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  • ISSN: 2378-9344
    Volume 5, Issue 3
    Research Article
    Samy S. Nitecki*, Maya K. Nitecki and Arie Bass
    Background: Klippel-Trenaunay syndrome (KTS) is characterized by capillary malformation, varicosities and bony or soft tissue hypertrophy. Conservative treatment is indicated in all cases.
    Surgery is reserved only for complications. Minimal invasive treatments such as thermal ablation and ultrasound-guided foam sclerotherapy (USGS) for venous insufficiency are currently preferred over surgery.
    Objectives: To present our treatment experience with KTS patients comparing the results of steam vein sclerosis (SVS) and foam to US-guided foam sclerotherapy (USGS) alone.
    Methods: Sixteen patients were treated with USGS alone or with SVS+USGS between 2003 and 2016. Assessment of signs, symptoms, results and overall patient satisfaction was performed before, during and after the treatments.
    Follow up visits (mean 39 months, range 24-60) were scheduled once a month for the first three months and once every three months thereafter.
    Results: Patients mean age was 28 years (range 15-56). The CEAP clinical classification was C4 in 11 patients (69%), 4 in C5 (25%) and one patient in C6 (6%). The average number of sessions was 14 (range 9-21) for USGS alone and 5 (range 3-7) after SVS.
    No major complications were encountered. All patients reported improvement in signs and symptoms. 75% were very satisfied with the cosmetic result.
    Conclusion: SVS and USGS are valid and effective minimal invasive ambulatory procedures for the treatment of KTS patients. Procedures are essentially pain-free with excellent results, albeit the treatment period is long.
    SVS first, followed by foam considerably and significantly shortens the treatment period. Long-term results and larger study groups are warranted.
    Review Article
    Amer Harky*, Darab Khan, Vineshwar Pal Singh, Muhammad Maaz Sajid, and Ewa Zywicka
    Endovascular repair of abdominal aortic aneurysm (AAA), now a day, is the main treatment method which has replaced the traditional open repair for elective AAA in majority of cases. Such endovascular stenting has proven to provide satisfactory early and mid-term outcomes. However, to provide a long-term benefit and ensure the appropriate quality of life is gained from such intervention, a regular follow up with imaging studies are required to detect any early stent-graft issues and plan re-intervention, if required. For this purpose, several imaging techniques have evolved overtime and different modalities have been investigated to provide highest rate of sensitivity and specificity for early detection of endoleaks. In this review article, we outline current literature behind the use of each imaging modalities and its implications on follow up method.
    Dieter Schmidt*
    Background: Atrial fibrillation (AF) is a precursor of stroke. Vitamin K antagonist has revealed risk reduction in ischemic stroke in many studies.
    Methods: Description of an unusual, hitherto unknown phenomenon in a patient
    Result: Rare attacks of blue-margined zigzag phosphenes in an elderly patient with atrial fibrillation that occurred binocularly in homonymous fields. The attacks only occurred during periods of low prothrombine, and disappeared within five to fifteen minutes after taking a vitamin K antagonist. The attacks were not influenced by valsalva provoking activity (coughing or bending). The patient had consistently normal visual acuity, and had never had a visual field defect or neurological deficits.
    Conclusions: The appearance of zigzag phosphenes in this patient with a low prothrombine time is an important warning sign. This phenomenon may be considered as a biological marker for stroke prevention. The occurrence of coloured zigzag phosphenes may refer to areas of hyperexcitable cortical neurons. This phenomenon may be explained by an event involving cerebral microemboli that occurred during periods of low INR values reversible via medications.
    Fatih Islamoglu*
    Modern management of CVI includes treatment of the cause (reflux) and result (varicose veins). Generally, the elimination of reflux has been accomplished with surgery. The new thermal ablation techniques such as endovenous laser ablation therapy (EVLT) and radiofrequency (RF) ablation have the advantage of being performed with only local anesthesia, but they have the potential for residual saphenofemoral reflux due to incomplete ablation of all side branches of the saphenofemoral junction (SFJ). Results of the our past experiments over 12 years showed the safety and effectivity of ligation + foam sclerotherapy as an alternative technique making possible daily surgery are not different than those of classic stripping.
    Case Report
    Richard Chang*, Dagny von Ahrens, Elliott Levy, and Richard Sherry
    Long term indwelling central venous catheters may become incarcerated making removal difficult. This rare complication has been reported with venous catheters of all calibers although small caliber catheters with low tensile strength (PICC lines, Passports, pediatric and neonatal central catheters) are at greater risk for fracture if resistance is encountered during removal. To address this complication, an enzymatic approach using low dose (2 to 4mg) tissue plasminogen activator was used successfully to facilitate removal of 7 stuck or incarcerated venous catheters. This report outlines the technique and describes in detail 2 cases where it was utilized. This approach is simple, effective, and should be considered by clinicians confronted with this sometimes difficult problem.
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