Nobuhisa Kurihara

Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser

OBJECTIVE Major side effects after endovenous laser ablation (EVLA) are pain and bruising. The aim of this study was to compare outcome and side effects after EVLA for primary varicose veins with 1470 nm diode laser using bare-tip orradial fiber. METHODS From October 2007 to December 2010, 385 patients (453 limbs) with primary varicose veins treated with 1470 nm laser were studied. Bare-tip fiber was used in 215 patients (242 limbs) (BF group) and radial fiber (ELVeS(TM)Radial, Biolitec AG, Germany) was used in 177 patients (211 limbs) (RF group). This study is a retrospective study and radial fiber was started for use from November 2008. Laser energy was administered at 6-12 W of power in the BF group and 10 W of power in the RF group with constant pullback of laser fiber under tumescent local anesthesia. The patients were assessed by clinical examination and venous duplex ultrasonography at 24-48 h, one week, one month, 4 months and one year follow-up postoperatively. RESULTS Mean operating time, length of treated vein and linear endovenous laser energy of all cases were 42.6 min, 36.2 cm and 83.4 J/cm, respectively. Major complications such as deep vein thrombosis and skin burns were not noted. Bruising (1.9% vs. 19.4%) and pain (0.9% vs. 7.4%) were significantly lower in the RF group. Cumulative occlusion rates by Kaplan-Meier method were 100% at 32 months in the RF group and 99.5% at 4 years in the BF group. CONCLUSION EVLA using 1470 nm laser with the radial fiber minimized adverse effects compared with bare-tip laser fiber. (English translation of Jpn J Vasc Surg 2013; 22: 615-621).

Differential detection rate of periodontopathic bacteria in atherosclerosis

PurposePeriodontitis has been associated with atherosclerotic cardiovascular lesions. There may be a link between periodontopathic bacterial infection and atherosclerosis.MethodsIn 53 patients with atherosclerosis, periodontal disease was classified according to the probing depth of the periodontal pocket. To compare the detection rate in different arterial lesion, specimens of diseased arteries (10 primary atherosclerotic lesions, 43 anastomotic lesions) and 21 control arteries without atherosclerotic findings macroscopically and microscopically in the arterial wall, obtained during the surgical procedures were examined for the presence of five species of putative periodontal bacteria using polymerase chain reaction (PCR) analysis.ResultsFifty-one of the 53 patients (96%) had periodontitis, and 34 (64%) of those patients had severe periodontitis or were edentulous. In total, PCR analysis detected DNA specific for periodontal bacteria in 28 of the 53 specimens (52%) of atherosclerotic arterial wall. Only 5 of 21 (23%) were detected in control specimens.ConclusionsA high percentage of periodontopathic bacteria were detected in atherosclerotic arterial wall specimens from patients with atherosclerosis, especially with primary atherosclerotic lesions, and most cases had severe periodontitis.

Arterial thrombosis after intravenous infusion of oral bacterium in a rat model.

Oral bacteria have been detected at atherosclerotic plaque, aneurysms, and thrombosed arteries in Buerger disease. We explored a possible relationship between the oral bacterium Porphyromonas gingivalis and arterial thrombosis at proximal and distal sites in rats. Eighteen rats underwent subcutaneous placement of an infusion pump connected to the jugular vein. The Pg infusion group received a continuous infusion of P. gingivalis for 2 weeks, and the controls received normal saline. At 2 and 4 weeks, specimens were obtained from the iliac, superficial, and below-knee arteries, which were studied pathologically and by polymerase chain reaction (PCR) analysis to detect P. gingivalis-specific DNA. The Pg infusion group had thrombosis in 33.3% at 2 weeks and in 55.6% at 4 weeks, but normal arterial wall structure was preserved without any features of infection. Positive PCR findings were recognized in 73.3% and 22.2% at 2 and 4 weeks, respectively. At 4 weeks, thrombosis was observed in a higher proportion, with the below-knee specimens having an especially high thrombus rate (83.3%). No control specimen had thrombosis or positive PCR results. Bacteremia due to the oral pathogen P. gingivalis may lead to thrombus formation in the peripheral arteries, especially in small-sized arteries.

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Objective: Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and effective treatments for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) are known complications of these procedures. The purpose of this article is to investigate the incidence of postoperative DVT and EHIT in patients undergoing EVLA and RFA. Methods: The patients were assessed by clinical examination and venous duplex ultrasonography before operation and at 24-72 hours, 1 month, and 1 year follow-up after operation. Endovenous ablation (EVA) had been treated for 1026 limbs (835 patients) using an RFA; 1174 limbs (954 patients) using a 1470-nm wavelength diode laser with radial two-ring fiber (1470R); and 6118 limbs (5513 patients) using a 980-nm wavelength diode laser with bare-tip fiber (980B). Results: DVT was detected in 3 legs (0.3%) of RFA, 5 legs (0.4%) of 1470R, and 27 legs (0.4%) of 980B. One patient in three symptomatic DVT treated with 980B developed asymptomatic pulmonary embolus. In all, 31 of the 35 DVTs were confined to the calf veins. The incidence of EHIT classes 2 and 3 was 2.7% following RFA procedure, 6.7% after 1470R, and 7.5% after 980B. Conclusion: The incidence of EHIT following EVA was low, especially the RFA procedure. EHIT resolves within 2-4 weeks in most patients. DVT rates after EVA were compared with those published for saphenous vein stripping. (This is a translation of J Jpn Coll Angiol 2015; 55: 153-161.).

Anatomical variation at the sapheno-femoral junction.

OBJECTIVE The aim of this study was to assess the anatomical variations of the sapheno-femoral junction (SFJ) and the incidence of these variations. MATERIALS AND METHODS Between April 2005 and March 2010, 2552 limbs of 1563 patients with complaints of varicose veins underwent ultrasonography. Ultrasonography was used to identify the anatomical variations of the SFJ, especially the relationship to the femoral artery. RESULTS Variations were seen in six limbs (0.24%) at the SFJ. The most common anatomical variation was the great saphenous vein crossing posterior to the common femoral artery, which was present in three limbs. CONCLUSION It is important to investigate the anomalies of the SFJ using preoperative duplex ultrasound, although the incidence of such anomalies is lower than that of the sapheno-popliteal junction. An anomaly of the SFJ always should be taken into consideration in order to minimize surgical complications of varicose veins. (English translation of Jpn J Phlebol 2012; 23: 25-29).