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  • ISSN: 2378-9344
    Early Online
    Volume 5, Issue 2
    Research Article
    Jayesh Betala, Jeoung Soo Lee, Eugene M. Langan III, and Martine LaBerge*
    Purpose: Endovascular stents to manage plaque formation in arteries cause restenosis with smooth muscle cells (SMCs) proliferation. Estrogen is known to exert cardiovascular protective effects and antiproliferative effects on vascular smooth muscle cells in vitro as well as in vivo. In this study, we evaluated the effect of estrogen (17-β estradiol) delivered withiopromide-370 (17-βE/Iop) on SMCs proliferation, apoptosis, protein expression and hypertrophy under static and dynamic strain conditions.
    Methods: Rat aortic SMCs were cultured in static and dynamic conditions for 24 hours, followed by short-term treatment with 17-βE/Iop. At a predetermined time, SMCs were analyzed for proliferation using MTT assay, apoptosis employing TUNEL assay, and hypertrophy by immunostaining for SM a-actin, and SM22a expression by western blot.
    Results: Rat aortic SMCs proliferation was significantly inhibited after treatment of 17-βE/Iop for 5 minutes, and inhibition was maintained up to 7 days in static conditions and up to 3 days in dynamic conditions as compared to untreated control. For apoptosis, hypertrophy, and protein expression levels, SMCs treated with 17-βE/Iop were not significantly different from untreated SMCs in both static and dynamic conditions.
    Conclusion: Estrogen with iopromide-370 (17-βE/Iop) showed significant SMCs proliferation inhibition with 5 minutes' treatment; however, no other effects were observed after treatment in both static and dynamic conditions.
    Lisa Schuler*, Iris Weingard, Martin Kiderlen, Athansios Theodoridis, Karsten Hartmann, and Venenzentrum Freiburg
    Objectives: In addition to combined high ligation and stripping or pure sclerotherapy, various endovenous thermal procedures are now available for treatment. Laser ablation (EVLA 1470nmTM), Radio frequency ablation (RFITT and ClosureFastTM) and superheated steam are compared in the present study.
    In this prospective study between 2009 and 2013, the GSV was ablated in 297 patients using one of four methods: EVLA 1470nm (n=75), Closure Fast (n=94), RFITT (n=81) or superheated steam (n=47). The recurrence rate after treatment was defined as the primary endpoint. Follow-up examinations with duplex ultrasound took place 14 days, 3 months and 1 year post-operatively, and thereafter annually with average follow-up time of 3.8 years and a follow-up rate of 81%.
    Results: At the time of the last follow-up examination, the following complete closure rates of treated GSV were found: EVLA 89%, RFITT 57%, superheated steam 56% and Closure Fast 94%. Serious complications occurred only with superheated steam (necrosis at the puncture site). The median pain intensity recorded 14 days post-operatively was 1-3 on a scale of 1-10 in all groups. Both the CIVIQ score and the VCSS were significantly improved by all endovenous thermal methods. In 5-12% of cases, reflux was found in the previously non-reflexive AASV.
    Conclusions: EVLA and Closure Fast are indicated for the treatment of GSV incompetence with high success rates, comparable to the results with high ligation and stripping. The RFITT and superheated steam methods presented with significantly lower closure rates.
    Adeola T. Adetiloye, Olusola C. Famurewa, Adeleye D. Omisore*, Anthony O. Akintomide, and Adeoye J. Adetiloye
    Background: Primary hypertension (PHT) has been linked to vascular endothelial dysfunction (ED) which is an initial step in the development of atherosclerosis. Brachial artery percentage flow mediated dilatation (%FMD) is widely used as a surrogate marker to assess endothelial function (EF). We aimed to evaluate %FMD in subjects with PHT and determine effect of additional co-existing traditional cardiovascular risk factors (CVRFs) on %FMD in them.
    Methods: Brachial artery % FMD of 125 subjects with PHT and 125 age and sex matched apparently healthy controls (HC) were measured by high resolution B-mode ultrasound. Their demographic data, clinical history, anthropometric and laboratory parameters like serum fasting lipid profile (FLP) and fasting blood glucose (FBG) were also taken. Data was analysed using SPSS version 22 and p value <0.5 considered as statistically significant.
    Results: Percentage FMD was significantly worse in subjects with PHT (2.30 ± 2.65) compared to the HC (7.10 ± 2.65), (p<0.01). Increasing age, male gender and postmenopausal status in the HC (all p<0.01) while increasing age and postmenopausal status in PHT (all p<0.01) subjects were associated with worse %FMD. In the PHT subjects, poor blood pressure (BP) control (p=0.014), duration of PHT (p=0.033) of more than 10 years and presence (p=0.016) of one additional co-existing traditional CVRF which were either age or menopausal status, further worsened %FMD. More than one co-existing CVRFs with PHT had no further effect on %FMD (p>0.05).
    Conclusion: There is worsening of % FMD in PHT compared to HC subjects. The presence of increasing age or postmenopausal status, poor BP control and duration of PHT further worsen %FMD in PHT subjects.
    Cases Report
    Ana de la C. Roman Montoya*, Clara Martinez Manrique, Noraima Contreras Vega, and Ivelisa Flores Ramirez
    A descriptive intervention was made of cases with varicose ulcers in the lower extremities, which were treated with different systemic antibiotics and topically another range of drugs, after a torpid evolution of the lesion that ranged between 3 and 12 months. The CM-95 solution was applied as fomentations and was administered orally, preserving the antibiotic therapy, until the total resolution of the lesion with a reduction of the cure time from 15 to 45 days. The effectiveness of the applied treatment with a positive evolution until complete healing was demonstrated, due to the immunomodulatory, anti-inflammatory and healing effects of the magnetically treated solution.
    Anca Sabina Petras, Marilena Spiridon, Irina Iuliana Costache* and Antoniu Octavian Petris
    We present a case of a young female associating multiple thromboses, both in the arterial and venous territories, in the context of acquired and hereditary thromboembolic risk factors, respectively, pregnancy and hereditary thrombophilia. Identification of the prothrombotic factors responsible for acquired or hereditary thrombophilias is justified in this case by the appearance of arterial thrombosis in a young woman without atherosclerotic risk factors, such as smoking, dyslipidemia, diabetes mellitus, hypertension, to which we finally discovered two heterozygous mutations in the hereditary thrombophilia profile. Thrombophilias can cause multiple or recurrent thromboses, in unusual sites, sometimes severe, with dramatic consequences, therefore the lifelong oral anticoagulation decision should be weighed according to the benefit/risk ratio.
    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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