Document Detail

High prevalence of right-to-left shunt in patients with symptomatic great saphenous incompetence and varicose veins.
MedLine Citation:
PMID:  19837542     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Varicose veins are common and increasingly are being treated by less invasive endoscopic methods such as foam sclerotherapy. Patent foramen ovale (PFO) is also common, present in approximately one-quarter of adults. PFO allows bubbles introduced by foam sclerotherapy to cross into the general circulation, potentially causing cerebral artery gas embolization with unevaluated consequences.
METHODS: Men and women aged 18 to 60 years with symptomatic varicose veins (CEAP C(3-5)) responded to an advertisement to recruit volunteers for a study on endovenous microfoam ablation (EMA). Participants' veins were screened by duplex ultrasound imaging, and those with isolated great saphenous vein (GSV) incompetence were tested for right-to-left (R-L) vascular shunt using transcranial Doppler (TCD) of the middle cerebral artery to detect the presence of bubble emboli after an injection of an agitated saline, blood, and air mixture as a contrast at rest and with the Valsalva maneuver.
RESULTS: Of 221 participants tested for R-L shunt, 85 (38.5%) were positive at rest (95% confidence interval [CI], 32.5-45.2) and 114 (51.8%) were positive after the Valsalva maneuver (95% CI, 45.4-58.5). A total 130 patients (58.8%) were positive for R-L shunt at rest or after Valsalva (95% CI, 52.5%-65.1%). This is significantly higher than the reported 26% prevalence of PFO in the general population (95% CI, 24.4-30.1).
CONCLUSIONS: The prevalence of R-L shunt in patients with GSV incompetence CEAP C(3-5) in this study was higher than expected in the general population. TCD does not differentiate between intracardiac shunts and intrapulmonary shunts, so this observation needs further investigation. This link between R-L shunt and varicose veins is novel and, whether etiologic or functional, may improve the understanding of both conditions. The findings have importance in the treatment of varicose veins with foam sclerotherapy and EMA.
David D Wright; Kathleen D Gibson; Jean Barclay; Alexander Razumovsky; Janet Rush; Charles N McCollum
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-10-17
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-02-23     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  104-7     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
BTG International Ltd in London, London, United Kingdom.
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MeSH Terms
Coronary Circulation
England / epidemiology
Foramen Ovale, Patent / complications,  epidemiology*,  physiopathology,  ultrasonography
Intracranial Embolism / etiology,  ultrasonography
Middle Aged
Polyethylene Glycols / adverse effects
Pulmonary Circulation
Regional Blood Flow
Saphenous Vein / physiopathology*,  ultrasonography
Sclerosing Solutions / adverse effects
Sclerotherapy / adverse effects
Severity of Illness Index
Ultrasonography, Doppler, Duplex
Ultrasonography, Doppler, Transcranial
United States / epidemiology
Valsalva Maneuver
Varicose Veins / epidemiology*,  etiology,  physiopathology,  therapy,  ultrasonography
Venous Insufficiency / complications,  epidemiology*,  physiopathology,  therapy,  ultrasonography
Young Adult
Reg. No./Substance:
0/Polyethylene Glycols; 0/Sclerosing Solutions; 9002-92-0/polidocanol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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