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Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. 总被引:3,自引:0,他引:3
T Kostas C V Ioannou E Touloupakis E Daskalaki A D Giannoukas D Tsetis A N Katsamouris 《European journal of vascular and endovascular surgery》2004,27(3):275-282
OBJECTIVE: To assess the true incidence, the reflux patterns and the mechanisms responsible for recurrent varicose vein disease according to current definitions and guidelines. PATIENTS AND METHODS: Ninety-three patients (69 female, 24 male, mean age: 48 years) were prospectively evaluated pre- and postoperatively (1 month and 5 years), using clinical and colour duplex examination of both lower limbs. The CEAP score and its modification for recurrence (REVAS) were used for classification. RESULTS: In 113 operated lower limbs, 28 (25%) were found to have a recurrence, 20 of which were symptomatic (20/28, 72%). However, in this group, the mean severity score decreased significantly from 6.5 (SD 3.1) to 5.2 (SD 2.8) (p<0.001, paired t-test). The correlation between the type and cause of recurrence revealed: (1) true recurrent varices in eight limbs (8/28, 29%), primarily caused by neovascularisation, (2) new varicose veins as a consequence of disease progression in seven limbs (7/28, 25%), (3) residual veins in three limbs (3/28, 11%) mainly due to tactical errors (e.g. failure to strip the GSV), (4) complex patterns in 10 limbs (10/28, 36%). In the limbs with recurrence, 42 sources of venous reflux were identified: (1) 19 new sites of venous reflux were due to disease progression (15% of the operated limbs), (2) 13 were caused by neovascularisation (11.5% of the operated limbs), (3) six resulted from tactical failures (5.3% of the operated limbs) and (4) four were due to technical failures (3.5% of the operated limbs). CONCLUSIONS: This study shows that the recurrence of varicose veins after surgery is not uncommon. However, the clinical condition of most affected limbs remains improved. Progression of the disease and neovascularisation are responsible for more than half of the recurrences. Rigorous evaluation of patients and assiduous surgical technique might reduce recurrence due to technical and tactical failures. 相似文献
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Papadopoulou MC Tsiouri I Salta-Stankova R Drakou A Rousas N Roussaki-Schulze AV Giannoukas AD 《The international journal of lower extremity wounds》2012,11(1):20-27
Lymphedema is an underrecognized and undertreated condition that requires a multidisciplinary approach in an individualized program that will address the special needs of each patient. In an ideal setting of an outpatient management program the team should be composed of a vascular surgeon, a dermatologist, a physiotherapist, a dietician, a psychologist, a social worker, and an office employee, working together in the assessment and management of all aspects of lymphedema. All treatment strategies and actions taken should ultimately focus on the improvement of the quality of life of patients suffering from lymphedema and on the prevention of lymphedema in high-risk patients. 相似文献
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Mavroforou A Stamatiou G Koutsias S Michalodimitrakis E Vretzakis G Giannoukas AD 《European journal of anaesthesiology》2007,24(11):903-911
Medical malpractice has been raised as an important problem in daily practice, while the media and public remain unforgiving to those perceived to have harmed the patients' life. This article highlights important legal issues related to medical malpractice and summarizes the sources and the nature of potential errors in anaesthesiology practice. 相似文献
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Karathanos C Sfyroeras GS Stamoulis K Drakou A Vretzakis G Giannoukas AD 《VASA. Zeitschrift für Gef?sskrankheiten》2011,40(3):241-245
We report three cases with concomitant ipsilateral proximal common carotid and internal carotid artery stenosis treated in one stage with carotid endarterectomy and retrograde primary stenting of the common carotid artery. The internal carotid artery was clamped during stenting to avoid cerebral embolization. All procedures were successfully completed and all patients remain asymptomatic at 18 months follow up. The one-stage hybrid approach appears to be a safe and effective procedure for the treatment of ipsilateral multifocal significant lesions. 相似文献
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George Vretzakis Athina Kleitsaki Konstantinos Stamoulis Metaxia Bareka Stavroula Georgopoulou Menelaos Karanikolas Athanasios Giannoukas 《Journal of cardiothoracic surgery》2010,5(1):7
Background
Cardiac surgery is a major consumer of blood products, and hemodilution increases transfusion requirements during cardiac surgery under CPB. As intraoperative parenteral fluids contribute to hemodilution, we evaluated the hypothesis that intraoperative fluid restriction reduces packed red-cell (PRC) use, especially in transfusion-prone adults undergoing elective cardiac surgery. 相似文献20.
The experience from the scandals in hospitals at Liverpool and Bristol in the UK where retention of tissue and organs was undertaken without the consent of the parents and relatives raised serious concerns regarding the efficacy of the existing Human Tissue Act 1961, in England and the operation of the law by medical practitioners. In the aftermath of these damaging scandals a combination of public distrust and government overreaction has led to the enactment of new legislation, the Human Tissue Act 2004, which is aiming to prevent any further instances of the retention of organs and tissue from dead children or adults without their next of kin's consent or knowledge. However, scientists have expressed concerns that such changes might seriously endanger several medical research programmes, and also tissue and organ donation for transplantation. The aim of this article is to highlight important issues raised by existing practice in the post-mortem examinations in the UK and the lessons learnt from this and to discuss the benefits and the potential problems arising from the new Act. 相似文献