysis models the aortic augmentation index was inversely related to Conclusion: MRA has replaced conventional angiography as the initial heart rate (p= 0.0001; 0.002) but not to PWV. (p=0.74), age (p=0.52) or investigation of PVD. There still remains a need for conventional height (p=0.97). The aortic pulse-wave velocity was related directly to angiography for selected patients for investigation and for all patients age (p=0.05), to heart rate (p=0.03) and to systolic pressure (p=0.02). undergoing angioplasty. Conclusions: In PAD patients, commonly used arterial stiffness The total number of patients investigated has increased as MRA has parameters exhibit a different behaviour, suggesting different become more established but the percentage of interventions undertaken underlying pathophysiological mechanisms. This observation might has decreased. have implications for cardiovascular risk stratification. Keywords: MRA,Peripheral vasucalr disease,Angiography Keywords: Peripheral arterial disease,Arterial stiffness,Aortic indexes pS2-2 arteriOmeGaLy iN FemaLe SUbJeCtS pS2-4 iNCreaSed aOrtiC aUGmeNtatiON iNdeX T. HALL1, J. V. BARANDIARAN1, N. EL-BARGHOUTI1, iN peripHeraL arteriaL diSeaSe E. P. PERRY1 G. SCANDALE1, A. ACERANTI1, G. CARZANIGA1, M. MINOLA1, 1 Scarborough Hospital, Scarborough, United Kingdom M. CINQUINI2, M. CAROTTA1, M. CATALANO1 1 Research Centre on Vascular Diseases and Angiology Unit - introduction: Arteriomegaly is described as tortuous, ectatic and University of Milan - L.Sacco H., Milan, Italy irregular vessels with prolonged blood flow and is predominantly a 2 Mario Negri Institute for Pharmacological Research, Milan, Italy disease of males. We present the cases of two arteriomegalic female subjects. We stress the rarity of such presentation and discuss its Objective: A low ankle-arm pressure index (<0,9) is associated with management. increased cardiovascular complications. This observation suggests a Case reports: 1: TC presented aged 84 in 2004 with right leg rest pain relationship between Peripheral Arterial Disease and the heart, which and tissue loss. She was hypertensive, emphysematous and a heavy can be investigated by means of a descriptive analysis of the central ex-smoker. The patient underwent conventional angiography. This pulse-wave form. The aim of this paper is to compare parameters of the demonstrated Type 3 arteriomegaly with aneurysmal degeneration of ventricular and vascular patterns in patients with and without PAD. the aorta, right femoral and bilateral iliac arteries. In addition there methods: The following parameters were measured in 92 male patients was complete occlusion of the left superficial femoral artery (SFA) and (43 with PAD and 49 controls) having an average age of 68 ± 7: aortic right distal SFA. She had failed attempted angioplasty of the right SFA augmentation index, ventricular ejection time and that of return of the due to heavy calcification. Bypass surgery was declined by the patient. wave reflection using the wave-pulse technique after tonometric testing The patient died in 2006 without further vascular intervention. for recording the radial artery. 2: JS, aged 83 in 2007 following a fall and the development of ischaemia results: For matching age, sex, height, heart rate and diastolic pressures, of the right lower limb. Comorbidities comprised previous stroke and the aortic augmentation index and the ventricular ejection time were atrial fibrillation. The subject underwent conventional angiography. higher in the PAD group (p=0.01; p=0.03) while the return time of the Type 3 arteriomegaly was diagnosed in combination with aneurymal reflected wave was lower (p=0.02). According to the univariate and degeneration of the aorta, bilateral iliacs and ectatic vessels down to the multivariate regression analysis models, the aortic augmentation index popliteal area. A thrombosed right popliteal aneurysm was suspected was inversely related to heart rate (p= 0.0001; 0.002) but not to age and confirmed on ultrasound duplex scan. During her inpatient stay (p=0.52), height (p=0.97) or diastolic pressure (p=0.97). she developed a further stroke and was discharged without vascular Conclusions: Male PAD patients exhibit significant changes in intervention. She died 3 months later. www.iua-eurochap2010.eu ~ 61
- 62. parameters that areindicative of the relationship between their hearts the affected leg – 15.4 cm/sec; mean MWD – 98.0 meters. GROUP and their arteries. Further studies are required in order to determine the 2 – 10 smokers: mean age – 58.7 years; mean ABI – 0.70, mean PSV physiological and clinical significance of these observations. – 11.7 cm/sec; mean MWD – 135.8 meters. Measurements of ABI, Keywords: Increased aortic augmentation, Peripheral arterial disease, PSV, and MWD were performed before and 1-3 days after 10 everyday ABI intravenous infusions of Cytoflavin (combination of succinic acid, inosine, nicotinamide and riboflavin). pS2-5 metabOLiC drUGS iNCreaSe eFFeCtiVeNeSS results: Measurements after the treatment demonstrated moderate OF mediCaL treatmeNt iN SmOKerS WitH increase of ABI (mean – 12.3%) and PSV (mean – 31.3%) among iNtermitteNt CLaUdiCatiON non-smoking patients. However, average increase of MWD in that M. S. BOGOMOLOV1, V. M. SEDOV1, G. Y. SOKURENKO1, group was only 27.4%. In Group 2 changes of ABI were not significant L. N. EDOVINA1, V. V. SLOBODYANYUK1 (-0.8%, on the average), but PSV and MWD in smokers increased very 1 Pavlov’s State Medical University, Department of Vascular Surgery, substantially (mean growing – 56.0% and 42.8%, respectively). Saint-Petersburg, Russia Conclusions: Administration of antioxidant and metabolic substances for treatment of chronic limb ischemia leads to improvement of the Objective: Modern approach to treatment of patients with peripheral peripheral hemodynamics. Increasing of peak systolic velocity of the arterial disease (PAD) suggests administration of antiplatelet blood in the tibial arteries and improving of patients’ walking capacity and vasodilating agents. Effectiveness of metabolic correction of after this treatment are more significant in smoking patients. claudication is still underestimated. Keywords: Intermittent claudication, Metabolic drugs, design and method: In accordance with Inclusion criteria (painfree Hemodynamics walking distance (PWD) <200 meters and ankle-brachial index (ABI) <0.95), 34 nondiabetic and diabetic patients were included in the study. pS2-7 iNtima-media tHiCKNeSS iNCreaSe aNd They were divided on two groups. GROUP 1 – 13 non-smokers (mean atHerOSCLerOtiC pLaQUeS iN aSymptOmatiC age – 67.7 years; mean PWD – 65.9 meters). GROUP 2 – 21 smokers patieNtS (mean age – 59.4 years; mean PWD – 66.9 meters). At the beginning M. CAZAUBON1, F. A. ALLAER2 of the study - 10 everyday intravenous infusions of Cytoflavin 1 Department of angiology american hospital, Paris, France (combination of succinic acid, inosine, nicotinamide and riboflavin). 2 Chair of medical evaluation, Dijon, France Treatment during the study: aspirin, nicotinic acid and drotaverine. results: Walking ability was improved in all of the patients: just after Objective: Describe and analyse the frequency of Intima-media the last cytoflavin infusion average increase of PWD was 62.0%, in thickness (IMT) increase and of atherosclerotic plaques (AP) when one month – 82.9%, and in three months – 82.5%. In 3 months after a Doppler (D) ultrasound is conducted in asymptomatic patients cytoflavin infusions increase of ABI in Group 1 was in average twice consulting in daily practice of community angiologists. more than in Group 2 (7.0% and 3.4%, respectively). In spite of this methods: an Doppler ultrasound examination was systematically fact, in nonsmoking group improvement of walking ability was less conducted to study the posterior wall, 1 cm far from the carotid significant: just after the last infusion average increase of PWD was bifurcation in all asymptomatic patients presenting at list one cv risk 37.3%, in one month – 49.8%, and in three months – only 49.7%. factor.. Increasing of PWD in Group 2 was, in average, 77.2%, 104.4% and results: 80 patients (53,7% women), 58years old were examined. 102.6%, respectively. In 3 months more than 50% accretion of PWD 67.5% were dyslipidemic, 47.5% have a familial past history of CV was registered in 5 (38.5%) of 13 patients from Group 1 (PWD disease, 37.5% are smoker or former smokers, 36.3% are hypertensive increasing - from 52.6% to 140.9%) and in 10 (47.6%) of 21 patients et 12.5% have a diabetes. IMT is standard in 31.3% of them and from Group 2 (PWD increasing from 64.4% to 688.9%). increased in 45.0%. 23.7% are presenting atherosclerotic plaques. The Conclusions: Complex treatment of patients with limb ischemia should frequency of increased IMT and AP are respectively 42.1% et 5.3% include medicine, which improve metabolism. This treatment is more in patients < 50 y, 44.4% and 25.9% between 50 to 60 y, 55.0% and effective in smoking patients. 35.0% between 60 to 70 y, 35.7% and 28.6% > 70 y (p<0,001). Their Keywords: Intermittent claudication, Medical treatment, Metabolic frequencies are 50,0% and 29,6% when dyslipidemia, 50.0% and 20,0% drugs in diabetics, 51.7% and 27.6% in case of hypertension, 43.3% and 26.7% in smokers et 44.7% and 24.7% in patients with past history of pS2-6 iNFLUeNCe OF metabOLiC drUGS ON CV disease. Logistic analysis shows an increase of the risk of having an periFeraL HemOdyNamiCS OF tHe LeGS iN patieNtS augmentation of IMT or of having an AP in 60 to 70 years old patients WitH iNtermitteNt CLaUdiCatiON (OR : 12,8 vs < 50 y), in patients older than 70 y (OR : 6,9 vs < 50 y) L. EDOVINA1, M. BOGOMOLOV1, Y. LUKYANOV1, and in dyslipidemic patients (OR : 6,7 vs absence). V. SLOBODYANYUK1 Conclusion: This study shows an increase of the IMT and of AP 1 Pavlov’s State Medical University, Saint-Petersburg, Russia in asymptomatic patients and especially when older than 60 and dyslipidemic. It point out the interest of a systematic DP carotid Objective: Peripheral arterial disease (PAD) is an important examination in asymptomatic patients presenting at least a major manifestation of atherosclerosis. One of the main goals of treatment cardiovascular risk factor after 40 years old. for patients with claudication is to improve their walking capacity. The Keywords: Intima media, Atheroslerosis, Asymptomatic patients overall approach to the medical treatment of patients with intermittent claudication was extensively reviewed in recent publications. These pS2-8 SeLF-repOrted maXimaL WaLKiNG reviews were mostly focused on risk-factor modification and antiplatelet CapaCity iN arteriaL CLaUdiCatiON: CaN tHe therapies. Unfortunately, potential effectiveness of using of metabolic WaLKiNG impairmeNt QUeStiONNaire be SeLF- drugs for symptomatic relief in patients with peripheral arterial disease COmpLeted? is still underestimated. P. ABRAHAM1, N. OUEDRAOGO1, G. MAHE1, M. VASSEUR1, design and method: In the study 21 non diabetic patients with PAD G. LEFTHERIOTIS1 were included (maximal walking distance (MWD) <200 meters and 1 University Hospital, Angers, France ankle-brachial index (ABI) <0.95). GROUP 1 – 11 non-smokers: mean age – 69.1 years; mean ankle-brachial index (ABI) – 0.60, mean peak Background: The walking impairment questionnaire (WIQ) allows systolic velocity (PSV) of the blood in the posterior tibial artery of for a standard estimation of self-reported exercise capacity in patients 62 ~
- 63. with peripheral arterydisease (PAD). If the WIQ questionnaire is to be pS2-10 VariabiLity aNd SHOrt-term deter- completed without medical supervision, in order to avoid any influence miNaNtS OF WaLKiNG CapaCity iN patieNtS WitH of the physician on patient’s answers, a potential issue is its relative iNtermitteNt CLaUdiCatiON complexity. We aimed to estimate the difficulties encountered by the P. ABRAHAM1, A. LE FAUCHEUR2, B. NOURY-DESVAUX2, patients to self-complete the WIQ. G. MAHE1, T. SAUVAGET2, J. L. SAUMET3, G. LEFTHERIOTIS1 methods: We prospectively studied 73 patients with claudication. 1 University Hospital, Angers, France The French version of the WIQ was self-completed by the patients 2 IFEPSA, Le sponts de Cé, France at arrival with a blue or black pen and then corrected with a red pen 3 University Cl Bernard, Lyon, France by a technician or a nurse in case of missing (no answer), duplicate (multiple answers to a single question) or paradoxical answers (e.g.: Objective: Global positioning system (GPS) recordings can provide lower difficulty for a higher task level) on each of the three sub-scale valid information on walking capacity in patients with peripheral questionnaires: distance (D), Speed (S), climbing stair capacity (C). arterial disease (PAD) and intermittent claudication (IC) during Thereafter patients performed a constant load treadmill walking tests community-based outdoor walking. This study used GPS to determine (maximized to 750 m) blinded to the results of the WIQ questionnaire. the variability of the free-living walking distance between two stops results: Half of the questionnaires (37 out of 73) had to be corrected (WDBS), induced by lower-limb pain, which may exist within a single for missing (n=23, 24 & 24), duplicate (n=3, 0 & 1) or paradoxical stroll in PAD patients with IC and the potential associated parameters (n=5, 6 & 1) answers within the D, S & C sub-scales respectively. obtained from GPS analysis. Median [25-75°centiles] distance on treadmill was 171 m [109-376]. methods: This cross-sectional study of 57 PAD patients with IC was Once the questionnaire corrected, the coefficient of correlation of the conducted in a university hospital. The intervention was a 1-hour free- WIQ-score (mean of the 3 subscale) to treadmill maximal walking living walking in a flat public park with GPS recording at 0.5 Hz. distance was r=0.652; p<0.05. GPS-computed parameters for each patient were WDBS, previous Conclusion: The WIQ correlates fairly with objective estimation of stop duration (PSD), cumulated time from the beginning of the stroll, maximal walking distance. It is a useful tool to estimate self-reported and average walking speed for each walking bout. The coefficient of exercise capacity in the clinical or research context but it is hardly self- variation of each parameter was calculated for patients with the number completed by the patients. It is quite complex with 14 questions and a of walking bouts (NWB) >5 during their stroll. A multivariate analysis choice among 5 possible answers (70 boxes). Supervised administration was performed to correlate WDBS with the other parameters. of the WIQ appears necessary in most cases. results: Mean (SD) maximal individual WDBS was 1905 (1189) vs Keywords: Questionnaires, Maximal walking distance 550 (621) meters for patients with NWB <5 vs NWB > 5, respectively (P < .001). In the 36 patients with NWB > 5, the coefficient of variation pS2-9 reLatiONSHip OF SymptOmS WitH NON-abi for individual WDBS was 43%. Only PSD and cumulated time were HemOdyNamiC iNVeStiGatiONS ON treadmiLL iN statistically associated with WDBS in 16 and 5 patients, respectively. patieNtS WitH SUSpeCted CLaUdiCatiON Conclusions: A wide short-term variability of WDBS exists and P. ABRAHAM1, G. MAHE1, N. OUEDRAOGO1, G. LEFTHERIOTIS1, likely contributes to the difficulties experienced by patients with IC to M. VASSEUR1 estimate their maximal walking distance at leisurely pace. Incomplete 1 University Hospital, Angers, France recovery from a preceding walk, as estimated through PSD, seems to dominantly account for the WDBS in patients with IC. Background: We aimed to study the relationship between symptoms Keywords: Global positioning system, Claudication, Community on treadmill and a hemodynamic parameter, different from ABI, based recordings independent from arterial stiffness and that can detect both proximal and distal regional blood flow impairment (RBFI) respectively: pS3-peripheral arterial disease (2) exercise-induced transcutaneous oxygen pressure (tcpO2)-changes. When concordant with pain location on treadmill, RFBI can provide pS3-1 mOrtaLity aNd ampUtatiON rate OF tHe objective evidence for the arterial origin of exercise-induced pain. CONSerVatiVe pHarmaCOLOGiCaL treatmeNt iN methods: ABI at rest was defined as a 9-category variable. The San patieNtS WitH CritiCaL LeG iSCHemia UNSUitabLe Diego Claudication Questionnaire assessed both proximal (hip, thigh, FOr reVaSCULariSatiON buttock) and distal (calf) exertional leg pain experienced on treadmill R. MARTINI1, R. CORDOVA1, G. M. ANDREOZZI1 and analysed with the results of exercise tcpO2 for each ABI caterogy. 1 U.O.C. Angiologia - Azienda Ospedaliera-Università di Padova, Exercise-related vascular-type pain was considered of vascular origin Padova, Italy when underlying concordant RFBI was observed. results: We studied 600 patients suspected of claudication. Of these, In spite of the recent progress in revascularization and in 81 were treated for diabetes, 203 had a past history of lower limb anaesthesiology procedures, today in vascular centres there are still peripheral arterial surgery or angioplasty. ABI could not be measured patients considered not suitable for revascularization. In these patients in 10 legs due to arterial incompressibility. Among the 1190 studied non interventional treatment such as pain treatment, prostanoids, spinal legs, the proportion of legs with pain of vascular origin decreased in cord stimulations or hyperbaric oxygen treatment associated or not a stepwise manner from 84.1 % for ABIs 0.50-&-lower down to 8.1 with wound management treatment are used to avoid amputation. In % for ABIs in the 1.21-to-1.30 intervals. For ABIs 1.31-&-over, the this work we describe the natural history of a group of 90 patients with proportion of legs with pain assumed of vascular origin increased to Critical Limb Ischaemia, considered not suitable for revascularization, 40.9 %. treated not interventionally. The rate of amputation and mortality were Conclusions: There is no abrupt ABI cut-off point to predict the observed over a 24-month period. Patients with CLI and end-stage concordance of pain at exercise to underlying exercise-induced RBFI general conditions, or needing immediate primary amputation were in patient with suspected PAD. The proportion of concordant pain and excluded from this study. Sixteen patients were not revascularized underlying RBFI decreases linearly with the increase in ABI up to an because of poor functional status (37.7%); seventy-six patients ABI ranging 1.21-to-1.30 and increases when ABI further increases. (64.4%) had inadequate outflow vessels. Among classical risk factors The relationship of ABI categories to pain associated with concordant for amputation and mortality in CLI, the level of independence, i.e. the exercise-induced RBFI, follows the expected U-shaped pattern. capacity of the patients to have an independent life, was assessed. Toe Keywords: Exercise, Transcutaneous oxygen pressure, Ankle to amputations or other foot-sparing surgical procedures were performed brachial index during treatment in 13% of limbs. Revascularisation was attempted in www.iua-eurochap2010.eu ~ 63
- 64. 12 patients (10.6%) within 8 months because a significant worsening of significantly higher plasma homocysteine (Hcy) levels than unaffected CLI. Major amputation was necessary in 8 patients (9.3%): 4 patients controls. Restenosis continues to be a frequent complication of had primary amputation and 4 had secondary amputation after a failed percutaneous revascularisation (PR) of the femoropopliteal artery revascularization attempt. Twenty-one patients (23.2%) died during (FPA) despite the initial technical success. The objectives of this study the 24-month period four of these had needed revascularization. The were to determine whether elevated Hcy level can predict restenosis in logistic regression showed that restricted level of independence (RLI) patients with claudication undergoing PR of FPA for total occlusions. was independently associated with amputation and death at 24 months design and method: 113 pts [males=67(59%), mean age 77(range 53- (P< 0.001). In conclusion our study reports that in patients, with not 95)] underwent PR to FPA. Plasma Hcy levels were measured 12-24 limb or life threatening skin lesions, if treated in specialised vascular hours prior to PR. All pts had total occlusions (range 2cm-40cm) of centres, made possible to achieve good result in terms of amputation FPA and >2 vessel infrapopliteal runoff. Clinical restenosis requiring ad death rate. repeat PR was defined by a >75% stenosis on duplex ultrasound and/ Keywords: Critical leg ischemia, Peripheral arterial disease or recurrent disabling claudication with a fall in ABI. Follow-up was attained at 6 months. pS3-2 Crp LeVeLS aS a prediCtOr OF reSteNOSiS results: Mean baseline Hcy level was 11.8±3.2mmol/L (7.6mmol/ FOLLOWiNG SFa reVaSCULariSatiON L–19.2mm/L). Baseline resting ABI’s ranged from 0.53 to 0.79. P. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3, No restenosis or only minimal intimal hyperplasia was observed in A. KELLY4 76(67%)pts at 6 months. Restenosis requiring repeat PR was observed 1 Department of Vascular Medicine, Mater Hospital, Sydney, in 37(32%). Restenosis was independent of length of occlusion. Hcy Australia level was significantly higher in the restenosis group (16.5±1.5mmol/L, 2 Department of Vascular Surgery, Mater Hospital, Sydney, p<0.005). Australia Conclusions: These results indicate that an elevated homocysteine level 3 Department of Anaesthetics, Mater Hospital, Sydney, Australia may predict restenosis that requires repeat revascularisation following 4 Sydney Endovascular Specialists, Sydney, Australia PR of FPA total occlusions. Studies investigating strategies to lower homocysteine levels in patients with PAD are underway and may result Objective: Superficial femoral artery (SFA) stenosis represents one of in reduced restenosis rates at 6 months for PR of FPA occlusions. the most common sites of peripheral vascular obstruction. Restenosis Keywords: Homocysteine, Restenosis, SFA continues to be a frequent complication of angioplasty (PTA) at this site despite the initial technical success. C-reactive protein (CRP) is an pS3-4 SterNaL WOUNd aNGiOGeNeSiS iN diabetiC acute phase reactant and pts with elevated basal levels of CRP are at aNd NON diabetiC patieNtS UNderGOiNG CardiaC an increased risk of cardiovascular disease.The objectives of this study VaLVe repLaCemeNt SUrGery were to determine whether CRP levels could be utilised as a predictor P. BHASKARAN1, N. J. STANDFIELD1, T. GOURLAY2 of restenosis in patients with claudication undergoing SFA PTA. 1 Hammersmith Hospital, Imperial College, London, United design and method: 100 pts [males=65 (65%), mean age 64 (range 34- Kingdom 80)] underwent PTA to SFA alone (n=75) or in combination with PTA to 2 University of Strathclyde, Glasgow, United Kingdom popliteal (n=25). CRP levels were measured 12-24 hours prior to PTA. All pts had target stenoses of 70 to 100% and >2 vessel infrapopliteal Background: In this study we propose to assess the sternal wound runoff. Clinical restenosis was defined by a >50% stenosis (increase in healing process following cardiac valve replacement patients. flow velocity by > 100%) on duplex. Average follow-up attained was Pathological and mechanical factors affect the collateral vessel 12 months. formation and angiogenesis. In diabetic patients acute and chronic results: Baseline resting ABI’s ranged from 0.60 to 0.83 and post- arterial changes prolong the recovery process from the insult. There is exercise ABI’s ranged from 0.27 to 0.70. CRP levels pre-procedure no interruption of arterial blood supply in these patients as the internal were <1mmol/L (35%), 1-2mmol/L (32%) and >2mmol/L (33%). thoracic arteries are not mobilised in these patients. No restenosis or only minimal intimal hyperplasia was observed in aim: To establish the difference in healing process of sternal wound 75 (75%) at 12 months. Revascularization was required in 25 (25%) following diabetic and non diabetic cardiac valve replacement patients pts (PTA=5, PTA/stent=20) for clinical restenosis. Of pts requiring using Laser Doppler Imager. revascularisation CRP levels were 1-2mmol/L (25%) and > 2mmol/L methods: Sternal area of diabetic and non diabetic patients were (95%). scanned at 5 time points (pre-induction and 72 hours after surgery) Conclusions: These results may be cautiously interpreted to indicate by measuring doppler shift of laser light caused by blood cell that elevated CRP levels prior to SFA intervention may be used as movements. a predictor of restenosis following SFA PTA. Further strategies to results: The neovascularisation and wound healing were steady decrease restenosis can thereby be implemented. and faster in non diabetic patients. The tissue perfusion was steadily Keywords: Restenosis, CRP, Superficial femoral artery increased thorough out on both sides of sternum. There was a decreased perfusion on left side compare to right side. pS3-3 pLaSma HOmOCySteiNe LeVeL prediCtiVe In diabetic patients the perfusion was dropped slightly following surgery OF pOteNtiaL FOr reSteNOSiS aFter SFa and increased after 24 hours. At 48 hours the process of angiogenesis reVaSCULariSatiON FOr OCCLUSiVe FemOrO- was decreased below the baseline and increased after that. pOpLiteaL diSeaSe Here we established the difference in the process of formation collaterals P. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3, and angiogenesis in diabetic and non diabetic patients, which is steady A. KELLY4 in nature through out. 1 Department of Vascular Medicine, Mater Hospital, Sydney, Summary: There was a reduced neovasculirisation process following Australia cardiac valvular surgical patients secondary to chronic pathological 2 Department of Vascular Surgery, Mater Hospital, Sydney, arterial changes in diabetic patients. Australia Keywords: Angiogenesis, Diabetic, Non diabetic 3 Department of Anaesthetics, Mater Hospital, Sydney, Australia 4 Sydney Endovascular Specialists, Sydney, Australia pS3-5 aSSeSSmeNt OF SterNaL WOUNd HeaLiNG FOLLOWiNG diabetiC aNd NON diabetiC COrONary Objective: Patients with peripheral arterial disease (PAD) have artery bypaSS GraFt SUrGiCaL patieNtS USiNG 64 ~
- 65. LaSer dOppLer imaGer pathology of the disease process. P. BHASKARAN1, N. J. STANDFIELD1, T. GOURLAY2 Summary: This study established the positional difference in tissue 1 Hammersmith Hospital, Imperial College, London, United perfusion in DM and Non DM patients secondary to narrowing of Kingdom the arteries, formation of collaterals and angiogenesis. Other groups 2 University of Strathclyde, Glasgow, United Kingdom showed different disease process and pathology. This helps to treat the patients depends on the skin perfusion. Background: Disturbances in sternal wound healing following Keywords: Diabetic, Non diabetic, Hypoxic coronary artery bypass graft (CABG) surgeries is a major problem. The reasons for the delayed healing are different. Regional blood supply by pS3-7 CritiCaL Limb iSCHaemia iN diabeteS: internal thoracic and intercostal arteries, operative technique, infection deFiNitiON, aSSeSSmeNt, prOGNOSiS control and post operative management are important factors affecting F. POLLICE1, P. POLLICE1, V. DELGADO1 the sternal healing process. In CABG patients, left internal thoracic 1 Department of Cardiology - Leiden University Medical Center, artery is used to establish anastomosis with the coronary artery. Wound Leiden, Netherlands Antilles healing of the left side requires collateral vessel formation in the process of wound healing. Background: We sought to establish risk factors predicting the out aim: To establish the role of internal thoracic and intercostals arteries come of foot lesions in longstanding diabetic patients with critical foot in collateral formation and angiogenesis in both sides of the sternum ischaemia(CFI). following CABG surgeries using Laser Doppler Imager. patients and methods: We investigated retrospectively 98 consecutive methods: Left and right parasternal tissue perfusion of 30 diabetic and diabetic patients with ischaemic foot lesions. The patients (mean age non diabetic patients were measured at 5 time points (pre-induction to 70 years, duration of diabetes 21 years)were jointly cared for by 72 hours after bypass). LDI laser Doppler imaging system measures the specialised diabetologists and vascular surgeons; 75 patients were frequency of the blood cells passing through the laser light field. treated by arterial revascularisation. Results: In diabetic patients, the tissue perfusion was dropped results: Good outcome (lesions healing) was observed in 53 patients significantly bilaterally immediately after surgery, but more on left (54%). Bad outcome was observed in 45 patients :not healing lesions side. The collateral vessel formation and angiogenesis were increased (n=5), major amputation (n=19), and death in relation to the foot lesions bilaterally in first 24 hours following surgery and kept same pace with (n=21). Patients with good and bad outcome did not differ regarding age, the right side after 48 hours. After 72 hours the tissue perfusion was sex, smoking status, type, duration and treatment of diabetes mellitus, dropped to base line and noticed significant drop on left side. presence of neuropathy, coronary heart disease, stroke, previous In non diabetic patients, the perfusion was gradually increased on the amputations, current revascularization, and localization, of the foot right side and dropped on the left side immediately after surgery. After lesions. The risk of bad outcome was increased 8.9 times in patients an 48 hours the perfusion was equalled bilaterally and dropped to the base dialysis for end –stage renal disease; 7.0 times if surgical complications line. were present; and 5.4 times with C-reactive protein(CRP) above the Summary: The new vessel formation was delayed on left side second quintile ( cut-off value 8 mg/dl). secondary to mobilization of left internal thoracic artery in both groups Conclusion: Management of longstanding diabetic patients with of surgical patients. The difference was more significant in diabetic ischaemic foot lesions leaves room for improvement. Dialysis treatment, patients. elevated CRP levels and surgical complications were strongly predictive Keywords: Angiogenesis, Diabetic, Sternum of non-healing lesions, major amputation and death. Keywords: Diabetes pS3-6 CLiNiCaL SiGNiFiCaNCe OF LaSer dOppLer SCaNNer iN peripHeraL VaSCULar diSeaSe pS3-8 aSSOCiatiON betWeeN miCrOaLbUmiNUria P. BHASKARAN1, M. ASLAM1, N. J. STANDFIELD1, T. GOURLAY2 aNd eLeVated LeVeLS OF prOiNFLammatOry 1 Hammersmith Hospital, Imperial College, London, United eNdOtHeLiUm-deriVed mediatOrS iN HyperteNSiVe Kingdom diabetiC patieNtS 2 University of Strathclyde, Glasgow, United Kingdom C. SERBAN1, S. DRAGAN2, I. MOZOS1, R. MATEESCU3, L. SUSAN4, A. PACURARI4, A. CARABA4, G. SAVOIU5, Background: In peripheral vascular disease (PVD), skin perfusion is I. ROMOSAN4 an important factor in the management of acute and chronic disease 1 University of Medicine and Pharmacy Victor Babes - Patho- process. It is very difficult to manage the hypoxic cellular changes physiology Department, Timisoara, Romania and require more extensive investigations and aggressive treatment to 2 Preventive Cardiology and Cardiovascular Rehabilitation Clinic, prevent progression of the disease. Timisoara, Romania aim: To evaluate the skin hypoxic changes secondary to different 3 University of Medicine and Pharmacy Victor Babes - Physiology disease processes in the management of PVD by using laser doppler Department, Timisoara, Romania scanner. 4 University of Medicine and Pharmacy Victor Babes - IVth Medical methods: 170 diabetic (DM) and non diabetic (Non DM) patients Clinic, Timisoara, Romania were selected with symptomatic of lower limb PVD. The blood flow of 5 University of Medicine and Pharmacy - Anatomy, physiology and the area of interest was estimated by Moor LDI laser doppler imaging pathophysiology Department, Timisoara, Romania system. Measurement of the doppler shift of laser light caused by blood cells passing within the laser light field of the distal dorsal part of the Objective: Microalbuminuria, an early indicator of chronic kidney foot were taken in standing and lying down positions to establish the disease is also a well-established risk factor for atherosclerosis in extend of the severity of the PVD. patients with cardiovascular disease. Inflammatory markers are known results: The skin perfusion measured in DM standing and Non to be sensitive predictors of atherosclerotic disease. The purpose of DM lying down groups showed statistically significant increase in this study was to study the association between microalbuminuria and microcirculation. Other groups such as hypercholesterolemic (HC), inflammatory markers (high-sensitivity C-reactive protein-hsCRP, smokers (S) and hypertensive (HT) patients did not establish any plasma fibrinogen) in hypertensive type 2 diabetic patients compared significant changes in both positions except there was an increase to hypertensive patients. perfusion in non HC, S and non HT patients. Angiogenesis secondary design and method: We compared the levels of fibrinogen, hsCRP to collateral circulation is affected by the etiological factors and and 24-h urine microalbuminuria of 71 patients with both arterial www.iua-eurochap2010.eu ~ 65
- 66. hypertension and type2 diabetes mellitus (mean age 60 ± 4.84 years) Keywords: Diabetic foot, Topical treatment with those of 50 patients with arterial hypertension (mean age 56 ± 5.60 years). For the measurement of microalbuminuria and hsCRP it pS3-10 imprOViNG Limb SaLVaGe iN CritiCaL was used the immunoturbidimetric method. Limb iSCHemia WitH iNtermitteNt pNUematiC results: The level of microalbuminuria was found to increase COmpreSSiON: a CONtrOLLed StUdy WitH eiGHteeN significantly in hypertensive diabetic patients, compared to that of the mONtHS FOLLOW Up hypertensive patients (117 ± 15.51 mg/l vs 45 ± 37.65 mg/l, P < 0.001). S. KAVROS1, N. TURNER1, A. VOLL1, D. LIEDL1, P. GLOVICZKI1 Hypertensive patients with type 2 diabetes mellitus had significantly 1 Mayo Clinic, Rochester, USA increased values of plasma hsCRP (6.95 ± 0.44 mg/l vs 4.02 ± 1.53 mg/l, P < 0.001) and fibrinogen (5.04 ± 0.30 g/l vs 3.33 ± 0.81 g/l, P Background: The purpose of this study was to evaluate the clinical < 0.001), compared to hypertensive patients. Microalbuminuria was role of IPC in the treatment of patients with chronic critical limb significantly correlated with hsCRP (r = 0.71, P < 0.001) and fibrinogen ischemia (CCLI), tissue loss and non-healing wounds of the foot on (r = 0.72, P < 0.001). whom peripheral arterial revascularization had been exhausted. Conclusions: Microalbuminuria is associated with elevated levels methods: This study comprises 2 groups: group 1 consisted of 24 of proinflammatory endothelium-derived mediators like hsCRP patients, median age 70 years, who received IPC for tissue loss and and fibrinogen, in hypertensive patients with diabetes mellitus. non-healing wounds of the foot secondary to CCLI, in addition to Microalbuminuria screening and effective treatment to reduce blood wound care; group 2 consisted of 24 patients, median age 69 years, pressure and microalbuminuria in hypertensive patients, particularly who received wound care for tissue loss and non-healing wounds of those with existing diabetes may improve cardiovascular and renal the foot secondary to CCLI, without the benefit of IPC. Outcome was outcomes. considered favorable if complete healing and limb salvage occurred, Keywords: Microalbuminuria, Hypertension, Diabetes mellitus and adverse if the patient had to undergo a below knee amputation subsequent to failure/deterioration of wound healing. pS3-9 SUSCeptibiLity OF baCteriaL CULtUreS tO results: In the Control Group 20 patients (83%) failed to heal their foot tOpiCaL aNtiSeptiCS iN diabetiC FOOt wounds and underwent a BKA; the remaining 4 (17%) had complete L. MASLOWSKI1, M. BARTOSZEWICZ2, K. CHECKA2, healing and limb salvage. In the IPC Group 14 patients (58%) had W. KWIATKOWSKA1, W. WITKIEWICZ3 complete foot wound healing and limb salvage. Ten patients (42%) in 1 Regional Specialist Hospital, Research and Development Center, this group underwent BKA after failing healing of the foot wounds. Department of Angiology, Wroclaw, Poland Both wound healing and limb salvage were significantly better in the 2 Medical University, Department of Microbiology, Wroclaw, IPC group (p<0.01). Poland Conclusion: Our study data reveal that IPC implementation used as an 3 Regional Specialist Hospital, Research and Development Center, adjunct to wound care in patients with chronic CLI and chronic non- Department of General and Vascular Surgery, Wroclaw, Poland healing wounds/tissue loss improves the likelihood of wound healing and limb salvage, when established treatment alternatives in current Topical antibacterial treatment is important therapeutic method in practice are lacking. diabetic foot. Keywords: Chronic Critical Limb Ischemia, Intermittent Pnuematic Aim of the study was the evaluation of susceptibility of bacteria Compres, Limb Salvage cultured from necrotic and purulent tissues collected from patients with diabetic foot to usual topical antiseptics. pS4 - Vascular Surgery (1) Study group: 15 patients with type 2 diabetes with diabetic foot (11 male, 4 female; mean age 65,7years; mean diabetes duration 15,5 yrs). pS4-1 COmpariSON OF eNdOLUmiNaL VerSUS OpeN In 10 patients obliterative atherosclerosis was diagnosed, in 6 of them repair iN tHe treatmeNt OF abdOmiNaL aOrtiC endovacular procedures were performed. Necrosis was observed in 11 aNeUrySmS patients, ulcers in 2 pts; in 5 cases incision and drainage was done; 7 F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 pts have had radiological signs of osteolisis. In 3 pts primary femoral 1 Department of Vascular Surgery, University of Naples, Naples, amputation was performed and distal foot amputations in next 3 pts. Italy method: In all patients tissue specimens was obtained for bacterial 2 Department of Interventional Radiology, Bari, Italy cultures. results: In all samples bacterial colonization was ascertained with purpose: Endovascular abdominal aortic aneurysm (AAA) repair is critical value above 105 CFU/g of tissue. In 9 pts mixed G+ and G- reported to result in less initial patient morbidity and a shorter hospital infection was recorded, G+ infection in 3, G- infection in 3. Cultures length of stay(LOS) when compared with conventional AAA repair. We were positive for Staphylococcus aureus, Staphylococcus. epidermidis, sought to examine the durability of this result during the intermediate Staphylococcus auricularis, Enterococcus sp., Pseudomonas sp., follow-up interval. Stenotrophomonas maltophilia, Acinetobacter baumani, E.coli, methods: The records of all admissions for all patients who underwent Citrobacter freundi and Serratia species. The in vitro susceptibility of AAA repair during a 26-month interval were reviewed. cultured germs to usual topical antiseptic as povidone-iodine, ethacridine results: Three –hundred thirty-seven (337) patients underwent lactate, chlorhexidine and octenidine hydrochloride in clinically used procedures to repair AAAs (163 open and 174 endovascular). concentrations was examined; studies were done using microbiological Endovascular procedures were performed with a variety of devices cultures either in plankton or in biofilm forms. In plankton cultures and configurations. The mean follow-up period was 10.6 months G+ bacterial species showed diminished susceptibility to povidone- (endovascular repair) and 12.3 months (open repair). LOS did not iodine; in biofilm cultures these bacteria were resistant to this antiseptic significantly vary by device (P=.24 to P=.92) or configuration (P=.24). agent. All Pseudomonas aeruginosa biofilm cultures were resistant The initial median LOS for procedures was significantly shorter to all examined antiseptics; former G- biofilm cultures also showed (P=.009) for endovascular repairs (5 days) than for open procedures diminished susceptibility to all topical antiseptics. G+ bacterial cultures (8days). The readmission-free survival rate after AAA repair at 12 were susceptible to ethacridine lactate, chlorhexidine and octenidine months was 95% for patients for open AAA repair versus 71% for hydrochloride either in plankton or in biofilm forms. patients for endovascular repair (P<.001). If the total hospital days Conclusion: chlorhexidine and octenidine hydrochloride should be were compared, including the initial and all subsequent AAA-related recommended as basic topical antiseptic agents. admissions, there was no significant difference for mean LOS for 66 ~
- 67. patients who underwentendovascular versus open AAA procedures experience in open repair. Surveillance can be crucial in preventing (11 days versus 13.6 days; P=.21). Although women had similar LOS late complications. to men for endovascular repair, (P=.44), they had longer initial LOS for Keywords: EVAR, Reintervention, Rupture open AAA repair (15 versus 10 days; P=.03). After endovascular repair, women were more likely than men to be readmitted by 12 months (51% pS4-4 tiSSUe FaCtOr patHWay aNd tHrOmbiN- versus 71% readmission-free survival rate; P=.03) and they had longer aNtitHrOmbiN COmpLeX iN bLOOd OF patieNtS WitH LOS on readmission (13.2 versus 5.2 days; P=.006 abdOmiNaL aOrtiCaNeUrySm dUriNG SteNt-GraFt Conclusion: Although initial LOS was shorter for the patients who impLaNtatiON underwent endovascular as compared with conventional AAA repair, R. GRENDZIAK1 this advantage was lost during the follow-up interval because of frequent 1 Regional Specialized Hospital, Department of Vascular Surgery, readmission for the treatment of procedure-related complications, Wroclaw, Poland chiefly endoleak. Keywords: Aneurysm Objective: Tissue factor (TF)pathway is the key initiator of trombin- generation and thrombo-embolic complications.TF takes also part in pS4-2 eNdOVaSCULartHOraCiCaOrtiCaNeUrySm inflammatory processes and together with vascular endothelial growth repair iN a patieNt WitH SeVere aOrtOiLiaC factor (VEGF) in proliferation and migration of vascular endothelial diSeaSe aNd eCtOpiC SiNGLe KidNey and muscle cells.Tissue factor pathway inhibitor (TFPI ) inhibits M. KAFEZA1, V. PSARROS1, K. PAPOUTSIS1, G. KOUVELOS1, thrombogenesis and thrombus formation and prevents the artery A. KOUTSOUBELIS1, C. BAKOYIANNIS1, S. GEORGOPOULOS1, stenosis.Thrombin-antithrombin complexes (TAT) reflect trombin- C. KLONARIS1, E. PAPALAMBROS1 generation occuring in blood. 1 University of Athens, Laiko General Hospital, First Department of desing and methods: The aim of the study was to evaluate the Surgery, Vascular Division, Athens, Greece concentration of TF, TFPI,VEGF and TAT complexes in blood of patients with abdominal aorta aneurysym (AAA) during stent-grafts introduction: While endovascular repair of thoracic aortic aneurysm implantation. Twenty six patients (22 men and 4 women) in mean is rapidly emerging, an increasing number of complex cases and age 71 years with AAA and implanted stent-grafts were enrolled in challenging access related problems are encountered. A variety of this study. Blood was drawn 3 times: before, just after and 24 hours techniques have been developed to overcome these limitations. after stent graft implantation. The concentration of TF, TFPI, VEGF, Case report: This report presents a patient with descending thoracic and TAT complexes were measured with with commercial kits,using aneurysm of 6,4cm diameter, with concomitant severe aortoiliac enzyme immunoassay (ELISA). disease. Preoperative imaging revealed a single ectopic right kidney, results: In plasma of patients with AAA the concentration of TF with the right renal artery arising near aortic bifurcation.A temporary were significantly higher than in controls i.e. 241 ± 164 pg/ml versus extra-corporeal, subclavian-femoral bypass was used to maintain kidney 133±79pg/ml, also higher were TFPI levels 101±18 ng/ml versus 63±18 perfusion while device access was obtained through an aortomonoiliac ng/ml. VEGF concentration were similar in examinated both groups. graft. Just after stent-grafts implantation TAT complexes were four times The device was deployed successfully and the patient had no higher and after 24 hours decreased to the level before operations deterioration of his renal function at discharge and follow up. Conclusion: Stent-graft implantation to patients with AAA caused Conclusion: Nowadays, endovascular endografting continues to a significiant decrease of plasma TF level probably by adsorbtion of evolve, while the use of alternative approaches and new techniques this protein on implanted prothesis where thrombin –generation was expand the number of patients eligible for endovascular repair. activated. Keywords: TEVAR, Access, iliac, Kidney perfusion Keywords: Tissue factor, Aortic aneurysm, Thrombin-generation pS4-3 Late SeCONdary prOCedUreS dUe tO pS4-5 a NOVeL SUtUre-LeSS deViCe (byFiX) FOr aNeUrySm rUptUre aFter eVar: teN yearS VaSCULaraNaStOmOSiS- tHe reSULtS OFpreCLiNiCaL eXperieNCe aNd CLiNiCaL StUdieS M. KAFEZA1, V. PSARROS1, A. KOUTSOUBELIS1, B. YOFFE1,2 G. KOUVELOS1, K. PAPOUTSIS1, C. BAKOYIANNIS1, 1 Y. Urin HDH, HAIFA, Israel C. KLONARIS1, S. GEORGOPOULOS1, E. BASTOUNIS1, 2 M.Schneider, MD, Klinik, Erfurt, Germany E. PAPALAMBROS1 1 University of Athens, Laiko General Hospital, First Department of Despite the development of EVAR (endovascular aneurysm repair) in Surgery, Vascular Division, Athens, Greece the last decade, open surgery is still the treatment of choice for elective and emergency patients with low-risk abdominal aortic aneurysms and Introduction-Objective: Endovascular aneurysm repair (EVAR) is long life expectancies applied with increasing frequency the last two decades having proved The successful performance of vascular anastomosis requires a high its low perioperative mortality and morbidity. However, mid- and long- level of skill, a long learning curve, and a substantial amount of time. term durability of the procedure has been challenged by late aneurysm The creation of a facilitated mechanical vascular anastomosis should rupture. In this study we present our experience on late secondary not compromise quality or patency rates and produce at least the same procedures after EVAR. results as those obtained with standard suturing techniques. design and methods: We report six cases of patients presented with The next study we performed was for laparoscopic aortic surgery on rupture one month to five years after EVAR. More specifically, we pigs using HDH device also showed very good results.We received report two patients presented with rupture and aortocaval fistula, three in all cases safe and reliable anastomosis and all procedures were patients with endoleak type I or III and rupture and one patient with completed laparoscopically. type II endoleak and contained rupture. All patients were treated with Clinical trails are in progress now and we did 6 operation on abdominal complete or partial removal of the endograft and interposition of an aortic for AAA and aortic iliac occlusion without complications aortic graft, except one case of type I endoleak which was sealed by at Barzilay Medical center and 2 femoro popliteal bypasses were an aortic cuff. performed in Germany with excellent results. Conclusions: Late rupture of a previously treated aneurysm by EVAR The patients are continuing the follow up and the midterm results are is quite uncommon; however a favorable outcome requires adequate very good. www.iua-eurochap2010.eu ~ 67
- 68. All studies showedthat this anastomotic device is reliable for fast, easy nerve palsy, postoperative complications, repeated operations and and safe anastomosis perfomance in aortic and peripheral arteries.The the incidence of amputation and the mortality rate (p<0.05). Mean routine usage of the BYFix device facilitates the surgeon’s work and ischemic time for preoperative, intraoperative, and total ischemic time promotes the patient’s recovery. in the group A and B were recorded and difference was significant for We have developed a new medical device for performing of sutureless intraoperative (P <.001) and total (P <.05) ischemic time. anasthomosis that can be attached to any kind of prosthetic grafts Conclusions: The use of early shunting of artery and vein after lower available on the market. After the attachment performed the device limb trauma can lead to great advantage in terms of significantly with the graft is inserted into the Aorta or another vessel and is fixed to improved outcomes, reducing total ischemic time, ischemic contracture, the vessel’s walls by the barbs. need to fasciotomy, ischemic nerve palsy and amputation and mortality Keywords: EVAR rates. Keywords: Arterial and venous shunt, Complex vascular trauma pS4-6 SpONtaNeOUS aOrtOCaVaL FiStULa: CaSe repOrt aNd LiteratUre reVieW pS4-8 tHe perCUtaNeOUS aNGiOpLaSty aNd H. RAVARI1, M. MOINI2, M. VAHEDIAN2, M. ALIAKBARIAN1 SteNtiNG treatmeNt iN patieNtS WitH SUbCLaViaN 1 Imam Reza Hospital, Department of vascular surgery, Mashhad, SteaL SyNdrOme Iran F. FERRARA1, I. MURATORI1, F. MELI1, C. AMATO1, 2 Sina Hospital, Department of vascular surgery, Tehran, Iran M. LUNETTA2, R. ALCAMO1, S. NOVO2 1 Division of Angiology, Palermo, Italy Spontaneous aortocaval fistula is a rare complication of abdominal 2 Division of Cardiology, Palermo, Italy aortic aneurysms. We describe two cases of spontaneous aortocaval fistula. The first patient is a 67-year-old woman who was admitted to Subclavian steal syndrome (SSS) is a complication of the atherosclerotic our hospital complaining of abdominal pain. Positive findings were disease or of arteritis which can lead to manifestations of cerebral pulsatile abdominal mass and tachycardia. Computed tomography vascular insufficiency. The aim of this report is to evaluate the benefits (CT) scan showed an infra-renal abdominal aortic aneurysm of 7 cm of subclavian stenosis PTA corrective treatment in patients who had in transverse diameter, indicative of contrast material in the inferior vertebral-subclavian steal syndrome, subdivided according to the vena cava. Another patient was a 59-year-old man with a compliant haemodynamic type of steal. of progressive abdominal pain and hypotension initiated two days We performed a retrospective study using data previously collected in prior to admission. After initial hemodynamic stabilization, an Doppler ultrasound exams register and then retrospectively reviewed. abdominal computed tomography (CT) scan was obtained with oral 72 patients with SSS were observed; 45 of these patients were and intravenous contrast. The CT scan showed an infrarenal aortic symptomatic. aneurysm of 8 cm in transverse diameter, as being suspicious for Patients with positive ultrasound test for SSS were then examined retroperitoneal leak. The Simultaneous contrast enhancement in the with an angiographic study that confirmed the presence of a stenosis inferior vena cava was also identified. Both patients underwent an or occlusion of the subclavian artery and, when present, the vertebral- urgent laparotomy in whom the diagnosis of an aortocaval fistula was subclavian steal syndrome. Patients included in the study were confirmed. We review the literature on spontaneous aortocaval fistula subdivided in the following groups: as a consequence of complicated aortic aneurysms, and briefly discuss - the 1st group included patients with a degree of subclavian stenosis, its clinical presentation and surgical management. ranging between 50% and 70%, who presented an intermittent SSS; Keywords: Aortocaval fistula, Abdominal aortic aneurysm, this group was composed of 15 patients aged between 51 and 73 years Arteriovenous fistula old. - the 2nd group included patients with a degree of subclavian stenosis pS4-7 tHe rOLe OFarteriaLaNdVeNOUS SHUNtiNG that ranged between 75% and 90%, who presented a complete SSS. We iN tHe COmpLeX VaSCULar traUma OF tHe arterieS also compared the difference in the probability of restenosis Fourteen OF tHe LOWer LimbS patients in the 1st group remained asymptomatic. One patient presented G. MARCUCCI1, A. SIANI1, R. ANTONELLI1, A. G. GIORDANO1, subclavian restenosis fifteen months after PTA. F. ACCROCCA1 Eighteen patients in the 2nd group remained asymptomatic, while nine 1 San Paolo Hospital, Civitavecchia, Rome, Italy patients showed a subclavian restenosis and three patients a subclavian occlusion. Objective: Complex lower limb vascular injuries are associated At the end of follow up 71,10% of all the patients were asymptomatic with a high degree of limb loss and an high mortality rate The aim of and their echocolordoppler and angiographic controls were normal this study was to determine the possible benefits of routine use of a while in the second group of patients a percentage of 40% of restenosis temporary intraluminal arterial shunt in patients with complex vascular was found. trauma of the arteries of the lower limb to significantly reduces total We believe that our data are only preliminary because of the limited ischemic time, complications, repeated operations, amputation, and number of cases involved and further studies are required to verify our hospitalization. hypothesis. design and method: From January 2004 to December 2009 13 Keywords: Subclavian steal syndrome, Doppler ultrasound, Vertebal complex blunt and penetrating vascular trauma, with arterial, venous reversal flow and bone involvement that required stabilization, with complete lower limb ischemia or bleeding were subjected to emergency operation. pS4-9 diaGNOStiC prOCedUreS: tHe timiNG Over 2 years seven artery injuries ( 4 popliteal, 3 superficial femoral OF FOLLOW-Up OF SUrGiCaL aNd eNdOVaSCULar arteries) were managed with insertion of a shunt at the initial phase of treatmeNt OF arteriaL diSeaSeS the operation ( Group B). Data from these procedures were analyzed P. L. ANTIGNANI1, C. ALLEGRA1 and compared with collected data from six complex vascular trauma ( 1 San Giovanni Hospital, Department of Angiology, Rome, Italy 4 popliteal, 2 superficial femoral arteries), treated without shunt during the preceding 3 years ( group A). A proper definition of the indications and criteria regulating the access results: Comparisons between the group A and group B showed that to instrumental procedures should have the following goals: improve early shunting of both artery and vein in both penetrating and blunt the appropriate use of the procedure, reduce waiting times for the injuries significantly reduced the incidence of fasciotomies, contracture, performance of the procedure by discouraging inappropriate use to 68 ~
- 69. foster the accessof those who are most in need and prevent vascular frequent. disease and complications by a greater capacity of the outcome to Keywords: Critical limb ischaemia, Arterial homografts influence the medical and/or surgical therapeutic decision, as stated in a number of proceedings published by the Health Councils of several pS5 - Vascular Surgery (2) Italian regions. In patients with an aneurysm of the abdominal aorta, the timing of pS5-1 iNtraOperatiVe aOrtiC embOLiSm aFter follow-up depends on the diameter of the aorta, the type of aneurysm, middLe LObe LObeCtOmy FOr reNaL LeyOmiO- and the attitudes of the vascular team. According to recent studies all SarCOma metaStaSeS patients over 65 years should undergo a screening of the abdominal P. AMORIM1, C. RODRIGUES2, A. RITA MATOS2, T. VIEIRA1, aorta. F. FÉLIX2, J. PEREIRA ALBINO1 For aortic ectasias under 3 cm, a follow-up must be carried out after 3 1 Vascular Surgery Service 2, Pulido Valente Hospital - CHLN, years, while for aneurysms between 3.2 and 3.4 cm, follow-ups should Lisbon, Portugal be performed every two years, and for aneurysms above 3.5 every 2 Thoracic Surgery Service, Pulido Valente Hospital - CHLN, Lisbon, year. Portugal In patients subjected to aortic or aorto-iliac-femoral surgical revascularization, an ECD is indicated within 30 days; then every three introduction: Acute occlusion at the aortic bifurcation by tumor months in the first year, six months in the second, and if there are no embolus is a rare finding. The potential for arterial embolism of a tumor complications only if they arise or if they are suspected as of the third invading the pulmonary veins or right atrium has been recognised year. before and may be the presenting picture of a pulmonary malignancy. In the cases treated with aortic endoprosthesis, a follow-up is performed However, the occlusion of the aortic bifurcation is a rare event. On the at discharge, at 3, 6, 9, and 12 months and then annually with CT other hand, the renal leyomiosarcoma constituted 0,12% of all invasive angiography. renal malignancies and has a similar prognosis to the transitional cell At the present time, there is no evidence for a periodical follow-up of carcinoma that is better than that of clear cell carcinoma. steno-obstructive femoral-distal lesions. There are no differences in the Case report: We present a rare case of intraoperative infra renal aortic controls on the basis of the material employed. acute emboli, while performing a middle lobe lobectomy for renal In patients subjected to surgical femoral-distal revascularization, a leyomiosarcoma metastases. The patient was promptly diagnosed, study is indicated at 3 - 6 –9-12 months, and then every 6-12 months. underwent emergency vascular surgery, and was done an aortic Keywords: Ultrasound evaluation, Diagnosis, Follow up thromboembolectomy by aorto iliac approach, she recovered without disabilities. pS4-10 beLOW tHe KNee bypaSS USiNG CryO- methods: In the literature review, we found only 11 case reports preSerVed arteriaL HOmOGraFtS FOr CritiCaL associated with lung malignancy and arterial embolism, none due to a LOWer Limb iSCHaemia: LONG term reSULtS iN a renal leyomiosarcoma. The treatment of choice is embolectomy within SiNGLe CeNter the first 6 hours when there is a complete occlusion. However, in our S. AMIOT1, C. PEROT1, R. SPEAR1, R. JASHARI2, case, this technique was not possible. Mortality can be as high as 70 % D. MASSOUILLE1, J. LANCELEVEE1, J. P. CHAMBON1 if the diagnosis is delayed, although cases have been described, like the 1 CHRU de Lille, Lille, France one we have treated, as successful surgery. 2 European Homograft Bank, Bruxelles, Belgium Conclusion: Neoplastic diseases of the lung can be associated with pulmonary vein or right atrium tumors. Symptoms of acute arterial From january 2001 to december 2009, 32 patients (15 male) underwent occlusion should always prompt a search for an arterial embolus. surgical revascularization using a cryopreserved arterial homograft at Surgical management offers the best results. the level or below the popliteal artery for critical lower limb ischaemia. Keywords: Aortic embolism, Leyomiosarcoma No patient was treated for acute ischaemia or for graft infection. All of them were on stage 4 or 5 according to Rutherford classification. A pS5-2 eNdOLUmiNaL SteNtiNG FOr SUperFiCiaL previous popliteal-level revascularization had already been performed FemOraL artery OCCLUSiON OFFerS SymptOmatiC at least once in 25(78%) cases. No great saphenous vein could be used, imprOVemeNt FOr patieNtS WitH peripHeraL wether already harvested or unsuitable. The proximal bypass site was VaSCULar diSeaSe distal external iliac artery in 1 case (3.1%), common femoral artery in J. MAKANJUOLA1, V. M. PATEL1, M. MOBASHERI1, T. HUSSAIN1 21 cases (65.6%), deep femoral artery in 4 cases (12.5%), superficial 1 Northwick Park Hospital, London, United Kingdom femoral artery in 5 cases (15.6%), and proximal popliteal artery in 1 case (3.1%). The distal site was infra-articular popliteal artery in 7 aims: The aim of this study was to assess the immediate and early cases (22%), proximal anterior tibial artery in 9 cases (28%), proximal occlusion rates of endoluminal superficial femoral arterial stents for posterior tibial artery in 6 cases (18.8%), tibio-peroneal trunk in 4 occlusive atherosclerotic disease. cases, peroneal artery in 5 cases (15.6%) and dorsal pedal artery in methods: This prospective study enrolled all patients over a two year 1 case (3.1%). Bypasses were exclusively made from cryopreserved period that required endoluminal stenting following failed angioplasty arterial homografts. Mean follow-up was 30 months (1 to 110 months), for mid superficial femoral artery occlusion. The procedures were and 1 patient was lost to follow-up. performed by two consultant radiologists after discussion at a multi- 30-day mortality was 0%. One early bypass thrombosis led to a mid- disciplinary meeting. Bare metal stents were inserted in all patients. thigh amputation. In the end of the study 10 bypasses were patent Clopidogrel was prescribed for 3 months in addition to aspirin. Stent without reintervention. During the study 22 bypasses were occluded, patency was assessed with a colour flow duplex scan performed by a 16 embolectomy were performed, allowing to keep 7 bypasses patent. vascular scientist the day after the procedure and 6 months later. A major amputation was required in 11 cases. One arterial homograft results: 20 patients presented with claudication (12) and critical had to be replaced by another homograft to treat a sepsis. At the end ischaemia (8). The median age was 75 years (range: 57- 94) and 11 of the study 7 patients had died (4 cardiovascular causes, 1 cancer, 2 (55%) were male. The median occlusion length was 16 cms (4 - 29 miscellaneous). cms). There were no immediate stent occlusions; 16 (80%) stents were Lower limb revascularization using cryopreserved arterial homografts patent at early follow up (median 6 months (1 - 12 months)). Of these is an acceptable option in critical ischeamia when great saphenous patients there was significant improvement in resting ankle brachial vein is lacking. Careful follow-up is mandatory and reintervention are pressure index (median 0.50 (0.00 – 1.01) vs. 0.87 (0.00 – 1.14), p < www.iua-eurochap2010.eu ~ 69
- 70. 0.02, Mann-Whitney Utest). There were no other complications. results: New lesions were seen on the postintervantional DW-MRI in Conclusion: Superficial femoral arterial stents have an adequate 28.0% (7/25) of the proximal EPD group versus 32.6%(6/19) of those patency rate at 6 months with patients achieving symptomatic with a distal filter (p=NS). The majority were clinically silent. The improvement. Further research is required to evaluate the long term new lesions in the vascular territory of the stented carotid artery in the patency of these stents. group as a whole and per patient were fewer in the proximal EPD group Keywords: Endoluminal stenting, Superficial femoral artery (p=NS). No significant differences were noted in the T2 appearance of the new lesions or the number of new lesions observed away from the pS5-3 eNdOLUmiNaL reVaSCULariZatiON OF NON vascular territory of the stented artery. embOLiC iLiaC OCCLUSiON FOr iNFeriOr Limb aCUte Conclusion: Proximal embolus protection devices show a nonsignificant iSCHemia: aN aLterNatiVe tO SUrGery trend toward fewer embolic events, which warrants large-scale studies. F. MERCIER1, A. AYMARD1, H. BENAMER1, X. GUILLOTTE1, Furthermore, proximal protection devices can be useful to control and E. LOUVARD1, R. MAGUEMOUN1, M. C. MORICE1 treat acute in-stent thrombosis. 1 Hôpital Européen de Paris la Roseraie, 120 av. de la République, Keywords: Stenosis Aubervilliers, France pS5-5 iNFLUeNCe OF aGe UpON COmpLiCatiON OF Endoluminal revascularization is proposed in grade D iliac occlusion CarOtid artery SteNtiNG of TASC II classification, rather than a surgical approach usually F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 approved, for acute ischemia of inferior limb. 1 University of Naples, Department of Vascular Surgery, Naples, Procedures were performed in three patients with moderate (2) or severe Italy (1) ischemia in stade IIb Rutherford classification. Patients had a past 2 Department of Interventional Radiology, Bari, Italy medical history of claudication stade IIb in Fontaine classification (3), no cardiac embolic etiology, smoking (3), HTA (3). Intervals between introduction: To asses the impact of age on technical success and symptoms and interventions were one day (1) and two weeks (2). All complications of carotid stenting in a prospective single-center cohort patients had duplex Doppler ultrasound evaluation with ankle-brachial study. pressure index (< 0,6), angiographic computed axial tomography (1), methods: One hundred eleven consecutive patients (74 men; angiographic magnetic resonance imagery (1). Femoral catheterisms median age 70 years) with >- 70% symptomatic(n=33) or >-90% were ispilateral (3) with introducer 6F, hydrophilic 0.035 guide asymptomatic(n=78) internal carotid artery(ICA) stenosis underwent wire, nitinol stents (7 mm x 80 mm and 8 mm x 100 mm), balloon carotid artery stent implantation. Primary technical success and peri- expandable stents (7 mm x 58 mm), balloon (6 x 80 mm, 7 x 40 mm), procedural complications were compared in patients aged>75 years pigtail 5F. Endoluminal iliac position was controlled by visualisation (n=28) to patients <75 years (n=83). of the opening of the nitinol stent. Complementary balloon inflation for results: Patient groups below and above 75 years compared well with iliac artery stenosis was mandatory in all patients. respect to baseline demographic and clinical data. Successful stenting All iliac arteries were revascularized. One clot migration occured in an was achieved in 108 (97%) patients. The combined neurological ipsilateral profunda femoral after inflation of balloon expandable stent. complication rate was 7% (n=8), with 1(1%) major stroke, 1 (1%) minor To avoid it and control the endoluminal position it was choosed after stroke, and no 30-day mortality. Technical angiographic complications the first case that the nitinol stent should be gently opened before any occurred in 8(7%) patients. No significant differences between patients inflation. One calf aponevrotomia was mandatory Length of stay were > 75 years and those <75 years were observed for primary success rates 2, 7and 21 days. Permeability was controlled clinically and with duplex (100% [28/28] versus 96% [80/83];p=0.8), overall complications (14% Doppler at 6 months. [4/28] versus 16% [13/83]; p=1.0), neurological complications (7% Endoluminal revascularization is a possible alternative to surgery in [2/28] versus 7% [6/83]; p=0.6). acute grade D iliac artery occlusion and treats simultaneously occlusion Conclusion: Elective carotid stenting can be performed safely in older and underlying iliac stenosis. Main risk is migration of the recent iliac patients with several comorbidities. Patients age does not seem to be an clot during the recanalization. The permeability at long term should be independent risk factor for poor outcome after endovascular treatment compared to chronic iliac grade D subintimal revascularization. of internal carotid artery stenosis. Keywords: Endoluminal revascularisation, Iliac artery occlusion, Keywords: Stenosis Acute inferior limb ischemia pS5-6 iNterNaL CarOtid aNd biLateraL pS5-4 CarOtid aNGiOpLaSty. deteCtiON OF VertebraL arterieS diSSeCtiON: a CaSe repOrt embOLiC SiGNaLS dUriNG aNd aFter tHe M. BOUCELMA1, T. BOUNZIRA1, D. BENSALAH1, D. HAKEM1, prOCedUre A. BERRAH1 F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, 1 University of Naples, Department of Vascular Surgery, Naples, Algeria Italy Cervicocerebral arterial dissections (CAD) are an important cause of 2 Department of Interventional Radiology, Bari, Italy strokes in younger patients accounting for nearly 20% of strokes in patients under the age of 45 years. Extracranial internal carotid artery purpose: To evaluate and compare the efficacy of proximal versus distal dissections comprise 70%- 80% and extracranial vertebral dissections embolus protection devices (EPD) during carotid artey angioplasty/ account for about 15% all CAD. Aetiopathogenesis of CAD is stenting (CAS) based on diffusion-weighted magnetic resonance incompletely understood, though trauma, an underlying arteriopathy imaging (DW-MRI). are considered important. We report a case of 39 years old woman methods: Forty-four patients (31 men; mean age 68 years, range 48- suffered a dissection of her left internal carotid artery and bilateral 85) underwent protected CAS and had DW-MRI before and after the cervical vertebral arteries after facial plastic surgery. This observation intervention. The cohort was analyzed according to the type of EPD discusses recent developments in understanding of the epidemiology, used:a proximal EPD was deployed in 25 (56,8%) patients (17 men) the pathogenesis, the methods of diagnosis and the approaches to mean age 66 years, range 48-85) and a dstal filter in 19 (14men;mean treatment. age 70 years, range 58-79). Fifteen (60.0%) patients with proximal Keywords: Stroke, Young patients, Vertebral artery dissection protection were symptomatic of the target lesion; in the distal protection group, 10 (52,6%) were symptomatic. 70 ~
- 71. pS5-7 SUrGery FOr CarOtid bOdy tUmOr iN pS5-8 a rare CarOtid-JUGULar FiStULa OF patieNt WitH eiSeNmeNGer SyNdrOme (CaSe CONGeNitaL etiOLOGy repOrt) J. PEREIRA ALBINO1, P. AMORIM1, L. CASTRO E SOUSA1, K. KANALIKOVA1, J. TOMKA1, K. KANALIKOVA2, I. SIMKOVA2, K. RIBEIRO1, G. SOBRINHO1, T. VIEIRA1, N. MEIRELES1, Z. ZITA1, L. PRETIOVA3 F. PINTO2 1 NUSCH - Department of Angiosurgery, Bratislava, Slovak 1 Vascular Surgery Service 2, Pulido Valente Hospital - CHLN, Republic Lisbon, Portugal 2 NUSCH - Department of Cardiology, Bratislava, Slovak Republic 2 Pediatric Cardiology Service, Santa Marta Hospital - CHLC, 3 NUSCH - Department of Anaesthesiology and Intensive Care, Lisbon, Portugal Bratislava, Slovak Republic The arterio-venous fistulas of the neck vessels are extremely rare Eisenmenger syndrome represents clinical status, developing in clinical situations. In review of the literature are described about 30 patients with advanced pulmonary hypertension associated with shunt cases, with carotid involvement. congenital heart disease. It is characterized by cyanosis, secondary The authors present a case of a 7-year-old boy, born in Cape Verde, erythrocytosis and all related multiorgan symptoms. Surgery in with pulsatile preauricular mass, with no other symptoms, referred to patients with Eisenmenger syndrome is associated with extremly high our department for evaluation. The mass existed since birth and had perioperative risk. Carotid body tumors (chemodectomas) are rare neck been gradually increasing in volume. lesions, originating from neuroendocrine tissue in carotid body.They The clinic strongly suggests the existence of arterio venous fistula, and can be for a long time asymptomatic, main signs and symptoms being an angiographic study confirmed the preoperative diagnosis although slow growing pulsatile mass, at the level of carotid bifurcation and a remaining doubt about the involvement of the internal carotid. peripheral cervical neuropathy related to largest tumors.Diagnosis is Conventional open surgery is decided as a first choice of treatment, made, beside physical examination, by different imaging modalities which has conducted to high ligation of the fistula and of the external (CCDS,CTA,MRA). Angiography is used for detail description of tumor carotid as well as all its branches, which immediately solved the vascularity and for performing Matas test.Treatment in most cases is situation. The postoperative period was uneventful. Although they surgical. In some patients percutanous embolisation is considered. have been discussed as possible alternatives endovascular techniques Authors present the case of 47-years old patient with truncus arteriosus were rejected by existing doubts in the anatomy of the malformation communis Collet-Edwards I, unoperable, with severe irreversible and patient’s age. pulmonary hypertension, in whom pulsatile mass formation on the The immediate result of this surgical option does not provide certainty left side of neck was diagnosed. It turned out to be a chemodectom, as to the potential healing of the fistula. So at 12 months of follow-up Shamblin II, completely surrounding external carotid artery. Because was decided to perform a MRI, which showed no evidence of fistula. of rapid progression in growth and clinical symptoms appearing, The patient is well, with excellent weight gain, and periodic monitoring patient was indicated for surgery. After preparation surgery was on our query. performed in general anestesia.Tumorous mass was extirpated from The early surgical alternative should be seen as a priority choice in this carotid bifurcation and resection of involved external carotid artery type of congenital fistulas of the cervical area and it is important to was performed. Perioperative care was leaded by experienced team resist the temptation of making a proximal ligation of the vessel. of specialists.No adverse complication in perioperative period was Keywords: Carotid, Jugular fistula noticed, neither in long-term follow-up. Conclusion:Carotid body tumor has a random occurence (0,03%of pS5-9 diaGNOSiNG CarOtid-JUGULar arteriO- all neoplasm).Patients with Eisenmenger syndrome are at high risk VeNOUS FiStULa: iS COLOr dOppLer SONOGrapHy for developing complications during surgery. Noncardiac surgery eNOUGH? should be provided by professionals experienced in care of patients R. CATALINI1, G. PAGLIARICCIO2, L. GIANTOMASSI1, with pulmonary hypertension and experted surgeons. Presence of O. ZINGARETTI1 both random diagnoses in one patient is unique. Review of literature 1 Vascular medicine - Department of internal medicine, Ancona, Italy describes only few case reports of carotid body tumor occurence in 2 Vascular surgery, Ancona, Italy patients with cyanotic congenital heart disease. An arteriovenous carotid-jugular fistula, which/ is usually a rare clinical event, becomes more likely after a traumatic or iatrogenic event after catheterization of a jugular vein. When characterized by congenital origin, it is often identified while performing a color Doppler sonography prescribed for other reasons. We describe the clinical case of a 74 years old man who was subjected to color Doppler sonography of the carotid arteries for the clinical evidence of carotid bruit. During the examination was founded a 60% stenosis of the right carotid bifurcation and, in the distal segment of the right internal extracranial carotid, a flow pattern characterized by very high diastolic velocity and flow turbulence while the adjacent internal jugular vein showed pulsatile “arterial-like” flow. While we could not direct image the arterio-venous throughput, the above evidence pointed us towards the diagnosis of arteriovenous fistula. Later, due to the emergence of occasional tinnitus, the patient was subjected to an AngioTC exam, which confirmed the color Doppler report, while at the same time showing that the focal arterio-venous throughput did not require a correction. Currently the patient is clinically asymptomatic and is followed up regularly by color Doppler sonography, showing no instrumental Keywords: Carotid body tumor, Eisenmenger syndrome, Surgery evolution of the fistula. www.iua-eurochap2010.eu ~ 71
- 72. Our experience confirms previous findings in the literature where it is responses, the three generics were compared with argatroban in human clear that the color Doppler sonography is the examination of choice plasma of normals and liver disease patients. in the diagnosis of carotid-jugular fistula, as it allows to obtain all the results: Assay dependent variations were observed among the generics necessary information without resorting to second level contrast tests. in the normals. When the generics were supplemented to plasma from Whenever it appears clinically or instrumentally necessary to treat liver disease patients, free of any other anticoagulant drugs, marked the fistula, it is possible to proceed with a direct contrast exam differences were noted in the PT and APTT responses. In the PT studies (angiography) to program the correction to be performed preferably supplementation of these agents resulted in a comparable response with endovascular technique (placement of stent graft). between argatroban and argaron (122+7 vs 134+8 secs). Slovastan Moreover, the non-invasive nature and easy reproducibility of the produced a much higher response (188+12 secs) and gartban only Color Doppler sonography allow for easy monitoring of the evolution produced a modest increase (24+4 secs). Interestingly, in the APTT of the fistula over time. assay, argatroban and argaron produced similar responses (32+4 vs Keywords: Arteriovenous fistula, Carotid, Doppler sonography 30+3 secs). Whereas, slovastan produced a much higher response (138+10 secs) and gartban (84+6 secs). In the thrombin time assays all pS5-10 rUptUred iLiaC artery aNeUrySm aFter three generics produced much higher anticoagulant response (140-160 abdOmiNaL aOrtiC aNeUrySm reSeCtiON: a CaSe secs) in contrast to argatroban which only produced 60+3 secs. In the repOrt amidolytic anti-IIa assays, all generics produced comparable inhibition T. JANUSAUSKAS1, E. JANUSAUSKAS2, V. KAZLAUSKAS2, of thrombin (6-8%) whereas argatroban produced a higher inhibition D. TRIPONIENE1, V. TRIPONIS1 (12+3 %). All of these studies were carried out at 1 µg/ml. 1 Vilnius University, Vilnius, Lithuania Conclusion: In comparison to normals, the liver disease patients 2 Vilnius City University Hospital, Vilnius, Lithuania showed a much wider variation in the anticoagulant responses with different generics, suggest that generic argatroban may exhibit marked Objective: To present a case of ruptured iliac artery aneurysm after differences in different disease. This may have safety and efficacy abdominal aortic aneurysm resection. implications. methods: We report a case of ruptured iliac artery aneurysm in 62 Keywords: Argatroban year old man with acute pain of abdomen and shock. Abdominal aortic aneurysm resection and aortic reconstruction with bifurcated vascular pS6-2 preVaLeNCe OF Free metHyL CHLOride aS graft was performed seven months previously. Both common iliac aN impUrity iN GeNeriC CLOpidOGreLpreparatiONS. arteries were ligatured, but internal iliac arteries were left functional. SaFety impLiCatiONS iN CardiO-VaSCULar patieNtS Abdominal aortic aneurysm and aneurysms of both common iliac A. DUGUOT1, H. BELVA-BESNET1, C. CONOCAR1, arteries were detected on a routine ultrasound scan five years before M. DAUMAS1, G. RAO2, I. MOHAN THETI2 the reconstruction. The size of the aneurysm and the location of a 1 Sanofi Research, Paris, France haematoma after rupture were specified on CT. 2 South Asian Atherosclerosis & Thrombosis, Bangelore, India results: The treatment involved the urgent open resection of ruptured left common iliac artery aneurysm and right common iliac artery Objective: Several generic versions of clopidogrel hydrochloride have aneurysm and ligature of iliac arteries. The patient died two hours after recently become available through out the world. They include Clopilet, the operation due to shock complications. Ceruvin, Clopigrel, Clopivas, Clopitab, Clavix, Deplatt and Plagril in Conclusions: Appealing to this fact we recommend total aneurysm sac India. Additional generics are marketed in Europe by Consilient (UK), exclusion of blood flow. Sandoz (Belgium) and Mylan (Germany). Some of these have been reported to contain methyl chloride which is formed from the hydrolysis of ester in the presence of hydrochloride as counter ion. In the European products the reported levels of methyl chloride were 40-50 ppm, which are well above the threshold of toxicologic concern (TTC), which is considered to be 20 ppm, considering a daily dose of 75 mg, expressed as clopidogrel base. Various salts of clopidogrel are known to degrade by two main pathways which include racemization and hydrolysis of methyl ester, which lead to the formation of methyl chloride in the case Keywords: Abdominal aortic aneurysm, Ruptured iliac artery of clopidogrel hydrochloride. The alkyl halogenides such as methyl aneurysm chloride are known to exhibit genotoxic properties. design and method: The aim was to compare the methyl chloride pS6 - arteritis, Vasculitis, therapeutic impurity levels in these preparations. A modified gas chromatographic method is employed using the flame ionization detection to quantitate pS6-1 GeNeriC arGatrObaN preparatiONS methyl chloride. diFFer iN tHeir aNtiCOaGULaNt aNd aNtiprOteaSe results: In the European preparations the amount of methyl chloride reSpONSeS iN patieNtS WitH LiVer diSeaSe. dOSiNG was found to be between 40-50 ppm., whereas in the preparations impLiCatiONS marketed in India this ranged from 10-110 ppm. Although the shelf life D. HOPPENSTEADT1, O. IQBAL1, S. MASOOD1, J. FAREED1 of the preparations from India are not known, these levels are likely to 1 Department of Pathology, Maywood, IL, USA increase to a higher level at higher temperatures. Conclusion: These studies clearly underscore the substandard nature of Objectives: Argatroban is a synthetic antithrombin agent currently generic clopidogrel hydrochloride preparations and warrant additional approved for anticoagulation management of HIT patients, in particular analytical studies to check the purity of generic versions of clopidogrel those requiring percutaneous intervention (PCI). Generic versions hydrochloride. More over, the effect of these impurities in the generic of argatroban, slovastan, gartban and argaron available in Japan are products need further investigations and are likely to contribute to the at various developmental stages. They have been shown to produce observed variations in the pharmacodynamic responses. different anticoagulant effects in the ACT and iSTAT ACT assays. Keywords: Clopidogrel In the iSTAT ACT assay gartban showed a very high anticoagulant response, whereas argaron shows a weaker effect. design and method: To further investigate the differential anticoagulant 72 ~
- 73. pS6-3 LOW adHereNCe tO aNtitHrOmbOtiC pS6-5 mULtiFaCtOriaLtreatmeNt eFFeCtiVNeSS iNdiCatiONS aNd GeNder diFFereNCeS iN aSpiriN OF dySLipidemia, type 2 diabeteS meLLitUS aNd USe iN patieNtS WitH preViOUS miNOr bLeediNG arteriaL HyperteNSiON iN patieNtS WitH CHd A. MATTIOLI1, A. FARINETTI2, R. LONARDI2, S. PENNELLA1,3, K. KAPANADZE1, N. N. KIPSHIDZE1 G. TAZZIOLI2, G. MATTIOLI3 1 Acad. Nodar Kipshidze National Center of Therapy, Tbilsi, 1 University of Modena and Reggio Emilia, Department of Sc, Georgia Modena, Italy 2 University of Modena and Reggio Emilia, Department of Surgery, The aim of the study was to estimate multifactorial treatment Modena, Italy effectiveness of dyslipidemia, type 2 diabetes mellitus and arterial 3 Istituto Nazionale di Ricerca Cardiovascolare, Modena, Italy hypertension. materials and methods: We studied 58 patients (mean age 49±14, Aspirin is use in widely mode to prevent cardiovascular disease. Patients male/female 26/32) with dyslipoproteinemia, type 2 diabetes mellitus (pts) presenting a previous episode of minor bleeding have high risk and arterial hypertension II (JNC VII). Their mean indices of T-C, for recurrence. The aim of the study was to evaluate the adherence to HDL-C, LDL-C and TG were: 247.28±26.1 mg/dl, 29.09±4.1mg/dl, guideline in aspirin prescription in pts with previous minor bleeding. 158.25±22.8mg/dl and 225.9±19.8mg/dl respectively), HbA1c varied design and method: Data were analyzed from 1.100 patients: from 6.5% to 7.0% and the levels of creatinine varied from 120 to 150 [504 men (45.8%) and 596 women (54.2%), mean age 54 ± 12 yrs] µmol/l. Patients were randomly assigned and divided into two groups referred for minor hemorrhage. All patients were followed for 1 (Gr.): Gr.1 patients received hypolipidemic drugs (statin), hypotensive year. The use of aspirin was evaluated: dose, time, other bleeding drugs (ACE inhibitors, Ca-antagonists, duretics) and metmorphine, episodes (major and minor), and indication according to guidelines and gliclazide during 8 weeks. And Gr.2 patients received only hypotensive gender. Cardiovascular and hemorrhagic risk factors were assessing. and antidiabetic drugs. We found 131 pts treated with aspirin and 89 pts treated with oral results: In the Gr.1 target levels of lipid profile, glucose levels and anticoagulants; 65 pts had a previous episode of atrial fibrillation and / arterial presure were reached in 62%, 65% and 70% respectively. As or a myocardial infarction. The daily aspirin dosage ranges from 80 to for Gr.2 lipid profile did not change in 84%, and target levels of arterial 500 mg. Hemoglobin was significantly lower in patients taking ASA pressure and glucose concentrations were reached in 50% and 52%, and anticoagulants (9.8 ± 3.5 vs 14 ± 4.1). respectively. results: We evaluate adherence to guideline in prescription aspirin in Conclusion: As a result, all patients with type 2 diabetes, should be cardiac patients with previous minor bleeding: 456 patients had cardiac treated with the above mentioned scheme at the early stage of the indication for aspirin and/or anticoagulants (including atrial fibrillation) disease, in order to reach target levels of lipid profile. Treatment but only 238 of them (52.19%) were treated, women were less likely must be aimed not only at dyslipidemia, but the risk factors of type to be treated with aspirin (30% vs 67%). Recurrence of hemorrhage 2 diabetes and arterial hypertension as well as these conditions create was higher in pts taking aspirin (42% versus 23% in control), with a vicious circle and aggravate one another. Multifactorial treatment of trend to even greater incidence in pts taking high dosage of aspirin and the above mentioned pathologies facilitates their management and anticoagulants (40% vs 60%). provides better prognosis. Conclusions: A previous minor bleeding discourages the use of aspirin Keywords: Dyslipoprotenemia, Ttype 2 diabetes mellitus, Arterial although indicated to guideline and that women were under treated with hypertension respect to men. Aspirin was associated with a higher rate of recurrences of minor bleeding, without important hemodynamic effects. Pts taking pS6-6 HyperbariC OXyGeN tHerapy iN reFraC- high dosage of aspirin or anticoagulants were more likely to develop tOry iSCHemiC CUtaNeOUS LeSiONS iN VaSCULitiS bleeding aNd CONNeCtiVe VaSCULar diSeaSe Keywords: Aspirin, Bleeding C. BELIZNA1, D. HENRION2, V. SOUDE3, B. BIENVENU4, F. MAILLOT5, E. ANDRES6, C. LAVIGNE1, A. GHALI1, pS6-4 tHe pHarmaCOGeNetiC apprOaCH tO tHe A. MERCAT3, P. ASFAR3 aNtiCOaGULaNt tHerapy 1 Angers CHU, Internal medicine, Angers, France Y. NOVIKOVA1, A. SHEVELA1, G. LIFSHITZ1, K. SEVOSTYANOVA1, 2 Inserm 771, Angers, France E. VORONINA1 3 Angers CHU, Medical reanimation, Angers, France 1 Institut de biologie chimique et medecine fondamentale, Novosibirsk, 4 Caen CHU, Internal medicine, Caen, France Russia 5 Tours CHU, Internal medicine, Tours, France 6 Strasbourg CHU, Internal medicine, Strasboug, France purpose: to study the frequency of occurrence of the warfarin metabolism gene in patients with deep venous thrombosis, to determine Hyperbaric oxygen therapy is currently used in ischemic cutaneous the optimal dosage of the drug depending on the genotype. arterial ulcers resistant to classical therapy. methods: a study of CYP2C9 and VKORC1 genes with the help of Nowadays, only few data have been reported concerning the use of this PCR/RFLP method of diagnostics was conducted on 159 patients form of treatment in ischemic lesions found in vasculitis and connective with deep venous thrombosis in lower extremities. Results: «Poor» vascular disease. metabolizers with the gene CYP2C9*2 variant Ñ/Ñ among patients in the We present the retrospective experience of few medical centers that research group were found in 108 ( 68%) of cases, whereas CYP2C9*3 currently employ hyperbaric oxygen. variant A/A -was found in 157 (98,7%) and the heterozygous variant Data from patients with vasculitis and connective vascular disease of polymorphism CYP2C9*3 C/T was registrated in 2 (1,3%) of the presenting with ischemic cutaneous ulcers and that have received patients. The polymorphous variant CYP2C9*2 C/T was detected in hyperbaric oxygen therapy have been retrospectively recorded (2005- 50 (31,4%), whereas the gene CYP2C9*2 substitution T/T – only in 1 2009). (0,6%) of the cases. Measures of transcutaneous oxymetry (TcpO2) have been performed in While investigating the frequency of occurrence of different these patients before starting the treatment based on hyperbaric oxygen, polymorphous variations of the VKORC1 gene it was discovered, that in order to detect local ischemia. The classical treatment programme among patients the heterozygous C/T variation is found more often consisted in a two times a day hyperbaric oxygen therapy every day, 5 than the “wild type days per week for a total length of treatment of three weeks. Keywords: Pharmacogenetic, Warfarin, Personolized therapy 18 patients, mean age 56.5 years old, have been treated with hyperbaric www.iua-eurochap2010.eu ~ 73
- 74. oxygen (retrospective experiencebetween 2005-2009). Among them, C. COSTA ALMEIDA1 10 patients have presented systemic sclerosis, two patients had pan- 1 Centro Hospitalar de Coimbra, Coimbra, Portugal arteritis, three patients Wegener granulomatosis and two patients Buerger‘s disease. Raynaud’s phenomenon secondary to collagen diseases, in special Measures of transcutaneous oxymetry have been repeated at the end of systemic scleroderma, being present for a long time before other hyperbaric oxygen therapy and have been found as improved (>50%) manifestations take place, produces severe, painful, recurrent lesions of in all patients (p<0.001). Complete cicatrisation of ulcers have been the extremities, with patient’s bad quality of life and the frequent need obtained in 14 patients. In two patients local improvement have been for minor surgical interventions or even amputations. Treatment of noticed. Pain complaints have been totally disappeared in 15 patients vasospastic ischemic episodes in this situation can be difficult, and their and have been significantly improved in the other two patients (more clinical importance is based on their frequency and duration, as well as than 50% on the analogical pain evaluation scale) and persisted after their intensity. An antagonist of endothelin’s receptors, bosentan, has 12 months. been used, successfully, to prevent these episodes, making them at least In conclusion, we suggest that hyperbaric oxygen therapy could less frequent, improving patients’ quality of life. represent an alternative therapy in refractory in refractory ischemic Case of a 63-year old lady with a Raynaud’s phenomenon for more than cutaneous lesions in vasculitis and connective vascular disease. The 20 years and increasing severity, with pain and recurrent development high cost of the hyperbaric oxygen therapy should not represent an of distal necrosis points and sub-ungueal abcesses in hands and feet, obstacle in the treatment choice, because of the rapid and constant with a terrible quality of life, is presented, for which it was never clinical improvement obtained with this form of therapy. possible to find a primary cause. Classified as “suspected secondary Keywords: Vasculitis,Hyperbaric oxygen therapy Raynaud’s phenomenon” (or suspected Raynaud’s syndrome), having to be admitted to hospital 3 or 4 times a year, for one month of pS6-7 diGitaL iSCHemiaaNd myeLOprOLiFeratiVe intravenous treatment with iloprost (prostaciclin I2 analog, the only diSOrderS treatment that has been able to reverse her severe ischemic episodes B. IMBERT1, N. KHERAT1, I. MARIE2, H. DESMURS-CLAVEL3, P. and prevent amputation). After last one month-stay in hospital, June CARPENTIER1 2009, she was put on oral intake of bosentan. 1 CHU de Grenoble, Clinique de medecine vasculaire, Grenoble, She has been taking bosentan in the dose for systemic sclerosis, France under adequate laboratory controls, with no adverse effects. Since the 2 CHU de Rouen, Service de médecine interne, Rouen, France beginning of the treatment – for almost one year now – she has nod had 3 Hopital Edouard Herrriot, Service de médecine interne, Lyon, any vasospastic ischemic digital episodes. France Conclusion: bosentan was very effective as a prophylactic measure in this case of severe Raynaud’s phenomenon, only suspected of being Arterial and venous thrombotic events are frequent in myelo- secondary because there is not any prove of this patient suffering of a proliferative disorders (MPD) (50%), and often indicative of disease. collagen disease so far (more than 20 years of evolution). On the other hand, microvascular damage, including ischemia and Keywords: Bosentan, Raynaud phenomenon prophylaxis, Distal digital necrosis, which are the most severe forms, often appear to be a necrosis source of wandering and delay to diagnosis. We report a retrospective multicenter study of 18 cases of severe pS6-9 abdOmiNaL aOrtitiS aNd dOXyCyCLiN: ischemia or necrosis of finger or toe, associated with MPD, including 9 CaSe repOrt polycythemia vera (PV) and 9 essential thrombocythemia (ET). They M. SPRYNGER1, C. NIZET1, L. A. PIERARD1 are 16 men and 2 women, average age 55 years, for which we collected 1 CHU, Liege, Belgium clinical, laboratory and monitoring data. results: The microcirculatory damage was indicative of the MPD in Background and purpose: This case report describes the use of 75% cases (14/18) in the form of distal ischemia, necrosis, including 10 doxycyclin in a patient with abdominal aortitis and peri-aortitis. digital and 4 necrosis immediately preceded by other microcirculatory Case description: A 66-year-old male patient presented with chronic events (purpura, pseudo- chilblain, livedo, severe Raynaud’s night-lombalgy and painful palpation of the abdominal aorta despite phenomenon). The toes are more frequently affected than the fingers long-lasting nonsteroidal antiinflammatory therapy. Symptoms had (72% vs. 28%) and damage was bilateral 4 times. began 2 1/2 months earlier. CT-scan revealed atherosclerosis and Time to diagnosis of SMP is greater than 6 months in 64% of cases with calcifications of abdominal arteries, thickening (7 mm) of the anterior an average of 11 months. wall of the infrarenal aorta and intraluminal aortic thrombus. The Blood count showed hemoglobin less than 170g/l and platelets less maximal diameter of the aorta was 37 mm. Ultrasounds showed than 700G/l in half of cases. Finding the JAK2 mutation or culture echolucent thickening of the aortic wall (6,5 mm), confirmed by MRI. hematopoietic progenitors led to the diagnosis in 80% of cases. Fibrinogen was elevated (5.66 g/l) and CRP was <1 mg/l. 18FDG-PET- The outcome was very favorable in 90% of cases, with healing in nine scan showed intense hypermetabolism in front of the infrarenal aorta weeks with antiplatelet treatment and / or Iloprost, sometimes even and common iliac arteries. Chlamydophila pneumoniae antibodies (IgG before cytoreductive treatment. However, amputation was performed and IgA) were elevated. The patient received doxycyclin 100 mg/d 2 times. during 3 months. Valsartan was continued. Pain quickly disappeared discussion: The delay in diagnosis of ET or PV is common before after we started the therapy and 2 months later, PET-scan showed ischemic events often dragging, which is all the more regrettable that excellent regression of hypermetabolism. The infrarenal aortic wall the prognosis of this condition is good. Differential diagnoses are thickness slowly regressed down to 2.7 mm. Anti-Chlamydophilia numerous. The CBC may be normal or subject to minimal disturbance pneumoniae IgA remained positive. which should attract attention. If doubt, to find a JAK2 mutation allows discussion: Aortitis may be due to inflammation, infection or may be diagnosis in 80-90% of cases. idiopathic. Corticotherapy can aggravate an active infectious process Keywords: Digital ischemia, Myeloproliferative disorders, and even cause life-threatening dissection. We describe the case of a Microvasculature 66-year old male patient with abdominal aortitis and peri-aortitis and chlamydophila pneumoniae infection who received doxycyclin with a pS6-8 prOpHyLaXiS OF SUSpeCted SeCONdary successful outcome. Doxycyclin inhibits matrix metalloproteinase-9. rayNaUd’S pHeNOmeNON A recent human study showed that this drug also selectively inhibits C. COSTA ALMEIDA1,, L. CARVALHO1, L. REIS1, J. FORTUNA1, specific cellular (aortic wall neutrophil and cytotoxic T-cell content) 74 ~
- 75. and molecular (cytokinesIL-6, IL-8, transcription factors AP-1, C/ mean platelets value was 234 ± 66 at baseline, reduced to 100 ± 60 at EBP, STAT3 and neutrophil-derived proteases) aspects of vascular day 6th (p<0.001), while in group B the mean value was 233 ± 61 at inflammation in abdominal aortic aneurysms. This antiinflammatory baseline and 199 ± 65 at day 6th (p=n.s.). At baseline, pts who tested effect of doxycyclin might participate in the favourable outcome of our positive had a slight increase I/M Thickness (0.80± 0.06 vs 0.84 ± patient. To our knowledge this represents the first case of inflammatory 0.054). After 6 months pts with antibodies developed 2 cases of major aortitis treated by doxycyclin. peripheral thrombosis, one pulmonary embolism and 10 cases of minor Keywords: Abdominal aortitis, Abdominal aortic aneurysm, thrombosis. The I/M thickness was slightly increased in pts of Group A Doxycyclin (0.84 ± 0.054 to 0.86 ± 0.1). Conclusions: We reported an increase in I/M thickness in pts developing pS6-10 treatmeNt OF NON-HeaLiNG WOUNdS WitH antibodies, suggesting an atherosclerotic thickening due to interaction aUtOLOGOUS bONe marrOW CeLLS, pLateLetS, between PF4 immunocomplexes and heparan sulphate on endothelium, FibriN GLUe, aNd COLLaGeN matriX inducing an immunoinjury to the endothelium H. RAVARI1, D. HAMIDI ALMADRAI1, M. SALIMIFAR1, Keywords: Heparin, Antibodies, Carotid arteries S. H. BONAKDARAN1 1 Mashhad University of Medical Siences, Mashhad, Iran pS6-12 a COLLabOratiVe mULti-diSCipLiNary COmmUNity apprOaCH tO a StreptOCOCCUS Objective: Foot ulcerations in diabetic patients are associated with pyOGeNeS iNFeCtiON increased morbidity and mortality, and they have a negative impact G. HANCOCK1, J. V. BARANDIARAN1, T. C. HALL1, on the quality of life. Management of diabetic foot ulcers presents N. EL-BARGHOUTI1, E. P. PERRY1 a major clinical challenge. There are several new approaches which 1 Scarborough Hospital, Scarborough, United Kingdom are separately using for treatment of non-healing wounds such as bone marrow stem cells injection along with their topically applying, introduction: Streptococcus pyogenes (group A) is one of the most platelets growth factors and fibrin glue. common pathogens in humans and virulent strains of this bacterium design and method: 10 diabetic patients (7 males and 3 females with can lead to cellulitis and toxicity of the layers of the skin. Assessing mean age 53 years) presenting with a chronic foot ulcer (mean duration extensive wounds caused by streptococcus pyogenes is unusual for 5 months) were included in a prospective study. The marrow-derived Community Tissue Viability Nurses as often such wounds are referred cells were injected into lower extremity chronic wounds along with for vascular and plastic surgery. We discuss the management of such platelets, fibrin glue and bone marrow-impregnated collagen matrix. a patient using a collaborative approach to promote healing in the The patients were followed up regularly one, two and four weeks later community of this complex condition. for all relevant parameters. Case Study: A 33 year old male was admitted to hospital septic, results: The wounds showed a steady overall decrease in wound size/ with a sudden onset of a spreading necrotic wound which resembled surface 77% after 2 weeks and 88% after 4 weeks. Complete wound necrotising fasciitis as it caused sporadic ulcerated lesions of the foot healing occurred in 30% patients after 4 weeks. and leg. The patient needed emergency debridement and multiple Conclusions: Our study suggests that the combination of mentioned surgical excision of necrotic tissues as the antibiotic therapy showed components (stem cells, platelets,fibrin glue and collagen matrix) slow response. On discharge he was managed jointly between vascular could be used safely in order to synergize the effect of each others for surgery, plastic surgery and the community Tissue Viability Teams. ultimate closure of chronic diabetic wounds. Despite large wounds, he was successfully treated in the community Keywords: Diabetic Foot, Stem Cell, Wound healing using moist wound healing and compression therapy by the community tissue viability team. pS6-11 aSSOCiatiON OF HepariN-pF4 aNtibOdieS Conclusion: Multi-disciplinary working between a team of vascular WitH iNtima-media tHiCKNeSS OF CarOtid and plastic surgeons, the community Tissue Viability Nurse and the arterieS patient, encouraged appropriate care planning. Through optimum A. MATTIOLI1, A. FARINETTI2, R. LONARDI2, S. PENNELLA1,3, wound care, compression therapy and patient education, the wound G. MATTIOLI3 reduced in size without the need for plastic or further surgery. 1 University of Modena and Reggio Emilia, Department Biomed Sc, Keywords: Streptococcus pyogenes, Compression therapy Modena, Italy 2 University of Modena and Reggio Emilia, Department of Surgery, pS7-Chronic venous disorders / Lymphedema Modena, Italy 3 Istituto Nazionale di Ricerca Cardiovascolare, Modena, Italy pS7-1 are tHere iNCUrabLe LeG ULCerS? F. ZERNOVICKY1, K. SAMELOVA2, F. ZERNOVICKY Jr.3 Serologic evidence of heparin-PF4 antibodies in patients (pts) with an 1 ANGIO, Bratislava, Slovak Republic otherwise unexplained thrombocytopenia and new thromboembolic 2 University Hospital, Geriatric clinic, Bratislava, Slovak Republic events suggest the occurrence of heparin-induced thrombocytopenia 3 National Cardiovascular Institute, Clinic of Vascular Surgery, (HIT). The aim of the study was to evaluate the prevalence of carotid Bratislava, Slovak Republic thrombosis in pts treated with heparin that developed PF4/heparin/IgG complexes. Leg ulcers present a serious problem as for the patients, so for healthcare design and method: Study population included 400 pts (mean age 65 system and for the whole society. Expenses for their treatment are ± 10 yrs) treated with unfractionated heparin. An immunoassay ELISA astronomically high. The key to the success is the correct diagnosis with test was used to detect anti-heparin/PF4 antibodies. Blood samples were exact definig of the etiology. The correct treatment must by specific. taken after 8 ± 2.3 days from the start of heparin treatment. Platelets, Authors present their material: 351 leg ulcers treated in 2002 - 2009. CRP, hemoglobin, serum iron, transferrin, ferritin and nutritional status 19 ischemic - 17 of them healed, 11 vasculitic - 9 of them healed, 4 were measured. All pts underwent Doppler ultrasound evaluation of lymphatic - all healed,but 1 repeatedly recurred, 3 were malignant - carotid intima/media (I/M) thickness at day 8 and after 6 months. We 1 healed, 1 refused surgery, 1 died. 314 were of venous origin - 284 compared pts who developed antibodies (group A) with pts who did not (90%) of them healed, but with 8,5% recurrency rate! develop antibodies (group B). Authors demonstrate the most common, but also some curious results: Heparin/PF4 antibodies were found in 112 pts (28%), mean diagnostic and therapeutic errors- having serious, sometimes fatal optical density was 1.236 ± 0.489 (range 1.956-0.50). In Group A consequences. www.iua-eurochap2010.eu ~ 75
- 76. Closing the authorsconstate, that there are much more wrongly treated, insufficiency.Stimulation with VEINOPLUS® could also impove as really incurable leg ulcers. venous hemodynamics.This finding should be investigated and Keywords: Etiologic diagnosis, Differentiated treatment, Conditions confirmed in further studies. of success Keywords: Veinoplus, Edema, Calf muscle pump pS7-2 pHLebOLOGiCaL paSSpOrt pS7-4 ObSerVatiONaL StUdy OF tHe SyNerGy T. ALEKPEROVA1, A. TRUXANOV2, S. MUSAEVA3, betWeeN SCLerOtHerapyaNd a Grade a VeiNOtONiC O. ALEKPEROV4 iN CHrONiC VeNOUS diSeaSe OF tHe LOWer LimbS 1 Medical Post-Graduate Academy, Moscow, Russia F. ALLAERT1, J. P. GOBIN2 2 National association of experts of regenerative medicine, Moscow, 1 Chair of medical evaluation, Dijon, France Russia 2 Phlebologists, Lyon, France 3 Privat Moscow Medical Centre Seguall, Moscow, Russia 4 Moscow Medical University, Moscow, Russia Objective: To describe the evolution of physical and functional symptoms of venous disease under the combined effects of sclerotherapy Objective: To create a common medical language for ÑVD, developed and a grade A venotonic. a universal document - phlebological passport, which meets all the methods: This observational study was conducted among phlebology, necessary for the process of treatment and rehabilitation. angiology and vascular medicine patients presenting with venous Design: Develop a universal document of rehabilitation assistance disease at CEAP stages C1S to C3S. Patients were being treated CVD. simultaneously with a grade A venotonic and sclerotherapy consisting methods: Phlebological passport has three sections - diagnostic, of at least two injections at three week intervals. The main criterion therapeutic, informational. The methodological basis of the diagnostic was the evolution of physical and functional symptoms as assessed section is CEAP. The health section reflects made appointments and by visual analog scales from 0 to 100. Secondary criteria consisted of medical manipulations and recorded their effectiveness is confirmed CIVIC questionnaire assessed quality of life and patient satisfaction. by ultrasound data-mapping with posttherapeuticaly monitoring. In results: The study included 1004 mainly female patients (89.4%) information submitted to the department all of the necessary information aged 50.4 ± 14.1. Of these, 13.2% were C1s, 31.8% were C2s and for the patient, identified individual risk of CVD and / or its recurrence, 55.1% were C3s. Among these patients 72.0% were treated with formed by the activities liquid sclerotherapy, 24.2% with foam sclerotherapy and 3.8% with Keywords: CEAP classification, Phlebopassport, Prevention and a combination of the two. After one month, pain went from 35.4 to rehabilitation 19.3 (p<0.001), heaviness from 44.4 to 21.5 (p<0.001), occurrence of oedema from 55.1% to 40.0% (p<0.001) and CIVIC questionnaire pS7-3 eLeCtrO-StimULatiON WitH VeiNOpLUS® items also altered significantly: mental outlook from 18.8 to 12.5, pain a NeW metHOd FOr tHe treatmeNt OF CHrONiC from 40.9 to 26.7, social factors from 31.4 to 22.0 and physical factors VeNOUS iNSUFFiCieNCy OF tHe LOWer LimbS from 22.0 to 14.9. Patients assessed their satisfaction as 68.5 on a scale V. Y. BOGACHEV1, O. V. GOLOVANOVA1, A. H. KUZNIETOV1, A. from 0 to 100. O. STCHEKOIAN1 Conclusion: Patients presenting for sclerotherapy experience significant 1 Russian State Medical University, Department of Angiology & venous symptomatology which must be alleviated. Combination of Vascular Surgery, Moscow, Russia sclerotherapy and a proven phlebotonic (grade A) reduces patient discomfort and increases satisfaction. Background: Electro-stimulation with VEINOPLUS® has recently Keywords: Varicosis, Sclerotherapy, Synergy emerged as a new technique to activate the calf muscle pump and improve symptoms of venous disease. The aim of this study was to pS7-5 LeG ULCerS aNd HydrOXyUrea: HaS tHe determine in patients suffering from venous chronic edema, the efficacy treatmeNt tO be diSCONtiNUed? of this treatment in terms of reduction of evening edema, diminution U. MICHON-PASTUREL1, I. LAZARETH1, A. BOUCHAREB1, of pain, improvement of quality of life and evaluate the durability of P. PRIOLLET1 the treatment. 1 Hopital Paris Saint Joseph, Paris, France method: 30 patients (32legs) aged 19-50 classified CEAP C3 with chronic evening venous edema wererecruited. All patients were treated Objective: Leg ulcers have been reported in patients undergoing with CE-registered VEINOPLUS® neuromuscular stimulator during 30 long- term hydroxyurea therapy for a myeloproliferative disease. days: (each session: 20 minutes). Main criteria was the circumference Drug withdrawal is often required, neather hydroxyurea efficiency on of the supramaleoal shin segment, measured with a tape in the evening, myeloprolifrative disorders is the best recognized therapeutic option. before treatment, daily and as control 5 days after treatment. As To demonstrate that hydroxyurea hydroxyurea can be purchased in secondary criteria, patients were assessed on day 0 and 35 regarding most of the cases, we report this observational study. pain on the Visual Analog Scale, Quality Of Life (QOL) according to Hydroxyurea-induced leg ulcers are usually painful and characterized CIVIQ questionnaire and venous Refilling Time (RT) measured by by a poor response to traditional local and systemic therapies. We also Photoplethysmography. Three months after the treatment, evaluation describe our experience with whole thickness pinch grafts (according of symptoms was made again. RESULTS: Total or partial reduction to the Reverdin’s method) in this indication. of evening edema was shown in 93.8% of limbs, circumference of design and method: All patients treated by long term hydroxyurea the supramalleolar shin diminished by 20,3mm (p<0.001), number and having leg ulcers, hospitalized in our vascular medicine unit, were of painful legs reducedfrom 28 to 12 and severity score was cut from involved. Cardiovascular risk factors, history of arterial or venous 8.3±1.1 to 3.8±0.9 (p<0.001), QOL score dropped from 34.5±7.8 to disease, clinical, haemodynamical and biological data were registered. 17.2 points ±4.6 (p<0.001) and RT increased from 17.1±0.9 to 21.5 A complete vascular assessment, with arterial and venous Doppler seconds ±1.1 (p<0.001). ultrasonography, was performed for all the patients. Conclusion: Electrostimulation with VEINOPLUS® is an effective results: Ten consecutive (five men and five women) patients seen in our and well-tolerated therapeutic method for the treatment of chronic vascular medicine unit from 2005 to 2009 were involved. All received venous disease when it comes to treatment of chronic edema, for long-term hydroxyurea treatment and have painful and refractory leg reducing pain and improving QOL. It can be used as additional means ulcers. Mean age was 78.2 years (59- 92) and mean therapy duration in the treatment and the prevention of symptoms of chronic venous 9 years. 76 ~
- 77. 8/10 had anunderlying venous disease, 7/10 an arterial disease. line treatment of low-flow vascular malformations. This study reports In half of patients (5/10), hydroxyurea was purchased and leg ulcers the treatment experience by echosclerosis polidocanol foam in low- healed in 4/5 patients. In half of patients, hydroxyurea was stopped and flow malformations of Vascular Medicine Department of Grenoble. leg ulcers healed in 2/5. Design: Retrospective single-center series 2 to 6 skin grafts by patient were performed. 2/10 patients had an materials and methods: The records of all patients with symptomatic arterial revascularization and 1/10 a venous crossectomy. vascular malformation type low-flow veno-venous or lymphatic or Finally, 60% of the patients healed their ulcers and 40% were improved. complex type Klippel-Trenaunay syndrome (KTS) echosclerosis 100% were painless. treated between January 2006 and December 2009 were analyzed. Conclusion: Leg ulcer is a polyfactorial disease which require a The therapeutic indication was always previously validated by the complete cardiovascular assessment and a vascular global management. Consultative Committee of vascular malformations of the University An exhaustive vascular checking is necessary. Skin grafts are efficient Hospital of Grenoble. All vascular malformations were classified in this indication, leading to 60% healing in our experience. according to the Classification of Hamburg. The sclerosant polidocanol Keywords: Leg Ulcer, Hydroxuurea, Skin graft was used as a foam. results: 24 patients 7-78 years were treated (19 venous malformations, pS7-6 prediCtOrS OF tHe pOSt-tHrOmbOtiC 3 venous malformations KTS and 2-nodes). The concentrations of SyNdrOme dUriNG LONG-term treatmeNt OF polidocanol used ranged from 0.25 to 3%. The average number of prOXimaL deep VeiN tHrOmbOSiS sitting was 2.3 [1-16]. After a median follow-up of 9.5 months [1-58], F. POLLICE1, P. POLLICE1, B. DI RENZO1 23 of 24 patients notaient a decrease in pain in 9 cases, a reduction of 1 L’Aquila University, Department of cardiology, L’Aquila, Italy over 50% of the initial volume was obtained and 58.3% reduction less than 50% of original volume. Two minor side effects were reported. Summary: Background. The post-thrombotic syndrome is a chronic, Conclusions: Treatment with echosclerosis using polidocanol foam poorly understood complication of deep venous thrombosis(DVT). seems to be well tolerated. This treatment will improve the symptoms Objectives: To evaluate predictors of the post-thrombotic syndrome, of abnormalities in slow flows without the risk of more aggressive including intensity of long-term anticoagulation, and to assess the sclerosing products such as ethanol. impact of the post thrombotic syndrome on quality of life. Keywords: Vascular malformation, Foam sclerotherapy patients and methods: The setting was 10 italian hospitals. One hundred and forty-five patients with an unprovoked episode of pS7-8 iNteNSiVe reHabiLitatiON prOGram FOr proximal DVT who were initially treated with 3 months of conventional LympHedema: ONe Or tWO WeeKS? intensity warfarin then participated in a trial comparing two intensities B. VILLEMUR1, F. VELLUT, J. Y. BOUCHET, B. BUCCI, V. EVRA, of long-term warfarin therapy. Post-thrombotic syndrome was assessed M. P. DE ANGELIS, A. MARQUER, D. PERENNOU at the end of the trial using a validated clinical scale generic and 1 CHU Grenoble, Cliqnue MPR, Vascular rehabilitation unit, venous disease-specific quality of life was compared inpatients with Echirolles 38434, France and without the post-thrombotic syndrome. Multivariable regression analyses were performed to identify predictors of the post-thrombotic introduction: Severe lymphoedema responds very well to an intensive syndrome and of its severity. rehabilitation program performed in a vascular rehabilitation unit results: After an everage follow-up of 2.2years, the prevalence of (Gironet et al 2004). Such programmes usually consist in: manual post-thrombotic syndrome was 37% and of severe post-thrombotic lymphatic drainage, intermittent pneumatic compression, multi-layer syndrome was 4%. Quality of life was worse in patients with the post- inelastic and elastic bandaging, patient education and physical exercise. thrombotic syndrome compared with patients who did not have it. The The optimal duration of these programs remains to be determined. presence of factor(F)V Leiden or the prothrombin gene mutation was Objectives: Quantifying the efficiency of an intensive vascular an independent predictor of both a lower risk (P=0.006) an reduced rehabilitation program for the treatment of lymphoedema. Testing the severity (P=0.045) of the post-thrombotic syndrome. Intensity of hypothesis that 2 weeks is more efficient than one week. anticoagulation did not influence the risk of developing the post- method: Twenty female patients (62,6±5,6 years) with idiopathic thrombotic syndrome. (7) or secondary (13) lymphedema of the upper (10) and the lower Conclusion: The post-thrombotic syndrome is a frequent and (10) limb were recruited for this study, and assessed before treatment burdensome complication of proximal DVT, even among patients (W0), after one week (W1) or two weeks(W2) of inpatient treatment. maintained on long-term oral anticoagulation. While the presence of Three criteria were used: an index of limb circumference (average of 8 FV Leiden or prothrombin gene mutation appears to be associated different circumferential measurements for the same limb), the range of with a reduced risk of post-thrombotic syndrome, this findings requires motion for passive flexion of elbow and knee; an ad hoc test of active further evaluation in prospective studies. mobility. Non parametric statistics were used. Keywords: Diabetic results: If an efficiency was obtained after one week, this efficiency was better after 2 weeks of intensive rehabilitation: decrease of limb pS7-7 treatmeNt OF LOW-FLOW VaSCULar circumference = 2 cm at W1 and 2,6 cm at W2 (p<0.001) ; the gain maLFOrmatiONS by eCHO-SCLerOtHerapy WitH of passive flexion was 10° at W1 and 13° at W2 (p=0.01);the active pOLidOCaNOL FOam: 24 CaSeS aNd LiteratUre mobility test was increased to 2,6 at W1 and 3,6 at W2 (p=0,03). reVieW Conclusion: A program of two weeks of intensive lymphoedema S. BLAISE1, M. CHARAVIN-COCUZZA1, H. RIOM2, M. BRIX3, rehabilitation is more efficient than a one-week program. C. SEINTURIER1, J. M. DIAMANT4, G. GACHET5, Bibliographie: 1. Gironet N et al. Lymphedema of the limb: predictors P. H. CARPENTIER1 of efficacy of combined physical therapy. Ann Dermatol Venereol 1 CHU Grenoble, Vascular Medicine Department, Grenoble, France 2004;131:775-9 2 Vascular Office, Grenoble, France Keywords: Lymphedema, Intensive rehabilitation 3 CHU Grenoble, Maxillo Facial Surgery Department, Grenoble, France pS7-9 prOGNOStiC VaLUe OF LympHOSCiNti- 4 Vascular Office, Grenoble, France GrapHy FOr prediCtiON OF pOStmaSteCtOmy 5 Vascular Office, Voiron, France LympHedema M. MYASNIKOVA1, N. GORDEEV1 Objectives: Treatment with sclerotherapy has been suggested as first 1 Pavlov’s State Medical University, Saint-Petersburg, Russia www.iua-eurochap2010.eu ~ 77
- 78. Objectives: Development ofpostmastectomy lymphedema of the upper limb is usually explaned by certain risk factors such as axillary pS8-Varicose veins surgery, radiotherapy, obesity, venous outflow obstruction, delayed wound healing, and infection. According to published reports, the pS8-1 VeiN – term CLaSSiFiCatiON/ VeNOUS reFLUX incidence of lymphedema of the arm in patients with breast cancer after patterNS aNd Great SapHeNOUS VeiN SpariNG radical surgery varies from 5 to 50%. The purpose of the carried study F. TOSCANO1, C. PEREIRA ALVES1, J. NEVES1, A. FORMIGA1 was to evaluate efficiency of lymphoscintigraphy for identifying those 1 Hospital Santo António dos Capuchos, Lisbon, Portugal risk factors that may result in secondary lymphedema after surgical treatment for breast carcinoma in a large patient series. Objective: Detailed analysis of reflux patterns of 94 consecutive design and method: Using dynamic lymphoscintigraphy we performed patients operated on by the same surgical team following the VEIN intravital visualization of functionally active lymph collectors of 600 Term Classification criteria. upper extremities: 300 in healthy subjects, 80 in patients with breast methodology: Computer registry of CEAP, Reflux patterns (Axial cancer before treatment, 70 in operated patients without postmastectomy [Ra]/Segmental [Rs]), type of surgery (Axial reflux= classic surgery; edema, and 150 – in patients with postmastectomy edema. Segmental reflux= GSV sparing) results: Three variants of normal lymph flow pattern were revealed results: 35 patients classified as Axial reflux; in healthy subjects: collector (62%), diffuse (18%) and nodular (20%). 59 patients classified as Segmental reflux. In patients that undergone mastectomy collector pattern was found 3 different patterns of segmental reflux were considered. in 56,2% and edema was very seldom in these patients; diffuse – in R(S1;S2;S3) 10% of patients without edema and in 42% of the patients with edema; S1- involving superficial varicose veins only - 17 patients nodular – in 25% of patients without edema and practically never in S2- involving varicose branches plus adjacent segments of GSV - patients with edema. 13 patients Conclusions: Diffuse pattern of lymph flow could be estimated as an S3- involving varicose branches plus the SFJ and a shorter or unfavorable prognostic sign. In these patients complex conservative longer segment of GSV – 29 patients treatment should be started in advance, before clinical appearance of CEAP distribution: Ra: C2 – 17; C4a – 6; C4b – 8; C5 – 4 the edema. Rs: C2 – 41; C4a – 13; C4b – 3; C5 - 2 Keywords: Postmastectomy lymphedema Clinical follow-up showed no recurrence so far. 10 - S3 sub group randomized patients were subjected to pos-op eco-doppler monitoring pS7-10 eFFeCtiVeNeSS OF mULtiLayer baNdaGe iN revelling recovery of normal flow of previously refluxive GSV HeaLiNG VeNOUS ULCerS segments. F. FERRARA1, I. MURATORI1, F. MELI1, C. AMATO1, Conclusions: M. LUNETTA2, R. ALCAMO1, S. NOVO2 1- Segmental reflux was frequent, 63% of patients. 1 Division of Angiology, Palermo, Italy 2- Preservation of GSV even if a refluxive segment existed (but with no 2 Division of Cardiology, Palermo, Italy continuous involvement) doesn’t seem to conditionate recurrence but instead is followed by recovery of normal GSV function. The multi-layer high compression system is described as the current 3- Our CEAP data confirmed more severe clinical classes among axial gold standard for treating venous ulcers. A recent meta-analysis of than segmental refluxes. bandaging systems found that multi-layer compression bandages Keywords: Varices, Saphenous, Sparing appeared to be superior to single-layer bandages in promoting venous ulcer healing. pS8-2 CLiNiCaL eXperieNCe OF SaLem eNdOtHe- The aim of this study is to compare the in patients with chronic venous LiaL StrippiNG OperatiON FOr tHe SUrGiCaL ulceration compared to standard short stretch (SS) compression treatmeNt OF primary VariCOSe VeiNS OF tHe bandaging. LOWer LimbS An open, randomized, prospective, single-center study was performed M. SALEM1, A. SALEM2, T. SALEM3 in order to determine the healing rates of VLU when treated with 1 Faculty of Medicine, Department of Vascular Surgery, Alexandria, different compression systems and different sub-bandage pressure Egypt values. Patients aged at least 18-years-old with leg ulceration of 2 Medical Research Institute, Department of Surgery, Alexandria, suspected venous etiology were screened for inclusion in the trial. Egypt Before inclusion in the study, all patients underwent a color Duplex scan 3 Faculty of Medicine, Department of Internal Medicine, Alexandria, (CS) examination and ankle-brachial pressure index measurements. Egypt Patients were randomized into two groups: 30 patients who were treated using a heel-less, open-toed, elastic class III compression device knitted Objective: New instrument Salem Stripper & operation Salem in tubular 30 patients treated with a multi-layer bandaging system Endothelial Stripping Operation are described. The operation & the comprised of single stretch compression bandage and inelastic bandage Stripper were invented & designed by the first author for the surgical impregnated with oxide paste and coumarin. Group A patients were treatment of primary varicose veins of the lower limbs to avoid the medicated every two days while group B patients were medicated every complications of vein stripping operation. ten days. Of the 63 patients, 60 completed the protocol. Two patient design & method: 500 patients with primary varicose veins of the received multi layer bandage had local allergic reaction, and one patients lower limbs were studied. All cases were collected at random in 14 with stretch bandage discontinued the study for poor compliance. After years (from Jan. 1991 – Jan.2005). The diagnosis was done by history 12 weeks in patients in group A was not observed a complete recovery, & clinical examination. No patient gave past history of deep vein while all patients in group B had achieved complete ulcer healing. The thrombosis.Routine laboratory investigations were done. Duplex results obtained in this study indicate that better healing results are Ultrasound was done to all cases. All cases were treated surgically by achieved with multi-component compression systems than with single- Salem Operation using Salem Stripper. component compression systems and that a compression system should results & conclusions: The age incidence was between 20 -56 years be individually determined for each patient according to individual with a mean of 32 years. Female sex represented 58%. The most characteristics of the leg and Calf Circumference. common presentations of primary varicose veins of the lower limb Keywords: Venous ulcers, Multi-layer compression system, Short were: varicosities, heaviness of the limb, dull aching pain, burning stretch compression pain & disfigurement. The great saphenous vein was affected in all 78 ~
- 79. cases, unilateral involvement was in 460 patients (92%), while bilateral The occurrence of postoperative recurrent VV(after two years) in 35% involvement was in 40 patients (8%) & association of short saphenous of the ND group and in 7% of D group, most often is due to inappropriate varices was in 12 patients (2.4%).The hospital stay after operation selection, incorrect initial diagnosis, poor correction of venous reflux, ranged between 5-10 hours with a mean of 7 hours (one day surgery). bad intraoperative technique and improper postoperative treatment or Postoperative residual varicosities were managed by sclerotherapy. progression of the disease. Postoperative ultrasound showed obliteration of the varices. Follow up Conclusions: CVI causing varicose disease is the result of venous of the patients was done for a period of 5 years from time of operation hypertension most often caused by a primary valvular reflux in the with a total recurrence of 39 limbs (7.22%). In Conclusion: Salem superficial veins. The disease develops in different reflux models. Operation is simple, safe, cheap & easy operation. The results were Preoperative and intraoperative triplex sonography gives objective excellent with no hemorrhage, no hematoma, no saphenuos neuritis, no information about the overall condition of the superficial and deep hospital stay & early return back to work venous system, the presence of varicose and valvular reflux. This Award winner, San Francisco, USA. allows development of accurate, functional morphologic reflux model, US Patent 1991. which allows for choosing the correct surgical approach - removing Keywords: Varicose veins, Salem Operation, Treatment of varicose valvular reflux and varicose veins at all levels and locations. veins Keywords: Preoperative intraoperative, Intraoperative, Triplex sonography pS8-3 earLy reSULtS FrOm SCLerOtHerapy FOr treatmeNt OF VariCOSe VeiNS pS8-5 treatmeNt OF SymptOmatiC VariCOSe D. LUKANOVA1, I. LOZEV2 VeiNS aNd SmaLL SapHeNOUS VeiN reFLUX WitH 1 National hospital of Cardiology, Clinic of Vascular surgery and eNdOVeNOUS LaSer abLatiON dOeS NOt reQUire Angiology, Sofia, Bulgaria CONCOmitaNt pHLebeCtOmy 2 Ministry of Internal Affairs, Clinic of Surgery, Medical Institute, J. LAREDO1, J. KWOCK1, B. B. LEE1, R. F. NEVILLE1 Sofia, Bulgaria 1 Georgetown University Medical Center, Washington, USA Sclerotherapy is a non-surgical method for treatment of varicose Objective: This study assessed the efficacy of office based endovenous veins by injection of a corrosive agent that causes fibrosis of the vein. laser ablation therapy (EVLT) in treating symptomatic varicose veins The injection is performed under visual or ultrasonographic control. and incompetence of the Small Saphenous Vein (SSV). All procedures Sclerosing solutions and foams are in use. were performed under local anesthesia without sedation and all patients The aim was to observe our early results from sclerotherapy for were assessed for the need for post EVLT sclerotherapy. treatment of reticular varicose veins and teleangiectasiae. methods: Patients with symptomatic varicose veins and venous Material and method: We treated 230 out-patients, mainly women, duplex ultrasound documented reflux of the SSV and CEAP clinical in one or several sessions. In all of them we did previous Doppler classification of 2 or greater underwent EVLT of the SSV with tumescent ultrasonography. Follow up examination was performed one month anesthesia. Concomitant phlebectomy of symptomatic varicose veins later. was not performed. Post procedure follow-up included venous duplex results: The early aesthetic and therapeutic results are excellent in 90% ultrasound and multiple clinical evaluations of symptomatic varicose of cases.They were the same after a month. Only mild complications veins. were observed, like hyperpigmentations, in 3% of patients. results: From December 2005 to June 2008, 95 SSVs were ablated Conclusion: The advantages of sclerotherapy are that it can be in 95 limbs in 82 patients (57 women, 25 men, mean age = 55.2 yrs). performed in a physician,s office, in patients on anticoagulants or in Two patients had previous EVLT of the ipsilateral greater saphenous elderly patients that are difficult to operate on. This safe procedure can vein (GSV) and 6 patients had previous GSV stripping in the ipsilateral be repeted after time. leg. CEAP clinical classification was C2 n = 18, C3 n = 43, C4 n = 11, Keywords: Sclerotherapy, Varicose vein, Sclerosing solutions C5 n = 3, C6 n = 20. Post procedure venous duplex ultrasound showed complete ablation of 98.8% of treated SSVs with one recanalization pS8-4 preOperatiVe aNd iNtraOperatiVe (2 wks: 63/63, 3 mos: 19/20, 6 mos: 5/5). Subsequent sclerotherapy tripLeX SONOGrapHy iN SUrGiCaL treatmeNt OF for residual symptomatic varicose veins was required in 29 of 95 VariCOSe VeiNS treated limbs in 29 patients (30.5%). One patient (1.1%) developed a I. LOZEV1, N. SMILOV1, P. LOZEV1, D. DARDANOV1, G. KIROV1 calf DVT post procedure and was treated with anticoagulation. Minor 1 Ministry of Interior, Medical Institute, Sofia, Bulgaria complications were limited to phlebitis and cellulitis seen in two patients (2.2%) and one patient (1.1%) respectively (out of 82 patients). inroduction: Rate of recurrence after surgical treatment of patients Conclusion: EVLT of the SSV in patients with symptomatic varicose with varicose disease causing CVI remains high, the most common veins and incompetence of the SSV is efficacious and is associated with causes are incorrect diagnosis and poor surgical technique. minimal complications. The majority of patients undergoing EVLT of Objective: Using prospective analysis, to assess the impact of the SSV do not require additional treatment of residual symptomatic preoperative and intraoperative triplex sonography on the radicality varicose veins. of surgical treatment and the reduction of recurrence in patients with Keywords: Small Saphenous Vein, Endovenous Laser Ablation, varicose disease. Phlebectomy design and method: Surgery for varicose veins (VV) was performed in 159 patients (167 limbs - Group ND) without using of preoperative pS8-6 eNdOVeNOUS LaSer abLatiON OF tHe and intraoperative triplex sonography - when the diagnosis is given by aNteriOr aCCeSSOry Great SapHeNOUS VeiN clinical examination and bi-directional Doppler. J. LAREDO1, S. SHIN1, B. B. LEE1, R. F. NEVILLE1 254 patients (276 limbs - Group D) were operated using preoperative 1 Georgetown University Medical Center, Washington, USA and intraoperative triplex sonography. Patients in group D and ND, two years after the operation were examined clinically and with triplex Background: The Great Saphenous Vein (GSV) is the most commonly sonography. affected vein in patients with superficial venous insufficiency. Results: Based on the results of preoperative triplex sonography study Incompetence of the Anterior Accessory Great Saphenous Vein of superficial veins and deep venous system, six models of valvular (AAGSV) is estimated to occur in approximately 10% of patients with reflux are made of LSV and SSV. symptomatic varicose veins and superficial venous insufficiency. The www.iua-eurochap2010.eu ~ 79
- 80. aim of this study was to determine the incidence of AAGSV reflux in days [1 - 21], p = 0.134). this patient population and to assess the efficacy of endovenous laser Conclusions: We have shown in this pilot study significant advantages ablation (EVLT) of AAGSV. of CDT-UGFS versus EVLT in a background of a comparable methods: From December 2006 to June 2008, patients with obliteration of the main trunk of the GSV (>8mm diameter). symptomatic varicose veins underwent clinical evaluation and venous Keywords: Foam, Laser, Quality of life duplex scanning. AAGSV reflux was treated by EVLT with tumescent anesthesia. Patients with GSV and AAGSV reflux underwent pS8-8 perSONaL eXperieNCe iN preSerViNG tHe simultaneous ablation of both veins. Post procedure follow-up included Great SapHeNOUS VeiN venous duplex ultrasound and clinical evaluation. If necessary, I. BIHARI1 sclerotherapy or stab phlebectomy of symptomatic varicose veins was 1 A + B Clinic, Budapest, Hungary staged in the follow-up period. results: A total of 313 limbs in 255 patients had reflux involving the aim: What is the aim of great saphenous vein preservation? Was it GSV, AAGSV and Small Saphenous Veins. The incidence of AAGSV successful over the last 30 years? reflux was 11.5% (36 limbs, 35 patients). EVLT ablations (n=36) of the Methods: Sapheno-femoral junction ligature, plasty, wrapping, distant AAGSV were performed in these patients (30 women, 5 men, mean sclerotherapy. age=51.8 yrs). Six patients had previous EVLT of the ipsilateral GSV results: Wrapping and distant sclerotherapy gave good results only and ten patients had prior GSV stripping in the ipsilateral leg. The for two years, ligature and plasty were efficient for 5 years. After this remaining 20 limbs had a competent GSV which was not treated. The time patients require varicose vein surgery because of recurrency. Two incidence of concomitant AAGSV and GSV reflux was 1.6% (5 limbs). successful coronary bypass operations were performed with saved Post procedure venous duplex ultrasound showed complete ablation great saphenous veins. of 100% of treated AAGSVs at 9 months. Subsequent sclerotherapy Conclusion: The aim of great saphenous vein preservation is for it to for residual symptomatic varicose veins was required in 11 of 36 be used later as a bypass material. Any debate centres on the femoral treated limbs in 35 patients (30.6%). No significant complications were part of the great saphenous vein, because the crural part in most cases observed. is healthy and should be saved intact. It seems that the time span, about Conclusion: Isolated incompetence of the AAGSV occurs in 20 years between varicose vein and bypass surgery, is too long to save approximately 10% of patients with symptomatic varicose veins. a non-healthy vein in a patient who is prone to varicose vein disease. EVLT of the AAGSV efficacious and is associated with minimal In many cases the saphenous vein requires further operations in order complications. to maintain the necessary quality for bypass surgery. We recommend Keywords: Anterior Accessory Saphenous, Endovenous Laser femoral part preservation if the patient’s atherosclerosis is known at the Ablation, Venous Insufficiency time of varicose vein surgery. Keywords: Great saphenous vein, Preservation, Bypass material pS8-7 a piLOt raNdOmiSed triaL OF CatHeter direCted FOam SCLerOtHerapy WitH tUmeSCeNCe pS8-9 iNCOmpeteNt perFOratOrS - tHe UNSeeN VerSUS LaSer abLatiON iN patieNtS WitH LarGe ViLLaiN SapHeNOUS diameterS: a N C. STUCKEY1, C. BARBIERI1, A. MARTIN2,1, K. MCDONALD3,2,1, C. R. LATTIMER1, E SHAWISH1, E. KALODIKI1, M. AZZAM1, C. CONROY2,1, R. MARTIN1, D. ROLLINS4 G. GEROULAKOS1 1 ACP, Overland Park, USA 1 Ealing Hospital and Imperial College, Department of Vascular 2 RVT, Overland Park, USA Surgery, SW7 2AZ London, United Kingdom 3 RDMS, Overland Park, USA 4 ORT, Overland Park, USA Objective: Ultrasound-Guided Foam Sclerotherapy (UGFS) alone is less effective in obliterating veins in patients with Great Saphenous Phlebologists have accepted the role of incompetent perforators in Vein (GSV) diameters at or above 8mm when compared to Endovenous the development of venous stasis ulcers. With the advent of portable, Laser Therapy (EVLT). We propose Catheter-Directed Tumescence- high resolution duplex ultrasound, the identification of the elusive assisted Ultrasound-Guided Foam Sclerotherapy (CDT-UGFS) as a incompetent perforators has been greatly facilitated. Given the new technique to improve GSV obliteration by reducing saphenous minimally invasive nature of the radiofrequency endovenous ablation, calibre and controlling foam deployment. the villain can now be seen and treated. This presentation analyzes design and method: Twenty-six symptomatic patients were only the results of treatment of incompetent perforators, in a private randomized into CDT-UGFS (mean venous diameter 9.1mm, range phlebology practice, over a 30 month period (05/17/07 - 11/17/09). In 8mm - 12mm) or EVLT (mean venous diameter 9.7mm; range 8.3mm our practice, all radiofrequency endovenous ablations accomplished - 12mm). Assessments were performed before and at three weeks after at one setting constitute an intervention. The 415 patients treated, treatment (23 legs) using: The Aberdeen Varicose Vein Questionnaire required 1322 interventions to ablate 3381 incompetent perforators (AVVQ) and a full duplex examination. Time to return to normal (2.6 Pi/intervention). During the first 20 months analyzed, 2041 Pi activities, treatment times and seven-day post-procedural visual were treated with an average time of 14.6 minutes/Pi. Over the last 10 analogue pain scores were also recorded. months, 1340 Pi were treated and required an average of 12.2 minutes/ results: In the CDT-UGFS group GSV obliteration was complete in Pi. This reduction of requisite treatment time represents a 16.4% 10/11 patients, with one patient demonstrating an incomplete occlusion reduction in time, and a commensurate improvement in the efficiency with mild reflux. In the EVLT patients, obliteration of the vein was of our practice. It also demonstrates the learning curve associated with complete in 11/12 patients while in one there was GSV patency but the radiofrequency endovenous ablation procedure. Our initial ablation without reflux. Post-procedure morbidity in the EVLT group included rate remains greater than 99.75%, and the sustained ablation rate, a thrombophlebitis requiring admission, a groin haematoma and a 30% evolving from this treatment period of 30 months, remains over 99.5%. non-occlusive femoral vein thrombosis. In the CDT-UGFS group there As the number of patients increases, the number of Pi per patient has was less average post-procedural pain (31/100 [2-99/100] vs 9/100 [1- decreased from 10.1per patient, down to 8.1 Pi per patient. 80 /100], p = 0.012), a trend towards improved median quality of life Keywords: Radiofrequency endovenoua abla, Incompetent perforator, (12.0 [5.5 – 34.5] vs 18.6 [10.6 – 66.9], p = 0.106), shorter median Intervention treatment times (48min [35 – 60] vs 90 min [65 – 132], p <0.001) with a trend towards earlier return to normal activities (2 days [0 – 21] vs 7 80 ~
- 81. pS8-10 eNdOVeNOUS LaSer abLatiON iN treat- 15 patients underwent resection surgery. meNt OF VariCOSe VeiNS Major and satisfactory results were obtained in 47 (90,1%) cases. M. VAKHITOV1, D. SEMENOV, A. ZSIBIN, Z. ULIMBASHEVA Recurrence of symptoms was diagnosed in 4 patients after resection 1 St. Petersburg State I.P.Pavlov Medical University, Department of operations and one patient after reconstructive surgery. In 3 cases pain General Surgery, St. Petersburg, Russia syndrome was observed after embolization of ovarian veins. In 2 cases the pain syndrome was treated conservatively, in one case it was an Crossectomy and stripping (CS) are considered as standard procedures open surgery. There was no cases of recurrence of disease. for sapheneous vein insufficiency. Endovenous laser therapy (EVLT) Conclusion: In case of nutcracker syndrome the most effective methods has been implemented over the last years as an alternative to CS. are reconstructive operations for elimination of venous hypertension in EVLT for ablation of the Great Saphenous vein (GSV) is supposed to the left renal vein. minimize postoperative morbidity. In the case of idiopathic dilatation of gonadal veins the most effective Aim: To compare endovenous laser ablation versus crossectomy and method is endovascular embolization of ovarian veins. stripping of the GSV in a prospective randomized trial. Keywords: Pelvic congestion syndrome, Reconstructive surgery methods: 138 patients suffering from GSV insufficiency were randomly assigned for EVLT or CS. 82 patients (90 lower extremities) pS9 - Venous thromboembolic disease were treated with a 810-nm Diode laser (Quanta-Italy) with spinal anaesthesia. Continuous emission, 15 W, variable retraction speed pS9-1 VeNOUS diSeaSeS iN iNJeCtiNG drUG USerS (approx.1mm/sec) were used. The speed of laser fiber retraction M. CZARNECKI1, B. KNYSZ1, W. KWIATKOWSKA2, depends on calibre of a vein. Parameters of laser coagulation J. GASIOROWSKI1, A. GLADYSZ1 were determined by results of our own clinical and morphological 1 Medical University of Wroclaw, Department of Infectious Diseases, researches. 22 specimens of proximal GSV were excised and studied Wroclaw, Poland by light microscopy for venous wall changes after thermal damage. 2 Regional Specialist Hospital, Research and Development Centre, All cases were combined with crossectomy, mini-phlebectomy (Muller Department of Angiology, Wroclaw, Poland technique) and compression. Duplex ultrasound examinations were performed at baseline and followed up for 1 week, as well as for 3, 18 Objective: The purpose of our study was to estimate the prevalence of and 21 months post treatment. venous diseases (VD) in intravenous drug users (IDUs). 56 patients (66 lower extremities) were treated by surgical operation. methods and design: Anonymous questionnaire (structured by Crossectomy, stripping of GSF, and phlebectomy of varicose veins authors) focusing on VD, filled by 73 IDUs attending the supervised were made with spinal anaesthesia. drug consumptions clinics in the region of Lower Silesia (Poland). results: Both study groups were well balanced concerning age, sex results: 19 women and 54 men, med.age - 34 years, 32 HIV (+) and 41 and CEAP (C2-C5). EVLT and CS were equally safe. CS induced HIV (-) were enrolled into the study. much more postoperative hematomas (9,8%) and dysaesthesia (14,7%) 45 (61,6%) asked patients have experienced VD: venous than EVLT, while EVLT patients had more bruising and ecchymosis thromboembolism, superficial thrombophlebitis (ST) and/or chronic (43%). For patients, treated with EVLA, uncompleted occlusion was in venous disorders (CVD). 17 (23,3%) patients suffered from deep vein 6,7 % and painful phlebitis in 2,3 % in GSV >10mm. 12 patients had thrombosis (DVT) of the lower limbs, 4 (5,5%) – pulmonary embolism reflux in the groin of a side-branch originating from the femoral vein. (PE), 14 (19,2%) – ST, 6 (8,2%) - both: DVT and ST. Nobody was Neither deep vein thromboses nor skin burns were observed during diagnosed for upper limb VD. Recurrent DVT was reported by 10 EVLT treatment. patients and ST - by 12. All patients with DVT injected drugs into lower Keywords: Varicose veins, Laser ablation, Crossectomy and stripping limb veins, including femoral veins. The mean length of time since the first injecting into groin to presentation of DVT was 5,6 years, most pS8-11 eNdOVaSCULar aNd SUrGiCaL tHreat- often – 1 year. 44(60,1%) patients complained of various symptoms of meNt OF peLViC CONGeStiON SyNdrOme CVD. 24 persons had venous leg ulcerations in the past. At the moment I. IGNATYEV1, R. BREDIKHIN1, E. FOMINA1, M. MIIKHAILOV2 of study 10(13,7%) patients suffered from the chronic ulceration. 11 1 Interregional Clinical and diagnostic center, Kazan, RUSSIA patients were hospitalized because of VD, mainly due to DVT (6) or 2 State Medical Academy, Kazan, Russia PE (2). We have registered higher prevalence of VD among HIV (+) comparing aim: Creation of optimal strategy of treatment patients with pelvic with HIV (-) subgroup. 65,6% of HIV (+) patients experienced DVT/PE congestion syndrome. or ST, 81,3% of them suffered from CVD, whereas in HIV (-) subgroup methods: 103 women with pelvic congestion syndrome were examined these values were: 34,1% and 24,4%, respectively. and treated. All women underwent transvaginal and transabdominal Conclusions: Prevalence of venous thromboembolism and chronic color duplex scanning. 52 women underwent multislice CT, pelvic venous disorders in IDUs is significantly higher than in general phleboscintigraphy and phlebography. population. The major risk factors for venous diseases in IDUs are: results: In 51 cases dilatation of ovarian veins till 5 mm, not punctions of the lower limb’s veins and HIV infection. accompanied by a syndrome of chronic pelvic pain was revealed. This Keywords: Chronic venous disorders, Venous thromboembolism, woman were treated conservatively. 17 women had aorto-mesenteric Intravenous drug addiction compression of the left renal vein (nutcracker syndrome). In all that cases ovarian vein diameter was more than 8 mm (mean 0,88 mm). pS9-2 eVaLUatiON OF OUtCOmeS FOLLOWiNG Reconstructive operation were performed on this patients: 10 eNdOVaSCULar reCaNaLiZatiON aNd SteNtiNG applications of the proximal ovarian-iliacal anastomoses, 5 - safenal- OF CHrONiCaLLy OCCLUded iLiaC aNd COmmON ovarian anastomoses. One prosthetics of left renal vein was made. And FemOraL VeiNS one more woman underwent transposition of the left renal vein. In the A. KURKLINSKY1, H. BJARNASON1 case of idiopathic reflux and presence of clinical pelvic congestion 19 1 Mayo Clinic, Rochester, USA patients underwent one-or two-sided embolization of ovarian veins. In one case the hemangioma in the origin of the left internal iliac vein design and methods: Retrospective case-series review of 89 was detected as a cause of widespread sexual and pelvic varicose. Set consecutive patients (62 women; median age 46.16 years) from March of embolization therapy on the branches of the internal iliac vein was 03, 2003 through December 01, 2008. realized. Results and Conclusions: Median primary patency for the duration of www.iua-eurochap2010.eu ~ 81
- 82. study was 11.31months. It was 43.27 months for the patients in the substitution 1958 G->A was found in 29,2%. The treatment of patients first year of the study reflecting longer follow-up time. There was no with deep venous thrombosis was carrying out with consideration of significant difference of primary patency duration when controlled for genotyping data. Folic acid and anti-aggregating drugs were including the year of the inclusion in the study, age, or gender. Primary patency in baseline therapy in patients with polymorphous variants of folate problems were detected most commonly during the first year of follow- cycle`s and thrombocytic haemostasis`. up. Irreversible loss of primary patency occurred in 4.5% of the cases Conclusion: The application of molecular-genetics methods in patients (only one attempted recanalization). Primary assisted patency was with deep venous thrombosis makes treatment and prophilaxis more established in 11% of cases; all remained patient with a mean follow- effective, it helps to individualize the therapeutic tactic. up of 25.32 months (IQ range 24.3 – 39.32). Secondary patency was Keywords: Deep venous thrombosis, System haemostasis genes, established in 3.4% cases (all lost to follow-up). Venous pressure Personolized therapy gradients across lesion were significantly reduced from 5.63 mm Hg to 0.71 mm Hg (p<0.0001; n=28). Non-invasive vascular laboratory pS9-5 CLiNiCaL SiGNS aNd riSK FaCtOrS OF assessment data were insufficient to draw statistical conclusions deep VeiNS tHrOmbOSiS OF LOWer eXtremitieS. regarding changes in venous obstruction or insufficiency. We conclude eFFiCieNCy aNd SaFety OF aNtiCOaGULaNt that stenting of chronically occluded iliac and common femoral veins tHerapy may provide long term patency of the vessels for over one year in the V. MISHALOV1, E. N. AMOSOVA1, N.Y. LITVINOVA1 majority of patients, in accord with earlier studies. 1 National Medical University, Kyiv, Ukraine Keywords: Venous obstruction, Venous stenting, Postphlebitic syndrome The purpose of our research was to conduct the retrospective analysis of clinical signs and risk factors for patients with diagnosis of acute pS9-3 impOrtaNCe OF LONG term FOLLOW Up OF deep veins thrombosis (ADVT) of lower extremities, treating oneself dVt reCaNaLiSatiON in the departments of vascular surgery and to compare effectiveness Z. PÉCSVÁRADY1 and safety of therapy. 1 Flór Ferenc Teaching Hospital, Kistarcsa, Hungary materials and methods: For period from 2004 to 2009 the diagnosis of ADVT was set for 518 patients, among them 256 (49,4%) men and The recent practice in Hungary to diagnose DVT is compression 262 (50,6%) women. All of patients with ADVT got therapy with ultrasonography ( CUS ) in the acute phase. However no regular follow anticoagulants. Enoxaparin sodium was prescribed in 428 (82,6%) up to check the recanalisation of the thrombus what is not even advised cases, UFH in 58 (11,2%) and in 20 (3,9%) – others LMWH. Were by the current international guidelines. Some paper already followed have analysed efficiency and complications after antithrombotical the recanalisation rate and found that the completion of this process is therapy in a hospital period. about ½-1 year. It is also known that the incomplet recanalisation is one results and their discussion: Therapy of UFH and LMWH was of the source of the recurrent DVT. effective (on the average a good result is got in more than in 86 % The author detailes the pathomechanism and the time course of the cases) enough. Enoxaparin treatment was related to considerably less recanalisation and draws attention the importance of the follow of hemorrhagic complications, than treatment of UFH (ð<0,05), that up, showing some special cases. It is also disccused that the rate concerned all of types of such complications. of recanalisation has to influence our daily practice to the period Conclusions: 1.Among patients with ADVT with primary localization of anticoagulation. Finally preliminary data are shown from the in ileofemoral and popliteal segments which treated in the departments recanalisation effect of novel anticoagulant agents. of vascular surgery prevailed senior persons more than 60 years old Keywords: Deep venous thrombosis (DVT), Ultrasound diagnosis of (52,7%). DVT, DVT treatment, Recanalization of thrombus 2.In 83,8% cases the most frequent symptoms of disease are an edema of extremity (in 80,1%) and pain syndrome 75,1%, which at pS9-4 tHe GeNetiC prediCtS OF tHe deep VeNOUS a monosymptomal variant (34,4% patients) are marked in 64,6% and tHrOmbOSiS 45,4% accordingly. Y. NOVIKOVA1, A. SHEVELA1, K. SEVOSTYANOVA1, 3. Efficiency of anticoagulant therapy was identical at enoxaparin E. VORONINA1 and UFH groups and was achieved in 95,6% and 91,3% accordingly, 1 Institut de biologie chimique et medecine fondamentale, Novosibirsk, however in cases of enoxaparin application regress of clinical signs in Russia was rapid 67,4% cases, while if UFH used only in 55,1% cases. 4. Treatment of with enoxaparin accompanied with reduced frequency The aim of present study is the determination of the thrombophilia of all hemorrhagic complications in 1,8 times, serious in 2,4 times and genetic markers among the patients with acute deep venous thrombosis moderate in 2,8 times with the purpose of conservative therapy prescription, recurrence and Keywords: Clinical signs and risk factor, Acute deep veins thrombosis, complication profilaxis. Anticoagulant therapy methods: by this moment we studied 195 patients with deep venous thrombosis of the lower limbs. Genome DNA patterns` was received pS9-6 preVeNtiON OF tHrOmbOtiC diSOrderS iN from venous blood by phenol-chloroform extraction. The definition of CaNCer patieNtS UNderGOiNG CHemOtHerapy allelic variants of the haemostasis system`s genes was carried out by F. POLLICE1, P. POLLICE1, L. DE GIULI1 the PCR/RFLP method. 1 L’Aquila University, Department of Cardiology and Medicine, results: The heterozygous polymorphism of the thrombocytic L’Aquila, Italy glycoprotein gene Gp1a-integrin-alpha-2 807 C->T was found in 42,6% of the cases, whereas the homozygous variant of the same gene was purpose: The role of prophylactic vena cava filters(VCF) in patients registered in the 8,1% patients. The heterozygous mutations of the gene with cancer is debated. Although VCF are often placed in patients PAI-1 substitution 675 5G->4G (58,3% of the cases), the gene FGB with cancer after recurrence of venous thromboembolic events (VTE), substitution G-455A Promoter (33,9%) and the gene FXII 46 C->T identification of this subset of patients has not been well-defined. This polymorphism (26%) was coming across most often. In 47% of the study was undertaken to assess factors associated with increased risk exeminees the gene MTHFR, heterozygous polymorphous substitution for recurrent VTE. 677 C->T was detected. The homozygous mutation of the folate methods: All patients with a history of thromboembolism or cycle`s enzyme methylenetetrahydrofolate dehydrogenase – MTHFD malignant disease and who required a VCF because of failure of or 82 ~
- 83. contraindication to anticoagulationtherapy were abstracted from the pS9-8 deep VeiN tHrOmbOSiS iN iNtraVeNOUS Registry of 10 italian hospitals. drUG USerS FrOm eXperieNCe OF aNGiOLOGiC Ward results: Ninety-nine patients (49 men, 50 women) with a mean age of aNd OUtCLiNiC 58 years were included in the study. New metastases occurred in 55% W. KWIATKOWSKA1, D. KOTSCHY1, J. PRZYTULSKA1, J. of patients, and 12% of patients had a history of VTE before cancer DRELICHOWSKA-DURAWA1, L. MASLOWSKI1, diagnosis. Corticosteroid agents were used during therapy in 48% of W. WITKIEWICZ1, M. CZARNECKI2, J. GASIOROWSKI2, patients. Acute VTE was present in 52% of patients at cancer diagnosis, B. KNYSZ2 and in 34% of patients VTE was associated with new metastases. 1 Regional Specialist Hospital, Research and Development Centre, Recurrent VTE occurred in 40% of patients, and significant risk factors Wroclaw, Poland included presence of new metastases (odds ratio [OR], 3.3; 95% 2 Medical University of Wroclaw, Department of Infectious Diseases, confidence interval[CI], 1.16-9.09; P=.02) and history of VTE (OR, Wroclaw, Poland 10.6; CI, 1.98-57.2; P=.006). Whereas a single episode of neutropenia did not reach significance (OR, 1.1; CI, 0.97-1.35; P= .11), multiple Objective: In the 90thies the number of intravenous drug users (IDUs) neutropenic episodes were significantly associated with recurrent VTE has increased. Main etiopathogenetic factors for DVT (Deep Vein (P=.04). Smoking, hormone replacement therapy, decreased mobility, Thrombosis) among IDUs are: multiple vein injuries, unsterilized post-surgical state, and obesity were not independently associated with injection needles, intravenous intake of insoluble particles. IDUs are up increased risk. Mean survival in this series was 30 months, and was to 21% of all of the patients admitted to hospitals with DVT diagnosis significantly worse in patients with VTE at cancer diagnosis and with and 50% in group under 40 years of age. Since 2004 we treated 5 young inability to tolerate anticoagulant therapy in conjunction with VCF. patients-IDUs diagnosed for DVT, 3 of them in the last year. We present Conclusion: Patients with malignant disease may be at increased risk 2 cases of IDUs (heroine) with the proximal DVT. for recurrent VTE after development of new metastases or multiple design and method: presentation of cases. episodes of neutropenia, especially those patients with a history of 28 years old female, 8 years of addiction, HCV and HIV positive, VTE. admitted to ward with symptoms of DVT, after treatment of right Keywords: Diabetic groin fistula. In physical examination: no fever, traces of punctures on extremities including plantar side of feet, scar from groin fistula, pS9-7 VaLidatiON OF a deep VeiN tHrOmbOSiS miscolored string-like veins, skin ulcerations, oedema and cyanosis of prediCtiON rULe iN primary Care right lower limb. High D-dimer concentration, femoral vein thrombosis M. MAUFUS1, J. L. BOSSON2, C. GENTY2, A. DELLUC3, confirmed in ultrasound examination. P. IMBERT4, P. GAGNE5, C. ROLLAND2, L. BRESSOLLETTE3, 29 years old male, 5 years of addiction, HCV-positive, admitted with G. LE GAL3 symptoms of DVT. In physical examination: fever, massive oedema 1 Universite Europeenne de Bretagne; EA3878 IFR 148; Departement and cyanosis of left lower limb, traces of vein punctures, groin de medecine interne, pneumologie et medecine vasculaire, Brest, lymphadenopathy, skin ulcerations and abscesses of both lower limbs. France High D-dimer concentration. Thrombosis of iliac, femoral, popliteal 2 CHU Grenoble, Centre Investigations Cliniques, Grenoble, and superficial veins confirmed in ultrasound examination, femoral France artery pseudoaneurysm filled with clots. In both cases Low Molecular 3 CHU de la Cavale Blanche, Universite Europeenne de Bretagne; Weight Heparin (LMWH), antibiotics and compression therapy were INSERM CIC 05-02, IFR148, Brest, France administered. The patients were discharged with advise to continue 4 Universite Joseph Fourrier, Departement de Medecine Generale, treatment with LMWH. Grenoble, France Conclusions: Taking into account medical reports, escalation of 5 Private medical office, Plaintel, France addiction and observed DVT cases in IDUs, in spite of lack of EBM data, addiction from intravenous drugs should be taken under Objective: Suspected Deep Vein Thrombosis (DVT) of Lower Limbs consideration as a risk factor for DVT in young patients. Lack of (LL) may require different tools to rule out or confirm the diagnosis. therapeutic guidelines for this group is also a problem to solve. Clinical probability provides help to select useful tests, interpret their Supported by European Regional Development Fund, Polish Govern. results, and decide to treat the patient meanwhile. Prediction rule that the grant WROVASC Integrated Cardiovascular Centre, Wroclaw, risk stratifies patient with suspected DVT are validated for inpatients, POLAND such Wells’score, but not for outpatients. We previously derived and Keywords: Deep vein thrombosis, Intravenous drug users internally validated such a prediction rule: Brest’score. The aim of this study is to externally validate this score. pS9-9 FaCtOrS iNFLUeNCiNG tHe deVeLOpmeNt design and methods: Brest’score was applied to OPTIMEV OF tHe pOSt-tHrOmbOtiC Limb outpatients with suspected LL-DVT, and without suspected pulmonary F. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2 embolism. Sensitivity and specificity were calculated for proximal and 1 University of Naples, Department of Vascular Surgery, Naples, distal DVT, according to each score. The area under the ROC curve Italy was calculated for each kind of DVT, in order to assess the validity of 2 Department of Interventional Radiology, Bari, Italy Brest’score on pedicting the presence or absence of DVT. results: Among 3 523 outpatients prospectively included in the purpose: This study was designed to determine whether patients OPTIMEV study for suspected LL DVT, overall prevalence of DVT having underlying venous disease in their contralateral limbs indicates was 29.7% (n = 1046), ranging from 21.7% in the non-high Brest’score a more severe long-term clinical outcome in the ipsilateral limb after a probability, to 61.4% in the high Brest’score probability. The area under deep vein thrombosis (DTV) and to determine what other factors may the ROC curve was 0.7870 [CI 95%; 0.7713 - 0.8028]. With subgroup influence the long-term outcome. analysis, the area under curve was 0.8340 [CI 95%; 0.8162 - 0.8518] methods: An acute DVT was initially diagnosed by means of duplex for proximal DVT (n=465), and 0.7494 [CI 95%; 0.7284 - 0.7705] for ultrasound scanning. Follow-up clinical examinations and bilateral distal DVT (n=581). duplex reflux studies were performed for a mean period as long as 3 Conclusions: Brest’score reliably identifies outpatients with LL DVT, years. The patients were divided into two groups: group I, those with weather proximal or distal. no history of a contralateral DVT, and group II, those with a history of a Keywords: Deep Vein Thrombosis, Primary health care, Diagnosis contralateral DVT. The patients were classified at their final examination according to the Clinical, Etiology, Anatomic, Pathophysiologic, www.iua-eurochap2010.eu ~ 83
- 84. (CEAP) classification. And the ipsilateral and contralateral limbs were compared. results: Sixty-three patientswere monitored in a mean follow-up period of 3 years. There was a significant difference in the incidence of symptoms between the ipsilateral limbs(P>.001) and the contralateral limbs (P<.001) for both groups. There was no significant difference between the incidence of superficial reflux between the ipsilateral and contralaetral limbs, but the deep venous system and perforator veins were involved more often in the ipsilateral limbs. In group I, only six patients (10%) had no evidence of venous dysfunction(CEAP=0) in their ipsilateral or contralateral limbs at the time of the final examination, and all patients had reversible risk factors. Of patients who had a mild clinical outcome (CEAP score, 1to3), 64% had a healthy contralateral limb, and the remaining 36% had mild to moderate disease. Conclusion: There are a significant number of patients with an acute DVT who had an underlying venous disease in the uninvolved contralateral limb. An ipsilateral post-thrombotic limb is more likely to develop in patients with primary venous reflux after an acute DVT. Keywords: Thrombosis pS9-10 iVUS iVC FiLter depLOymeNt - a metHOd FOr iNteGratiON OF iVUS iNtO daiLy praCtiCe D. KASSAVIN1, G. CONSTANTINOPOULOS1 1 Monmouth Medical Center - Department of Surgery, Long Branch, NJ, USA The use of IVUS for diagnostic and therapeutic procedures provides many advantages to the vascular specialist. Studies performed with IVUS accurately correlate with those obtained with angiography and in certain circumstances are better able to evaluate the severity of vessel disease while avoiding the risks of prolonged radiation exposure, nephrotoxic contrast agents and potential allergic reactions. IVUS has been implemented for a variety of diagnostic and therapeutic vascular procedures, ranging from intraprocedural device deployment to follow up surveillance. We review our experience with the deployment of one hundred IVC filters using IVUS whereby a transition was made from the combined use of IVUS and traditional roadmapping techniques (venography or renal vein cannulation) to the sole use of the IVUS as the roadmapping tool for IVC filter insertion. Our experience with the IVUS for IVC filter deployment has served as a bridge for its incorporation into other vascular procedures. IVUS has the potential to become a standard in the vascular specialists’ armamentarium. Keywords: Intravascular Ultrasound, Inferior vena cava filter 84 ~
- 85. aUtHOr’S iNdeX BONAKDARAN S. H. PS6-10 BOSEVSKI M. OC5-7 a BOSNARDO C. OC7-1 ABOYANS V. SY4-1 BOSSON J.L. OC3-1, OC3-4, PS9-7 ABRAHAM P. PS2-8, PS2-9, PS2-10, SY11-1 BOUCELMA M. PS1-7, PS1-10, PS5-6 ABUSHOV N. OC1-7, OC2-7 BOUCHAREB A. PS7-5 ACCROCCA F. OC2-2, PS4-7 BOUCHET J. Y. PS7-8 ACERANTI A. PS2-4 BOUDJELIDA H. PS1-10 AGHAMOHAMMADZADEH R. SY15-2 BOUNZIRA T. PS5-6 ALBAZDE O. OC2-6 BOUTOUYERIE P. SY15-3 ALCAMO I. R. OC7-4 BREDIKHIN R. PS8-11 ALCAMO R. PS4-8, PS7-10 BRENNER E. OC7-5 ALEKPEROV O. PS7-2 BRESSOLLETTE L. PS9-7 ALEKPEROVA T. PS7-2 BRIX M. PS7-7 ALEXANDRESCU V. SY14-3 BROTAS V. OC6-7 ALIAKBARIAN M. PS4-6 BROUTZOS I. OC1-4 ALIYEV E. OC1-7 BUBALA M. PS1-4 ALIYEV Z. OC2-7 BUCCI B. PS7-8 ALLAER F. A. PS2-7 BUDIU O. SY14-1 ALLAERT F. OC7-6, PS7-4 ALLAIRE E. SY1-1 C ALLEGRA C. OC3-7, OC4-7, OC7-2, PS4-9 C. HOMORODEAN C. SY14-5 ALSAIGH T. SY9-4 CARABA A. PS1-1, PS3-8 AMATO C. OC7-4, PS4-8, PS7-10 CARITÀ P. SY4-2 AMIOT S. PS4-10 CAROTTA M. PS2-3, PS2-4 AMITRANO M. OC3-3 CARPENTIER P. OC5-6, OC6-6, PS6-7, PS7-7, AMORIM P. PS5-1, PS5-8 SY2-1, SY5-1, SY9-3, SY12-1, AMOSOV V. OC4-1 SY12-3, SY13-2 AMOSOVA E. N. PS9-5 CARSIN M. OC5-1 ANDERCOU A. SY14-1 CARVALHO L. OC2-4, PS6-8 ANDERCOU O. SY14-1 CARZANIGA G. PS2-3, PS2-4 ANDREI M. SY14-1 CASTRO E SOUSA L. PS5-8 ANDREOZZI G. M. PS3-1, SY11-2 CATALANO M. OC2-5, PS2-3, PS2-4 ANDRES E. PS6-6 CATALINI R. PS5-9 ANTIGNANI P. L. OC3-7, OC4-7, OC7-2, PS4-9 CATINELLA D. PS3-2, PS3-3 ANTONELLI R. OC2-2, PS4-7 CAZAUBON M. PS2-7 ARCENIO E. OC4-5 CHA S. OC1-2 ASCHER E. SY10-1, SY13-3 CHAARI M. OC6-4 ASFAR P. PS6-6 CHAMBON J. P. PS4-10 ASLAM M. PS3-6 CHARAVIN-COCUZZA M. PS7-7 ASSIE C. OC6-2 CHAUDET H. PS1-7 AVGERINOS E. OC1-4 CHECKA K. PS3-9 AYMARD A. PS5-3 CHIROSA I. OC3-6 AZZAM M. OC4-6, PS8-7 CHO H. PS1-9 CHOROSTOWSKA-WYNIMKO J. OC2-1 b CHRISTENSEN I. OC5-5 BACCOUCHE H. OC6-4 CIAMMAICHELLA M. OC3-3 BAKOYIANNIS C. PS4-2, PS4-3 CINQUINI M. PS2-3, PS2-4 BANFIC L. J. PS1-2, PS1-3 CLARA G. OC6-7 BARANDIARAN J. V. PS2-1, PS2-2, PS6-12 CLEMENT D. L. SY4-3 BARBIERI C. OC4-2, PS8-9 COCHET E. OC6-6 BARBOS O. SY14-1 COFFIN O. OC5-2 BARTOSZEWICZ M. PS3-9 COMEROTA A. J. SY8-4 BASTOUNIS E. PS4-3 CONOCAR C. PS6-2 BAUMGARTNER I. SY13-1 CONROY C. OC4-2, PS8-9 BAUTRANT E. OC6-1 CONSTANS J. SY12-1 BECKER F. SY1-4 CONSTANTINOPOULOS G. PS9-10 BELCH J. SY13-1 CONTEGIACOMO G. OC5-4, PS4-1, PS5-4, PS5-5, PS9-9 BELIZNA C. OC6-3, PS6-6 CORDOVA R. PS3-1 BELLE L. OC5-6 CORRADO E. SY4-2 BELVA-BESNET H. PS6-2 COSTA ALMEIDA C. OC2-4, PS6-8 BENAMER H. PS5-3 COUTURIER P. OC3-4 BENSALAH D. PS5-6 CUTOLO M. SY12-2 BERGAUER A. OC1-5 CZARNECKI M. PS1-4, PS9-1, PS9-8 BERRAH A. PS1-7, PS1-10, PS5-6 BEUCHER A. OC6-3 d BHASKARAN P. PS3-4, PS3-5, PS3-6 D. OLINIC D. SY14-5 BIALEK P. OC2-1 DALAINAS I. OC1-4 BIENVENU B. PS6-6 DARDANOV D. PS8-4 BIHARI I. PS8-8 DASKALOPOULOS M. OC1-4 BJARNASON H. PS9-2 DAUMAS M. PS6-2 BLAISE S. PS7-7 DE ANGELIS M. P. PS7-8 BOGACHEV V. Y. PS7-3 DE BOSSCHERE J. P. OC5-1 BOGOMOLOV M. S. PS2-5, PS2-6 DE GIULI L. PS9-6 BOLSHAKOV O. OC4-1 DECAMPS LE CHEVOIR J. SY12-1 www.iua-eurochap2010.eu ~ 85
- 86. DELGADO V. PS3-7 GUILMOT J.-L. SY12-1 DELLUC A. PS9-7 GUITTON J. B. OC5-6 DEREZINSKI T. OC1-3 DESMURS-CLAVEL H. PS6-7 H DESSI A. OC6-6 HAKEM D. PS5-6 DI MICCO P. OC3-2, OC3-3 HALENKA M. PS1-5, PS1-6 DI RENZO B. PS7-6 HALL T. PS2-1, PS2-2, PS6-12 DIAMANT J. M. PS7-7 HAMEL-DESNOS C. SY10-3 DIMITROV G. PS2-3 HAMIDI ALMADRAI D. PS6-10 DRAGAN S. PS1-1, PS3-8 HAMON M. OC5-2 DRELICHOWSKA-DURAWA J. PS1-4, PS9-8 HANCOCK G. PS6-12 DRIVER V. SY13-1 HANNING S. PS3-2, PS3-3 DROC I. SY14-3 HEAGERTY A. M. SY15-2 DUBENEC S. PS3-2, PS3-3 HENRION D. PS6-6 DUGUOT A. PS6-2 HOPPENSTEADT D. PS6-1 DUNCAN A. OC1-2 HUSSAIN T. PS5-2 e i EDOVINA L. N. PS2-5, PS2-6 IGNATYEV I. PS8-11 EGGERMONT J. OC6-1 IMBERT B. OC5-6, PS6-7 EL-BARGHOUTI N. PS2-1, PS2-2, PS6-12 IMBERT P. PS9-7 ELALAMY I. OC6-4 IQBAL O. PS6-1 ENON B. OC6-3 EVRA V. PS7-8 J JACKULIAKOVA D. PS1-5, PS1-6 F JAGUS P. OC2-1 FAREED J. PS6-1, SY8-2 JAKUBOWSKI G. OC1-3 FARINETTI A. PS6-3, PS6-11 JANUSAUSKAS E. PS5-10 FARKAS K. OC2-3 JANUSAUSKAS T. PS5-10 FÉLIX F. PS5-1 JANVRESSE A. OC6-2 FENSTER A. OC5-3 JÁRAI Z. OC2-3 FERNANDES E FERNANDES J. SY3-1 JASHARI R. PS4-10 FERNANDEZ F. OC3-6 JAWIEN A. OC1-3 FERRARA F. OC7-4, PS4-8, PS7-10 JEZOVNIK M. K. OC7-7, SY4-4 FLIS V. OC1-5 FOMINA E. PS8-11 K FORMANKIEWICZ B. OC1-3 KAFEZA M. PS4-2, PS4-3 FORMIGA A. PS8-1 KALODIKI E. OC4-6, PS8-7, SY8-2 FORTUNA J. PS6-8 KALRA M. OC1-2 FRADIN S. OC5-2 KANALIKOVA K. PS5-7 FRYSAK Z. PS1-5, PS1-6 KAPANADZE K. PS6-5 KARASEK D. PS1-5, PS1-6 G KARIMOV M. OC1-7 GACHET G. PS7-7 KASSAVIN D. PS9-10 GAGNE P. PS9-7 KAVROS S. PS3-10 GALANAUD J. OC3-1 KAZLAUSKAS V. PS5-10 GALEA V. OC6-4 KEDZIOR M. OC2-1 GALLUCCI M. OC4-7 KELEKIS N. OC1-4 GASIOROWSKI J. PS1-4, PS9-1, PS9-8 KELLY A. PS3-2, PS3-3 GENTY C. OC3-1, OC3-4, PS9-7 KERN P. SY2-3 GEORGIEVSKA-ISMAIL L. J. OC5-7 KHERAT N. PS6-7 GEORGOPOULOS S. PS4-2, PS4-3 KIKUCHI R. OC4-5 GEROTZIAFAS G. OC6-4 KIM H. PS1-9 GEROULAKOS G. OC4-6, PS8-7 KIM Y. PS1-9 GHALI A. OC6-3, PS6-6 KIPSHIDZE N. N. PS6-5 GIANNAKOPOULOS T. OC1-4 KIROV G. PS8-4 GIANNOPOULOS A. OC1-6 KISKINIS D. OC1-6 GIANTOMASSI L. PS5-9 KISS I. OC2-3 GILLOT C. SY7-2 KLONARIS C. PS4-2, PS4-3 GIORDANO A.G. OC2-2, PS4-7 KNYSZ B. PS1-4, PS9-1, PS9-8 GLADYSH A. PS1-4 KOBILICA N. OC1-5 GLADYSZ A. PS9-1 KOLOSSVÁRY E. OC2-3 GLOCKNER J. OC6-5 KOTSCHY D. PS9-8 GLOVICZKI M. L. OC6-5 KOUTSOUBELIS A. PS4-2, PS4-3 GLOVICZKI P. OC1-2, PS3-10, SY9-1 KOUVELOS G. PS4-2, PS4-3 GOBIN J. P. PS7-4 KOVALEVA O. OC4-1 GOLOVANOVA O. V. PS7-3 KTENIDIS K. OC1-6 GORDEEV N. PS7-9 KURKLINSKY A. PS9-2 GOURLAY T. PS3-4, PS3-5, PS3-6 KUZNIETOV A. H. PS7-3 GRANDE J. P. OC6-5 KWIATKOWSKA W. PS1-4, PS3-9, PS9-1, PS9-8 GREENSTEIN A. S. SY15-2 KWIATKOWSKI J. PS1-4 GRENDZIAK R. PS4-4 KWOCK J. PS8-5 GROVER T. OC5-5 GUILLAUMON A. OC7-1 L GUILLOTTE X. PS5-3 LABARERE J. OC3-4 86 ~
- 87. LANCELEVEE J. PS4-10 MIOVSKI Z. PS1-2, PS1-3 LARCHER L. OC7-5 MISHALOV V. PS9-5 LAREDO J. PS8-5, PS8-6 MOBASHERI M. PS5-2 LAROCHE J.P. OC3-1 MOHAN THETI I. PS6-2 LARRUE V. SY3-3 MOINI M. PS4-6 LASSOUAOUI S. PS1-10 MOLLO M. OC6-1 LATTIMER C. R. OC4-6, PS8-7 MONREAL M. OC3-2, OC3-3 LAUNAY J. SY12-1 MOON S. PS1-8 LAVIGNE C. OC6-3, PS6-6 MORELLO R. OC5-2 LAZARETH I. PS7-5, SY12-1 MORICE M. C. PS5-3 LAZARIDIS I. OC1-6 MOSCHOU M. OC1-4 LE FAUCHEUR A. PS2-10 MOULAKAKIS K. OC1-4 LE FLOCH E. SY2-2 MOZOS I. PS1-1, PS3-8 LE GAL G. PS9-7 MRDZA B. OC1-5 LE HELLO C. OC5-2 MURALIDHARA G. OC5-3 LE NOBLE F. SY15-1 MURATORI I. OC7-4, PS4-8, PS7-10, SY4-2 LEE B. B. PS8-5, PS8-6 MUSAEVA S. PS7-2 LEE J. PS1-9 MYASNIKOVA M. PS7-9 LEFTHERIOTIS G. PS2-8, PS2-9, PS2-10 LEGER P. SY5-2, SY12-1 N LERMAN L. O. OC6-5 NA D. L. PS1-8 LEVESQUE H. OC6-2 NEVES J. PS8-1 LIAPIS C. OC1-4 NEVILLE R.F. PS8-5, PS8-6 LIEDL D. PS3-10 NICOLAIDES A. SY3-4, SY7-1 LIFSHITZ G. PS6-4 NICOLINI P. SY9-2 LINDHOLT J. S. SY1-2 NIETO J.A. OC3-2, OC3-3 LITVINOVA N.Y. PS9-5 NIGLIO A. OC3-3 LONARDI R. PS6-3, PS6-11 NIKOL S. SY13-1 LONDON G. SY15-4 NITKOWSKI P. OC2-1 LOUVARD E. PS5-3 NIZET C. PS6-9 LOZEV I. PS8-3, PS8-4 NORGREN L. SY13-1 LOZEV P. PS8-4 NOURY-DESVAUX B. PS2-10 LUDÁNYI A. OC2-3 NOVIKOVA Y. PS6-4, PS9-4 LUKANOVA D. PS8-3 NOVO G. SY4-2 LUKES J. PS1-6 NOVO S. OC7-4, PS4-8, PS7-10, SY4-2 LUKYANOV Y. PS2-6 NOVOTNY D. PS1-5, PS1-6 LUNETTA M. OC7-4, PS4-8, PS7-10 O m OBA C.M. OC4-5 M. OBER M. SY14-5 OUADAHI N. PS1-10 MAGUEMOUN R. PS5-3 OUEDRAOGO N. PS2-8, PS2-9 MAHE G. OC5-1, PS2-8, PS2-9, PS2-10 MAILLOT F. PS6-6 p MAÏZA D. OC5-2 PACURARI A. PS1-1, PS3-8 MAKANJUOLA J. PS5-2 PAGLIARICCIO G. PS5-9 MALIK R. A. SY15-2 PAPALAMBROS E. PS4-2, PS4-3 MARCUCCI G. OC2-2, PS4-7 PAPAPETROU A. OC1-4 MARIA OLINIC M. SY14-5 PAPASIDERIS C. OC1-4 MARIE I. OC6-2, PS6-7 PAPOUTSIS K. PS4-2, PS4-3 MARQUER A. PS7-8 PATEL V. M. PS5-2 MARTIN A. OC4-2, PS8-9 PÉCSVÁRADY Z. PS9-3 MARTIN R. OC4-2, PS8-9 PENNELLA S. PS6-3, PS6-11 MARTINEZ M. OC3-6 PEREIRA ALBINO J. OC6-7, PS5-1, PS5-8 MARTINI R. PS3-1 PEREIRA ALVES C. PS8-1 MAS J. L. SY3-2 PERENNOU D. PS7-8, SY11-3 MASLOWSKI L. PS3-9, PS9-8 PERNOD G. OC3-4, OC5-6, SY8-1 MASOOD S. PS6-1 PEROT C. PS4-10 MASSOUILLE D. PS4-10 PERRY E .P. PS2-1, PS2-2, PS6-12 MATEESCU R. PS1-1, PS3-8 PICHOT O. OC4-4, OC6-6, SY9-3, SY10-2 MATOS C. OC6-7 PIERARD L. A. PS6-9 MATTIOLI A. PS6-3, PS6-11 PINTO A. SY11-4 MATTIOLI G. PS6-3, PS6-11 PINTO F. PS5-8 MAUFUS M. OC5-6, PS9-7 PIOTROWICZ R. OC1-3 MCBANE R. OC3-5 PIQUET J. OC6-3 MCDONALD K. OC4-2, PS8-9 PISTORIUS M.-A. SY12-1 MEIRELES N. OC6-7, PS5-8 PLISSONNIER D. OC6-2 MELAS N. OC1-6 POCOCK E. S. SY9-4 MELI F. OC7-4, PS4-8, PS7-10 POLANSKA M. OC2-1 MERCAT A. PS6-6 POLANSKI J. OC2-1 MERCIER F. PS5-3 POLLICE F. OC5-4, OC5-5, OC7-3, PS3-7, MICHON-PASTUREL U. PS7-5 PS4-1, PS5-4, PS5-5, PS7-6, PS9-6, PS9-9 MIGDALSKI A. OC1-3 POLLICE P. OC5-4, OC5-5, OC7-3, PS3-7, MIIKHAILOV M. PS8-11 PS4-1, PS5-4, PS5-5, PS7-6, PS9-6, PS9-9 MILOTIC F. OC1-5 POREDOS P. OC7-7, SY4-4 MINOLA M. PS2-3, PS2-4 POSTACCHINI I. OC2-1 www.iua-eurochap2010.eu ~ 87
- 88. POSTACCHINI M. OC2-1 SOLANILLA A. SY12-1 POWELL J. T. SY1-3 SOUDE V. PS6-6 PRANDONI P. OC3-2, OC3-3 SPEAR R. PS4-10 PRETIOVA L. PS5-7 SPRYNGER M. PS6-9 PRIOLLET P. PS7-5, SY12-1, SY12-4 SRIRAM V. OC5-3 PRIOR M. SY11-5 STANCU B. SY14-1 PROCZKA R. OC2-1 STANDFIELD N. J. PS3-4, PS3-5, PS3-6 PRZYTULSKA J. PS9-8 STCHEKOIAN A. O. PS7-3 PSARROS V. PS4-2, PS4-3 STIRN B. OC1-5 PTOHIS N. OC1-4 STROZZI M. PS1-3 PUTAREK K. PS1-3 STUCKEY C. OC4-2, PS8-9 PUZZI M. B. OC7-1 SUSAN L. PS1-1, PS3-8 Q t QUERE I. OC3-1, SY8-3 TAGIZADE G. OC1-7 QUINTAVALLA R. OC3-2 TASCH C. OC7-5 TAZZIOLI G. PS6-3 r TEXTOR S. C. OC6-5 R. HIATT W. SY13-1 THOUVENY F. OC6-3 RAO G. PS6-2 TOMKA J. PS5-7 RAO G. H. R. OC5-3 TOSCANO F. PS8-1 RASTEL D. SY2-2 TRIBOUT L. SY12-1 RAVARI H. PS4-6, PS6-10 TRIGONIS C. OC1-6 REIS L. OC2-4, PS6-8 TRIPONIENE D. PS5-10 RHEDER J. OC7-1 TRIPONIS V. PS5-10 RIBEIRO K. PS5-8 TRUIJLLO SANTOS J. OC3-2 RIOM H. PS7-7 TRUXANOV A. PS7-2 RITA MATOS A. PS5-1 TURNER N. PS3-10 RODRIGUES C. PS5-1 ROLLAND C. PS9-7 U ROLLINS D. OC4-2, PS8-9 UHL J.- F. SY2-4, SY7-2 ROMOSAN I. PS1-1, PS3-8 ULIMBASHEVA Z. PS8-10 ROS E. OC3-6 ROSSI R. OC5-4, PS4-1, PS5-4, PS5-5, PS9-9 V ROSSI-SEIGNERT A. K. OC6-1 VAHEDIAN M. PS4-6 VAKHITOV M. OC4-1, PS8-10 S VALE P. PS3-2, PS3-3 SALEM A. OC1-1, PS8-2 VAN BELLE E. SY13-1 SALEM M. OC1-1, PS8-2 VANZETTO G. OC5-6 SALEM T. OC1-1, PS8-2 VAS-BIOBANK WORKING GROUP OC2-5 SALIMIFAR M. PS6-10 VAS-SCIENTIFIC TEAM OC2-5 SAMELOVA K. PS7-1 VASSEUR M. PS2-8, PS2-9 SÁNCHEZ-CRUZ J.J. OC3-6 VAVERKOVA H. PS1-5, PS1-6 SANSONE M. OC7-3 VAYSSAIRAT M. SY12-1 SARATZIS A. OC1-6 VELLUT F. PS7-8 SARATZIS N. OC1-6 VIEIRA T. PS5-1, PS5-8 SARRADON P. OC4-3 VILLEMUR B. PS7-8, SY11-3 SASSI M. OC6-4 VISCONTI C. SY4-2 SATGER B. SY5-3 VISONÀ A. OC3-2, OC3-3 SAUMET J. L. PS2-10 VOLL A. PS3-10 SAUVAGET T. PS2-10 VORONINA E. PS6-4, PS9-4 SAVOIU G. PS1-1, PS3-8 VRKIC KIRHMAJER M. PS1-2, PS1-3 SCANDALE G. PS2-3, PS2-4 SCHMID-SCHÖNBEIN G. W. SY9-4 W SEDOV V. M. PS2-5 WILLOTEAUX S. OC6-3 SEINTURIER C. OC6-6, PS7-7 WITKIEWICZ W. PS1-4, PS3-9, PS9-8 SEMENOV D. PS8-10 WYSOKINSKI W. OC3-5 SENET P. SY12-1 SERBAN C. PS1-1, PS3-8 X SESSA C. OC6-6 XIROMERITIS K. OC1-4 SEVESTRE M.A. OC3-1, OC3-4 SEVOSTYANOVA K. PS6-4, PS9-4 y SHAWISH E. PS8-7 YOFFE B. PS4-5 SHEVELA A. PS6-4, PS9-4 SHIN S. PS8-6 Z SIANI A. OC2-2, PS4-7 ZAKIRJAYEV E. OC1-7, OC2-7 SIMAS A. OC6-7 ZEENY M. OC5-1 SIMKOVA I. PS5-7 ZEMMOUR D. PS1-10 SINTES P. SY12-1 ZERNOVICKY F. PS7-1 SLAVIK L. PS1-5 ZERNOVICKY JR. F. PS7-1 SLOBODYANYUK V. V. PS2-5, PS2-6 ZEYNALOVA G. OC2-7 SLOTEMA E. OC4-3 ZINGARETTI O. PS5-9 SMILOV N. PS8-4 ZITA Z. PS5-7 SOBRINHO G. OC6-7, PS5-8 ZSIBIN A. PS8-10 SOKURENKO G. Y. PS2-5 ZYZKA V. OC3-1 88 ~
- 89. General information Congress Dinner on Saturday, September 25 at 19:30 Dates and Congress venue the Congress dinner will be held at Le Cercle National des 19 EuroChap th Armées which is located Place St Augustin, in the heart of September 24 to 26, 2010 Paris. Maison de la Chimie - 28, rue Saint-dominique the building was inaugurated in 1928, by the President of 75007 Paris / France the republic Gaston doumergue. Phone: +33 (0)1 40 62 27 00 - Fax: + 33 (0)1 45 55 98 62 the building of the Place Saint-Augustin is due to the chief www.maisondelachimie.com architect of the Palais nationaux, Charles Lemaresquier, member of the institute. Access thierry Chevalier, the Chef, worked in the kitchens of the Subway: largest luxury hotels, the Crillon and the ritz. Lines 8 and 13 (Invalides), Line 12 (Assemblée nationale) In addition, thierry Chevalier continues to train with the greats: Marc Veyrat, Michel Bras, Pierre hermé, rEr Alain ducasse, Peter Gagnère. Line C (Esplanade des Invalides) Cercle national des Armées BUS 8, place Saint Augustin - 75008 Paris Bus 69 (Esplanade des Invalides) Phone: + 33 (0)1 44 90 26 26 Bus 63, 73, 83, 84, 94 (Assemblée nationale) Fax: +33 (0)1 45 22 17 75 Official Language Official language is English. All presentations, discussions and questions must be in English. no simultaneous translation is organised. Administrative and Scientific Secretariat Welcome desk hall 28 bis – level 0 the congress secretariat is open: - on Friday, September 24 from 07:45 to 19:00 - on Saturday, September 25 from 07:45 to 18:00 - on Sunday, September 26 from 07:45 to 18:00 Subway Line 9, station Saint Augustin AIM France - AIM Group International Line 14, station Gare Saint Lazare (5 mn) 52, rue Bichat - 75010 Paris - France Phone: +33 (0)1 40 78 38 00 Exhibition Fax: +33 (0)1 40 78 38 10 An exhibition is held at room 8 – level 0 of the Maison de E-mail: eurochap2010@aimfrance.fr la Chimie. Exhibition is opened: - on Friday, September 24 from 07:45 to 19:00 Badges - on Saturday, September 25 from 07:45 to 18:00 the wearing of the badge is mandatory inside the - on Sunday, September 26 from 07:45 to 18:00 Congress Center: - red: Speakers, Moderators, Guests Participants’ list - Participants and authors of oral and posters communi- the list of participants is available and can be viewed at cations: the welcome desk. w transparent: 3 days registration w yellow: one day registration, September 24, 2010 w White: one day registration, September 25, 2010 Cloakroom w Black: one day registration, September 26, 2010 hall 28 bis - level 0 - Blue: Exhibitors A cloakroom is available during opening hours of the - Green: Press congress secretariat. It is located near the welcome desk. Please make sure that no personal belongings are left after secretariat’s closing each day. www.iua-eurochap2010.eu ~ 89
- 90. Scientific Information In compliance with EBAC/ EACCME guidelines, all speakers/ chairpersons participating in this programme have Posters disclosed potential conflicts of interest that might cause Posters are displayed in room 8, level 0 of the Congress a bias in the presentations. the Organising Committee Centre. is responsible for ensuring that all potential conflicts of Posters must be displayed for the two first days of the interest relevant to the programme are declared to the meeting. audience prior to the CME activities. Posters set up: - Friday 24 September, 2010 from 07.30 to 11.00 (Before the first coffee break) Dismantling: - Saturday 25 September, 2010 from 15.30 to 16.00 (After the coffee break) Your poster has been given a number and shall be fixed on the poster board marked with the same number. Pins and tape are at your disposal at the welcome desk. the Organizing Secretariat will not be responsible for posters that have not been collected at the end of the meeting. Guided visit session of the posters: Presenting authors are requested to stand close to their poster during the guided visit sessions as follows: - Friday 24, September 2010 from 14:00 to 15:30 presentation of the posters on the themes: w PS1- Atherosclerosis w PS2 - Peripheral arterial disease (1) w PS3 - Peripheral arterial disease (2) w PS4 - Vascular Surgery (1) w PS5 - Vascular Surgery (2) - Saturday 25, September 2010 from 14:00 to 15:30 presentation of the posters on the themes: w PS6 - Arteritis, vasculitis, therapeutic w PS7 - Chronic venous disorders / Lymphedema w PS8 - Varicose veins w PS9 - Venous thromboembolic disease Preview room room 103 - level 1 All the speakers have to come to the preview room. We advise all the speakers to provide to the preview room their presentation a half-day minimum before the beginning of the session. Computers (PC and Mac) are available in the preview room. CME Accreditation «the event “19th EuroChap European Chapter Meeting of the IUA” is accredited by the European Board for Accreditation in Cardiology (EBAC) for “18” hours of External CME credits. Each participant should claim only those hours of credit that have actually been spent in the educational activity. EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS).” 90 ~
- 92. A unique actionat the core of chronic venous disease No. 1 phlebotropic drug worldwide Presentation and composition: Micronized, purified flavonoid fraction 500 mg: diosmin 450 mg; hesperidin 50 mg. Therapeutic proper- ties: Vascular protector and veno- tonic. Daflon 500 mg acts on the return vascular system: it reduces venous disten- sibility and venous stasis; in the microcircula- tion, it normalizes capillary permeability and rein- forces capillary resistance. Pharmacokinetics: Microniza- tion of Daflon 500 mg increases its gastrointestinal absorp- tion compared with nonmicronized diosmin (urinary excretion 57.9% vs 32.7%). Therapeutic indications: Treatment of organic and idio- pathic chronic venous insufficiency of the lower limbs with the following symptoms: heavy legs; pain; nocturnal cramps. Treatment of hemorrhoids and acute hemorrhoidal attacks. Side effects: Some cases of minor gastrointestinal and autonomic disorders have been reported, but these never required cessation of treatment. Drug interactions: None. Precautions: Pregnancy: experimental studies in animals have not demonstrated any teratogenic effects, and no harmful effects have been reported in man to date. Lac- tation: in the absence of data concerning the diffusion into breast milk, breast-feeding is not rec- ommended during treatment. Contraindications: None. Dosage and administration: In venous dis- ease: 2 tablets daily. In acute hemorrhoidal attacks: the dosage can be increased to up to 6 tablets daily. As prescribing information may vary from country to country, please refer to the complete data sheet supplied in your country. Les Laboratoires Servier - France. - Correspondent: Servier International - 35, rue de Verdun - 92284 Suresnes Cedex - France. Website: www.servier.com Daflon 500 mg (MPFF) is also registered under various trade names, including: Detralex, Arvenum 500, Elatec, Alvenor, Ardium, Capiven, Variton 1 - Ramelet AA, Clin Hemorheol Microcir. 2005;33:309-319. 2 - Nicolaides A, Int Ang. 2008;27:1-60. 2 tablets daily Chronic venous disease