Both ablation catheters with irrigated system and 8mm tip-catheters have shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. The purpose of this prospective study was to compare the efficiency of radiofrequency catheter ablation (RFA) of the cavotricuspid isthmus using a new type of open irrigation-tip catheter versus 8 mm tip-catheters to eliminate atrial flutter (AFL).Sixty consecutive patients, matched for age, presence of cardiopathy, atrial dimensions and comorbidity, underwent RF ablation of cavotricuspid isthmus (CTI) for the treatment of typical atrial flutter, using an open irrigated tip catheter - Surround Flow™ - (N.=30) or an 8-mm-tip catheter (N.=30). The RF pulses were applied point-by-point for 30 seconds, with power limited at 35 w for the irrigated catheter and by temperature control (60/70 w) for the 8-mm catheter.The CTI block was successfully performed in 100% of cases. There was no significant difference with regard to ablation parameters, such as total time of RF ablation (608±324 vs. 556±244 s, P=0.79), number of RF applications (12±8 vs. 10±5, P=0.56), total procedure duration (86.4±23.6 vs. 78.1±22.5 min, P=0.58) and time of fluoroscopy (12±6 vs. 14±6 min, P=0.25) and periprocedural complications (1 groin hematoma in the 8 mm group). During follow-up of 11.6 months on average, one patient in the 8 mm group had recurrence of typical atrial flutter.Efficacy and safety of CTI ablation was comparable between both techniques (open irrigated catheter and 8mm tip catheter). The ablation parameters were comparable and homogeneous between the two groups.
AIMS: Stenting to relieve iliac vein obstruction is now practical and safe. However, the rates of ulcer healing, pain, and edema relief are 76%, 52%, and 42% respectively. In addition, a high ulcer recurrence (up to 86%) has been reported. Currently, patient selection depends on symptoms, imaging methods, and intravascular ultrasound (IVUS) for the assessment of iliac vein stenosis without consideration of the collateral circulation. The aim of this article is to present the results of a noninvasive method of measuring lower limb outflow resistance (LOR) and also to test the hypothesis that LOR is extremely variable in limbs with iliac obstruction and that some patients with iliac stenosis may have a LOR close to that of normal limbs as a result of a well-developed collateral circulation.MATERIALS AND METHODS: LOR was measured at different venous pressures from 60 to 25 mmHg using air-plethysmography in 15 limbs without and 15 limbs with iliac vein obstruction. Reflux in ml/sec (venous filling index [VFI]) and venous clinical severity score (VCSS) were also measured in all limbs.RESULTS: The LOR at 25 mmHg (LOR25) was found to be the most discriminating measurement between the two groups. The area under the receiver operating characteristic curve was 0.973 (95% confidence interval [CI] 0.923–1.000). The range of LOR25in limbs without obstruction was 0.0043–0.038 mmHg/ml/min and 0.0170–0.330 mmHg/ml/min in limbs with obstruction. By plotting VFI against LOR25, a subgroup of limbs was identified with iliac obstruction that had a high VCSS (5–12) and a near-normal LOR25(0.050 mmHg/ml/min) presumably as a result of a well-developed collateral circulation but a high VFI in the range of 5–14 ml/s. Another subgroup of limbs with iliac obstruction and a high VCSS (5–18) had a high LOR25 (0.100–0.330 mmHg/ml/min) presumably from a poorly developed collateral circulation.CONCLUSION: The noninvasive measurement of LOR25provides a quantitative estimation of overall lower LOR. It can indicate which limbs are compensated by the development of a good collateral circulation and which are not. The combination of LOR25with VFI enables the clinician to determine the relative contribution of reflux and obstruction in individual limbs. A low LOR25in the presence of severe iliac stenosis or occlusion is an indication of a well-developed collateral circulation and suggests that stenting would provide little benefit if any. However, this hypothesis needs to be verified by future prospective studies.
Objectives To evaluate the effect of eccentric compression applied by a new crossed-tape technique on procedure-related pain occurrence after endovenous laser ablation (ELA) of the great saphenous vein (GSV). Methods From April 2005 to June 2006, 200 consecutive ELA procedures were randomized to receive (group A: 100) or not (group B: 100) an eccentric compression applied in the medial aspect of the thigh. Patients were scheduled for a seven-day examination to assess the level of pain experienced. Pain intensity was measured using a visual analogue scale giving a numerical grade from 0 (no pain) to 10 (worst pain ever). Results The intensity of postoperative pain was significantly reduced ( P < 0.001) in the eccentric compression group as compared with the non-compression one. Conclusions This technique of eccentric compression greatly reduces the intensity of postoperative pain after ELA of the GSV.
Background: The possible role of the venous system in the pathogenesis of chronic neurodegenerative diseases has been hypothesized for decades. Quite recently, the description of a venous condition defined as chronic cerebrospinal venous insufficiency (CCSVI) and its strong association with multiple sclerosis (MS) has brought back the attention of the scientific community to the hypothesis of an aetiological or concomitant role of an altered venous function in the occurrence of this pathology. CCSVI is identified by sonographic criteria, thus the indication for its possible treatment is based on ultrasound findings. Method: We retrospectively examined 167 consecutive patients affected by clinically defined MS and CCSVI, identified by ultrasound assessment by the presence of at least two sonographic criteria. Ultrasonographic diagnosis of CCSVI was then integrated by venography and intravascular ultrasound examination (in 43 patients). Patients were all submitted to endovascular procedure (venoplasty). Results In 37% of cases there was no correspondence between the preoperative ultrasound assessment and the venographic findings. In the event of incongruity between venography and sonography, the intravascular ultrasound examination investigation, when performed, confirmed ultrasound findings in 42% of cases and venography results in 58%. At one month in 12% of cases ultrasound assessment showed the persistence of altered flux. In 67% of cases patients reported subjective amelioration, regarding non-specific symptoms. Conclusion: The pathophysiology of CCSVI is yet to be defined. The superior cava venous system is highly complex in terms of anatomy and possible anomalies, as well as its haemodynamic mechanisms. Further studies are required to define the parameters of diagnosis and treatment of CCSVI.
