| 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 |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
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. |
Affiliation:
|
BTG International Ltd in London, London, United Kingdom. David.wright@btgplc.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Coronary Circulation England / epidemiology Female Foramen Ovale, Patent / complications, epidemiology*, physiopathology, ultrasonography Humans Intracranial Embolism / etiology, ultrasonography Male Middle Aged Polyethylene Glycols / adverse effects Prevalence 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 |
| Chemical | |
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
Previous Document: Recurrence of a popliteal venous aneurysm.
Next Document: Recovery from hind limb ischemia is less effective in type 2 than in type 1 diabetic mice: roles of ...