The best medical treatment of venous insufficiency in 2013uvcd
This document summarizes the best medical treatment of venous insufficiency in 2013. It discusses the epidemiology, etiology, socioeconomic aspects, and management of chronic venous disorders. It provides details on medical therapeutic methods, including venoactive drugs, compression therapy, and lifestyle adaptations. It evaluates the efficacy of various venoactive drugs like calcium dobesilate, MPFF, and hydroxyethyl rutosides in treating symptoms and venous leg ulcers based on clinical trials and meta-analyses. It also explains the effects of drugs on the macrocirculation, microcirculation, and leukocyte-endothelium interaction in attenuating venous inflammation.
Twenty years of evar in the us the procedure that changed a specialtyuvcd
The document discusses the major impact that endovascular aneurysm repair (EVAR) has had on the field of vascular surgery over the past 20 years. It summarizes that EVAR blurred specialty relationships, forced retraining of vascular surgeons, changed operating room practices, doubled training requirements, promoted vascular surgery as a specialty, and increased demand for and compensation of vascular surgeons. Randomized clinical trials showed EVAR had superior early outcomes compared to open repair for abdominal aortic aneurysms. This led to its rapid adoption in the United States despite many patients having hostile anatomies for the procedure.
Deep venous disease treatment is evolving. New scoring systems like the LET classification system provide standardized assessment of deep vein thrombosis. For iliofemoral DVT, interventional treatment options are indicated and being improved, with goals of reducing post-thrombotic syndrome through improved recanalization and valve preservation. Emerging dedicated devices aim to remove thrombi through local thrombolysis or without lytic agents, facilitating faster outpatient procedures. Stents are also being increasingly used, and new anticoagulants are improving standard DVT treatment.
The hybrid vascular e ptfe graft as an alternative for hemodialysis accessuvcd
The hybrid vascular ePTFE graft is proposed as an alternative for difficult hemodialysis access cases. It combines an ePTFE graft with a covered nitinol stent to create a sutureless venous anastomosis. This is aimed at improving graft patency by reducing intimal hyperplasia. The initial experience with the hybrid graft shows it can be used safely and effectively to establish access in complex patients with few alternative options. Further studies are still needed to determine if it provides long term patency results superior to other grafts.
Visceral debranching for the treatment of taaauvcd
The document discusses visceral debranching for the treatment of thoracic aortic aneurysms (TAAAs). It describes the hybrid technique which involves extra-anatomic revascularization of the celiac, superior mesenteric artery (SMA), and renal arteries, followed by exclusion of the TAAA using endovascular stent grafts. This reduces visceral ischemic time, avoids aortic cross-clamping, and has advantages over open surgery such as lower morbidity and mortality. The operative technique, outcomes, and examples of patients treated with this approach are provided.
The best medical treatment of venous insufficiency in 2013uvcd
This document summarizes the best medical treatment of venous insufficiency in 2013. It discusses the epidemiology, etiology, socioeconomic aspects, and management of chronic venous disorders. It provides details on medical therapeutic methods, including venoactive drugs, compression therapy, and lifestyle adaptations. It evaluates the efficacy of various venoactive drugs like calcium dobesilate, MPFF, and hydroxyethyl rutosides in treating symptoms and venous leg ulcers based on clinical trials and meta-analyses. It also explains the effects of drugs on the macrocirculation, microcirculation, and leukocyte-endothelium interaction in attenuating venous inflammation.
Twenty years of evar in the us the procedure that changed a specialtyuvcd
The document discusses the major impact that endovascular aneurysm repair (EVAR) has had on the field of vascular surgery over the past 20 years. It summarizes that EVAR blurred specialty relationships, forced retraining of vascular surgeons, changed operating room practices, doubled training requirements, promoted vascular surgery as a specialty, and increased demand for and compensation of vascular surgeons. Randomized clinical trials showed EVAR had superior early outcomes compared to open repair for abdominal aortic aneurysms. This led to its rapid adoption in the United States despite many patients having hostile anatomies for the procedure.
Deep venous disease treatment is evolving. New scoring systems like the LET classification system provide standardized assessment of deep vein thrombosis. For iliofemoral DVT, interventional treatment options are indicated and being improved, with goals of reducing post-thrombotic syndrome through improved recanalization and valve preservation. Emerging dedicated devices aim to remove thrombi through local thrombolysis or without lytic agents, facilitating faster outpatient procedures. Stents are also being increasingly used, and new anticoagulants are improving standard DVT treatment.
The hybrid vascular e ptfe graft as an alternative for hemodialysis accessuvcd
The hybrid vascular ePTFE graft is proposed as an alternative for difficult hemodialysis access cases. It combines an ePTFE graft with a covered nitinol stent to create a sutureless venous anastomosis. This is aimed at improving graft patency by reducing intimal hyperplasia. The initial experience with the hybrid graft shows it can be used safely and effectively to establish access in complex patients with few alternative options. Further studies are still needed to determine if it provides long term patency results superior to other grafts.
Visceral debranching for the treatment of taaauvcd
The document discusses visceral debranching for the treatment of thoracic aortic aneurysms (TAAAs). It describes the hybrid technique which involves extra-anatomic revascularization of the celiac, superior mesenteric artery (SMA), and renal arteries, followed by exclusion of the TAAA using endovascular stent grafts. This reduces visceral ischemic time, avoids aortic cross-clamping, and has advantages over open surgery such as lower morbidity and mortality. The operative technique, outcomes, and examples of patients treated with this approach are provided.
Eversion or standard carotid endarterectomy local or general anesthesia does ...uvcd
1) This document discusses different techniques for carotid endarterectomy (CEA), including eversion endarterectomy (EEA) versus standard CEA with patchplasty, and whether general (GA) or local anesthesia (LA) makes a difference.
2) Meta-analyses and randomized trials like the GALA trial found no significant differences in stroke or death rates between EEA versus CEA, or between GA versus LA.
3) The conclusions are that the choice of surgical technique and anesthesia method depends on surgeon and patient factors, with completion imaging advisable, but overall the scientific evidence shows no difference in outcomes between the various options.
Eversion or standard carotid endarterectomy local or general anesthesia does ...uvcd
1) This document discusses different techniques for carotid endarterectomy (CEA), including eversion endarterectomy (EEA) versus standard CEA with patchplasty, and whether general (GA) or local anesthesia (LA) makes a difference.
2) Meta-analyses and randomized trials like the GALA trial found no significant differences in stroke or death rates between EEA versus CEA, or between GA versus LA.
3) The conclusions are that the choice of surgical technique and anesthesia method depends on surgeon and patient factors, with completion imaging advisable, but overall the scientific evidence shows no difference in outcomes between the various options.
