Eurochap2010 final program

www.iua-eurochap2010.eu ~ 1

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IN CONJUNCTION WITH

9th World Congress for MicrocirculationMaison de la Chimie, September 26-28, 2010

9th Annual Congress of the « Société Française de Médecine Vasculaire »La Villette, September 23-25, 2010

UNDER THE AUSPICES OF

Société Française de Médecine Vasculaire (SFMV)

Société de Chirurgie Vasculaire de Langue Française (SCVLF)

Société Française d’Angiologie (SFA)

Collège Français de Pathologie Vasculaire (CFPV)

Collège des Enseignants de Médecine Vasculaire (CEMV)

ACKNOWLEDGMENTS

The International Union of Angiology thanks for their participation

Ad Rem Technology


WELCOME ADDRESS

Dear Participant,

On behalf of the European Chapter of the International Union of Angiology, and the French societies of vascular medicine and surgery, I am very pleased to offer you a warm welcome to the 19th Eurochap!

The special position of this additional congress allowed us to experiment some specific features, organized in a compact form with only two parallel rooms:

- short lectures keeping time for discussions are organized in thematic symposia addressing the changes in concepts and practices in the different vascular fields;- specific postgraduate sessions based on clinical case solving and decision making will use electronic votes in addition to the comments of experts, in order to increase interactivity; - and the “Forum of Vascular Initiatives”, which will be an occasion to share the richness of the initiatives of the IUA and its members for the teaching of vascular medicine and surgery, the quality of care for the vascular patients and the promotion of patients associations and even humanitarian actions.The innovations also take a great part, since our congress attracted many proposals from which we were able to select 150 abstracts organized in seven oral and ten poster sessions with discussion rounds; furthermore the last congress day will be shared with the 9th World Congress for Microcirculation that follows in the same location.

As you can see, everything has been thought in order to promote and facilitate scientific exchange in a positive and friendly atmosphere. Many top scientist and physicians invited from all over Europe and abroad accepted to play the game with you according to these principles, and we need you to be as active as possible in order to get as much as you can from the feast!

As the congress takes place in the Maison de la Chimie, in the historical center of Paris, we hope it will also be for you the occasion to enjoy the cultural wealth of Paris.

For the Organizing Committee,

Professor Patrick Carpentier, President

SUMMARY Synopsis .................................................................................... 4 ScientificProgram Friday, September 24 ............................................................. 7 Saturday, September 25 ......................................................... 14 Sunday, September 26 ........................................................... 20 Congress Map and Exhibition Plan ......................................... 24 Abstracts Symposia .............................................................................. 26 Oral Communications ......................................................... 43 Posters ................................................................................. 58 Authors’ Index .......................................................................... 85 General Information ................................................................. 89

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Friday, September 24, 2010From 07:45 registration Hall 28 bis

08:30-09:20 amphithéâtre LavoisierPlenary lecture

the 2010 milestones of the vascular surgeonJ. Fernandes e Fernandes

09:30-11:00 amphithéâtre LavoisierSY1 - Symposium

abdominal aortic aneurysms: an update

petit amphithéâtreSY2 - Corporate Symposium SIGVARIS

Efficient compression therapy to treat venous diseases: scientific, medical and practical key factors

11:00-11:30 Coffee break - Posters and Exhibition visit Room 8


Carotid stenosis: moving concepts and practices

petit amphithéâtreOC1 - Free communicationsVascular surgery: arteries

13:00-14:00 Break - Posters and Exhibition visit Room 8

14:00-15:30 amphithéâtre LavoisierSY4 - Symposiumearly detection

of the high vascular risk subjects

petit amphithéâtreOC2 - Free communicationsperipheral arterial disease

room 8poster Sessions

pS1 to pS5



Therapeutic education of the vascular patient

petit amphithéâtreOC3 - Free communications

Venous thromboembolic disease17:30-18:30 amphithéâtre Lavoisier

SY6 - Corporate symposiumCook Medical

New developments in endovascular technologies

petit amphithéâtreSY7 - Symposium

New insights about the calf muscle pump functionOrganized thanks to an unrestricted grant

from Ad Rem Technology - Veinoplus

SatUrday, September 25, 201008:30-09:20 amphithéâtre Lavoisier

Plenary lecturethe 2010 milestones of the vascular physician

J. Belch09:30-11:00 amphithéâtre Lavoisier

SY8 - SymposiumVenous thromboembolic disease:

moving concepts and practicesOrganized thanks to an unrestricted grant from Eumedica

petit amphithéâtrePostgraduate Course

Leg and foot ulcers - Critical limb ischemia



Varicose vein treatment in the future


Venous thromboembolic disease - thrombophilia13:00-14:00 Break - Posters and Exhibition visit Room 8


Ultrasound guided procedures


Clinical microcirculation

room 8poster Sessions

pS6 to pS915:00-15:30 Coffee break - Posters and Exhibition visit Room 8

15:30-17:30 amphithéâtre LavoisierPlenary session

Forum of vascular initiatives

19:30 Congress dinner at the Cercle National des Armées (under registration)

Pleanary sessionSymposia and free communicationsPosters

sYNOPSIS


sYNOPSIS

SUNday, September 26, 201009:30-11:00 petit amphithéâtre

SY11 - Joint Symposium with theItalian Society of Angiology and Vascular Medicine

physical exercise and vascular medicine

room 262OC4 - Free communications

Varicose veins

11:00-11:30 Coffee break - Exhibition visit Room 8

11:30-13:00 petit amphithéâtreSY12 - Symposium

From raynaud phenomenon to digital ulcerOrganized thanks to an unrestricted educational grant

from Actelion Pharmaceuticals


atherosclerosis

13:00-14:00 Break - Exhibition visit Room 8


Critical limb ischemiaOrganized thanks to an unrestricted grant

from Sanofi Aventis

petit amphithéâtreSY14 - Joint Symposium with the

Romanian Society of Angiology and Vascular Surgery

Complications of vascular procedures


rare vascular diseases and progressin vascular diagnosis

15:30-16:00 Break - Exhibition visit Room 8

16:00-17:30 amphithéâtre LavoisierSY15 - Joint Symposium EuroChap - Microcirculationrelationship between macro and microcirculation


Venous disorders

Pleanary sessionSymposia and free communicationsPosters

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ORGANIZING COMMITTEE

LOCAL ORGANIZING COMMITTEEPresident: Patrick CArPEntIEr (IUA) Members: François-André ALLAErt (SFA) François BECKEr (CEMV) Christian BOISSIEr (IUA) Michèle CAzAUBOn (SFA) nabil ChAKFE (SCVLF) Fabien KOSKAS (SCVLF) Philippe nICOLInI (SCVLF) Gilles PErnOd (SFMV) Pascal PrIOLLEt (CFPV) Isabelle QUéré (SFMV) Michel VAySSAIrAt (CFPV)

INTERNATIONAL UNION OF ANGIOLOGY Executive Board

Honorary presidentP. BALAS (Greece)

presidentR. SIMKIN (Argentina)

president electK. ROZTOCIL (Czech Republic)

immediate past presidentE. BASTOUNIS (Greece)

advisors to the presidentC. ALLEGRA (Italy)N. ANGELIDES (Cyprus)E. ASCHER (USA)P. CARPENTIER (France)J. FAREED (USA)J. FERNANDES E FERNANDES (Portugal)J. FLETCHER (Australia)S. GEORGOPOULOS (Greece)H. GIBBS (Australia)P. GLOVICZKI (USA)Y-Q. GU (China)E. HUSSEIN (Egypt)B.B. LEE (USA)S. NOVO (Italy)H. PARTSCH (Austria)P. POREDOS (Slovenia)G. RAO (India)A. SCUDERI (Brazil)H. SHIGEMATSU (Japan)J. ULLOA (Colombia)

Vice presidentsY-Q. GU (China)P. VALE (Australia)K. ROZTOCIL (Czech Republic)M. DE CASTRO SILVA (Brazil)A. SIDAWY (USA)E. HUSSEIN (Egypt)T. ABDOOL CARRIM (Rep. S. Africa)

Secretary General: A. JAWIEN (Poland)assoc. Secretary General: P. POREDOS (Slovenia)treasurer General: J. BELCH (UK)assoc. treasurer General: G. GEROULAKOS (UK)

Chapter SecretariesK. KOMORI (Japan)T. KARPLUS (Australia)P.L. ANTIGNANI (Italy)C. GOLDENSTEIN (Argentina)R. SHEPHERD (USA)A.S. EL GATIT (Libya)J. PILAI (Rep. S.Africa)S. NOVO (Italy)

advisors to the boardF. ALLAERT - C. BAKOYIANNIS - J. BARBOSAF. BENEDETTI VALENTINI - G. BIASI - D. CLEMENTM. DE CASTRO SILVA - G. DERIU - E. DIAMANTOPOULOSK. FILIS - W.R. HIATT - A.T. HIRSCH - D. HOPPENTAEDTA. MANSILHA - G. MARCUCCI - P.G. MATTHEWSL. NORGREN - Z. PECSVARADY M.E. RENNO DE CASTRO SANTOS - A. SCHIRGERF. SPINELLI - A. VISONA’ - Z.G. WANG - J.H. ULLOA

representatives of other Societies:International Union of Phlebology (IUP)A. SCUDERI (Brazil)

Mediterranean League of Angiology and Vascular Surgery (MLAVS)CH. LIAPIS (Greece)

Central European Vascular Forum (CEVF)V. STVRTINOVA (Slovak Rep.)

Latin American Venosu Forum (LAVF )P. KOMLOS (Brazil)

I.A.S.A.C.OS. NOVO (Italy)

International Society of Vascular Surgery (ISVS)F. VEITH (UK)

Vascular Independent Research & Education EuropeanOrganisation (VAS)M. CATALANO (Italy)


Scientific Program - Friday, September 24, 2010

08:30 - 09:20 Plenary lecture Amphitheatre Lavoisier

Chair: P. Carpentier (Grenoble, France)

the 2010 milestones of the vascular surgeon J. Fernandes e Fernandes (Lisbon, Portugal)

09:30 - 11:00 SY1 - Symposium Amphitheatre Lavoisier

abdominal aortic aneurysms: an update Chairpersons: P. Gloviczki (Rochester, USA), A. Jawien (Bydgoszcz, Poland)

Sy1-1 s Pathogenesis of the abdominal aortic aneurysm E. Allaire (Créteil, France)

Sy1-2 s Screening for abdominal aortic aneurysm J.S. Lindholdt (Viborg, Denmark)

Sy1-3 s The long-term results of EVAR I trial J.T. Powell (London, UK)

Sy1-4 s Medical approach to the patient with an abdominal aortic aneurysm F. Becker (Geneva, Switzerland)

09:30 - 11:00 SY2 - Corporate Symposium SIGVARIS Petit Amphithéâtre

Efficient compression therapy to treat venous diseases: scientific, medical and practical key factors Chairpersons: P. Carpentier (Grenoble, France), P. Kern (Vevey, Switzerland)

Sy2-1 s Compression therapy: a bright future requiring many efforts P. Carpentier (Grenoble, France)

Sy2-2 s New strategies to improve compliance of compression therapy (20-36 mmHg) D. Rastel, (Grenoble, France)

Sy2-3 s Compression after sclerotherapy P. Kern (Vevey, Switzerland)

Sy2-4 s The effects of medical compression stockings on venous anatomy J.F. Uhl (Paris, France)

11:00 - 11:30 Coffee break - Posters and Exhibition visit Room 8


Carotid stenosis: moving concepts and practices Chairpersons: E. Bastounis (Athens, Greece), F. Becker (Geneva, Switzerland)

Sy3-1 s The surgical treatment of carotid stenosis: new information from recent trials and what is required for future studies J. Fernandes e Fernandes (Lisbon, Portugal)

Sy3-2 s Carotid stenosis: place of carotid stenting J.L. Mas (Paris, France)

Sy3-3 s Stroke and Thrombolytic therapy: an update V. Larrue (Toulouse, France)

Sy3-4 sAsymptomaticCarotidStenosisandRiskStratification A. Nicolaides (Nicosia, Cyprus)

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11:30 - 13:00 OC1 - Free Oral Communications - Vascular surgery: arteries Petit Amphithéâtre

Chairpersons: F. Koskas (Paris, France), N. Chakfe (Strasbourg, France)

OC1-1 Symptomatic huge abdominal aortic aneurysms M. Salem, A. Salem, T. Salem (Alexandria, Egypt)

OC1-2 Minimal incision aortic aneurysm repair: an underutilized but safe technique M. Kalra, A. Duncan, S. Cha, P. Gloviczki (Rochester, USA)

OC1-3 Prevalence of abdominal aortic aneurysm in screening survey of small town’s residents in northern Poland A. Jawien, B. Formankiewicz, T. Derezinski, A. Migdalski, R. Piotrowicz, G. Jakubowski (Bydgoszcz, Poland)

OC1-4 Retrograde trans-popliteal recanalization of the superficial femoral artery: the face-down technique I. Broutzos, I. Dalainas, K. Moulakakis, N. Ptohis, M. Daskalopoulos, C. Papasideris, A. Papapetrou, K. Xiromeritis, M. Moschou, E. Avgerinos, T. Giannakopoulos, N. Kelekis, C. Liapis (Athens, Greece)

OC1-5 Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute lower limb ischemia V. Flis, N. Kobilica, A. Bergauer, B. Mrdza, F. Milotic, B. Stirn (Maribor, Slovenia)

OC1-6 Endovascular repair of traumatic aortic rupture: single center experience N. Melas, A. Giannopoulos, N. Saratzis, A. Saratzis, I. Lazaridis, C. Trigonis, K. Ktenidis, D. Kiskinis (Thessaloniki, Greece)

OC1-7 Surgical treatment principles in patients with traumatic injuries of main vessels, bone-joints of extremities N. Abushov, M. Karimov, G. Tagizade, E. Zakirjayev, E. Aliyev (Baku, Azerbaidjan)

13:00 - 14:00 Break - Posters and Exhibition visit Room 8


Early detection of the high vascular risk subjects Chairpersons: J. Belch (Dundee, UK), S. Novo (Palermo, Italy)

Sy4-1 s Screening for PAD in the general population V. Aboyans (Limoges, France)

Sy4-2 s Asymptomatic carotid lesions predict global cardiovascular risk beyond the cards of the risk S. Novo (Palermo, Italy)

Sy4-3 s Early markers in hypertension: often of vascular origin! D. Clément (Ghent, Belgium)

Sy4-4 s Atherosclerosis and venous thrombosis - the same disease entity with two different faces P. Poredos, M.K. Jezovnik (Ljubljana, Slovenia)

14:00 - 15:30 OC2 - Free Oral Communications - peripheral arterial disease Petit Amphithéâtre

Chairpersons: G. Marcucci (Civitavecchia, Italy), M. Catalano (Milan, Italy)

OC2-1 Function of endothelial cells in limb ischemia R. Proczka, M. Kedzior, P. Jagus, P. Bialek, M. Polanska, M. Postacchini, I. Postacchini, P. Nitkowski, J. Chorostowska-Wynimko, J. Polanski (Warsaw, Poland)


OC2-2 Does really exist a high risk patient for conventional carotid endarterectomy? G. Marcucci, F. Accrocca, A. Siani, A.G. Giordano, R. Antonelli (Civitavecchia, Rome, Italy)

OC2-3 High prevalence of peripheral arterial disease: results of the evaluation of ankle/brachial index in hungarian hypertensives (ERV) screening program K. Farkas, Z. Jarai, E. Kolossvary, A. Ludanyi, I. Kiss (Budapest, Hungary)

OC2-4 Cronocol implant reduces surgical site infection and improves final outcome in ischemic patients C. Costa Almeida, L. Reis, L. Carvalho, C. Costa Almeida (Coimbra, Portugal)

OC2-5 European biobank on vascular diseases M. Catalano, VAS-Scientific Team, VAS-Biobank Working Group (Milan, Italy)

OC2-6 Assessmentofcollateralbloodflowinischemiclowerlimb O. Albazde (London, UK)

OC2-7 Comparative studding of hemorheological indexes in patients with critical limb ischemia N. Abushov, E. Zakirjayev, Z. Aliyev, G. Zeynalova (Baku, Azerbaijan)

14:00 - 15:30 Posters Sessions - PS1 to PS5 Room 8

Presenting authors are requested to stand close to their poster during the guided visit. Authors will have 4 minutes to present orally their work.

14:00 - 15:30 pS1 - atherosclerosis Room 8

pS1-1 Association between serum uric acid, carotid intima-media thickness and target organ damage in hypertensive patients C. Serban, S. Dragan, I. Mozos, R. Mateescu, L. Susan, A. Caraba, A. Pacurari, G. Savoiu, I. Romosan (Timisoara, Romania)

pS1-2 Arterial elasticity - Carotid artery e-tracking versus arteriograph method on brachial artery Z. Miovski, L. J. Banfic, M. Vrkic Kirhmajer (Zagreb, Croatia)

pS1-3 Endothelial function in healthy individuals and patients with coronary artery disease L. J. Banfic, Z. Miovski, K. Putarek, M. Vrkic Kirhmajer, M. Strozzi (Zagreb, Croatia)

pS1-4 RiskprofileofcardiovasculardiseasesandsubclinicalatherosclerosisinHIV positive Polish patients W. Kwiatkowska, B. Knysz, M. Czarnecki, J. Gasiorowski, J. Drelichowska-Durawa, M. Bubala, J. Kwiatkowski, W. Witkiewicz, A. Gladysh (Wroclaw, Poland)

pS1-5 Endothelial prothrombotic markers in dyslipidemic patients D. Karasek, H. Vaverkova, M. Halenka, Z. Frysak, D. Jackuliakova, D. Novotny, L. Slavik (Olomouc, Czech Republic)

pS1-6 Soluble intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 in asymptomatic dyslipidemic subjects D. Karasek, H. Vaverkova, M. Halenka, Z. Frysak, D. Jackuliakova, D. Novotny, J. Lukes (Olomouc, Czech Republic)

pS1-7 Hypertension in patients with systemic lupus erythematosus (SLE) M. Boucelma, H. Chaudet, A. Berrah (Algiers, Algeria - Marseille, France)

pS1-8 Impact of white matter changes on activities of daily living in mild to moderate dementia S. Moon, D. L. Na (Suwon, Seoul, South Korea)

pS1-9 Simultaneous evaluation of coronary artery disease and aortic atherosclerosis using multidetector CT in acute ischemic stroke patients H. Kim, H. Cho, J. Lee, Y. Kim (Seoul, South Korea)

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pS1-10 Stroke in the young: relation with thrombocytemia M. Boucelma, S. Lassouaoui, D. Zemmour, H. Boudjelida, N. Ouadahi, A. Berrah (Algiers, Algeria) 14:00 - 15:30 pS2 - peripheral arterial disease (1) Room 8

pS2-1 Has MRA replaced conventional angiogram in the investigation of peripheral vascular disease? A district general hospitals perspective T. Hall, J. V. Barandiaran, N. El-Barghouti, E .P. Perry (Scarborough, UK)

pS2-2 Arteriomegaly in female subjects T. Hall, J. V. Barandiaran, N. El-Barghouti, E. P. Perry (Scarborough, UK)

pS2-3 Different behaviour of pulse wave velocity and augmentation index in patients with peripheral arterial disease G. Scandale, G. Dimitrov, G. Carzaniga, M. Minola, M. Cinquini, M. Carotta, M. Catalano (Milan, Italy)

pS2-4 Increased aortic augmentation index in peripheral arterial disease G. Scandale, A. Aceranti, G. Carzaniga, M. Minola, M. Cinquini, M. Carotta, M. Catalano (Milan, Italy)

pS2-5 Metabolic drugs increase effectiveness of medical treatment in smokers with intermittent claudication M. S. Bogomolov, V. M. Sedov, G. Y. Sokurenko, L. N. Edovina, V. V. Slobodyanyuk (Saint-Petersburg, Russia)

pS2-6 Influence of metabolic drugs on periferal hemodynamics of the legs in patients with intermittent claudication L. Edovina, M. Bogomolov, Y. Lukyanov, V. Slobodyanyuk (St-Petersburg, Russia)

pS2-7 Intima-media thickness increase and atherosclerotic plaques in asymptomatic patients M. Cazaubon, F. A. Allaer (Paris, Dijon France)

pS2-8 Self-reported maximal walking capacity in arterial claudication: can the walking impairment questionnaire be self-completed? P. Abraham, N. Ouedraogo, G. Mahe, M. Vasseur, G. Leftheriotis (Angers, France)

pS2-9 Relationship of symptoms with non-ABI hemodynamic investigations on treadmill in patients with suspected claudication P. Abraham, G. Mahe, N. Ouedraogo, G. Leftheriotis, M. Vasseur (Angers, France)

pS2-10 Variability and short-term determinants of walking capacity in patients with intermittent claudication P. Abraham, A. Le Faucheur, B. Noury-Desvaux, G. Mahe, T. Sauvaget, J. L. Saumet, G. Leftheriotis (Angers, Les Ponts de Cé, Lyon, France)

14:00 - 15:30 pS3 - peripheral arterial disease (2) Room 8

pS3-1 Mortality and amputation rate of the conservative pharmacological treatment in patients with critical leg ischemia unsuitable for revascularisation R. Martini, R. Cordova, G. M. Andreozzi (Padova, Italy)

pS3-2 CRP levels as a predictor of restenosis following SFA revascularisation P. Vale, S. Dubenec, D. Catinella, S. Hanning, A. Kelly (Sydney, Australia)

pS3-3 Plasma homocysteine level predictive of potential for restenosis after SFA revascularisation for occlusive femoropopliteal disease P. Vale, S. Dubenec, D. Catinella, S. Hanning, A. Kelly (Sydney, Australia)

pS3-4 Sternal wound angiogenesis in diabetic and non diabetic patients undergoing cardiac valve replacement surgery P. Bhaskaran, N. J. Standfield, T. Gourlay (London, Glasgow, UK)


pS3-5 Assessment of sternal wound healing following diabetic and non diabetic coronary artery bypass graft surgical patients using laser doppler imager P. Bhaskaran, N. J. Standfield, T. Gourlay (London, Glasgow, UK)

pS3-6 Clinicalsignificanceoflaserdopplerscannerinperipheralvasculardisease P. Bhaskaran, M. Aslam, N. J. Standfield, T. Gourlay (London, Glasgow, UK)

pS3-7 Criticallimbischaemiaindiabetes:definition,assessment,prognosis F. Pollice, P. Pollice, V. Delgado (Leiden, Netherlands Antilles)

pS3-8 Association between microalbuminuria and elevated levels of proinflammatory endothelium- derived mediators in hypertensive diabetic patients C. Serban, S. Dragan, I. Mozos, R. Mateescu, L. Susan, A. Pacurari, A. Caraba, G. Savoiu, I. Romosan (Timisoara, Romania)

pS3-9 Susceptibility of bacterial cultures to topical antiseptics in diabetic foot L. Maslowski, M. Bartoszewicz, K. Checka, W. Kwiatkowska, W. Witkiewicz (Wroclaw, Poland)

pS3-10 Improving limb salvage in critical limb ischemia with intermittent pnuematic compression: a controlled study with eighteen months follow up S. Kavros, N. Turner, A. Voll, D. Liedl, P. Gloviczki (Rochester, USA)

14:00 - 15:30 pS4 - Vascular Surgery (1) Room 8

pS4-1 Comparison of endoluminal versus open repair in the treatment of abdominal aortic aneurysms F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy)

pS4-2 Endovascular thoracic aortic aneurysm repair in a patient with severe aortoiliac disease and ectopic single kidney M. Kafeza, V. Psarros, K. Papoutsis, G. Kouvelos, A. Koutsoubelis, C. Bakoyiannis, S. Georgopoulos, C. Klonaris, E. Papalambros (Athens, Greece)

pS4-3 Late secondary procedures due to aneurysm rupture after EVAR: ten years experience M. Kafeza, V. Psarros, A. Koutsoubelis, G. Kouvelos, K. Papoutsis, C. Bakoyiannis, C. Klonaris, S. Georgopoulos, E. Bastounis, E. Papalambros (Athens, Greece)

pS4-4 Tissue factor pathway and thrombin-antithrombin complex in blood of patients with abdominal aortic aneurysm during stent-graft implantation R. Grendziak (Wroclaw, Poland)

pS4-5 A novel suture-less device (BYFix) for vascular anastomosis - the results of preclinical and clinical studies B. Yoffe (Haifa, Israel - Klinik, Erfurt Germany)

pS4-6 Spontaneousaortocavalfistula:casereportandliteraturereview H. Ravari, M. Moini, M. Vahedian, M. Aliakbarian (Mashhad, Tehran, Iran)

pS4-7 The role of arterial and venous shunting in the complex vascular trauma of the arteries of the lower limbs G. Marcucci, A. Siani, R. Antonelli, A. G. Giordano, F. Accrocca (Civitavecchia, Rome, Italy)

pS4-8 The percutaneous angioplasty and stenting treatment in patients with subclavian steal syndrome F. Ferrara, I. Muratori, F. Meli, C. Amato, M. Lunetta, R. Alcamo, S. Novo (Palermo, Italy)

pS4-9 Diagnostic procedures: the timing of follow-up of surgical and endovascular treatment of arterial diseases P. L. Antignani, C. Allegra (Rome, Italy)

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pS4-10 Below the knee bypass using cryopreserved arterial homografts for critical lower limb ischaemia: long term results in a single center S. Amiot, C. Perot, R. Spear, R. Jashari, D. Massouille, J. Lancelevee, J. P. Chambon (Lille, France - Brussels, Belgium)

14:00 - 15:30 pS5 - Vascular Surgery (2) Room 8

pS5-1 Intraoperative aortic embolism after middle lobe lobectomy for renal leyomiosarcoma metastases P. Amorim, C. Rodrigues, A. Rita Matos, T. Vieira, F. Félix, J. Pereira Albino (Lisbon, Portugal)

pS5-2 Endoluminal stenting for superficial femoral artery occlusion offers symptomatic improvement for patients with peripheral vascular disease J. Makanjuola, V. M. Patel, M. Mobasheri, T. Hussain (London, UK)

pS5-3 Endoluminal revascularization of non embolic iliac occlusion for inferior limb acute ischemia: an alternative to surgery F. Mercier, A. Aymard, H. Benamer, X. Guillotte, E. Louvard, R. Maguemoun, M. C. Morice (Aubervilliers, France)

pS5-4 Carotid angioplasty. Detection of embolic signals during and after the procedure F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy)

pS5-5 Influenceofageuponcomplicationofcarotidarterystenting F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy)

pS5-6 Internal carotid and bilateral vertebral arteries dissection: a case report M. Boucelma, T. Bounzira, D. Bensalah, D. Hakem, A. Berrah (Algiers, Algeria)

pS5-7 Surgery for carotid body tumor in patient with Eisenmenger syndrome (case report) K. Kanalikova, J. Tomka, K. Kanalikova, I. Simkova, Z. Zita, L. Pretiova (Bratislava, Slovak Republic)

pS5-8 Ararecarotid-jugularfistulaofcongenitaletiology J. Pereira Albino, P. Amorim, L. Castro E Sousa, K. Ribeiro, G. Sobrinho, T. Vieira, N. Meireles, F. Pinto (Lisbon, Portugal)

pS5-9 Diagnosingcarotid-jugulararteriovenousfistula:iscolordopplersonographyenough? R. Catalini, G. Pagliariccio, L. Giantomassi, O. Zingaretti (Ancona, Italy)

pS5-10 Ruptured iliac artery aneurysm after abdominal aortic aneurysm resection: a case report T. Janusauskas, E. Janusauskas, V. Kazlauskas, D. Triponiene, V. Triponis (Vilnius, Lithuania)



therapeutic education of the vascular patient Chairpersons: P. Carpentier (Grenoble, France), P. Léger (Toulouse, France)

Sy5-1 s Therapeutic education of the patient with peripheral arterial disease P. Carpentier (Grenoble, France)

Sy5-2 sEducation of the patient with venous thromboembolic disease P. Léger (Toulouse, France)

Sy5-3 s Therapeutic education of the patients with chronic venous disorders B. Satger (La Léchère, France)


16:00 - 17:30 OC3 - Free Oral Communications - Venous thromboembolic disease Petit Amphithéâtre

Chairpersons: G. Pernod (Grenoble, France), A. Visona (Castelfranco Veneto, Italy)

OC3-1 Comparison of the clinical history of symptomatic isolated muscular calf vein thrombosis versus deep calf vein thrombosis J. Galanaud, M.A. Sevestre, C. Genty, J.P. Laroche, V. Zyzka, I. Quere, J.L. Bosson (Montpellier, Amiens, Grenoble, Fort de France, France)

OC3-2 Bleeding complications in patients with cancer receiving anticoagulant therapy for venous thromboembolism.findingsfromtheRIETE registry A. Visonà, P. Di Micco, J.A. Nieto, J. Truijllo Santos, R. Quintavalla, P. Prandoni, M. Monreal (Castelfranco Veneto, Naples, Parma, Padua, Italy - Cuenca, Cartagena, Badalona, Spain)

OC3-3 Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism. Findings from the RIETE registry A. Visonà, P. Di Micco, A. Niglio, M. Amitrano, M. Ciammaichella, P. Prandoni, M. Monreal, J.A. Nieto (Castelfranco Veneto, Naples, Avellino, Rome, Padua, Italy - Badalona, Cuenca, Spain)

OC3-4 Venous thromboembolism in the elderly: epidemiological data overview based on the prospective OPTIMEV cohort G. Pernod, M. A. Sevestre, C. Genty, J. Labarere, P. Couturier, J. L. Bosson (Grenoble, Amiens, France)

OC3-5 Thrombosisofatypicallocation,Mayoseries:profileoflocalcausesinorganveinthrombosis W. Wysokinski, R. Mcbane (Rochester, USA)

OC3-6 Evaluationofapneumaticdeviceefficacytopreventvenousdisordersinairtravel F. Fernandez, I. Chirosa, M. Martinez, J.J. Sánchez-Cruz, E. Ros (Granada, Spain)

OC3-7 Calf vein thrombosis and risk of pulmonary embolism P. L. Antignani, C. Allegra (Rome, Italy)

17:30 - 18:30 SY6 - Corporate Symposium Cook Medical Amphitheatre Lavoisier

New developments in endovascular technologies Chair: N. Chakfé (Strasbourg, France)

Sy6-1 s Fenestrated endografts for thoracoabdominal aortic pathologies J-P. Becquemin (Créteil, France)

Sy6-2 s Future developments in Abdominal Aortic Aneurysm treatment F. Thaveau (Strasbourg, France)

Sy6-3 sIs there a room for drug eluting stents in SFA lesions? N. Chakfé (Strasbourg, France)

17:30 - 18:30 SY7 - Symposium Petit Amphithéâtre

New insights about the calf muscle pump function Chairpersons: P. Carpentier (Grenoble, France), A. Nicolaïdes (Nicosia, Cyprus) Organized thanks to an unrestricted educational grant from Ad Rem Technology - VEINOPLUS

Sy7-1 sPathophysiology of the calf muscle pump A. Nicolaïdes (Nicosia, Cyprus)

Sy7-2 sFunctional anatomy of the muscular pumps of the lower limb J.F. Uhl (Paris, France)

sHow to improve the calf muscle function in CVD patients A. Jawien (Bydgoszcz, Poland)

14 ~

Scientific Program - Saturday, September 25, 2010

08:30 - 09:20 Plenary lecture Amphitheatre Lavoisier

Chair: A. Jawien (Bydgoszcz, Poland)

the 2010 milestones of the vascular physician J. Belch (Dundee, UK)


Venous thromboembolic disease: moving Concepts and practices Chairpersons: I. Quéré (Montpellier, France), A. Comerota (Michigan, USA) Organized thanks to an unrestricted grant from Eumedica

Sy8-1 s Medicalsignificationoftheasymptomaticvenousandpulmonaryembolism G. Pernod (Grenoble, France)

Sy8-2 s Newer trends in the management of thrombosis. Impacts on Vascular Indications E. Kalodiki (London, UK)

Sy8-3 s Superficialthrombophlebitis,asignificantsubsetofvenousthromboembolicdisease I. Quéré (Montpellier, France)

Sy8-4 s The concept of early thrombus removal for iliofemoral deep venous thrombosis A. Comerota (Michigan, USA)

09:30 - 11:00 Postgraduate Course Petit Amphithéâtre

Leg and foot ulcers - Critical limb ischemia Moderators: P. Carpentier (Grenoble, France), M.-A. Sevestre-Pietri (Amiens, France) Experts: K. Roztocil (Prague, Czech Republic), G. Marcucci (Rome, Italy), M.C. Portilho (Brazil), P. Gloviczki (Rochester, USA) This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the end of the session, participants will understand the importance of a thorough medical diagnostic and pre-therapeutic evaluation of patients with leg or foot ulcers; they will have an increased awareness of the educational and social needs of these patients; they will be able to make the diagnosis of critical limb ischemia and will understand the need for a multidisciplinary approach of the patient suffering from this condition.



Varicose vein treatment in the future Chairpersons: M. de Castro-Silva (Belo Horizonte, Brazil), P. Nicolini (Lyon, France)

Sy9-1 s Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum on 3 the Care of Patients with Varicose Veins P. Gloviczki (Rochester, USA)

Sy9-2 s Future techniques for varicose vein ablation P. Nicolini (Lyon, France)


Sy9-3 s We need to know more about the natural history of venous hemodynamics in patients with varicose veins! O. Pichot, P. Carpentier (Grenoble, France)

Sy9-4 s Molecular Mechanisms for Microvascular Endothelial Apoptosis under Pressure Elevation and Therapeutic Targets G. Schmid-Schönbein (San Diego, USA)


Venous thromboembolic disease - thrombophilia Moderators: G. Pernod (Grenoble, France), P. Nguyen (Reims, France) Experts: A. Visona (Castelfranco Veneto, Italy), M.E. Renno de Castro Santos (Brazil), M. Sprynger (Liège, Belgium) This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the conclusion of the session, attendees will have an increased awareness of the importance of the evaluationof the benefit/risk ratio for the decision about the treatment of these conditions.They will have a deeper understanding of the clinical signification of the different inherited and acquired thrombophilia and the drawbacks of their systematic evaluation.

13:00 - 14:00 Break - Posters and Exhibition visit Room 8


Ultrasound guided procedures Chairpersons: O. Pichot (Grenoble, France), E. Ascher (New York, USA)

Sy10-1 sUltrasound assisted arterial procedures E. Ascher (New York, USA)

Sy10-2 sVascular access for hemodialysis O. Pichot (Grenoble, France)

Sy10-3 sUltrasound guided treatment of varicose veins C. Hamel-Desnos (Caen, France)


Clinical microcirculation Moderators: M. Vayssairat (Paris, France), P. Carpentier (Grenoble, France) Experts: C. Allegra (Rome, Italy), A.T. Guillaumon (Brazil), J.C. Wautrecht (Brussels, Belgium)

This session is based on the interactivity between the audience and an international panel of experts discussing decision making about clinical cases with the help of concordance script tests and the powervote technique. At the end of the session, participants will have a broader understanding of the needs of patients seeking medical help for a vascular acrosyndromes, and will be able to diagnose atypical acrosyndromes suchascomplicatedchilblainsandparoxysticfingerhematomaand tomanageacost effective etiological evaluation of Raynaud phenomenon.

14:00 - 15:30 Posters Sessions - PS6 to PS9 Room 8

Presenting authors are requested to stand close to their poster during the guided visit. Authors will have 4 minutes to present orally their work.

16 ~

14:00 - 15:30 pS6 - arteritis, vasculitis, therapeutic Room 8

pS6-1 Generic argatroban preparations differ in their anticoagulant and antiprotease responses in patients with liver disease. Dosing implications D. Hoppensteadt, O. Iqbal, S. Masood, J. Fareed (Maywood, USA)

pS6-2 Prevalence of free methyl chloride as an impurity in generic clopidogrel preparations. Safety implications in cardiovascular patients A. Duguot, H. Belva-Besnet, C. Conocar, M. Daumas, G. Rao, I. Mohan Theti (Paris, France - Bangelore, India)

pS6-3 Low adherence to antithrombotic indications and gender differences in aspirin use in patients with previous minor bleeding A. Mattioli, A. Farinetti, R. Lonardi, S. Pennella, G. Tazzioli, G. Mattioli (Modena, Italy)

pS6-4 The pharmacogenetic approach to the anticoagulant therapy Y. Novikova, A. Shevela, G. Lifshitz, K. Sevostyanova, E. Voronina (Novosibirsk, Russia)

pS6-5 Multifactorial treatment effectivness of dyslipidemia, type 2 diabetes mellitus and arterial hypertension in patients with CHD K. Kapanadze, N. N. Kipshidze (Tbilsi, Georgia)

pS6-6 Hyperbaric oxygen therapy in refractory ischemic cutaneous lesions in vasculitis and connective vascular disease C. Belizna, D. Henrion, V. Soude, B. Bienvenu, F. Maillot, E. Andres, C. Lavigne, A. Ghali, A. Mercat, P. Asfar (Angers, Caen, Tours, Strasbourg, France)

pS6-7 Digital ischemia and myeloproliferative disorders B. Imbert, N. Kherat, I. Marie, H. Desmurs-Clavel, P. Carpentier (Grenoble, Rouen, Lyon, France)

pS6-8 Prophylaxis of suspected secondary Raynaud’s phenomenon C. Costa Almeida, L. Carvalho, L. Reis, J. Fortuna, C. Costa Almeida (Coimbra, Portugal)

pS6-9 Abdominal aortitis and doxycyclin: case report M. Sprynger, C. Nizet, L. A. Pierard (Liege, Belgium)

pS6-10 Treatmentofnon-healingwoundswithautologousbonemarrowcells,platelets,fibringlue,andcollagen matrix H. Ravari, D. Hamidi Almadrai, M. Salimifar, S. H. Bonakdaran (Mashhad, Iran)

pS6-11 Association of heparin-PF4 antibodies with intima-media thickness of carotid arteries A. Mattioli, A. Farinetti, R. Lonardi, S. Pennella, G. Mattioli (Modena, Italy)

pS6-12 A collaborative multi-disciplinary community approach to a streptococcus pyogenes infection G. Hancock, J. V. Barandiaran, T. C. Hall, N. El-Barghouti, E. P. Perry (Scarborough, UK)

14:00 - 15:30 pS7 - Chronic venous disorders / Lymphedema Room 8

pS7-1 Are there incurable leg ulcers? F. Zernovicky, K. Samelova, F. Zernovicky Jr. (Bratislava, Slovak Republic)

pS7-2 Phlebological passport T. Alekperova, A. Truxanov, S. Musaeva, O. Alekperov (Moscow, Russia)

pS7-3 Electro-stimulation with VEINOPLUS®-anewmethodforthetreatmentofchronicvenousinsufficiency of the lower limbs V. Y. Bogachev, O. V. Golovanova, A. H. Kuznietov, A. O. Stchekoian (Moscow, Russia)


pS7-4 Observational study of the synergy between sclerotherapy and a grade a veinotonic in chronic venous disease of the lower limbs F. Allaert, J. P. Gobin (Dijon, Lyon, France)

pS7-5 Leg ulcers and hydroxyurea: has the treatment to be discontinued? U. Michon-Pasturel, I. Lazareth, A. Bouchareb, P. Priollet (Paris, France)

pS7-6 Predictors of the post-thrombotic syndrome during long-term treatment of proximal deep vein thrombosis F. Pollice, P. Pollice, B. Di Renzo (L’Aquila, Italy)

pS7-7 Treatment of low-flow vascular malformations by echo-sclerotherapy with polidocanol foam: 24 cases and literature review S. Blaise, M. Charavin-Cocuzza, H. Riom, M. Brix, C. Seinturier, J. M. Diamant, G. Gachet, P. H. Carpentier (Grenoble, Voiron, France)

pS7-8 Intensive rehabilitation program for lymphedema: one or two weeks? B. Villemur, F. Vellut, J. Y. Bouchet, B. Bucci, V. Evra, M. P. De Angelis, A. Marquer, D. Perennou (Echirolles, France)

pS7-9 Prognostic value of lymphoscintigraphy for prediction of postmastectomy lymphedema M. Myasnikova, N. Gordeev (St-Petersburg, Russia)

pS7-10 Effectiveness of multilayer bandage in healing venous ulcers F. Ferrara, I. Muratori, F. Meli, C. Amato, M. Lunetta, R. Alcamo, S. Novo (Palermo, Italy)

14:00 - 15:30 pS8 - Varicose veins Room 8

pS8-1 Vein-Termclassification/venousrefluxpatternsandgreatsaphenousveinsparing F. Toscano, C. Pereira Alves, J. Neves, A. Formiga (Lisbon, Portugal)

pS8-2 Clinical experience of Salem endothelial stripping operation for the surgical treatment of primary varicose veins of the lower limbs M. Salem, A. Salem, T. Salem (Alexandria, Egypt)

pS8-3 Early results from sclerotherapy for treatment of varicose veins D. Lukanova, I. Lozev (Sofia, Bulgaria)

pS8-4 Preoperative and intraoperative triplex sonography in surgical treatment of varicose veins I. Lozev, N. Smilov, P. Lozev, D. Dardanov, G. Kirov (Sofia, Bulgaria)

pS8-5 Treatment of symptomatic varicose veins and small saphenous vein reflux with endovenous laser ablation does not require concomitant phlebectomy J. Laredo, J. Kwock, B. B. Lee, R. F. Neville (Washington, USA)

pS8-6 Endovenous laser ablation of the anterior accessory great saphenous vein J. Laredo, S. Shin, B. B. Lee, R. F. Neville (Washington, USA)

pS8-7 A pilot randomised trial of catheter directed foam sclerotherapy with tumescence versus laser ablation in patients with large saphenous diameters: A N C. R. Lattimer, E. Shawish, E. Kalodiki, M. Azzam, G. Geroulakos (London, UK)

pS8-8 Personal experience in preserving the great saphenous vein I. Bihari (Budapest, Hungary)

pS8-9 Incompetent perforators - the unseen villain C. Stuckey, C. Barbieri, A. Martin, K. Mcdonald, C. Conroy, R. Martin, D. Rollins (Overland Park, USA)

18 ~

PS8-10 Endovenous laser ablation in treatment of varicose veins M. Vakhitov, D. Semenov, A. Zsibin, Z. Ulimbasheva (St. Petersburg, Russia)

PS8-11 Endovascular and surgical threatment of pelvic congestion syndrome I. Ignatyev, R. Bredikhin, E. Fomina, M. Miikhailov (Kazan, Russia)

14:00 - 15:30 PS9 - Venous thromboembolic disease Room 8

PS9-1 Venous diseases in injecting drug users M. Czarnecki, B. Knysz, W. Kwiatkowska, J. Gasiorowski, A. Gladysz (Wroclaw, Poland)

PS9-2 Evaluation of outcomes following endovascular recanalization and stenting of chronically occluded iliac and common femoral veins A. Kurklinsky, H. Bjarnason (Rochester, USA)

PS9-3 Importance of long term follow up of dVt recanalisation Z. Pécsvárady (Kistarcsa, Hungary)

PS9-4 the genetic predicts of the deep venous thrombosis Y. Novikova, A. Shevela, K. Sevostyanova, E. Voronina (Novosibirsk, Russia)

PS9-5 Clinicalsignsandriskfactorsofdeepveinsthrombosisoflowerextremities.efficiencyandsafetyof anticoagulant therapy V. Mishalov, E. N. Amosova, N.Y. Litvinova (Kyiv, Ukraine)

PS9-6 Prevention of thrombotic disorders in cancer patients undergoing chemotherapy F. Pollice, P. Pollice, L. De Giuli (L’Aquila, Italy)

PS9-7 Validation of a deep vein thrombosis prediction rule in primary care M. Maufus, J. L. Bosson, C. Genty, A. Delluc, P. Imbert, P. Gagne, C. Rolland, L. Bressollette, G. Le Gal (Brest, Grenoble, Plaintel, France)

PS9-8 deep vein thrombosis in intravenous drug users from experience of angiologic ward and outclinic W. Kwiatkowska, D. Kotschy, J. Przytulska, J. Drelichowska-Durawa, L. Maslowski, W. Witkiewicz, M. Czarnecki, J. Gasiorowski, B. Knysz (Wroclaw, Poland)

PS9-9 Factorsinfluencingthedevelopmentofthepost-thromboticlimb F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy)

PS9-10 Ivus IVcfilterdeployment-amethodforintegrationofIVus into daily practice D. Kassavin, G. Constantinopoulos (Long Branch, NJ, USA)

15:00 - 15:30 coffee break - Posters and Exhibition visit Room 8

15:30 - 17:30 Plenary session Amphitheatre Lavoisier

Forum of Vascular Initiatives chairpersons: R. simkin (Buenos Aires, Argentina), P. carpentier (Grenoble, France)

s Vascular centers F. Benedetti-Valentini (Rome, Italy)

s the adventure of running a vascular journal A. Nicolaïdes (Nicosia, Cyprus)

s Building-up an e-learning vascular website P. Carpentier (Grenoble, France), C. Boissier (Saint-Etienne, France)


s VAS (Vascular - Independent Research and Education - European Organisation): almost 20 years of stable European collaboration on Angiology/Vascular Medicine M. Catalano (Milan, Italy)

s Brazilian experience on vascular teaching J.L. Nascimento Silva (Rio De Janeiro, Brazil) s Franco-Vietnamese vascular teaching cooperation P. Desouter, J.M. Diamand (Grenoble, France)

s The Italian Likoni project in Kenya C. Allegra (Rome, Italy)

s Fighting elephantiasis in Burkina Faso A. Cornu-Thénard (Paris, France)

s IUA Eurochap 2011 in Slovenia P. Poredos (Ljubljana, Slovenia)

s IUA World Congress in Prague K. Roztocil (Prague, Czech Republic)

20 ~

Scientific Program - Sunday, September 26, 2010

09:30 - 11:00 SY11 - Joint Symposium with the Italian Society of Angiologyand Vascular Medicine

Petit Amphitheatre

physical exercise and Vascular medicine Chairpersons: P.L. Antignani (Rome, Italy), G.M. Andreozzi (Padova, Italy), P. Abraham (Angers, France)

Sy11-1 s Effects of physical exercise on the cardiovascular system P. Abraham (Angers, France)

Sy11-2 s The balance or unbalance of ATS risk factors could compromise the results of physical training in claudicants ? G.M. Andreozzi (Padova, Italy)

Sy11-3 s Interval training in patients with intermittent arterial claudication B. Villemur (Grenoble, France), D. Pérennou (Grenoble, France)

Sy11-4 s Physical training in patients with hypertension A. Pinto (Palermo, Italy)

Sy11-5 s Physical exercise in elderly arteriopathic patients M. Prior (Verona, Italy)

09:30 - 11:00 OC4 - Free Oral Communications - Varicose veins Room 262

Chairpersons: E. Kalodiki (London, UK), C. Allegra (Roma, Italy)

OC4-1 Anatomic preconditions for recurrent varices in surgical treatment of primery varicose veins M. Vakhitov, O. Bolshakov, V. Amosov, O. Kovaleva (St. Petersburg, Russia)

OC4-2 Closurefast catheter endovenous ablation - a three year experience C. Stuckey, C. Barbieri, A. Martin, K. Mcdonald, C. Conroy, R. Martin, D. Rollins (Overland Park, USA)

OC4-3 Treatmentofsuperficialvenousinsufficiencybyendovenouslasertherapy:lessonsfromapersonaltrial on 1000 cases P. Sarradon, E. Slotema (Toulon, Marseille, France)

OC4-4 Endovenous radiofrequency-powered segmental thermal ablation (RSTA) of the great saphenous vein: 2-year european follow-up O. Pichot (Grenoble, France)

OC4-5 Clinical comparison of thigh only versus endovenous laser ablation (EVLA) in great saphenous vein insufficiencytreatment R. Kikuchi, E. Arcenio, C.M. Oba (Sao Paulo, Londrina, Brazil)

OC4-6 Asevenfoldincreaseinvolumeflowinthegreatsaphenousveinduringapplicationofabelowknee stocking: a potential hazard following foam sclero M. Azzam, C. R. Lattimer, E. Kalodiki, G. Geroulakos (London, UK)

OC4-7 The role of foam sclerotherapy in elderly patient (over 70) with severe disabling CVD C. Allegra, P. L. Antignani, M. Gallucci (Rome, Italy)

11:00 - 11:30 Coffee break - Exhibition visit Room 8



From raynaud phenomenon to digital ulcer Chairpersons: M. Cutolo (Genova, Italy), M. Vayssairat (Paris, France) Organized thanks to an unrestricted educational grant from Actelion Pharmaceuticals

Sy12-1 s Basic exploration of Raynaud’s phenomenon : a consensus of French experts J. Constans (Bordeaux, France)

Sy12-2 s Clinical usefulness of capillaroscopy M. Cutolo (Genova, Italy)

Sy12-3 s Raynaud phenomenon: the appearance of digital ulcers changes everything P. Carpentier (Grenoble, France)

Sy12-4 s The therapeutic challenge of digital ulcers in systemic sclerosis P. Priollet (Paris, France)

11:30 - 13:00 OC5 - Free Oral Communications - atherosclerosis Room 262

Chairpersons: C. Le Hello (Caen, France), M. Cazaubon (Paris, France)

OC5-1 Easy assessment of dietary pattern for atherosclerosis diseases in clinical practice G. Mahe, M. Carsin, J. P. De Bosschere, M. Zeeny (Angers, Rennes, France - Beirut, Lebanon)

OC5-2 Medical management and prognosis of patients with atherothrombotic disease requiring a revascularisation C. Le Hello, R. Morello, S. Fradin, O. Coffin, D. Maïza, M. Hamon (Caen, France)

OC5-3 Management of vessel wall disease is better than the management of risk factors G. H. R. Rao, V. Sriram, G. Muralidhara, A. Fenster (Minnesota, USA - Ontario, Canada)

OC5-4 Computed tomographic angiography for the evaluation of carotid artery stenosis F. Pollice, P. Pollice, R. Rossi, G. Contegiacomo (Naples, Bari, Italy)

OC5-5 Percutaneous treatment with drug-eluting stent in diabetic patients F. Pollice, P. Pollice, T. Grover, I. Christensen (Leiden, Netherlands Antilles)

OC5-6 Low ankle brachial index is a risk factor for revascularization in coronary patients M. Maufus, J. B. Guitton, G. Vanzetto, L. Belle, B. Imbert, P. Carpentier, G. Pernod (Grenoble, Annecy, France)

OC5-7 Progressionofperipheralarterialdiseaseintype2diabeticpatients:influenceoffibrinogenandcrp M. Bosevski, L. J. Georgievska-Ismail (Skopje, Makedonija)

13:00 - 14:00 Break - Exhibition visit Room 8


Critical Limb ischemia Chairpersons: K. Roztocil (Prague, Czech Republic), E. Emmerich (Paris, France) Organized thanks to an unrestricted grant from Sanofi Aventis

Sy13-1 s A randomized, double-blind, placebo-controlled gene therapy study using NV1FGF for prevention of amputation and death in critical limb ischemia (TAMARIS). Rationale, design and baseline patient characteristics J. Belch (Dundee, UK)

22 ~

Sy13-2 s Pathophysiology of Critical Limb Ischemia P. Carpentier (Grenoble, France)

Sy13-3 s Critical Limb Ischemia: the Limits of Revascularization E. Ascher (New York, USA)

s Results of gene and cell therapy in CLI: are we close to salamander? J. Emmerich (Paris, France)

14:00 - 15:30 SY14 - Joint Symposium with the Romanian Society of Angiology and Vascular Surgery

Petit Amphitheatre

Complications of vascular procedures Chairpersons: A. Andercou (Cluj-Napoca, Romania), D. Olinic (Cluj-Napoca, Romania)

Sy14-1 s Anastomotic aneurysms and infections after peripheral procedures A. Andercou, O. Andercou, B. Stancu, O.Budiu, O. Barbos, M. Andrei (Cluj-Napoca, Romania)

Sy14-2 s Complications after interventional venous procedures M. Catalano, E. Perilli (Milan, Italy)

Sy14-3 s Complications of vascular access I. Droc, V. Alexandrescu (Bucharest, Romania) Sy14-4 sEarlyfailureofarteriovenousfistulaforhemodialysis V. Popovic, J. Pasternak, J. Pfau, M. Kacanski, D. Nikolic, Z. Horvat (Novi Sad, Serbia)

Sy14-5 s Interventional retrieval of fractured central venous catheter D. Olinic, C. Homorodean, M. Olinic, M. Ober (Cluj-Napoca, Romania)

14:00 - 15:30 OC6 - Free Oral communicationsrare vascular diseases and progress in vascular diagnosis

Room 262

Chairpersons: G. Gerotziafas (Paris, France), M.L. Gloviczki (Rochester, USA)

OC6-1 A new diagnostic criterion with colour duplex scanning in pudendal neuralgia by entrapment M. Mollo, E. Bautrant, J. Eggermont, A. K. Rossi-Seignert (Aix-en-Provence, France)

OC6-2 Long term follow-up of giant cell arteritis-related upper/lower limb vasculitis. a series of 36 patients C. Assie, A. Janvresse, D. Plissonnier, H. Levesque, I. Marie (Rouen, France)

OC6-3 Digestive arteries dissection in a retrospective monocentric series C. Belizna, A. Ghali, C. Lavigne, A. Beucher, F. Thouveny, S. Willoteaux, J. Piquet, B. Enon (Angers, France)

OC6-4 Evaluation of thrombin generation assay in the monitoring of treatment with vitamin K antagonists, enoxaparin and fondaparinux G. Gerotziafas, V. Galea, M. Chaari, M. Sassi, H. Baccouche, I. Elalamy (Paris, France)

OC6-5 Application of 3 tesla blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) to study oxygenation of the kidney in renovascular disease M. L. Gloviczki, J. Glockner, J. P. Grande, L. O. Lerman, S. C. Textor (Rochester, USA)

OC6-6 Duplexguidedangioplastyofarteriovenousfistulaeforhemodialysis:retrospectivestudyof45patients in a French univeristary hospital A. Dessi, C. Seinturier, O. Pichot, E. Cochet, P. H. Carpentier, C. Sessa (Grenoble, France)

OC6-7 Klippel-Trenaunay-Weber syndrome and epithelioid angiosarcoma. a rare association J. Pereira Albino, A. Simas, C. Matos, G. Sobrinho, V. Brotas, N. Meireles, G. Clara (Lisbon, Portugal)


15:30 - 16:00 Break - Exhibition visit Room 8

16:00 - 17:30 SY15 - Joint Symposium Eurochap - Microcirculation Amphitheatre Lavoisier

relationship between macro and microcirculation Chairpersons: B. Levy (Paris, France), H.A.J. Struijker-Boudier (Maastricht, the Netherlands)

s The development of microvascular networks F. Le Noble (Berlin, Germany)

Sy15-2 sModulationofsmallarteryflow:wallremodelingandperivascularadiposetissue A. Greenstein (Manchester, United Kindom)

Sy15-3 s Relationship between macro- and microcirculation P. Boutouyerie (Paris, France)

s Match and mismatch between large arteries and microcirculation G. London (Paris, France)

16:00 - 17:30 OC7 - Free Oral communications - Venous disorders Room 262

Chairpersons: F. Allaert (Dijon, France), M. Jezovnik (Ljubljana, Slovenia)

OC7-1 Treatment of venous stasis ulcer, through cell therapy with keratinocyte autograft in patients users of micronized diosmin and hesperidin A. Guillaumon, C. Bosnardo, M. B. Puzzi, J. Rheder (Campinas, Brazil)

OC7-2 Assessingmesoglycantreatmentefficacyin1483outpatientswithchronicvenousinsufficiency C. Allegra, P. L. Antignani (Rome, Italy)

OC7-3 Clinical and haemodynamic sequelae of deep venous thrombosis F. Pollice, P. Pollice, M. Sansone (l’Aquila, Italy)

OC7-4 Post-surgicalveinthrombosisandonsetofpost-thromboticsyndrome:influenceof4G/5G polymorphism F. Ferrara, C. Amato, F. Meli, I. Muratori, M. Lunetta, I. R. Alcamo, S. Novo (Palermo, Italy)

OC7-5 Anatomical description of the ostial valve in the saphenofemoral junction C. Tasch, L. Larcher, E. Brenner (Schongau, Germany - Feldkirch, Innsbruck, Austria)

OC7-6 Meta-analysis approach of the effect of venoactive drug on ankle circum-ference in CVD patients F. Allaert (Dijon, France)

OC7-7 Inflammation-pathogeneticmechanismofvenousthrombosis M. Jezovnik, P. Poredos (Ljubljana, Slovenia)

24 ~

CONGRESS MAP


EHIBITION PLAN

Stand Exhibitors

N° 1 KREUSSLER PHARMA N° 2 AD REM TECHNOLOGY - VEINOPLUSN° 3 LABORATOIRES INNOTHERAN° 4 PIERRE FABREN° 5 MINERVA MEDICAN° 6 SIGVARISN° 7 PERIMEDN° 8 DANISH MYO TECHNOLOGY A/SN° 9 WILEY BLACKWELLN° 10 ADINSTRUMENTS LTDN° 11 IMMUNDIAGNOSTIK AGN° 12 CELLIX LTDN° 13 RHEO MEDITECH, INCN° 14 MOOR INSTRUMENTS N° 15 LIVING SYSTEMS INSTRUMENTATION

Stand Exhibitors

N° 1 KREUSSLER PHARMA N° 2 AD REM TECHNOLOGY - VEINOPLUSN° 3 LABORATOIRES INNOTHERAN° 4 PIERRE FABREN° 5 MINERVA MEDICAN° 6 SIGVARISN° 7 PERIMED

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SympOSia

Sy 1 - abdominal aortic aneurysms: an update

Sy1-1 patHOGeNeSiS OF abdOmiNaL aOrtiCaNeUrySmSE. ALLAIRE1

1 Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France

Abdominal aortic aneurysms (AAAs) form and rupture because of the destruction of aortic extracellular matrix digested by an excess of proteinases. Some of these proteinases are activated by the plasmin pathway. Inflammatorycells infiltrating theaorticwallare importantsources of proteinases. Other cells – endothelial, vascular smooth muscle cells- are other putative sources.An important specificity ofAAAs is the disappearance of vascular smooth muscle cells (VSMCs) in the media layer, which may impair adequate wall repair. In addition, VSMCs produce TGF-beta1 and inhibitors of proteinases, thereby protectingtheaorticwallagainstinflammationandproteolysis.Lackof VSMCs may turn the aortic wall into a structure vulnerable to inflammation-drivenproteolysis.Recent data have linked the formation of a luminal thrombus and AAA expansion. The surface of the thrombus promotes the recruitment of polymorphonuclears which deliver an excess of proteases to the wall. The atrophy of AAA wall is in fact more severe at sites of thrombus accumulation. The exact mechanisms by which AAAs rupture remains poorly documented. The accumulation of destructive factors is focal at site of rupture, suggesting a very local phenomenon. Recent report suggest that inflammationmay not be the main feature of rupturedareas, but rather excessive angiogenesis. A last striking feature is that patients with AAAs associated to atherosclerosis have generalized “atrophy” of vessels distant to the main lesion, and that other tissues of these patients heal poorly. Recent data from our laboratory suggest that mechanisms of healing of tissues under strain are altered in these patients. This observation may help identify new molecular and genetic factors linked to this deadly aortic disease. The promotion of aortic healing represents an innovative approach for future treatments alternative to interventional techniques.

Sy1-2 SCreeNiNG FOr abdOmiNaL aOrtiC aNeUrySmSJ. S. LINDHOLT1

1 Vascular Research Unit, Viborg Hospital, Denmark

AAA includes an asymptomatic phase with a relatively low-risk treatment, compared with the symptomatic phase, which is a good argument to consider screening. However, all criteria formulated by theCouncilofEuropemustbefulfilled;Ultrasonographicscreeningisa valid, suitable and acceptable method of screening as the estimated sensitivity and specificity is 98% and 99%, respectively, acceptancerates are above 75%, and 95% accept control scans. The offer ofscreening for AAA causes transient, mild reactions of fear, but repeated screeningseemsonlyrequiredin5%oftheinitiallynegativefindings.Evidencebasedlargescaledrandomisedtrialshaveidentified5.5cmas cut point for repairing asymptomatic AAA, and survivors enjoy the same quality of life as the general population of the same age, and it seemsthatonly2-5%ofpatientsrefuseanofferofsurgery.Finally, the benefits of screeningmust outweigh the costs.All fourexisting randomised trials are reporting benefit of screening ofmenaged 65 and above, and the pooled mid-term and long term relative risk reductionisbotharound50%,and2%reductioninoverallmortality.Cost effectiveness have proven attractive in the large MASS trial, and recently the Viborg Study reported after 14 years that the number needed to screen to save one life was just 135, the frequency of emergency operationsduetorupturewassignificantlyreducedby56%.Thecostper life year gained could be calculated at 157€ and the cost per QALY

at 178€ based upon all cause mortality. This is lower than 1/10 of the costs in the well-known implemented cancer programs.In all, offering men aged 65-74 years screening for AAA seems acceptable according to criteria from Council of Europe, however nation-wide implementation in Europe is only ongoing in UK.

Sy1-3 tHe LONG-term reSULtS OF tHe eVar itriaLJ. T. POWELL1

1 Vascular Surgery Research Group, Imperial College at Charing Cross, St Dunstan’s Road, London W6 8RP, UK

The 3 published randomised trials comparing elective endovascular versus open repair for abdominal aortic aneurysms have been remarkably consistent in showing a 3-fold 30-day operative survival benefit of endovascular aneurysm repair (EVAR)1-3. These trials(EVAR-1, DREAM and OVER) also have reported mid-term results, with survival rates to between 2 and 4 years after randomisation4;5. However the long-term follow of the EVAR trials6;7 has yielded some surprises. The EVAR 1 trial randomised patients with large aneurysms (at least 5.5 cm in diameter, anatomically suitable for EVAR) to either endovascular repairoropenrepair.After8yearsoffollow-up,54%remainedalive,exactly the same proportion in those randomised to EVAR as in those randomised to open repair: EVAR was not associated with a long-term survivalbenefit6.Therefore,otherlong-termoutcomesassumegreaterimportance to more than half of the patients, particularly the new endograft-related complications reported throughout follow-up. The reporting of new endograft-related complications was highest within thefirst6monthsofaneurysmrepair(22.9newcomplicationsper100-patient years of follow up), reducing to 3.4 new complications per 100-patient years of follow up between 6 months and 4 years, with weak evidence that rates might start to increase again after 4 years. There is other evidence to indicate that EVAR might not be as durable as open repair. There were 25 secondary ruptures after EVAR, the majority (72%)ofwhichprovedtobefatal.Incontrast,therewerenosecondaryruptures reported after open repair. These endograft ruptures appear to explain the erosion of the statistically significant3%aneurysm-relatedsurvivalbenefitforEVARversusopenrepair,observedduringthefirst4yearsoffollowup5.These long-term results question the durability of EVAR and for the moment there is no better evidence. Or is perhaps the durability of EVAR acceptable but with the general aging of the population, the durability of the aorta is not adequate?References(1) EVAR Trial Participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364:843-848.(2) Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351:1607-1618.(3) Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT, Jr., Matsumura JS, Kohler TR et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302:1535-1542.(4) Blankensteijn JD, de Jong SE, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SM et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005; 352:2398-2405.(5) EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365:2179-2186.(6) The UK EVAR Trial Participants. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010; 2010;362:1863-70.(7) The UK EVAR Trial Participants. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med 2010; 362:1872-80


Sy1-4 mediCaL apprOaCH tO tHe patieNt WitHaN abdOmiNaL aOrtiC aNeUrySmF. BECKER1

1 Division of Angiology and Hemostasis, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland

Until recently, abdominal aortic aneurysm has only been seen through an immutable progression and a very high mortality in case of rupture. In this frame any AAA discovered was monitored by imaging as long as the surgical benefit versus risk of rupturewas in favor of apreventive surgery. The threshold diameter of the AAA being at50 mm.Nevertheless, -firstlywhenanalyzing thecausesofdeathofpatientswith AAA, the AAA rupture is not the main cause, it may even be the last one, -secondly the operative mortality in scheduled surgery for AAA is largely due to pre-existing co-morbidities, -thirdly even if we have no evidence-based drug to slow the progression of AAA, actions against some reducible factors (like smoking and sedentariness) are likely to slow the AAA progression rate. Faced with a patient who has just been discovered a AAA <50 mm AP, we must not only monitor the evolution of AAA by scheduled ultrasound examinations, we must act on cardio-vascular risk factors and on co-morbidities that are able to exacerbate the potential surgical risk. In particular, smoking cessation, improvement of respiratory function, regular exercise... are probably as important as the repeated imagings. It is probably also useful to inquire about the relatives over 50 years of the patient.

SY 2 - Efficient compression therapy to treat venous diseases: scientific, medical and practical key factors (Corporate Symposium - Sigvaris)

Sy2-1 COmpreSSiON tHerapy iN CHrONiC VeNOUSdiSOrderS: a briGHt FUtUre reQUiriNG maNy eFFOrtSP. CARPENTIER1

1 Centre de Recherche Universitaire de La Léchère (73210), France

Although compression therapy is increasingly acknowledged as the cornerstone of the treatment of patients with chronic venous disorders (CVD), its use in everyday practice is far from satisfactory, and many efforts have to be developed by the manufacturers, the vascular scientists, the attending physicians and the patients in order to get the potentialbenefitthatcanbedrawnfromthismajortherapeutictool:- Patients have to appropriate their compression device, to learn how to use and to look after it, and to adapt in some way their lifestyle to the treatment,allobjectivesthatarenothingshortofdifficultandrequireknowledge, skills and motivation, which means that compression therapyrequiresspecifictherapeuticeducationprograms.- Physicians have to play their role in these therapeutic education programs,andalready theprescriptionprocess isonefirst importantstep for building motivation, insuring the adequacy of the device to the vascular status of the patient and for customizing it to its personal needs: education of the physicians is also necessary.- A lot of work is needed from the vascular scientists who have yet to validate the efficacyof compression stockings in some importantindicationssuchasvenousedema,andtodefinetheoptimalpressureand stiffness for each clinical situation through adequate therapeutic trials, in order to make the use of compression stockings quite an evidence-based practice.- The acceptability (esthetics, comfort, easiness to handle) and physical properties of the compression have very much improved during the last decade. However, a lot remains to be done from the manufacturers in this respect, and they also have to play their role in the promotion of the therapeutic trials.All these efforts, and their coordination, are necessary to make compression therapy more effective in real life.

Sy2-2 NeW StrateGieS tO imprOVe COmpLiaNCeOF COmpreSSiON tHerapy (20-36 mmHG)D. RASTEL1, E. LE FLOCH2, B. LUN3

1 Grenoble, France2 Paris, France3 Saint-Just Saint-Rambert, France

Compression therapy (CT) is one of the key treatment of deep and superficial venous disorders. CT based on Medical compressionstockings (MCS) is generally preferred to bandages thanks to the better control of the delivered pressure. Nervertheless, it is admitted thatthecompliancetoMCSremainsinsufficientduetodifficultiestoput on, to wear and to remove MCS. In a recent survey among French phlebologists (MCS with 20-36mmHg at the ankle; alias french class 3),21.4%ofpatientsareuncompliant,70.4%havedifficultiestoputonand25.4%feeldiscomfort.Then, new strategies of research have been conducted to improve compliance to MCS over long term periods of treatment such as it is required to treat post thrombotic syndrome or severe venous pathologies. One of the key point for compliance is the putting on process where its main parameter is fabric friction factor at the level of the instep and the ankle. So, the objectives of the strategy was to reduce friction. This was driven through different studies:1 - To improve our knowledges on skin-MCS interface, coefficentof friction and secondary skin parameters. In brief, hydration (corneometer®), micro-structure (Visioscan®), water loss (Tewameter®), elasticity (Cutometer®) have been measured.2 - To optimise the ergonomic description of patients’ body movements during putting on and pulling off processes, a biomechanician approach have been considered. Muscle activities were investigated using surface electromyography measurements. We concluded that muscle activity of the thumb is mainly involved in putting on and muscle groups of shoulder in removing MCS.2 - To facilitate the putting on process (slippy aspect), improvement (yarns selection) and innovation (dynamic in elasticity) in MCS concept and design were implemented («EXPERT» from SIGVARIS). Conducted on a pannel of 30 patients in different situations (comparative test) we noticed that for 79% putting on is improved and 93% feltconfortable with this new MCS.

Sy2-3 COmpreSSiON aFter SCLerOtHerapyP. KERN1

1 Private office of vascular medicine in Vevey, Switzerland

As recommended in the guidelines of the German Society of Phlebology most specialists apply compression after sclerotherapy of saphenous varicose veins and collaterals. Applying an extrinsic selective compression associated with compression bandage after sclerotherapyofthegreatsaphenousveinsignificantlyenhancesresultsat2years(echographicrecanalisation11vs23%,respectively)1.Onthe contrary, short term (< 6 weeks) results and incidence of side effects are not influenced by compression (low grade 15-20mmHgmedical compression stocking (MCS)2, or 5 days instead of one day compression bandages3).In the setting of telangiectasias, several studies demonstrated a beneficialeffectofwearingMCSaftersclerotherapy.Thiswasshownfor telangiectasias greater than 0.5 mm in diameter4. The best effects were observed in patients wearing MCS 20-30 mmHg for three weeks5.Recently,thisbenefitwasconfirmedbyaprospectivestudy6.After one session of sclerotherapy for telangiectasias on the lateral aspect of the thigh (C1A or SEPASPN1), 100 patients were randomized either to daily 23-32 mmHg MCS for three weeks or no compression. Objective rating of vessel disappearance was significantly betterafter compression (p= .026). Poor results were more frequent in the no compression group (43% versus 24%).Micro-thrombi were lessprevalent in the compression group. Finally, a subsequent study7, comparing1to4weekMCS,showedasignificantreductionofpost-

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sclerotherapy pigmentations when MCS was worn for 4 weeks.In conclusion, even if the usefulness of MCS wearing after sclerotherapy ofsaphenousveinsseemstobemoreobvious,it’sefficacyatpresentis less well documented in this indication than after sclerotherapy of telangiectasias.References:1- Ferrara F, Bernbach HR, La compression écho-guidée après sclérothérapie. Phlébologie 2009 ; 62 : 36-412- Hamel-Desnos C; Guias BJ, Desnos PR, Mesgard A. Foam sclerotherapy of the saphenous veins. Randomised controlled trial with or without compression. Eur J Vasc Endovasc Surg. 2010 Apr; 39: 500-73- O’Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinical trial of different bandage regimens after foam sclerotherapy for varicose veins. Br J Surg. 2010 May; 97: 650-6.4- Goldman MP, Beaudoing D, Marley W, Lopez L, Butie A. Compression in the treatment of leg telangiectasia: a preliminary report. J Dermatol Surg Oncol. 1990; 16:322-5.5- Weiss RA, Sadick NS, Goldman MP, Weiss MA. Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. Dermatol Surg 1999; 25:105-8.6- Kern P, Ramelet A-A, Wütschert R, Hayoz D. Compression after sclerotherapy for telangiectasias and reticular leg veins: a randomized controlled study. J Vasc Surg 2007; 45: 1212-16.7-NoothetiPK,KristianMC,MagpantayA,GoldmanMP.Efficacyofgraduatedcompression stockings for an additional 3 weeks after sclerotherapy treatment of reticular and telangiectactic leg veins. Dermatol Surg 2009; 35: 53-8.

Sy2-4 tHe eFFeCtS OF mediCaL COmpreSSiON StOCKiNGS ON VeNOUS aNatOmyJ. - F. UHL1, 2

1 URDIA research unit, EA4566 University Paris Descartes, Paris, France2 Vascular surgeon, 113 av. victor Hugo, 75116 Paris, France

Objective: to study the effects of medical compression stockings (MCS) onboththesuperficialanddeepveinsveinsofthelowerlimbs.methods: The spiral CT with 3D reconstruction of the lower limbs (with or without injection) is an accurate method to assess the 3D shape ofthelegandthediameterofthesuperficial/deepveins.Itispossibleto obtain a realistic 3D model of the leg and its anatomical structures. That makes possible to evaluate the interface pressure and effects due to the compression stockings. Technical limits: exposition to X rays, a venous injection is usually not advisable, and this exam is strictly limited to the lying position. The MRI in standing position in T2 is a more informative protocol.The Duplex US through a stocking with a transparent window is another way to assess both the anatomical and hemodynamical effect of the MCS on the veins.results:AccordingtotheLaplace’slaw,themodificationsoftheshapeof the leg i.e cross sections at different levels, give a radius for each location, and so different interface pressures all around the limb. The results of these theoretical values of the interface pressure are close to the real values measured at the same location by a probe: the compression of the saphenous veins in lying position is observed below the knee providing the pressure at the ankle (B point) is at least 25 mm of Hg. It is not possible to make a compression of the veins at the thigh level without a pad.Conclusion: The Laplace law and the interface pressure work well regarding the superficial veins. But, in reality, the problem ismuchmore complex regarding the effect of MCS on the deep veins: during the muscular contraction, they act like an extra aponeurosis and seem to play an important role even for a lower pressure interface.Key words: Multisclice CT - MRI - interface pressure - MCS

Sy 3 - Carotid stenosis: moving concepts and practices

Sy3-1 tHe SUrGiCaL treatmeNt OF CarOtidSteNOSiS: NeW iNFOrmatiON FrOm reCeNt triaLS aNd WHat iS reQUired FOr FUtUre StUdieS

J. FERNANDES E FERNANDES1

1 Faculty of Medicine, University of Lisbon, Hospital Santa Maria and Lisbon Cardiovascular Institute, Lisbon, Portugal

Severe carotid bifurcation stenosis is a major cause of stroke in the western population. Carotid Endarterectomy (CEA) has been shown to reducestrokeriskinstenosis>70%forsymptomaticandasymptomaticpatients (ECST; NASCET, ACAS and ACST) and became the established procedure for the treatment of severe carotid bifurcation disease, because combined mortality and neurological morbidity were inferior to best medical treatment. Reduction of surgical risk and improvement on durability of CEA resulted from judicious use of indwelling shunts during endarterectomy and systematic use of patch closure. Per-operative quality control of CEA adequacy has been associatedwithreductionofneurologicaleventsasconfirmedbyourown experience of systematic completion assessment of CEA with per-operativecolour-flowDuplexScan.Carotid Angioplasty and Stenting (CAS) a less invasive procedure, not requiring surgical intervention, has been suggested as an alternative for treatment of carotid stenosis.Recently published RCT’s (EVA-3S, SPACE and ICSS) comparing CAEandCASinsymptomatic>70%stenosishaveprovidedevidencethat CAS is associated with higher incidence of ipsilateral stroke, increased incidence of silent brain infarcts as assessed by DW NMR (ICSS) and concluded that CEA should continue as the procedure of choice for symptomatic patients.Asymptomatic carotid disease is a relatively benign disease with a stroke riskof3%/yearassuggestedinnaturalhistorystudiesandisamarkerof cardiovascular disease. Reported CAS results in asymptomatic stenosisareconstantlyassociatedwithneurologicalmorbidity>3%,with non-negligible restenosis rate, thus casting doubts on its real efficacyandCEAtobereallyeffectivemusthaveasurgicalrisk<3%(AHA Guidelines). Increased stroke risk in asymptomatic stenosis is associated with plaque vulnerability as assessed by its echogenicity, plaque structure analysis and evidence of progressing stenosis on repeated Duplex examinations. Non-invasive evaluation of plaque activity provided by the Activity Index was shown to identify asymptomatic stenosis with higher risk of developing neurological events thus improving selection of patients thatwillbenefitofcarotidinterventionstopreventstroke.Therefore, a study in asymptomatic patients at high risk of stroke is required comparing interventional procedures (CEA and CAS) with a subgroup of patients under well established contemporary best medical treatment.

Sy3-2 CarOtid SteNOSiS: pLaCe OF CarOtidSteNtiNGJ. L. MAS1

1 Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France

Large randomized clinical trials (RCTs) have shown that the addition of endarterectomy to medical therapy is effective in reducing the risk of stroke among patients with severe carotid stenosis. At present, RCTs in patients with symptomatic carotid disease show inferior results of stenting compared to surgery with regard to the risk of stroke or death within 30 days of treatment.Bothmethodsoftreatmentseemtohavesimilarefficacyatpreventingmid/long-term ipsilateral stroke after the treatment period, but with wide confidence intervals, despite a significantly higher incidenceof restenosis in patients treated with stenting. Longer follow-up is needed to assess the impact of the potentially higher rate of recurrent stenosis after stenting compared with surgery on late recurrent stroke. Toimprovetherisk-benefitprofileofstenting,itiscrucialtoestablishwhich factors among patient characteristics and the procedure itself are associated with a high risk of stroke after carotid stenting. Recent meta-analysis show a striking age-related difference with equivalent


risks of stroke or death after stenting and surgery below the age of 70 and a two-fold increase in risk of stenting over endarterectomy above this age. RCTs in patients with asymptomatic stenosis have shown that the absolutebenefitofendarterectomyversusmedical treatmentaloneissmall, especially in women. In addition, there is growing evidence that the risk of ipsilateral stroke without surgery has been going down to <1% per year, thanks tomore effectivemedical therapy. If stentingis associated with an excess procedural risk of stroke (as it probably is),thisexcessriskwillprobablyerodeornullifythesmallbenefitofrevascularisation versus medical treatment alone. Therefore, the right question may be whether carotid stenting (or surgery) further reduces stroke risk in patients who receive best medical therapy.

Sy3-3 StrOKe aNd tHrOmbOLytiC tHerapy. aNUpdateV. LARRUE1

1 Department of Vascular Neurology, University Hospital of Toulouse, Toulouse, France

Fifteenyearsafterdemonstrationofitsefficacyintravenousthrombolytictherapy with alteplase remains the only validated treatment of acute ischemicstroke.Theefficacyoftreatmentisstronglytimedependent.Ithasbeendemonstratedupto4.5hofstrokeonsetandefficacyrapidlydecreases within this time frame. Safety of intravenous thrombolysis for stroke in clinical practice has been confirmed by large phase IV studies. Implementation of thistreatment is however still a challenge in many areas because it requires expertise in both clinical neurology and brain imaging interpretation. Inaddition,theefficacyofintravenousthrombolysisremainsuncertainin important subgroups such as patients over 80 years.Intravenous thrombolysis with alteplase is poorly effective in patients with large vessel occlusion. Additional or alternative therapies are currently evaluated in these patients. These include thrombolysis acceleration with transcranial ultrasound, intra-arterial administration offibrinolytics,andembolectomywithmechanicaldevices.

Sy3-4 aSymptOmatiC CarOtid SteNOSiS aNd riSKStratiFiCatiONA. NICOLAIDES1 (for the ACSRS study group)1 Department of Biomedical Sciences - University of Cyprus, Nicosia, Cyprus

Best evidence indicates that the annual risk of ipsilateral cerebral stroke in patients with moderate-severe asymptomatic internal carotid stenosis (ACS) receiving optimal medical intervention alone has fallen to approximately 1% making routine carotid endarterectomyunjustified. However, if patient subgroups with sufficiently higheraverage risk, despite current optimal medical intervention, could be reliablyidentified,thencarotidsurgerymaystillbejustified.The ACSRS performed under the auspices of the IUA was a prospective, multicentre, cohort study of patients undergoing medical intervention for vascular disease that has answered this question. Hazard ratios for stenosis, clinical features and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models.1121patientswith50-99%asymptomaticICAstenosisinrelationtothebulb (ECST method) were followed-up for 6-96 (mean 48) months. A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral TIAs or stroke, low gray scale median (GSM), increased plaque area, plaque types 1, 2 and 3 and presence of discrete white areas without acoustic shadowing (DWA) were associated with increased risk.ROC curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with

clinical features and a model of stenosis combined with clinical and plaquefeatureswere0.59(95%CI0.54to0.64),0.66(0.62to0.72)and 0.82 (0.78 to 0.86) respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area and DWA were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close toobservedrisk.Ofthe923patientswith?70%stenosis,thepredictedcumulative five year stroke rate was <5% in 495, 5-9.9% in 202,10-19.9%in142and?20%in84patients.Thus,cerebrovascularriskstratificationispossibleusingacombinationof clinical and ultrasonic plaque features.

SY 4 - Early detection of the high vascular risk subjects

Sy4-1 SCreeNiNG FOr pad iN tHe GeNeraLpOpULatiONV. ABOYANS1

1 Vascular Unit, Dupuytren University Hospital, Limoges, France

Over these last 25 years, the clinical and epidemiological studies have clearly shown that PAD is a frequent condition in general population, and the subjects affected even by its asymptomatic form are at high risk of death and cardiovascular events. As for the population screening of anylife-threateningdisease,screeningforPADshouldfollowspecificconditions: the screening method should be accurate, robust, safe, well-accepted, cost-effective and it should be followed by a successful medical intervention to improve the prognosis in case of positive test. The ankle-brachial index is the most widely-used tool to detect PAD, becauseitpresentsthefiveformercharacteristicsenlistedabove.Thekey and unresolved issue remains the management of asymptomatic PAD. Further studies are necessary to assess the successful strategies whichmaydefinitelyvalidatethepopulationscreeningforPAD.

Sy4-2 aSymptOmatiC CarOtid LeSiONS prediCt GLObaL CardiOVaSCULar riSK beyONd tHe CardS OF tHe riSKS. NOVO1, P. CARITA1, C. VISCONTI1, E. CORRADO1,I. MURATORI1, G. NOVO1

1 Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis, Division of Cardiology, University Hosp., University of Palermo, Italy

Atherosclerotic Cardiovascular Disease (CVD) is the biggest cause of morbidity and mortality worldwide and remains the major threats to the future public health of multiple countries. Decades of research have determined that atherosclerosis develops insidiously, being advanced by the time that symptoms occur. In healthy subjects, the atherosclerotic process is the product of a number of genetic, social, physiological and environmental factors and a comprehensive approach to prevention would address all of these. Risk Factors may bedefinedasconditionscasual-linked toATSandcanbedivided intraditional (modifiable and not modifiable) and emerging. Recently,various biomarkers of inflammation have also been increasinglyinvestigated as possible indicators of increased cardiovascular risk. Several seemingly modest RF may, in combination, result in a much higher risk than an impressively raised single factor. This means that the RF may interact to increase risk into a logarithmic way. For these reasons, risk estimation systems have been developed to assist clinicians to assess the effects of several risk factors combinations in planning cardiovascular preventive strategies. The various countries use different systems in order to respect the different populations of reference, in example the Progetto Cuore (ISS) aims at estimating the risk in Italian population. Each score system should consider a broader perspective and attempt to estimate the «global» cardiovascular risk (GCVR)ofdevelopingafirstadverseCVevent in thefollowingtenyears by evaluating several traditional RF. The most recent guidelines

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recommend the use of risk assessment tools to help identify individuals at«high»risk,whocouldbenefitfromtherapeuticintervention,beforemaking clinical management decision. However, the term global risk estimation is perhaps a misnomer, as no system accommodates all known risk factors. Furthermore, many evidences indicate that the non invasive evaluation of signs of preclinical atherosclerosis could help to betterdefinethepatternofriskinasymptomaticsubjects.TheriskofCV events in patients with preclinical atherosclerotic lesions is higher than in the controls. The preclinical ATS is, indeed, an early stage of this process: it is characterized by a minimal damage (then potentially susceptible to correction) and, above all, indicates a multifocal disease. In these regards, the ultrasound evaluation of Intima-media thickness and/or asymptomatic plaque of carotid arteries it’s a high sensitive and specificmethod.Inarecentstudyweaimedatdeterminingtheeffectsof including carotid IMT and ACP evaluation on the accuracy of CV prediction. Our intention was to investigate if a new model of risk stratificationincorporatingtheIMT/ACPbeyondtheriskvariablesofthe «Progetto Cuore» could more accurately predict the GCVR in 454 [215maleand239 female] asymptomatic subjects.After afive-yearfollow-up,overallCVmajoreventsoccurred in the13%of subjects(n=62) and none of the traditional RF evaluated was alone able to predict events. We reported a strong association between presence of preclinical carotid ATS and rate of events. In more details, in the group ofsubjectsatGCVR<20%totaleventsoccurredinthe8%ofsubjectswith normal ultrasound findings, in the 13% (n=14) with increasedIMTand in the15%(n=23)withACP(p<0.012).Weshowed thatin managing subjects at «low-intermediate risk» (that currently has poor propabilities to receive complete informations and therapies for cardiovascular prevention), the evidence of signs of asymptomatic IMT or ACP, could provide further informations in improving their risk prediction. Similarly, in another study (enrolling 558 asymptomatic patients) after a ten-year follow-up we reported that although the overall incidenceofafirstCVeventreflectedthedifferentriskprofiles(4,14,and20%,respectively),therateofeventsincreasedto35,46,and63%,respectively in those patients with baseline evidences of preclinical ATS. Furthermore, at the multivariate analysis asymptomatic carotid lesionssignificantlyinfluencedtheincidenceofevents.Accordingtoour and other similar results, the carotid pre-ATS could be a marker of «additional» risk.

Sy4-3 earLy marKerS iN HyperteNSiON: OFteN OF VaSCULar OriGiN!D. L. CLEMENT1

1 University of Ghent, Ghent, Belgium

The reappraisal of the 2007 guidelines on the management of Hypertension have emphasised the importance of estimating total cardiovascular risk. Even minor blood pressure elevation, can become a major treat in case also other risk factors are present. Lastyearsreflectionsalongthislinehasgoneevenfurther.Evenminordegree of organ damage, when added to other risk factors or minor disease, can lead to a seriously total increased risk. This reasoning has focused all attention in hypertension to organ damage, even when it has not yet come to a clinically level; therefore the term of «subclinical» organ damage is being used. Microalbuminuria is a good marker of early changes in kidney function.Thetestisquiteeasyandnormallimitsratherwelldefined.Cost effectiveness score is excellent and there is good correlation to prognosis. However, clinicians still underuse the technique. The electrocardiogram is largely alike at the level of the heart. ECG is cheap and very easy to perform. Recent information shows that prognostic information can be obtained even when amplitude of R waves is falling in between «normal» values.Ankle brachial artery pressure index (ABI) is to be seen in the same context. Besides its diagnostic capacities, it has a very strong correlation to long term prognosis. Recent data point out the value of ABI also when it falls just around normal limits.

Fundoscopy has been forgotten last years in hypertension clinics. However, recent papers have indicated that the image seen by visual inspection, can be digitised and fed into the computer providing very wellquantifiableinformation.Conclusion:totalcardiovascularriskisregularlydefinedbyriskfactorsor organ damage. Sub clinical organ damage could bring in a lot of new information on long term prognosis. This is particularly the case when several bits of sub clinical changes occur together. Analysis of these changes could open the way for much earlier prevention and treatment.

Sy4-4 atHerOSCLerOSiS aNd VeNOUS tHrOm-bOSiS tHe Same diSeaSe eNtity WitH tWO diF-FereNt FaCeSP. POREDOS1, M. K. JEZOVNIK1

1 University Clinical Centre Ljubljana, Department of Vascular Diseases, Zaloska 7, SI-1000, Ljubljana

In past decades studies have indicated that there is an association between atherosclerotic and venous thrombembolic disease (VTE). This presumption is supported by similar or identical risk factors for both diseases and common pathogenetic mechanisms. Some studies have shown also that patients with VTE are at increased risk for atherosclerotic thrombembolic events. We investigated if in patients with idiopathic VTE the prevalence of preclinical indicators of atherosclerosis (increased intima-media thickness-IMT, number of atherosclerotic plaques is higher than in healthy subjects. Further we studied flow mediated endotheliumdependent (FMD) vasodilatory response of brachial artery in both groups of investigated subjects. Forty-nine patients with idiopathic VTE of both sexes (mean age 52.3 ± 14.3) and 48 age-matched healthy controls were included. Using ultrasound carotid and femoral arteries were investigated and IMT as well as the presence of atherosclerotic plaques and their thickness were determined. Flow mediated vasodilatory response was studied by the determination of changes of the diameter of brachial artery during reactive hyperaemia. Intima-mediawasonaverageandinallinvestigatedbedssignificantlythicker in patients than in controls (0.94 mm ± 0.29 mm vs 0.71±0.15 mm, p< 0.001). In patients with VTE a higher prevalence of atherosclerotic plaques was registered. Furthermore, total plaque thickness was significantly higher in patients than in controls.ComparedtothecontrolgroupFMDwassignificantlyreducedinthegroup of patients: 4.9% (95%CI 1.1-8.7%) vs. 12.7% (95%CI 7.8-17.6%), p<0.001. Patients with VTE had also significantly reducedendothelium independent dilation of the brachial artery. Functional and morphological deterioration of arterial wall were interrelated. Furthermore, FMD was related to circulating indicators of endothelial dysfunction.The findings of our study show a close interrelationship betweenthe presence of the idiopathic VTE and preclinical atherosclerotic deterioration of the peripheral arteries. This means that patients with VTE have simultaneous deterioration of the arterial and venous wall and that there is a close relationship in the development of both diseases.

Sy 5 - therapeutic education of the vascular patient

Sy5-1 tHerapeUtiC edUCatiON OF tHe patieNtWitH peripHeraL arteriaL diSeaSeP. H. CARPENTIER1

1 Department of Vascular Medicine, Grenoble University Hospital, F-38043 Grenoble cedex, France

Patients with peripheral arterial disease are expected to control their risk factors, to be compliant with non symptomatic long term treatment and to be able to detect any warning sign for a complication. This cannot be achieved only by the usual information delivered by the physician


during a classical medical consultation. It is the aim of therapeutic education is to modify the behavior of the patient in order to obtain the required changes in lifestyle, to help him to cope with the disabilities related to his disease or its treatment, and to make him an active partner in the management of his disease.A program called “Let’s Walk” was developed by the vascular medicine teams of Grenoble and Montpellier with the collaboration of a group of patients with arterial claudication. The educational course was made of three face to face educational consultations and five workshopswhere small groups of patients were interactively informed about the risk factors, the natural history and the treatments of peripheral arterial disease and atherothrombosis, and motivated for a better control of physicalactivity,dieteticsandotherneededlifestylemodifications.Apreliminary evaluation of the 90first patients showed that only twothird of the patients completed the whole educational course, but that thisgroupexperiencedasignificantincreaseofknowledge,motivation,self-perceived health status and physical activity. This program is currently available in 12 other French centers.

Sy5-2 edUCatiON OF tHe patieNt WitH VeNOUStHrOmbOembOLiC diSeaSeP. LEGER1

1 Clinique Pasteur, Toulouse, France

Therapeutic patient education is a crucial factor in the therapeutic management of patients with thromboembolic disease. Education has been structured and modeled. Many recommendations regarding the role of the trainers, as well as the role and implementation of Education in the treatment of chronic diseases, are available.Therapeutic education of patients with thromboembolic disease is mainly focused on anticoagulation treatment. The objectives of Education are numerous: - To avoid hemorrhagic and thrombotic events, - To train the patient on how to manage his treatment with VKA through a comprehensive patient-centred approach - To emphasize the «patient-actors» concept by sharing knowledge and expertise with caregivers. The aim is to integrate the treatment and disease in the patient’s daily life and allow him to achieve an acceptable quality of life. Education is best achieved by a multi-professional team, using many teaching tools and different means of transmission of knowledge. Role-playing situations can often help assess the patient’s knowledge. Education is based on the achievement of educational diagnosis for each patient and the set up of a therapeutic agreement with the patient followed by an action plan. Evaluation is an integral part of the activity. A minimum knowledge is required for the patient called «Safety agreement» is often used in the case of education of a patient treated with anticoagulants. Recentstudiesconfirmtheimportanceandtheefficiencyoftherapeuticpatient education specially, in Self-monitoring of oral anticoagulation. ArecentstudyshowedasignificantdifferenceinfavourofthegroupEducation on the occurrence of serious bleeding complications and recurrencethrombosis.OR0.25(95%CI0.1to0.7),p<0.01.Education is effective in patients treated with anticoagulants. It reduces bleeding and thrombotic complications.

Sy5-3 tHerapeUtiC edUCatiON OF tHe patieNtSWitH CHrONiC VeNOUS diSOrderSB. SATGER1

1 Centre de Recherche Universitaire de La Léchère, 73260, France

Chronic venous disorders (CVD) have no effective curative therapy and need long term care management. Patients have to manage their illness for a long time; a high motivation for treatment with a good compliance to compression therapy is required, and they may have to change their lifestyle with the importance of venous hygiene. Thus a need for active participation of patients to their treatment is requested

and any mean able to improve the quality of life is welcome. In order to address these needs, several educational programs for voluntary patients were developed in French spa resorts with some improvements over the years. Initially focused on the promotion of a better knowledge in venous disease by the patients, by the time the educational programs developped towards a more customized approach to the needs of each patient.Thefirstonenamed«Ecolede laveine»started15yearsago in thespa resort of La Léchère, with topics approached during interactive work-groups. A series of patients showed improved knowledge and compliance to compression therapy in the short term. «Veinothermes» was developed two years ago by a multiprofessional group with the help of referent patients. The program combines three educational workshops and an individual education consultation aiming at the selection of objectives for the patient to be achieved within threemonths.A systematic evaluationof thefirst 94patientsshowedsignificantbehaviouralchanges,includinganimprovementofcompliance to compression therapy and of quality of life.A third programme was experimented for persons with a recent history of proximal deep vein thrombosis with a six days training course combining four educational workshops and a specific rehabilitationprogram using spa therapy.These experiments with CVD show that it can be useful for this category of chronic vascular patients, and desserve a larger application.

Sy 7 - New insights about the calf muscle pump function

Sy7-1 patHOpHySiOLOGy OF tHe CaLF mUSCLe pUmpA. NICOLAIDES1

1 Department of Biomedical Sciences - University of Cyprus, Nicosia, Cyprus

The lower limb venous return consists of three muscle pumps in series: foot, calf and thigh. Stepping on the ground empties the venous plexus of the foot into the calf (priming) and subsequent contraction of the muscles to lift the heel off the ground empties the calf into the thigh; finally lifting the leg off the groundmaintains contraction ofthe quadriceps contributing to the emptying of the thigh. Proximal propagation is the result of competent valves.Reflux, in the superficial systemallowsaproportionof theexpelledbloodtoflowdowntothelowerlimbdependingonrateofrefluxandtheinterval of relaxation between steps. This produces a high ambulatory venouspressure (AVP)which isworseduring slowwalking.Refluxin the deep veins is associated with an even higher AVP and damage tothemicrocirculationproducingskinchangesandoedema.Outflowobstruction in the presence of reflux produces the worst possibleclinical condition unless the popliteal valves are competent. Thus, thepoplitealvalvesarekeyinmaintainingtheefficacyofcalfmusclepump. When competent they protect the lower limb from developing the post thrombotic sequelae.In clinical practice elastic compression controls oedema all the time but improves the calf muscle pump function only during walking and contributes to lowering the average venous pressure throughout the day. Intermittent calf compression or musle stimulation devices empty the veins at rest (during sitting) also contributing to a lower average venous pressure throughout the day. The combination of (a) elastic compression, (b) intermittent calf compression, (c) iliofemoral recanalisation when indicated and (d) venotonic drugs offer a patient withadeficientvenouspump,thebesttherapeuticoption.What is not yet known is the quantitative contribution of each modality and which combination is optimal for different clinical situations.

Sy7-2 FUNCtiONaL aNatOmy OF tHe mUSCULarpUmpS OF tHe LOWer LimbJ.-F. UHL1,2, C. GILLOT1

1 URDIA research unit, EA4566 Laboratory of anatomy - University

32 ~

Paris Descartes, Paris, France2 Vascular surgeon, 113 avenue victor Hugo, 75116 Paris, France

Objective: to study the anatomy of the muscular veins responsible for the venous return of the lower limb.methods: 3 main techniques were used in this study: The anatomical dissection after Latex injection of venous network, the CT venography (MSCT in lying position with contrast injection of the foot) and the T2-weighted MRI of the calf in different body positions (supine, prone, upright).results: The 4 anatomical components of the muscular pumps are: the foot pump, the leg pump (soleus muscle), the popliteal pump (gastrocnemius muscles) and the thigh pump (semimembranosus muscle).Anatomy of these muscular pumps is not well-known: its main aspects will be demonstrated by dissections and 3D reconstruction of the venous system.A systematization of the veins of the soleus muscle will be proposed.The gastrocnemius pump, the most powerful, is synchronized with the thighpumpwhichactslikeasafetyvalvetodrainthehighflowofthepopliteal vein in the deep femoral vein.Conclusion: A chain of muscles from the foot to the thigh makes a true functional unit to activate the venous return. A failure of one or several of these pumps, activated during walk, will be responsible for a worsening of the chronic venous disease of our patients. Key words: VenoCT - MRI - Anatomy- muscular pumps- calf pump

Sy 8 - Venous thromboembolic disease: moving Concepts andpractices

Sy8-1 mediCaL SiGNiFiCatiON OF tHe aSymptO-matiC VeNOUS aNd pULmONary embOLiSmG. PERNOD1

1 Vascular Medical unit, CHU Grenoble, Grenoble, France

Pulmonary embolism (PE) is a common disorder with an estimated annual incidence of approximately 300,000 cases in Europe. PE is an important cause of mortality: in the past two decades, the case fatality rate for PE was estimated to vary from 7% to 11%. Over the lastyears, there has been an increasing number of diagnosis of incidental, asymptomatic pulmonary emboli that are detected in patients undergoing chest computer tomography (CT) for reasons other than the research of suspected PE. With the increasing use of chest CT scans, incidental diagnoses of PE are becoming a common problem in clinical practice. However, information on the prevalence and on the natural history of unsuspected silent PE is extremely limited. In particular, whether the diagnosis of an unsuspected asymptomatic PE is associated with increased morbidity and mortality rates remains unclear. Furthermore, the optimal therapeutic strategies when asymptomatic PE is incidentally diagnosed are uncertain. In the absence of evidences on the risk to benefitratioofanactivetreatment,itiscurrentlyrecommendedthatthesame initial and long-term anticoagulation as for comparable patients with symptomatic PE is prescribed. Moreover, approximately one third of patients with deep venous thrombosis have silent pulmonary embolism. Silent pulmonary embolism is more frequent in patients with proximal deep venous thrombosis than in those with distal deep venous thrombosis, and asymptiomatic pulmonary embolism may lead to pulmonary hypertension.The aim of this presentation was to focus on epidemiological data and practical approach regarding unsuspected silent PE.

Sy8-2 NeWer treNdS iN tHe maNaGemeNt OF tHrOmbOSiS. impaCtS ON VaSCULar iNdiCatiONSE. KALODIKI1, J. FAREED2

1 Ealing Hospital & Imperial College London, SW7 2AZ & Loyola University, UK2 USA

The conventional management of thrombotic and cardiovascular disorders is based on the use of heparin, oral anticoagulants and aspirin. Despite remarkable progress in life sciences, these drugs still remain a challenge and mystery to us, and their use is far from optimized. The development of low molecular weight heparins (LMWHs) and the synthesis of heparinomimetics, such as the chemically synthesized pentasaccharide,representarefineduseofheparin.Genericversionsofvarious branded LMWHs are also developed. Chemical and enzymatic modifications of heparin and related glycosaminoglycans have alsoresulted in the introduction of anticoagulants with different biologic actions. An anti-Xa enriched LMWH namely AVE 5026 is also developed for specific indications in cancer associated thrombosis.Additional drugs from this knowledge will continue to develop; however, none of these drugs will match the polypharmacology of heparin. Parenteral antithrombin agents such as hirudins, angiomax and argatroban have been used in the management of heparin compromised patients. Newer parenteral anticoagulants from both the natural and synthetic sources are also developed. A newer parenteral anti-Xa drug, namely otamaxiban represents a potent anticoagulant which may be useful in various hematologic indications. A parenteral LMWH, namely M118 is currently undergoing clinical trials and can be developed for expanded indications. Among the antiplatelet drugs, aspirin still remains the leading drug in the management of thrombotic disorders. The newer antiplatelet drugs such as ADP receptor inhibitors, GPIIb/IIIainhibitorsandotherspecificreceptorinhibitorshavelimitedeffectsand have been used in patients who have already been treated with aspirin. Warfarin provides a convenient and affordable approach in the long-term outpatient management of thrombotic disorders. Warfarin and other anticoagulant usage has been optimized by utilizing INR and improved monitoring approaches. The optimized use of these drugs still remains as the approach of choice to manage thrombotic disorders.Thenewanticoagulanttargets,includingspecificsitesinthehemostatic network such as tissue factor, individual clotting factors (IIa, VIIa, IXa, Xa, XIIa and XIIIa), recombinant forms of serpins (antithrombin, heparin co-factor II and tissue factor pathway inhibitors), recombinant activated protein C, thrombomodulin and site specificserine proteases inhibitors complexes have also been developed. Of these activated protein C and thrombomodulin have been useful in the management of disseminated intravascular coagulation (DIC) and related syndromes. There is a major thrust on the development of orally bioavailable anticoagulant drugs (anti-Xa and IIa agents), which are slated to replace oral anticoagulants. Both anti-factor Xa ( rivaroxiban and apixiban) and antithrombin (dabigatran) agents have been developed for oral use and have provided impressive clinical outcomes in sponsored trials for the post surgical prophylaxis of venous thrombosis; however, safety concerns related to liver enzyme elevations and thrombosis rebound have been reported with some of their use. For these reasons the US FDA did not approve the orally active antithrombin agent ximelagatran for several indications. While rivaroxiban and dabigatran are available for qualified indicationsin Europe and Canada these drugs are not approved in the United States. The synthetic pentasaccharide (fondaparinux) has undergone an aggressive clinical development. Unexpectedly, fondaparinux also produced major bleeding problems at minimal dosages. Fondaparinux represents only one of the multiple pharmacologic effects of heparins. Thus, its therapeutic index will be proportionately narrower. The methylated pentasaccharide, namely idraparinux, is effective for long term prophylaxis, but its use is associated with bleeding. Other forms of pentasaccharide such as the biotinylated form which can be reversed with fucoidin are also developed. The newer antiplatelet drugs have added a new dimension in the management of thrombotic disorders. The favorable clinical outcomes with aspirin and clopidogrel have validated COX-1 and P2Y12 receptors as targets for new drug development. Prasugrel, a novel thienopyridine, cangrelor and tricoglor represent newer P2Y12 antagonists. Cangrelor and tricoglor are direct inhibitors, whereas prasugrel requires metabolic activation. While


clinically effective, prasugrel may have a narrower safety spectrum and its dosage requires further optimization. The newer parenteral and oral antithrombin and anti-Xa agents may be useful in the short and long term management of heparin compromised patients, in particular those who develop thrombocytopenia. These drugs may also be useful inspecificindications,inparticulartheoralanti-Xaandanti-IIaagentsfor the long term outpatient management of thrombosis. Because of the lower molecular weigh, synthetic oral anti-Xa and anti-IIa drugs as well as the newer antiplatelet drugs may pass through the placenta and also pass through the blood brain barrier. These drugs cannot be used in pregnant women and patients with central nervous system (CNS) disorders. Since heparins have a therapeutic effect on cancer associated thrombosis it’s useful in the management of hematologic malignancies. The relative therapeutic value of the newer anticoagulants will remain unknown until additional clinical data becomes available. Although the newer anticoagulant and antiplatelet drugs are attractive for several reasons, none of these are expected to replace the conventional drugs in poly-therapeutic approaches. The generic versions of heparin and LMWH along with other anticoagulants will also become available. However, their safety and efficacy has to be closely watched andvalidated. Heparins, warfarin and aspirin will continue to play a major role in the management of thrombosis and related vascular disorders beyond 2010.

Sy8-3 SUperFiCiaL tHrOmbOpHLebitiS, aSiGNiFiCaNt SUbSet OF VeNOUS tHrOmbOembOLiC diSeaSeI. QUÉRÉ1

1 Vascular Medicine, Hôpital Saint Eloi, Montpellier, France

Superficial venous thrombosis (SVT) is avery frequent event.Untilrecently, the scarcity of strong epidemiological data and therapeutic trials has led to a mostly empirical and debated management. Clinically relevant superiority of any kind of treatment over another (placebo, surgery,nonsteroidalanti-inflammatoryagents,anddifferentregimensof anticoagulants) could not be demonstrated.Important advances were recently realized in the epidemiological and therapeutic fields. In the large prospectivemulticenter observationalPOST(Prospectiveobservationalsuperficialthrombophlebitis)Frenchstudy, one out of four patients with SVT had a concurrent deep venous thromboembolism (DVT, pulmonary embolism (PE)) and 10% ofpatients with an isolated SVT, i.e. without concurrent deep VTE at presentation, experienced a VTE complication (SVT, DVT, PE) at three months. Preliminary results of the international Calisto trial have been presented and will be discussed during this talk.

Sy8-4 tHe CONCept OF earLy tHrOmbUSremOVaL FOr iLiOFemOraL dVtA. J. COMEROTA1,2

1 Director Jobst Vascular Center, USA, 2 Adjunct Professor of Surgery, University of Michigan, USA

Anticoagulation alone is standard treatment for most patients with acute deep venous thrombosis (DVT). However, patients with iliofemoral DVThaveincreasedpostthromboticmorbidity1andsuffersignificantlyhigher recurrence rates compared to patients with infrainguinal DVT.2 Following the natural history of iliofemoral DVT treated with anticoagulation alone reveals that the overwhelming majority have a poorquality-of-life(QOL),15%willdevelopulcerationwithin5years,andatleast40%willhavevenousclaudication.3,4A prospective analysis of patients treated with anticoagulation for acute DVT demonstrates that patients with iliofemoral DVT have the most severe postthrombotic morbidity (OR 2.23; P<.001).5 The same investigators reported that common femoral or iliac vein thrombosis and the degree of postthrombotic morbidity at 1 month were the best predictors of postthrombotic syndrome (P<.001). Randomized trials of venous thrombectomy versus anticoagulation

alone have demonstrated that patients receiving thrombectomy have significantly better outcomes at 6 months, 5 years, and 10 years.6Furthermore, nonrandomized reports have demonstrated patency and preservation of valve function following thrombectomy in two-thirds or more of patients. Catheter-directed thrombolysis (CDT) has evolved as the treatment of choice for the majority of patients with iliofemoral DVT. Success rates of80-95%arecommonlyreportedifpatientsaretreatedwithin2weeksof onset.7, 8 Nonrandomized observations of long-term patency without refluxandlowrecurrencerateshavebeenreported.8Acohort-controlledtrial demonstrated improved QOL following CDT compared to patients treated with anticoagulation alone.9 It has recently been observed that the amount of thrombus removed is directly proportional to improved QOL and reduced postthrombotic morbidity.10, 11 A small randomized trial of CDT versus anticoagulation alone demonstrated improved patency and valve function following CDT.12 Two randomized trials arecurrentlyunderwaytofurtherassessthelong-termbenefitofCDTversus anticoagulation for acute DVT.13, 14 Based upon available data, a strategy of thrombus removal for patients with iliofemoral DVT appears superior to anticoagulation alone and should be recommended to all who are active and ambulatory.(1) Prandoni P, Villalta S, Bagatella P, Rossi L, Marchiori A, Piccioli A, et al. The clinical course of deep-vein thrombosis. Prospective long-term follow-up of 528 symptomatic patients. Haematologica 1997;82(4):423-8.(2) Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis? Am J Med 2001;110(7):515-9.(3) Delis KT, Bountouroglou D, Mansfield AO. Venous claudication iniliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg 2004;239(1):118-26.(4) Akesson H, Brudin L, Dahlstrom JA, Eklof B, Ohlin P, Plate G. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990;4(1):43-8.(5) Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149(10):698-707.(6) Plate G, Eklof B, Norgren L, Ohlin P, Dahlstrom JA. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg 1997;14(5):367-74.(7) Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. J Vasc Surg 2007;46(5):1065-76.(8) Baekgaard N, Broholm R, Just S, Jorgensen M, Jensen LP. Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral venous thrombosis. Eur J Vasc Endovasc Surg 2010;39(1):112-7.(9) Comerota AJ, Throm RC, Mathias SD, Haughton S, Mewissen M. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg 2000;32(1):130-7.(10) Grewal N, Martinez J, Andrews L, Comerota AJ. Quantity of clot lysed after catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with post-thrombotic morbidity. J Vasc Surg 2010;In press.(11) Grewal N, Martinez J, Andrews L, Assi Z, Kasanjian S, Comerota AJ. Objective outcome measures of patients with iliofemoral DVT treated with catheter-directed thrombolysis. Presented at American Venous Forum, February 2010 2010(12) Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg 2002;24(3):209-14.(13) Enden T, Klow NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost 2009;7(8):1268-75.(14) Comerota AJ. The ATTRACT Trial: Rationale for Early Intervention for Iliofemoral DVT. Perspect Vasc Surg Endovasc Ther 2010.

Sy 9 - Varicose vein treatment in the future

Sy9-1 CLiNiCaL praCtiCe GUideLiNeS OF tHeSOCiety FOr VaSCULar SUrGery aNd tHe ameriCaN VeNOUS FOrUm ON tHe Care OF patieNtS WitH VariCOSe VeiNSP. GLOVICZKI1

1 Mayo Clinic, Rochester, MN, USA

34 ~

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) established a committee to provide evidence based guidelines for treatment of patients with varicose veins (CEAP Class 2). The guidelines also included recommendation for treatment of superficial and perforator vein incompetence in patients with moreadvanced (CEAP Class 3-6) venous disease. Recommendations of the Guideline Committeewere Strong (Grade 1), if the benefits clearlyoutweighed risks, burden, and costs or the suggestions were Weak (Grade2)ifthebenefitswerecloselybalancedwithrisksandburden.The level of available evidence to support the evaluation or treatment could be of High (A), Medium (B) and Low or Very Low (C) quality. The following recommendations were proposed: The committee recommended that in patients with varicose veins a complete history and detailed physical examination is complemented by duplex scanningofthedeepandsuperficialveins(Grade1A).Thecommitteealso recommended that the CEAP classification is used for patientswith varicose veins and that the revised Venous Clinical Severity Score is used to assess treatment outcome (both Grade 1B). The committee suggested compression therapy for patients with symptomatic varicose veins (Grade 2C) but recommended against compression therapy as the primary treatment if the patient is a candidate for an intervention (Grade 1B). Compression therapy was recommended, however, as the primary treatment to aid healing of venous ulceration and as an adjuvant treatment to intervention to prevent ulcer recurrence (Grade 1B). To decrease recurrence of venous ulcers, ablation of the incompetent superficialveinsinadditiontocompressiontherapywasrecommended(Grade 1A). For treatment of the incompetent great saphenous vein (GSV) the committee recommended endovenous thermal ablation (radiofrequency or laser) over high ligation and inversion stripping of the saphenous vein to the level of the knee (Grade 1 B). The committee also recommended phlebectomy or sclerotherapy to treat varicose tributaries (Grade 1B) and suggested foam sclerotherapy as an option for treatment of the incompetent saphenous vein (Grade 2C). The committee recommended, however, against selective treatment of perforator vein incompetence in patients with simple varicose veins (CEAP Class 2, Grade 1B) but suggested treatment of pathologic perforators (outwards flow of > 500 ms duration, vein diameter of>3.5 mm) located underneath healed or active ulcers (CEAP Class 5-6, Grade 2B). The committee also recommended treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs or transcatheter sclerotherapy, used alone or in combination (Grade 2B)

Sy9-2 FUtUre teCHNiQUe FOr VariCOSe VeiNabLatiONP. NICOLINI1

1 Vascular Surgeon, Clinique du Parc, Lyon, France

Within 10 years, crossectomy and stripping of the saphenous veins associated with stab avulsions was gradually replaced by the thermal percutaneous techniques of destruction. The radiofrequency (RF) is firsttechnique(11years),LASERisamorerecenttechnique(8years).On the same bases as two previous ones, a new technique of thermal destruction with steam is in the course of evaluation. Some warmed sterile water is sent under pressure (600 bars) in the form of vapor (temperature from 100 to 150 ° C) to the trunk of the saphenous vein by a percutaneous approach.A prospective multicentric study began in November 2008 with inclusion of 80 patients. The sx months results are superposables to those of the RF and LASER. A deep venous thrombosis was found in the immediate post operative course without after-effects. In the mediumtermwefindapigmentationandadysethesia.Subjecttoconfirmationofthemedium-termresults,thistechniqueispromising. It should cheaper than 2 more other technique. Furthermore It also allows to treat the collateral without phlebectomy.

Sy9-3 We Need tO KNOW mOre abOUt tHeNatUraL HiStOry OF VeNOUS HemOdyNamiCS iN patieNtS WitH VariCOSe VeiNS!O. PICHOT1, P. CARPENTIER2

1 Centre de médecine vasculaire, Grenoble, France2 Hôpital A. Michallon, Service de médecine vasculaire, BP 217X, Grenoble, France

The natural history of venous hemodynamics in patients with varicose veins is far from being understood. The classical old theoretical model, lacking of objective scientific evidence,whichwas favoringtherefluxhypothesisanddescribingachronicveindiseaseprogressingdownwards under the effect of the venous hyper pressure is currently challenged by the theory of a primary parietal disease of the venous reticulum. Several observational studies using duplex ultrasound bring evidence in favor of the ascending hypothesis of varicose disease progression. Particularly,ithasbeendemonstratedthatprimaryvenousrefluxcanoccurinanysuperficialordeepveinofthelowerlimbs,suggestingthatrefluxappearstobealocalormultifocalprocessandthatthetypologyoftherefluxcorrelateswiththeageofpatientsaswellaswiththeCEAPclinicalclass.Inotherhand,somedatasuggeststhatrefluxprogressiondoesn’t concern all the patients and thus that competent valves will not necessarily deteriorate overtime. Outcomes observed after minimally invasive alternative to the conventional high ligation and stripping have demonstrated that the sole ablation of the saphenous trunk results in restitution of saphenous vein termination competence and sometimes in legs varicose veins disappearance and in opposite, removing the only vein reservoir leadsinabout2thirdsofcasestosaphenousrefluxdisappearanceanddecrease of the saphenous trunk diameter.Actually, in an individual patient presenting with varicose veins, precise criteria are missing in order to determine the risk of progression ofthesuperficialveininsufficiency.Inthesametime,evenifatailoredtreatment is usually proposed to address the patient’s complaints, the choiceofthemoreefficientandlessinvasivetreatmentmodalityisstilloften non evidence based.Prospective studies of superficial veins disease natural history, andstandardized evaluation of postoperative outcomes after the different available varicose treatments modalities are mandatory in order to optimize therapeutic strategy.

Sy9-4 mOLeCULar meCHaNiSmS FOr miCrO-VaSCULar eNdOtHeLiaL apOptOSiS UNder preSSUre eLeVatiON aNd tHerapeUtiC tarGetSG. W. SCHMID-SCHÖNBEIN1, T. ALSAIGH1, E. S. POCOCK1

1 Department of Bioengineering, University of California, San Diego La Jolla, California, 92093-0412, USA

Chronic venous hypertension is associated with markers for microvascular inflammation, tissue restructuring, and apoptosis, butthe cellular and molecular mechanisms underlying these processes remain uncertain. Key signatures of inflammation in microvascularregions with elevated venous blood pressure are already evident in acute forms of venous pressure elevation. This observation suggests that acute venous pressure elevation may represent one of the trigger mechanisms for the inflammatory cascade encountered during theprogression of the disease. In the present study we examined the hypothesis that acutely elevated venous pressure together with the reduction of shear stress induces elevated enzymatic activity in venules. This activity in turn causes cleavage of surface receptors promoting endothelial dysfunction. Using a rodent model for venous hypertension by repeated venular occlusions with 15 min durations, microzymographic techniques for enzyme activity detection in-vivo, and immunohistochemistry for receptor labeling, we found increased activity of the matrix metalloproteases (MMP-1, -8 and -9). In this short time we also observed that elevated venule pressure causes in


some venules a reduced labeling density with an antibody against the extracellular domain of the vascular endothelial growth factor receptor 2 (VEGFR2) while in other venules we observed an increased VEGFR2 expression compared to the levels before venous pressure elevation. We conclude that short-term pressure elevation increases enzymatic activity in venules, which may contribute to endothelial dysfunction associated with this disease. Supported by NIH grant HL 10881.

Sy 10 - Ultrasound guided procedures

Sy10-1 ULtraSOUNd aSSiSted arteriaLprOCedUreSE. ASCHER1

1 Mt. Sinai School of Medicine, New York, USA

purpose: The technique of balloon angioplasty of peripheral arteries and failing infrainguinal bypasses requires use of arteriography and fluoroscopicguidance.Patientsnotyetondialysiswithchronicrenalinsufficiency(CRI)andnon-maturingAVaccessespresenttherapeuticproblem. Because standard treatment with balloon angioplasty is based on nephrotoxic contrast for diagnosis and treatment, we sought alternative therapies. We attempted to perform balloon angioplasty and stent placement for infrainguinal arteries, bypasses, carotid arteries and AV accesses under duplex guidance to avoid/minimize use of nephrotoxic contrast material and radiation exposure.methods: Over the last 72 months, 260 patients underwent 360 duplex-guided infrainguinal arterial balloon angioplasties (236 stenoses, 124 occlusions)forclaudicationandlimb-threateningischemiain57%and43%,respectively.Additional 44 patients had attempted balloon angioplasties of 50 failing infrainguinal bypasses.All arterial or graft cannulations were done under direct duplex visualization. Fluoroscopy and contrast was employed to reach ipsilateral CFA in cases of contralateral access (5%). Guide wiremanipulation from ipsilateral CFA to a site beyond the most distal stenotic lesion, selection and placement of balloons and stents were done solely with duplex scanning.Forty-one patients (63% asymptomatic) with severe (>70%) carotidstenoses (27 primary, 14 restenoses) underwent duplex-assisted carotid balloon angioplasty and stenting (CBAS). Fluoroscopy was used to assist guidewire passage into aorta and common carotid artery and also to place cerebral protection device (39 cases). Catheterization of internal and external carotid arteries, balloon and stent deployment were successfully achieved with ultrasound guidance alone in all cases.results: Overall technical success of infrainguinal angioplasties was 95% (99.6% and 86% for stenoses and occlusions, respectively).Technical success of bypass angioplasties was 98% (49/50 cases).Six-month primary patency rates for both lower extremity arterial and bypassangioplastieswere70%.Oneipsilateralstroke(2.4%)occurredintraoperativelyduringduplex-assisted CBAS with complete clinical recovery in 4 months.Conclusions: The proposed technique is an effective modality for treatment of infrainguinal arterial occlusive disease and failing infrainguinal arterial bypasses. Advantages include direct visualization of puncture site, accurate selection of balloons and stents and confirmation of technical adequacy by hemodynamic and imagingparameters.Additional benefits are avoidance of radiation exposureand contrast material.Duplex-assisted CBAS is feasible and may reduce the need of intraarterial contrast injection in selected patients deemed high risk for renal failure.

Sy10-2 ULtraSOUNd GUided prOCedUreS: VaSCULar aCCeSS FOr HemOdiaLySiSO. PICHOT1

1 Centre De Médecine Vasculaire, Grenoble, France

In addition to clinical examination, duplex ultrasound (DU) is the choice technique for assessment of arteriovenousfistulae in patientsundergoing hemodialysis. DU presents a high sensibility for a- or symptomatic venous stenosis diagnosis. It provides an accurate anatomical and hemodynamic analysis of the stenosis and allows to measureinthesametimethevascularaccess(VA)floweveninpatientswho’s the VA is not yet used for dialysis delivery. Actually, information providedbyDUissufficienttodecidetotreatstenosis,andtooptimizethe choice between surgical and endovascular revision. Even in case of a clinically obvious indication of angioplasty, DU preliminary examination allows to optimize practical modalities of angioplasty. Recently, ultrasound guided angioplasty (UGA) has become a very promising option. DU allows to guide every step of the angioplasty procedure, including stenting if necessary, and to analyze continuously the results of the procedure in an anatomical and hemodynamic way as well. Immediate preoperative ultrasound analysis of the stenosis is thefirststepoftheUGA.Itallowschoosingthetypeandthesizeofthe balloon and the most suitable site of vascular access, which can be guided by ultrasound if necessary. Introducers, guide wires, balloons and stents are easily imaged by DU.Comparedtoconventionalfluoroscopicguidance,UGApresentssomeadvantages: risks related to contrast injection and X rays exposure are avoided; continuous monitoring of the procedure allows detecting immediately occurrence of eventual complications and also recoil phenomena; local hemodynamic results assessment of angioplasty and intraoperative VA flow measurement demonstrates more accuratelythantheonlymorphologicalanalysistheefficiencyoftheprocedure,especially in case of multiple stenosis; at least, UGA appears to be ofteneasier,faster,andcheaperthanfluoroscopicguidance.Nevertheless, UGA requires collaboration of two practitioners accustomed with the use of ultrasound. Furthermore preoperative DU examination is mandatory to verify ultrasound accessibility of the stenosis to be treated.

Sy10-3 treatmeNt OF VariCOSe VeiNS. ULtraSOUNd-GUided prOCedUreSC. HAMEL-DESNOS1

1 Saint Martin Private Hospital, Caen, France

The use of ultrasound imaging assistance in procedures for the treatmentofvaricoseveinsbeganin1986,whenthefirstdescriptionwas published of ultrasound guided sclerotherapy (UGS).Objective: The objective of this presentation is to highlight the importance and the contribution of duplex ultrasonography in various procedures for treating varicose veins in the lower limbs.design and method: The ultrasound guided procedures being essentially endovenous procedures, the UGS and the thermal ablation (TA) are tackled.The common points and the peculiarities, according to the procedures, are successively described.results: In all cases, prior to any treatment, a clinical and duplex ultrasonographic assessment is performed. The assessment makes it possible to study the condition and to choose the most suitable treatment for the case in question, in concertation with the patient. It also makes it possibletoassessmorespecificallyanyhemodynamic,anatomicaland/ortechnicaldifficultiesthatmayneedtobeovercome.Afterwards, in the case of UGS, the treatment is performed entirely under ultrasound imaging control and comprises four stages - identifying the vein to be treated, puncturing the vein, injection of the sclerosing agent and checking the post-injection outcome.In the case of TA, the veins to be treated are marked on the skin surface, a procedure performed with ultrasound imaging assistance. Then, during the treatment, ultrasound scanning is used for puncturing the veinandintroducingthecatheter,forpositioningthefibreorapplicatorcorrectly, for tumescent anaesthesia, and for performing a post-procedural examination.Conclusion: For treating varicose veins in the lower limbs, the duplex

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ultrasonography is proving to be an essential tool. Appropriate training and learning the skills accurately are an indispensable prerequisite for effective and safe endovenous treatments of all types.

Sy 11 - physical exercise and Vascular medicine (Joint symposium with the italian Society of angiology and Vascular medicine)

Sy11-1 eFFeCtS OF pHySiCaL eXerCiSe ON tHeCardiOVaSCULar SyStemP. ABRAHAM1

1 University of Angers, Angers, France

A normal vascular function is essential for exercise. The energetic substrates required for the biochemical processes leading to movement, as well as the oxygen used to oxidize these substrates are both provided totheexercisingmusclebyblood.Thenmusclebloodflowmustincreasewithexercisetofittheoxygenandmetabolicrequirementoftheactivemuscle. As a result, the increase in the workload is linearly associated toanincreaseinbloodflowtotheexercisingmuscles.Cardiacoutputincreases to fit the increase inmuscle blood flow.Nevertheless, thephysiological adaptation to exercise not only includes an increase in cardiac output, but a redistribution of the total flow to the differentvascular beds (splanchnic, renal, cutaneous, etc…). The fraction of the cardiac output distributed to each vascular bed is variable and depends on the intensity and duration of exercise, environmental conditions and training status. The underlying mechanism of short term and long term vascular changes induced by exercise are still subject to debate. The presentation will review current concepts about the physiological mechanisms involved in blood flow regulation in peripheral vesselsduring exercise. Then, the structural and functional changes induced by exercise training in peripheral vessel will shortly be presented. Last, as an introduction to the other presentations, the different underlying mechanisms,beyondthesolebloodflowimpairment,thatmayresultin exercise limitation in patients showing vascular-type claudication will be analysed. These mechanisms should not be underestimated and should likely be accounted for to further improve the quality of rehabilitation programs in PAD patients.

Sy11-3 iNterVaL traiNiNG iN patieNtS WitHiNtermitteNt arteriaL CLaUdiCatiONB. VILLEMUR1, D. PÉRENNOU1

1 Unité de Rééducation Vasculaire, Clinique Universitaire de Médecine Physique et Rééducation, Centre Hospitalier Universitaire de Grenoble, France

During controlled studies with patients with intermittent claudication from peripheral arterial disease, it was found that exercise training improved patients walking distance. The study’s objective was to determine the effects and the adverse events of treadmill interval training with active recovery by a prospective study.methods: Eleven patients with the second stage of peripheral arterial disease took part in a rehabilitation program (aged 68,5±10,3 years)5 days a week for 2 weeks. Each day, they had to practice global physical activity, up and low lesionnel exercises, intermittent pressotherapy and program of treadmill walking. The interval training program consisted of treadmill exercise, 30 minutes each morning and evening with increased intensity: for thefirstweek, speedwas increased, forthe second one, trend was increased. Each session of interval training consisted of 5 cycles successively of 6 minutes. Each cycle consisted of 3 minutes of work followed of 3 minutes of active recovery.results: At the beginning of the rehabilitation program, the walking distance was in average 610 meters (120-1930) and 1252 meters (320-2870 at the end (p=0,033). Every patient improved their walking distance. No adverse event was noted. Conclusion: This study showed that the interval training with active recoveryforpatientswitharterialintermittentclaudicationwasefficient

and safety tolerate and the patient’s motivation were excellent. More studieswillbeusefultoconfirmtheseresults.

Sy11-2 tHe baLaNCe Or UNbaLaNCe OF atSriSK FaCtOrS COULd COmprOmiSe tHe reSULtS OF pHySiCaL traiNiNG iN CLaUdiCaNtS?G. M. ANDREOZZI1

1 Angiology Care Unit of University Hospital of Padua, Padua, Italy

The correction of atherosclerotic risk factors is the unavoidable assumption to assure the maximal effectiveness and duration of the results of any therapeutic intervention (pharmacological and surgical) for the treatment of Intermittent Claudication.Aim of this study has been to verify if the presence/absence of risk factors and the degree of their correction could compromise the responsiveness of claudicant patients to the supervised physical training.methods: Initial (IDC), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. The measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70%oftheACDmeasuredbyanon-maximaltreadmillexercise.Thepatients’cohorthasbeenstratifiedinsevengroupsandeighteensub-groups (no smokers, smokers in the past, still smokers, no-diabetics, well balanced and unbalanced diabetes, absent, well balanced and unbalanced hypercholesterolemia, normal weight, over weight and light obesity, hypertensive and no-hypertensive, with and without previous myocardial infarction and TIAs or stroke). The mean and standard error of ICD, ACD and RT before and after 18 days of physical training have been calculated and compared with Student’s t test in each group and sub-group. On the data before and after training of ICD, ACD and RT of each group of risk factors the multivariate analysis of the variance has been carried out by ANOVA. All the analyses were considered significantwhenthepvaluewaslessthan0.05.results: ICD values increased from 55.12 to 121.86 m, ACD from 103.16to191.58m,TRreducedfrom204.04to87.46sec,confirmingthe relevant (p<0.0001) effectiveness of supervised physical training on the walking capacity of claudicant patients. The comparison between the deltas (value after minus value before) of each sub-group didnot showanysignificantdifference.Themultivariateanalysisofthe variance (ANOVA) of before and after ICD ACD and RT of each risk factor groups showed values relevantly lesser than 0.05, indicating thatriskfactorsdidnotinfluencetheresultofphysicaltraining.Conclusions: The supervised physical training is confirmed as aneffectivetoolforthetreatmentofclaudicantpatient.Wedidnotfindanysignificantdifferenceintheresponsetotheprogrammerelatedwiththepresence, absence or balance degree of the risk factors, and we conclude that physical training effectiveness is independent from the their presence, absence or balance degree. This statement is very important because highlights the physical training as the only therapeutic tool for PAD independent from the results of the risk factors’ treatment.

Sy11-4 pHySiCaL traiNiNG iN patieNtS WitH HyperteNSiONA. PINTO1

1 U.O. FISIOPATOLOGIA CIRCOLATORIA - Dipartimento Biomedico di Medicina Interna e Specialistica - AOUP «P. Giaccone», Università degli Studi di Palermo, Italy

Elevated blood pressure (BP) is an extremely common and important risk factor for cardiovascular disease and stroke. Because drug therapy for hypertension effectively reduces the risk of stroke and coronary disease, efforts to control BP levels and correlated diseases have concentrated on pharmacological therapy. Still, despite the common use of antihypertensive medications, rates of hypertension control


remainssuboptimal(1,2).Lifestylemodificationsasadjuvanttherapyin medication-treated hypertension are recently being recommended by guidelines (3), yet there are considerable gaps in our knowledge about theeffectsof therapiescenteredonbehaviouralmodifications.Several studies of the relation between BP levels and physical exercise have mainly focused on exercise of the dynamic aerobic type (4-7). This type of exercise requires a prolonged period of time and involves a large number of muscles. Aerobic exercise has been recognized as the most recommended when the issue is the promotion of general health (5,6). Recently more emphasis is being placed on resistive exercise, with the same objective. Resistance or resistive training consists of local muscle work with overloads, such as weights, bars, and clamps, performed with moderate weights, frequent repetitions, and pauses, being, therefore, characterized as discontinuous exertion. (8-10). Resistive training is now currently used in programs of cardiac rehabilitation; when practiced under appropriate supervision, it leads tosignificantbenefitswithlowrisks(11),contributingtothereductionin resting BP. In a meta-analysis with normotensive and hypertensive individuals, dynamic resistance exercise has been reported to cause a mean3%reductioninsystolicbloodpressure(SBP)anda4%reductionin diastolic blood pressure (DBP) in both groups, with no changes in body weight or resting heart rate (12). Development of adjuvant therapy based on physical exercise in a great number of subjects, as required by recent guidelines, not only entails considerable economic investment, but also requires adequate technical support and continuing supervision of trained physiotherapists. In addition, some pathologic conditions limit or prohibit certain types of physical activity. All these reasons contribute to less use of these important non-pharmacological interventions both on hypertensive patients and on non-hypertensive high-risk subjects than expected. The benefits of physical activitycentred on walking programs are well demonstrated: walking is inversely associated with total mortality (13); faster walking pace was inversely associated with cardiovascular disease and total mortality independently of the time spent walking (14); this inverse association was not explained by other cardiovascular risk factors (13-15). Specifically in relation to walking activity on hypertensive subject,Iwane et al. demonstrated that walking 10,000 steps/day or more, irrespective of exercise intensity or duration, is effective in lowering BP, increasing exercise capacity, and reducing sympathetic nerve activity in hypertensive patients (16).So, even a light/moderate aerobic physicalactivityprogram,suchasfastwalking,providesasignificantbenefitinhypertensives,andcouldbeprescribedaddedtodrugtherapyor alone.References 1.Burt VL, Cutler JA, Higgins M, et al. Trend in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Hypertension. 1995; 26:60-69. 2.Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998; 339:1957-1963. 3.European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003 Jun; 21(6):1011-1053. 4.Lima EG, Spritzer N, Nerkenhoff FL, et al. Noninvasive ambulatory 24 hours blood pressure in patients with high normal blood pressure and exaggerated systolic pressure response to exercise. Hypertension. 1995; 26:1121-1124. 5.Kelley G, McClellan P. Antihypertensive efffects of aerobic exercise: a brief metaanalytic review of randomized controled trials. Am J Hypertens. 1994; 7:115-119. 6.Fagard RH. The role of exercise in blood pressure control: supportive evidence. J Hypertens. 1995; 13:1223-1227. 7.Kingwell BA, Jennings GL. Effects of walking and other exercise programs upon blood pressure in normal subjects. Med J Aust. 1993;158(4):234-238. 8.Kelemen MH. Resistive training safety and assessment guidelines for cardiac and coronary prone patients. Med Sci Sports Exerc. 1989; 21 (6):675-677. 9.Stewart KJ. Weight training in coronary artery disease and hypertension. Prog Cardiovasc Dis. 1992; 35 (2):159-168. 10.Morrissey MC, Harman EA, Johnson MJ. Resistance training modes: specificyandeffectiveness.MedSciSportExer.1995;27:648-660.11.Verrill DE, Ribisl PM. Resistive exercise training in cardiac rehabilitation.

An update. Sports Med. 1996; 21 (5):347-383. 12.Kelley G. Dynamic resistance exercise and resting blood pressure in adults: a meta analysis. J Appl Physiol. 1997; 82 (5):1559-1565. 13.Williams PT. Physical fitness and activity as separate heart disease riskfactors: a meta-analysis. Med Sci Sport Exerc. 2001; 33:754-761. 14.Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sport Exerc. 2001; 33: S459-S471. 15.Tanasescu M, Leitzmann MF, Rimm EB, et al. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation. 2003 May 20;107(19):2435-2439. Epub 2003 Apr 28. 16.Iwane M, Arita M, Tomimoto S, et al. Walking 10,000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension. Hypertens Res. 2000 Nov;23(6):573-580.

Sy11-5 pHySiCaL eXerCiSe iN eLderLy arteriO-patHiC patieNtSM. PRIOR1

1 Vascular Rehabilitation Unit - Azienda Ospedaliera Universitaria Integrata, Verona, Italy

At present, physical exercise is considered a cornerstone in the initial treatment of peripheral arterial disease (PAD). The best results are obtained when a supervised program of treadmill based walking exercise is used. More than 100% increases in treadmill exerciseperformance,togetherwithsignificantimprovementsofpeakoxygenconsumption, and of quality of life are described. Possible mechanisms underlying the training response in PAD include improvements in leg blood flow and oxygen delivery, mostly related to incrementedmuscle capillary density. These changes are likely mediated by an improvement of endothelial function and nitric oxide release. Exercise training may also improve skeletal muscle metabolism, and blood viscosity,andreducelocalandsystemicinflammation.Inadditiontohemodynamic and metabolic mechanisms, improved biomechanics of walking may contribute to increased walking ability. An elevation of pain perception threshold, possibly induced by an increase in endorphinsrelease,couldalsobeconsidered.Allthesebeneficialeffectsofexercisedon’tseemtobeage-related.OlderPADpatientsbenefitfrom exercise training too, given that the presence of comorbidity doesn’t limit their involvement in training sessions. In fact, once the main exercise response determinants are considered, age is not «per se»significantlycorrelatedtoareducedimprovementofclaudicationdistance upon completion of a treadmill walking program. Moreover, theloweristheinitialphysicalfitness,thehigheristhefitnessincreaseat the same training load. Then, it is particularly important that elderly arteriopathicpatientstakeparttospecificsupervisedexercisetrainingprograms, given that they are usually more compromised than younger ones, in functional capabilities and in quality of life. At this regard, our rehabilitation program integrates the treadmill training sessions with gymnastics sessions based on physical exercises specifically aimedto enhance proprioceptive ability, joint flexibility, muscular massand strength and walking mechanics. Such a program evidenced an improvement not only of walking distance, but also of the quality of lifescoresmeasuredwithspecificquestionnaires.

Sy 12 - From raynaud phenomenon to digital ulcer (organized thanks to an unrestricted educational grant from Actelion pharmaceuticals)

Sy12-1 baSiC eXpLOratiON OF rayNaUd’S pHeNOmeNON: a CONSeNSUS OF FreNCH eXpertSJ. CONSTANS (Bordeaux) AND M.-A. PISTORIUS (Nantes) for the French Working GroupP. CARPENTIER (Grenoble), J. DECAMPS LE CHEVOIR (Paris), J.-L. GUILMOT (Tours), J. LAUNAY (Paris), I.LAZARETH (Paris), P. LEGER (Toulouse), P. PRIOLLET (Paris), P. SENET (Paris),P. SINTES (Paris), A. SOLANILLA (Bordeaux), L. TRIBOUT (Paris), M. VAYSSAIRAT (Paris)

A consensus was made by experts from French vascular medicine society

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microcirculation working group and from the French microcirculation society. The aim was to propose recommendations on the first-linestatement of Raynaud’s.Three steps were considered: defining the kind of acrosyndrome,differentiating etiologica factors from factors that impact on Raynaud’s clinicalexpression,anddefiningassessmentthatneedstoberelevant,reasonable and not to be anxiogenicClinical assessment can identify .Raynaud’s suspect of revealing a patholological process such as connective tissue disease or apparently primary Raynaud’s. In the absence of signs of associated disease, the clinical factors that lead to consider Raynaud’s as suspect are severe crisis(severaltimesaday,nosummerremission,allfingersconcerned,unexplained aggravation. When these factors are present, one needs to follow up the patient.When Raynaud’s seems to be primary, nailfold capillaroscopy and antinuclear antibodies (ANA) need to be performed. Then no follow up is believed to be necessary. If capillaroscopy or ANA are positive, thenannual followup ismandatorybecause40%patientswill haveother characteristics of systemic sclerosis. Literature does not give the answer on the extend of assessment to be performed in that case.Finally a patient suffering from Raynaud’s needs careful clinical assessment, nailfold capillaroscopy and ANA. Other investigations and follow-up depend on associated clinical signs.

Sy12-2 CLiNiCaL USeFULNeSS OF CapiLLarOSCOpyM. CUTOLO1

1 Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy

Nailfold videocapillaroscopy (NVC) represents the best and safest method to detect and to analyze morphological microvascular abnormalities, especially in presence of secondary Raynaud’s phenomenon. In normal conditions or in primary Raynaud phenomenon (but not during the cold-exposure test), the nailfold capillaroscopic pattern shows regular disposition of capillary loops along the nailfold bed and no abnormal enlargements or capillary loss. In patients with primary Raynaud phenomenon, however, one or more abnormal capillaroscopic findings, should alert the physician to thepossibility of secondary Raynaud phenomenon, owing to the presence of a previously undetected connective autoimmune disease, for example systemic sclerosis (SSc). Morphological markers of microvascular damage include giant capillaries, microhemorrhages, loss of capillaries, the presence of avascular areas and angiogenesis; these features characterize more than 95%of patientswith overt SSc even if are not obesrvedconcomitantly. These sequential and dynamic capillaroscopic changes are typical of the microvascular involvement in SSc, and can be described by the term ‘SSc pattern’ . Most importantly, imaging with NVC enables the early differentiation between primary and secondary Raynaud phenomenon by identifying morphological patterns specific to various stages of SSc (patterns‘early’, ‘active’ and ‘late’); the inclusion of these NVC patterns could increasethesensitivityofclassificationcriteriaforSSc.Reduced capillary density on NVC correlates with a high risk of developing digital skin ulcers and the presence of pulmonary arterial hypertension, and can therefore be used as a marker of SSc severity and progression.Therapies targeting underlying vascular disease in SSc improve symptoms of Raynaud phenomenon and reduce ischemic injury to involvedtussue/organs;however,targetedtreatmentoffibrosisremainsa challenge.Immunesuppressive tharapies still of efficacy in the modulation ofthe immune response underlying SSc and generally characteriwing all connective tissue diseases (i.e. Cyclophosphamide, Rituximab, Ciclosporin).

Therefore, NVC represents the safest method to analyze microvascular abnormalities in SSc, and enables the early differential diagnosis between primary and secondary Raynaud phenomenon.Inaddition,abnormalfindingsonNVCatbaseline togetherwith thepresenceofSSc-specificautoantibodiesindicateaveryhighprobability(over80%)ofdevelopingdefiniteSSc,whereastheirabsencerulesoutthis outcome.Early diagnosis of SSc could enable the early start of treatment, which could slow disease progression and clinical complications.References:De Angelis R, Grassi W, Cutolo M. Arthritis Rheum. 2009 15;61:405-10Herrick AL, Cutolo M. Arthritis Rheum. 2010 May 5. [Epub ahead of print]Cutolo M, Sulli A, Smith V. Nat Rev Rheumatol. 2010 Aug 10. [Epub ahead of print

Sy12-3 rayNaUd pHeNOmeNON: tHe OCCUrreNCe OF diGitaL ULCerS CHaNGeS eVerytHiNG!P. CARPENTIER1

1 Clinique Universitaire de Médecine Vasculaire, Centre Hospitalier Universitaire de Grenoble, France

Raynaud phenomenon is a vascular acrosyndrome that is widespread inthegeneralpopulationandmostoftenprimary,withoutsignificantinfluence on the health status and quality of life. But when thisphenomenon is associated with digital ulcers, the situation becomes quite different:- A benign primary Raynaud can be ruled out in front of these associated trophic changes, and the underlying disease is most often a systemic sclerosis, with or without additional clinical features, requiring a diagnostic work-up and a specificmanagement with both local andsystemic therapeutic targets. The hypothenar hammer syndrome is the second etiology to be called in mind in this situation, and although the recurrence of this occupational disease is rare, it requires a specificmedical and medico-social approach.-Digitalulcersrelatedtosystemicsclerosisaredifficulttoheal(meanduration>100days),resultinasignificantalterationofthequalityoflife and hand disability in everyday life, often show multiple recurrences (66%), and can end up in tissue loss or even digital amputations(1.2%).- Their treatment is difficult, with no clearly efficient treatmentdemonstrated in therapeutic trials, and the prevention of recurrences, which has been found more easily achievable, is therefore one main therapeutic goal.

Sy12-4 tHe tHerapeUtiC CHaLLeNGe OF diGitaLULCerS iN SyStemiC SCLerOSiSP. PRIOLLET1

1 Department of Vascular Medicine, Groupe Hospitalier Paris-Saint Joseph, 75014 Paris, France

Digital ulcers(DU) are a major complication in the course of systemic sclerosis(SSc).DUoccurupto60%ofpatientswithlimitedordiffuseSSc. These lesions lead to substantial morbidity (reduce quality of life,pain,disabilityanddisfigurement) thatcanescalate togangreneand amputation. Management of DU remains a challenge. It involves non-pharmacologic and pharmacologic modalities for treatment and prevention of these lesions. Non -pharmacologic therapies include avoidance of cold exposure, emotional stress, nicotine exposure, trauma or vasoconstricting drugs. Supporting therapies include pain medications, antibiotics and occlusive dressings. Agents to treat Raynaud’s phenomenon are often used for the treatment and prevention of DU in SSc. Direct vasodilatating drugs such as calcium channel blockers, alpha-adrenergic inhibitors, angiotensin converting enzyme inhibitors, angiotensin receptors blockers, nitrates and intravenousprostacyclins areusedwithvariabledegreesof efficacy.Placebo-controlled study using an oral endothelin receptor antagonist, bosentan,demonstrateda48%reductioninthemeannumberofnewulcers during the treatment period; however, there was no difference


between treatment groups in the healing of existing ulcers. Other agents considered for the treatment of DU include phosphodiesterase-5-inhibitor,selective serotonin reuptake inhibitors, antiplatelet as well as anticoagulant therapies and statin. Surgical procedures may be required as a last resort for severe DU. Finally, patients therapeutic training is essential for DU prevention in SSc.

Sy 13 - Critical Limb ischemia(Organized thanks to an unrestricted grant from Sanofi Aventis)

Sy13-1 a raNdOmiZed, dOUbLe-bLiNd, pLaCebO-CONtrOLLed GeNe tHerapy StUdy USiNG NV1FGF FOr preVeNtiON OF ampUtatiON aNd deatH iN CritiCaL Limb iSCHemia (tamariS). ratiONaLe, deSiGN aNd baSeLiNe patieNt CHaraC-teriStiCSJ. BELCH7, E. VAN BELLE1, S. NIKOL2, L. NORGREN3,I. BAUMGARTNER4, V. DRIVER5, W. R. HIATT6 (Tamaris steering committee)1 Department of Cardiology, CHRU de Lille and EA 2693, University Lille-Nord de France; 2 Department of Angiology, Askleplios Klinik St. Georg, Hamburg; 3 Department of Surgery, Orebro University Hospital, Orebro, Sweden; 4 Swiss Cardiovascular Center, Division of Angiology, Inselspital, Bern University Hospital, Bern, Switzerland; 5 Clinical Research Foot Care, Endovascular and Vascular Services, Boston University School of Medicine and Boston University Medical Center, Boston; 6 Division of Cardiology, University of Colorado School of Medicine, Denver, Colorado USA; 7Institute of Cardiovascular Research, (Vascular & Inflammatory Diseases Research Unit) Ninewells Hospital and Medical School, Dundee

Background: Patients with critical limb ischemia (CLI) unsuitable for revascularizationhaveahighrateofamputationandmortality(30%and 25% at 1 year respectively). Local gene therapy using plasmidDNAencodingacidicfibroblastgrowthfactor(NV1FGF,riferminogenepecaplasmid) demonstrated an increased amputation-free survival in a phase II trial. This paper provides the rationale, design and baseline characteristics of CLI patients enrolled to the pivotal phase III trial (EFC6145/TAMARIS). methods: An international, double-blind, placebo-controlled, randomized study included 525 CLI patients recruited from 170 sites worldwide who were unsuitable for revascularization and had non-healing skin lesions, to evaluate whether repeated intramuscular administration of NV1FGF results in reduction of major amputations or deaths at 1 year. results:Meanageofthepopulationwas70±10yearsincluding70%malesand53%diabeticpatients.Fiftyfourpercentofthepopulationhadpreviouslowerextremityrevascularizationand22%hadpreviousminor amputation of the index leg. Ninety six percent of patients had an ankle pressure < 70 mmHg and/or a toe pressure < 50 mmHg or a TcPO2<30mmHg.In94%theindexleghaddistalocclusivediseaseaffectingarteriesbelow theknee.Statinswereprescribed in54%ofpatients, andantiplateletdrugs in80%.Variation in regionoforiginresulted in only minor demographic imbalance. Patients with diabetes had more risk factors including history of coronary artery disease, but were similar to non-diabetic patients regarding limb haemodynamics and vascular lesions.Conclusion: The clinical and vascular anatomy presentation of patients with CLI with ischemic skin lesions who were unsuitable for revascularization was homogeneous with little imbalance according to regionof origin or diabetic status.Thefindings from this largeCLIcohort are important for the understanding of the epidemiology of the disease. reference: This study is registered with ClinicalTrials.gov, number

NCT00566657

Sy13-2 patHOpHySiOLOGy OF CritiCaL Limb iSCHe-miaP. CARPENTIER1 1 Clinique Universitaire de Médecine Vasculaire, Centre Hospitalier Universitaire de Grenoble (38043), France

The microvascular system is able to adapt for a large range of blood flowconditionstopreservetissularviabilitythroughadequateoxygencell delivery. The most crucial parameter for a proper functioning of this sophisticated distribution network is the arterio-venous pressure gradient, which explains the prognostic value of distal arterial pressure measurements in patients with peripheral arterial disease, and the well documented superiority of revascularization over vasomotor interventions in the situation of limb salvage.However, when the arterial hemodynamic conditions are beyond the adaptation capability of the microcirculation, the decompensation of this highly regulated system produces several pathophysiological vicious circles that have also to be taken into account in the medical management of the patient:- the low arterio-venous pressure gradient induces heterogeneity of capillary perfusion related to the non-uniformity of capillary geometry, which results in even deeper hypoxia in some tissular areas and higher risk of cellular death;- this perfusion heterogeneity is further enhanced by a regional hyperviscosityrelatedtoadeficiencyofthephysiologicalhemodilution,whichisdependinguponthearterialbloodflowvelocity;- the hypoxic vasoplegia suppress the physiological vasomotion - an other compensatory mechanism for tissue perfusion heterogeneity – and themyogenic reflexwhichphysiologicallyprotects thecapillarynetworks against orthostatic pressure, therefore facilitating edema formation;- the decrease in transcapillary pressure gradient related to poor capillary perfusion and edema-related interstitial hyperpressure results in capillary collapsus and further decrease in functional capillary density. The understanding of these mechanisms allow the optimization of the adjuvant medical, pharmacological and physiotherapeutic management of patients with critical limb ischemia in dedicated multidisciplinary vascular centers.

Sy13-3 CritiCaL Limb iSCHemia: tHe LimitSOF reVaSCULariZatiONE. ASCHER1

1 Mt. Sinai School of Medicine, New York, USA

introduction: Bypasses to the infrageniculate arteries were adopted by vascular surgeons for management of critical lower extremity ischemia more than four decades ago. These challenging operations have proven to be an acceptable alternative to major amputations, especially in the elderly diabetic population. Perhaps the most important factor determining success is the utilization of autologous vein as a conduit. Herein we discuss the reported results of distal bypass to arteries in the foot and calf using non-autologous conduit.Prosthetic Bypasses with Adjacent Arterio-Venous Fistulas (AVF):Bypasses to Infrageniculate Arteries: We recently reviewed our experience with 112 PTFE bypasses with complementary AVF performed in 103 patients at our institution. Of these, 58 were men (56%)and45women(44%)withaverageages71.5±9.Indicationsfor surgery were limited to patients with critical ischemia: severe rest pain in 39%, non-healing ischemic ulcers in 33% and gangrene in28%.Six-millimeterexpandedand ringedPTFEgraftswereutilizedfor all 112 bypasses. Lack of suitable autologous vein for the bypass was the indication for the use of prosthetic material in 91 cases. In the remaining 21 cases, patients were too unstable to withstand prolonged operations with multiple vein harvesting.

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Thearteriesusedforoutflowincluded:theanteriortibialin53cases(45%),theposteriortibialin26(23%),andtheperonealin21(19%).We created complementary distal anastomosis AVFs in the following fashion: We selected the larger of the two deep veins, ligated vein branches, mobilized the recipient artery and performed a 1-2 cm arteriotomy, ligated adjacent deep vein and transected it at anywhere from 0.5 to 1 cm distal to the endpoint of the arteriotomy, fashioned and anastomosed the open end of the central vein portion to the adjacent artery and then performed an end-to-side anastomosis between the distal end of the PTFE graft and the vein. Completion arteriogram was performed in all cases to evaluate the adequacy of the technique.The30-daymortalityrateinoursetofpatientswas2.9%.All3patientsdied from acute myocardial infarction. The overall cumulative graft patencyratesforthe112infrapoplitealbypasseswere75%,65%and55%at1,2and3years,respectively.Overallcumulativelimbsalvageratesforthe112infrapoplitealbypasscaseswere81%,76%and73%at 1, 2 and 3 years, respectively.Bypasses to Pedal Vessels: Our experience with this technique consists of 20 patients who presented with very limited distal runoff with no autogenous vein and very small adjacent deep veins. Adjunctive turn-down arteriovenous fistulae were constructed with great saphenousvein in 15 patients and with the small saphenous vein in 5 patients. The recipient arteries were the distal posterior tibial in 7 cases, the dorsalis pedis in 7 cases and the plantar branches in 6 cases. Our technique for the saphenous turn-down fistula includes: 1)transection of the greater or lesser saphenous vein in the lower leg; 2) circumferential mobilization of the vein down to the level of the ankle; 3) ablation of the distal valves with an antegrade valvulatome and coronary dilator; 4) subcutaneous tunneling of the free portion of the vein in a gentle arc towards the paramalleolar artery; 5) anastomosis of the peripheral end of the vein to the side of the artery and; 6) anastomosis of the distal end of a 6 mm PTFE ringed graft to the vein at or near its anastomosis to the artery.Of the 20 cases with PTFE bypass and a saphenous turn-down arteriovenous fistula, 13 had a patent graft and fistula from 6 to 24months (mean 14 months). Five patients have had patent graft and fistulaformorethan2years.Limbsalvagewasachievedin14(70%)of these cases from 3 to 24 months (mean 12 months). We believe that, despite the limited patency rates of non-autologous pedal bypasses, limb salvage will be achieved in a certain percentage therefore making the attempt a viable and worthwhile endeavor.Summary: While an aggressive approach to ischemic limbs salvage using totally autogenous infrapopliteal bypasses has demonstrated encouraging results,a significantnumberofpatientswill facemajoramputationduetotheinsufficientveinlength.Intheseinstances,thephysician must rely on using less durable grafts made of prosthetic material. Methods developed by our group provide surgeons with additional options for treatment of these challenging cases. The cumulative patency rates are acceptable and support the value of using this adjunctive technique.

Sy 14 - Complications of vascular procedures - a Symposium of the romanian Society of angiology and Vascular Surgery

Sy14-1 aNaStOmOtiC aNeUrySmS aNdiNFeCtiONS aFter peripHeraL prOCedUreSA. ANDERCOU1, O. ANDERCOU1, B. STANCU1, O. BUDIU1,O. BARBOS1, M. ANDREI1

1 University of Medicine and Pharmacy Iuliu Hatieganu, Second Surgical Clinic, Cluj Napoca, Romania

purpose: Most common and feared complications after peripheral reconstructions are anastomotic aneurysms and local infections, which leads to high rate of graft failure and limb loss. Anastomotic aneurysms can be categorized into to groups: those that result from a perforation of an artery by traumatic or iatrogenic injury, and those that results from dehiscence of a surgical vascular anastomosis. Usually, synthetic graft

material are well tolerated by the organism, but in particular situations, theycanleadtosevereinfections,difficulttotreat.materials and methods: A retrospective study were carried out in which sequential cases of pseudoaneurysms and infections occured aftervascularproceduresbetween2005and2009wereidentifiedfromoperating rooms records. Data collected included epidemiological characteristics of each patient, method of presentation, history of previous vascular surgery, treatment received by each case and results after treatment. results: In these period we performed 150 reconstructions of the lower limbs. Time from graft implantation to aneurysm formation varied from 1 month to 3 years. Clinical signs were represented by groin swelling associated with pain but in 2 cases only pulsatile mass in the groin was the only sign. Treatment consisted in defect repair by direct suture or complete revision of anastomosis. Another treatment option was excision of a segment of the graft and replacement with additional graft material. Treatment of infections was both medical with large spectrum of antibiotics and surgical by graft excision and extraantomic bypass reconstruction or arterial ligature followed by above knee amputation.Conclusion: The development of an anastomotic aneurysm should be viewed as a total failure of the anastomosis. The best therapeutic strategy is excision of a segment of the graft and replacement with an interponat. In the presence of infection the only option is to bypass the region through an extraanatomic procedure and eventually to cover theinfectedsitewithamuscularflap.Intensiveuseoflargespectrumantibiotics and a proper surgical technique can prevent appearance of these complications.

Sy14-2 COmpLiCatiONS aFter iNterVeNtiONaLVeNOUS prOCedUreSM. CATALANO1, E. PERILLI1 1 Research Center on Vascular Diseases and Angiology Unit - University of Milan - L.Sacco Hospital, Milan, Italy

In recent years, mini-invasive procedures (laser and radio-frequency) for out-patient use have been developed, aimed at lowering the peri-operative morbidity of surgery but retaining the same level of effectiveness.Complications, both major or minor, can rarely occur with these methods(lessthan3%ofpatients).According to the main data in literature on endovenous laser, the incidence of major complication, (TED), is 0.12%. The occurrenceof minor complications are: pain during the procedure (16.1%),bruises (60.6%), haematoma (5.5%), temporaryparaesthesia (3.4%),hyperpigmentation (2.9%), superficial vein thrombosis of collateralveins(3.4%)andburns(0.2%).BothTED(2.1%)andminorcomplicationssuchasskinburns(1.2%)and paraesthesia (12.3%) are slightly more frequent with radio-frequency procedures. In order to maintain the proper safety level needed for performing this treatment on out-patients and to reduce complications it is important to pay special attention to several aspects:•Rigorouspersonneltraining•In-depthclinical investigationandultrasonographicexaminationofthe venous circulation to select patients•Wholeproceduremustbeentirelyecho-guided (including theveinaccess, the guide wire, the catheter and the optical fibre, the laserequipment while delivering energy). •Peri-venousanaesthesia(wi)thechographicmonitoring).Othertypesof anaesthesia increase the risk of TED and lower the likelihood of a successful outcome of the treatment.• Antithrombotic prophylaxis with fractioned heparin, class threeelastic compression•Echographicandclinicalfollow-upofthepatientConclusions: Endovenous laser and radio-frequency are two safe mini-invasive methods that can be considered out-patient treatments.


Sy14-3 COmpLiCatiONS OF VaSCULar aCCeSSI. DROC1, V. ALEXANDRESCU2

1 Army’s Center for Cardiovascular Diseases, Bucharest, Romania2 Princess Paola Hospital, Brussel, Belgium

Endovascular procedures proved to be an alternative for classical vascular surgery. Postoperative complications are less frequent but sometimes very severe. Femoral pseudoaneurysms and retroperitoneal hematoma are ones of the rare complications after femoral puncture, with local and systemic signs. That’s why the surveillance and prompt surgical treatment is very important especially for high risk patients.This is a retrospective study which was perfomed on patients aged 48-80 years old developing complications after endovascular treatment in our institutions. All patients required emergency surgical treatment. The diagnosis was established by clinical exam, echo-doppler and CT. The main risk factors were: hypertension, COPD, obesity, use of antiplatelet agents, periprocedural heparinisation. The maximal incidence was reported in the 7th decade. All the patients needed surgical treatment. Postoperative evolution was favorable.After cardiac and vascular procedures, clinical and paraclinical postinterventional surveillance is mandatory in order to detect and treat major complications, which sometimes can be fatal.

Sy14-4 earLy FaiLUre OF arteriOVeNOUS FiStULaFOr HemOdiaLySiSV. POPOVIC1, J. PASTERNAK1, J. PFAU1, M. KACANSKI1,D. NIKOLIC1, Z. HORVAT1

1 Clinical Centre Vojvodina, Novi Sad, Serbia

Background:Increasinguseofprimaryarteriovenousfistulae(pAVFs)is a desired goal in hemodialysis patients. However, in many instances, AVFsfailtoadequatelymatureduetoill-definedmechanisms.Objective: To determine the factors affecting early failure and high complication rate of AVFsmethods: A retrospective study was conducted analyzing data during six year period on hemodialysis patients with previously created vascular accesses at Clinical Center in Novi Sad. Five hundred eighty AVFs were analyzed. There were 216 men and 188 women, with an average age ranging from 21 to 82 years (mean age, 51.39 years). results: The types of procedures performed included placement of arteriovenous grafts in 12 patients, creation of AVFs in 484 patients and revision of AVFs in 83 patients. Conclusions: Main risk factors for early failure and high complication rate included: hypothension, diabetes mellitus, cardiac desease, previos temporary catheter insertion. Autologous access is the best angioaccess for dialysis also in all groups of patients and can be performed in most patients.

Sy14-5 iNterVeNtiONaL retrieVaL OF FraCtUredCeNtraL VeNOUS CatHeterD. D. OLINIC1, C. C. HOMORODEAN1, M. MARIA OLINIC1,M. M. OBER1

1 University of Medicine and Pharmacy, County Clinical Emergency Hospital, Cluj-Napoca, Romania

Central venous catheters are often used for chemotherapy, parenteral nutrition and long term antibiotics. A potential complication with their use is fracture of the catheter with the intravascular fragment migrating centrally as a foreign body embolus. The incidence of this complication is approximately 1-2/1000. A case is presented in which the central venous catheter, implanted perioperatory in a patient with gastric neoplasia, was unfortunately cut, during manoeuvers to withdraw the catheter. The distal part of the catheter migrated into the pulmonary artery, while the proximal part remained in the upper vena cava. Radiology assessed the complication, while patient remained asymptomatic. Interventionists were immediately asked to extract the ruptured catheter, in order to

avoid further complications (pulmonary infarction, endocarditis, arrhythmia).A right femoral vein 8F approach was done. A two loops snare was used to capture the proximal end of the catheter, but this one was attached to the wall. A pigtail catheter was then successfully used to attach the central part of the catheter, in the right atrium. By withdrawing the pigtail catheter, the bended ruptured catheter was than pooled progressively into the inferior vena cava and the right iliac vein. Once in the smaller diameter iliac vein, one extremity of the ruptured catheter was easier to capture, using the dedicated snare. Pooling back the snare, the bending of the ruptured catheter was abolished. Venous introducer, snare and captured ruptured catheter were progressively extracted, without venous injury.Although rare, complications of ruptured venous catheter may require the intervention of a skilled team, with the use of dedicated extraction devices and the ability of operators to improvise.

Sy 15 - Common session eurochap - microcirculation: relationship between macro and microcirculation

Sy15-2 mOdULatiON OF SmaLL artery FLOW:WaLL remOdeLiNG aNd periVaSCULar adipOSe tiSSUeA. S. GREENSTEIN1, R. AGHAMOHAMMADZADEH1,R.A. MALIK1, A. M. HEAGERTY1

1 Cardiovascular Research Group, School of Biomedicine, University of Manchester

Themajordeterminantofflowthroughsmallarteriesisvariationintheluminal diameter. In patients with essential hypertension a reduction in lumen diameter occurs by eutrophic remodeling: an inward re-arrangement of the arterial wall. In patients with diabetes there is a pathological outward growth of the arterial wall with preservation, rather than narrowing of the lumen diameter. The inability to reduce lumen diameter in the context of hypertension may lead to a predisposition to target organ damage and this forms the basis of the ‘passive pressure microcirculatory bed’ hypothesis. This pathological pattern of wall growth also been seen in patients with acromegaly, endocrine hypertension and recently in elderly patients with late-life depression where it correlates with vascular lesions seen on MR scanning.Luminal diameter is also controlled by a fine balance betweenendothelium mediated vasodilation and constriction of the small artery wall. Recently, it has been observed that this balance can be influencedbyadiposetissuewhichsurroundsthesmallartery,knownas perivascular adipose tissue (PVAT). In health, PVAT releases soluble relaxing factors which work via both endothelial dependent (nitric oxide) and endothelium independent mechisms. In obesity the anti-contractilecapacityofPVATislostduetoinflammationinadipocytes.The resultant increase in tone has been postulated to contribute to the development of hypertension in obesity.

Sy15-3 reLatiONSHip betWeeN maCrO- aNd miCrOCirCULatiONP. BOUTOUYERIE1

1 Hôpital Européen Georges Pompidou, Unité de Pharmacologie clinique, Service de Pharmacologie

Abstract: large arteries and small arteries properties may interact to explain the pathophysiology of cerebrovascular diseases in many ways. First, atherosclerosis at the level of the aorta and cervical arteries is a major cause of stroke. Here, epidemiological evidences are given, together with insights in the mechanical properties of the atherosclerotic plaque. Second, cognitive impairment may result from vascular causes (small vessel disease, stroke), or neurodegenerative disease such as Alzheimer disease, and even more often both conditions are associated. Here, we present evidence of strong and meaningful associations between large artery stiffness, cognitive decline and white

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matter lesions. Last, there is a unifying condition known as pulse wave encephalopathy, related to the transmission of pulse pressure to the brain tissue along large arteries to the microcirculation, where excessive pulsatility induces fragility and damages. Evidence for this phenomenon and its link with arterial stiffness and chronic brain damage are to be given. Theefficacyofantihypertensive treatments topreventcerebrovasculardiseases may be carried by their effect on large arteries, namely arterial stiffness. Whatever the mechanisms involved, the consequences of risk factors on large and small arteries matters for the understanding of most cerebrovascular diseases and related conditions.


Free OraL COmmUNiCatiONS

OC1 - aortic aneurysms OC1-1 SymptOmatiC HUGe abdOmiNaL aOrtiCaNeUrySmS:mOrbidity aNd mOrtaLityM. SALEM1, A. SALEM2, T. SALEM3

1 Faculty of Medicine, Department of Vascular Surgery, Alexandria, Egypt2 Medical Research Institute, Department of Surgery, Alexandria, Egypt3 Faculty of Medicine, Department of Internal Medicine, Alexandria, Egypt

Objective: is to evaluate the results of surgical reconstruction of symptomatic huge abdominal aortic aneurysms (AAAs).design & method: Twenty eight patients with symptomatic huge abdominal aortic aneurysms were studied in ten years period from 1995-2005.The diagnosis was done by: history, clinical examination, various imaging which include: Duplex Ultrasound, CTA, MRA, DSA & mid –stream aortography . Aortic reconstruction was done by using Bifurcated Dacron graft or aneurysmorrhaphy in mycotic saccular type (two cases).results & Conclusions: The age incidence ranged from 45 -78 years with a mean of 64 years. Male sex was predominant than female sex with M:F ratio 6:1. There was a history of Diabetes mellitus, smoking, hypertention, hypercholesterolaemia, obesity, myocardial infarction(7cases ) & renal impairment (two cases). The most common presentations of AAAs were abdominal pain, back pain, pulsating abdominal mass & acute abdomen (in two leaking AAAs ). The size of the aneurysm (diameter) ranged between 10-22 cm with a mean of 14 cm, the size was measured by Duplex Ultrasound &CTA. Postoperative. Morbidity: Lower limb ischemia due to thrombosis was present in two cases & distal embolization in two cases, thrombectomy & embolectomy were done respectively & successfully except One big toe amputated after embolectomy. Myocardial infarction occurred in four cases, Two of them died. Another two cases developed uraemia, one of them died. One of the two cases presented with leaking aneurysm died. The over all mortality rate within thirty postoperative days was 14.3%, no intraoperative mortality. In conclusion, the morbidity &mortality rates were proportional with increase in size of the aneurysm & increase with the presence of preoperative cardiac, renal dysfunction & risk factors.Keywords: Aortic aneurysm,Pulsating Abdominal mass, Ischaemia of the lower limb

OC1-2 miNimaL iNCiSiON aOrtiC aNeUrySmrepair: aN UNderUtiLiZed bUt SaFe teCHNiQUeM. KALRA1, A. DUNCAN1, S. CHA1, P. GLOVICZKI1

1 Mayo Clinic, Rochester, USA

Objective: To evaluate our experience with minimal incision aortic repair (MIAR, incision <15 cm) and compare the results of abdominal aortic aneurysm (AAA) repair to traditional open surgery (OR) and endovascular repair (EVAR).methods: Data from consecutive patients undergoing elective MIAR over a 6 year period (2003-2008) were retrospectively reviewed. Patients undergoing suprarenal and/or iliac reconstruction were excluded, the remainder were compared to patients concurrently undergoing OR or EVAR. results: MIAR was performed in 142 males and 30 females (mean age 72 years) with AAA: infrarenal (117), juxtarenal (20), with iliac aneurysms (15) and aortoiliac occlusive disease (20). There were 10 conversions;30daymortalitywas1.7%.Mediantimetoregulardiet,ICU and hospital stay (LOS) were 4,1.6 and 5 days. Infrarenal AAA repair by MIAR (n=64) was compared to OR (n=65) and EVAR (n=63). Patient characteristics, 30-day mortality and complications were

compared with Pearson chi-square test, survival using Kaplan-Meier curves.EVARpatientswereolderandhadsignificantlymorecardiacand pulmonary comorbidities (p=0.05). 30-day major complication and mortalityratesforMIAR,ORandEVARwere5%,15%,5%(p=0.15)and1.7%,1.6%and1.6%(p=0.99)respectively.MedianLOSforMIAR=5days was shorter than OR=7 days (p=0.003); longer than EVAR=2 days(p< .001). Median hospital charges were lowest for MIAR, +$1,325 greater for OR (p=0.32); +$15,305 for EVAR (p<0.001). The >30-day complication rate forMIARwas5%;OR12.5%(p=0.2).The30 to180-day and >180-day EVAR re-intervention rate for endoleak and/or migrationwas4.7%(3/63)and6.3%(4/63).Three-yearsurvivalwas91%,87%,and81%(p=0.35)forMIAR,ORandEVAR.Conclusion: MIAR is safe and results in fewer complications and shorterhospitalstaycomparedtostandardopenrepair.Itissignificantlymore cost effective than EVAR. MIAR may become the new gold standard for AAA repair.Keywords: Minimal incision, Open repair, Endovascular repair

OC1-3 preVaLeNCe OF abdOmiNaL aOrtiCaNeUrySm iN SCreeNiNG SUrVey OF SmaLL tOWN’S reSideNtS iN NOrtHerN pOLaNdA. JAWIEN1, B. FORMANKIEWICZ1, T. DEREZINSKI1, A. MIGDALSKI1, R. PIOTROWICZ1, G. JAKUBOWSKI1

1 Collegium Medicum, University of Nicolai Copernicus, Bydgoszcz, Poland

purpose: The aim of the study was to evaluate the prevalence of Abdominal Aortic Aneurysm (AAA) among asymptomatic men aged 65 years and older in the community of 14 700 citizens’ town in northern Poland.method: Ultrasonography was used as an assessment for abdominal aorta in a population of small town’s men over 65 years old. The criteria for diagnosing AAA were: 1.diameter of the infrarenal aorta more than 30 mm or 2. diameter of infrarenal aorta 50 per cent greater than the diameter of suprarenal aorta.results: Among 14 700 citizens of the studied town’s population the men 65 of age or more accounted for 641. The screening was performed in253men,leadingtotheattendancerateof39%.23(9.1%)outof253screened men had positive ultrasound results for AAA. The anterior to posterior diameter of the aorta was successfully measured in all studied men and the size of diagnosed AAA ranged from 30 to 65mm. The meanageofmenwithAAAwas72,8years.Almost87%(20)patientswith detected AAA were active smokers or only recently not smoking. Hypertension and cardiovascular disease were respectively accounted for56%and30%ofanotherriskfactorsforAAA.Only1patientwithAAAhad positive familial history. Five (1.9%) patientswere foundto have the diameter of AAA >= 55mm and all of them underwent elective AAA surgical reconstruction (3 patients - open repair, 2 patients - endovascular repair). There were no postoperative mortality. The progression of smaller lesions found in 19 patients (7.5%) aremonitored on a regular basis by ultrasound and clinical examination.Conclusion: The performed screening identified 23 (9.1%) patientspreviouslynotawareofhavingAAA.Thesefindingshaveproventhatscreening for AAA is not only valuable for big populations but also for smaller communities with comparable rate of diagnosed AAA.Keywords: Abdominal Aortic Aneurysm, Prevalence, Screening

OC1-4 retrOGrade traNS-pOpLiteaL reCaNaLi- ZatiON OF tHe SUperFiCiaL FemOraL artery:tHe FaCe-dOWN teCHNiQUeI. BROUTZOS1, I. DALAINAS2, K. MOULAKAKIS2,N. PTOHIS1, M. DASKALOPOULOS2, C. PAPASIDERIS2,A. PAPAPETROU2, K. XIROMERITIS2, M. MOSCHOU2,E. AVGERINOS2, T. GIANNAKOPOULOS2, N. KELEKIS1, C. LIAPIS2

1 2nd Department of Radiology, Athens, Greece2 Department of Vascular Surgery, Athens, Greece

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purpose: The aim of this prospective, single-Institution study is to evaluate the technical success, clinical impact, and short term results of theretrogradetranspoplitealrecanalizzationofthesuperficialfemoralartery (SFA), (face-down technique).methods: From September 2008 to April 2010, 24 patients were treated with the face-down technique. Data collection and analysis, as well as follow-up, were performed in a prospective manner. All patients were males, mean age 69 years (range 58-82). In all cases the antegrade recanalizzation was not possible due to impossibility of re-entry in the true lumen in subintimal recanalizzation attempts, or impossibility of proceeding with the antegrade access due to occlusion of the proximal part of the SFA. Twenty-two patients (91.7%) were classified withTASC D lesions. The procedure started with the patient to a prone position and placement of a 5-6F introducer sheath into the popliteal artery under fluoroscopic guidance.A 0.035» hydrophilic guidewirewas used for recanalizzation in all cases.results: Immediate technical success was achieved in 21 of the 24 patients (87.5%). In two patients, the femoral-popliteal axiswas thrombosed immediately after the procedure. One patient underwent bellow-knee amputation, while the other an uncomplicated thrombectomy of the femoral-popliteal axis. The third patient was complicated with intra-procedural dissection of the unilateral iliac-femoral-popliteal axis. He was immediately transferred to the operating theatre and treated with surgical fenestration and thrombectomy. The patient restored good pedal flows after the surgical procedure.At amean follow-up of 6 months (range 1 to 16 months) 12 patients remain withpatentpoplitealarteryandwithoutsignificantrestenosis.Conclusion: The face-down technique is a valid alternative to failed antegrade subintimal recanalizzation of the SFA with an acceptable periprocedural success rate. However, the mid-term durability of the procedure is limited and therefore it should be attempted only in patients with critical limb ischemia.Keywords: Retrograde Recanalizzation, Subintimal Recanalizzation, Face down

OC1-5 iNtraVeNOUS tHrOmbOLySiS WitH reCOm-biNaNt tiSSUe pLaSmiNOGeN aCtiVatOr (rt-pa) iN aCUte LOWer Limb iSCHemiaV. FLIS1, N. KOBILICA1, A. BERGAUER1, B. MRDZA1,F. MILOTIC1, B. STIRN1

1 University Hospital Maribor, Maribor, Slovenia

Background: Over the past years, thrombolysis for the treatment of acute limb ischemia has been the subject of intense evaluation, however most authors have attempted to address this issue by the use of intra-arterial thrombolysis. Some patients are for various reasons unable to undergo such treatment. The aim of this study was to evaluate the effect of intravenous thrombolysis in patients with acute lower limb ischemia (ALI).methods: In the present study we prospectively evaluated the outcome of ALI after intravenous thrombolytic treatment with 100 mg rt-PA in patients with acute thrombosis of lower limb arteries and onset of symptoms within 12 hours prior to treatment. During 3 years (2007-2009) eighteen patients out of 86 were included (range 65-80, 11 women). Written consent was obtained. Occlusions of in situ thromboses of native vessels and the level of ischemia between IIA and IIBwereaccepted.Thrombosiswasverifiedwithduplexultrasoundexamination. Thrombotic occlusions were located in external iliac artery(2),commonfemoralartery(2),superficialfemoralartery(11)and popliteal artery (3). All patients received thrombolytic treatment with100 mg rt-PA given intravenously over a period of 180 minutes. Standard exclusion criteria for thrombolysis treatment were applied. Degree of lysis, patency of initially occluded vessels and clinical outcome including amputation-free survival (major amputations) were assessed. results:Completeandpartialthrombolysiswasobtainedin8(44%)and6(33%)patients,respectively,howeverclinicalimprovementwas

documented in all patients. There were no amputations during a follow up period of 36 months and no hemorrhagic complications in early posttreatmentperiod(within30days).Fivepatientsdied(28%)duringfollow up period from unrelated causes. Conclusion: Findings indicate that thrombolytic treatment with intravenous rt-PA in selected patients with ALI who are unable or unwilling to undergo intra-arterial treatment is feasible. Keywords: Intravenous thrombolysis,Tissue plasminogen activator,Acute lower limb ischemia

OC1-6 eNdOVaSCULar repair OF traUmatiCaOrtiC rUptUre: SiNGLe CeNter eXperieNCeN. MELAS1, A. GIANNOPOULOS1, N. SARATZIS1,A. SARATZIS1, I. LAZARIDIS1, C. TRIGONIS1, K. KTENIDIS1,D. KISKINIS1

1 Aristotle University of Thessaloniki, Thessaloniki, Greece

introduction: Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency. The endovascular treatment of such pathologies is a proposed alternative to open surgery, which is typically associated with high rates of morbidity and mortality. The objective of this studywas to evaluate the efficacy of thoracicaortic disruptions treated with thoracic stentgraft.methods: 18 male patients (mean age 28.5 years) were admitted to our institution between 2003 and 2009 due to blunt aortic trauma – following violent motor vehicle collisions. Plain chest x-ray, spiral computed tomography and aortography were used for diagnosis in all cases. In six cases, transesophageal echocardiography was also available. All subjects were poor surgical candidates, due to major concomitant injuries and were treated using endovascular technique.results:Technicalsuccesswas100%.Inonecasethedeploymentofa second cuff was necessary for exclusion of a endoleak. There were no procedure related deaths. 3 patients presented with uncontrolled hypertension which continued after graft deployment but subsided 3 months later. No cardiac, neurological or peripheral vascular complications were noted within the 30 day post operative follow up period except in one patient who presented Horner syndrome due to subclavian artery transpotition. During late follow up (36 months) one major complication appeared. One patient was converted to hybrid E-vita repair (18nth month) due to stentgraft collapse and pseudoaneurysm formation. All patients are alive with no documented complication. Conclusion(s): Endovascular repair of thoracic aortic disruption is technically feasible and early follow-up results are promising.Keywords: Traumatic aortic rupture

OC1-7 SUrGiCaL treatmeNt priNCipLeS iNpatieNtS WitH traUmatiC iNJUrieS OF maiN VeSSeLS, bONe-JOiNtS OF eXtremitieSN. ABUSHOV1, M. KARIMOV2, G. TAGIZADE1,E. ZAKIRJAYEV1, E. ALIYEV1

1 Scientific Center of Surgery after M. TOPCHUBASHOV, Baku, Azerbaidjan2 Azerbaijan Medical University, Baku, Azerbaidjan

introduction: Debate continues about the choice of optimal surgical treatment principles in patients with traumatic injuries (TI) of main vessels, bone-joints (MVBJ) of extremities. Aim: to define moreprecisely the surgical treatment principles, to examine of complications in the postoperative period and theirs prophylactic measures, to improve the immediate and remote results in patients with TI of MVBJ of extremities.materials ans methods: 902 patients with vascular injuries, in side 855personswithextremityvasculartrauma,ofthese127(14,8%)withcombined skeletal trauma. Localization of injury: upper extremity-52(40,9%), lower-75(59,1%). Gunshot wounds–52 (40,9%), stab–30(23,6%), lacerated–20 (15,8%), blunt–25 (19,7%). Arteriography


was used in 19 (14.19%) patients with stable homodynamics andno establish diagnosis. Treatment methods of bone-joint injuries: transosseous osteosynthesis-9 (7,0%), intramedullary osteosynthesis-13 (10,3%), osteosynthesis with metal pins-16 (12,7%), skeletaltraction-20(15,7%),plasterimmobilization-69(54,3%).results: We consider, that prophylaxis of early infective complications in patients with TI of MVBJ (114-89,7%) depends on preferableemployment of external fixationmethods; primary repair of injuredartery (later injured vein) for ischemia time decrease at stable fractures. At unstable fractures priority should be given to osteosynthesis before repair of injured vessels. Initial surgical correction of the bone-joints injuries was used in 37 (29,1%), of injured vessels in90 (70,9%) patients. Surgical repair of injured vessels-97 (76,4%)patients. Combined vascular and skeletal trauma was associated with ahigher(42(33,2%)from127)employingoftransplantatforvascularreconstructionmore than isolatedvascular trauma(147(20,2%)from728,p<0,001).Vascularligation(11,8%)mustbeusedonlyatforcedcircumstances. 48(37,7%) patients were presented with combinednerve injuries. The long-term results: bad-7 (8,5%), satisfactory-53(64,7%),fine-22(26,8%)patients.Conclusion: Investigations show, that adherence of developed principles promote for improvement of surgical treatment results in patients with TI of MVBJ of extremities. The long-term prognosis, on the whole, was connected with condition of extremity blood circulation and reestablishment of nerve’s functions.Keywords: Traumatic injuries,Main vessels, Bone-joints, Extremities

OC2 - peripheral arterial disease

OC2-1 FUNCtiON OF eNdOtHeLiaL CeLL iN LimbiSCHemiaR. PROCZKA1, M. KEDZIOR2, P. JAGUS2, P. BIALEK1,M. POLANSKA2, M. POSTACCHINI1, I. POSTACCHINI1,P. NITKOWSKI1, J. CHOROSTOWSKA-WYNIMKO2,J. POLANSKI1

1 2nd Department of Vascular Surgery, Warsaw, Poland2 Medical Diagnostic Laboratory, Warsaw Institute of Tuberculosis and Lung Disease, Warsaw, Poland

Objective: Inpatientswith lower limbischemia,specificallycriticallimb ischemia, the local angiogenic response is unsatisfactory in maintaining adequate local perfusion. From our previous results, it is apparent that the level of vascular endothelial growth factor rises in this group of patients, however in patients with critical limb ischemia it does not produce the expected biological effects. The aim of the study, was to assess the impact of the patients serum on the activity of human umbilical vein cells( HUVEC) in patients with critical ischemia, moderate ischemia and in healthy patients.method: We analysed three group of patients; with critical ischemia, moderate ischemia and healthy. In each group five patients wereexamined. 5% solution of patients serum was added to MTT andincubated for 4 hours. Absorbance was measured by 570nm wave. We measuredalsotheeffectof5%serumonelongationofvascularbuds.results: The cessation of proliferative progression of HUVEC cells was discovered in the CLI group of patients. Furthermore, the effect of the examined serum on the angiogenic activity of endothelial vascular cells was analyzed. We observed enlarged total elongation of vascular bud in patients with critical ischemia comparing to patients with moderate ischemia and to healthy ones (p<0.01, p<0.001).Conclusion: VEGF of patients with critical peripheral ischemia develops strong biological effect on HUVEC ! We suspect, that in critical ischemia, incompetence of VEGF receptors plays a crucial role. Further investigations on larger group is needed.Keywords: VEGF, HUVEC, CLi

OC2-2 dOeS reaLLy eXiSt a HiGH riSK patieNt FOrCONVeNtiONaL CarOtid eNdartereCtOmy?G. MARCUCCI1, F. ACCROCCA1, A. SIANI1, A.G. GIORDANO1,R. ANTONELLI1

1 San Paolo Hospital, Civitavecchia, Rome, Italy

Objective:theincreasinguseofcarotidstenting(CAS)hasbeenjustifiedin the patients at “high risk” for conventional carotid endarterectomy (CEA). Based on our own patient population and the results reported in the literature, we try to demonstrate that CEA is a safe procedure, even in patients with high risk comorbidities.design and method: we analyzed our 625 CEA interventions in 545 patientsbetweenJune2003toJune2009.Ofthesepatients,59%hadaseverecoronarydisease,15%hadaseverepulmonarydisease,8%renal malfunction, 18% had a controlateral internal carotid arteryocclusion,5%recurrentcarotidstenosisorhostileneckand37%weremore than 80 years old.results: comparing with the “not –high risk” patients, so called “high risk”patientspresentednotsignificativedifferences inmorbilityandmortalityrate(1.2%vs1.5%postoperativeneurologicalevents;p=ns;0.4%mortality inbothgroups).Inpatientswithredosurgeryorhostile neck, cranial nerve lesions rate was not statistically different of those of patients without redo surgery. In patients over 80 years of age, weachievedaneurologicaldeficitratewas1.6%andmortality0.2%.Conclusion: our results and those from the literature show that CEA is a safe procedure in patients with carotid artery disease. Coronary, pulmonary or renal disease, controlateral carotid occlusion carotid restenosis, hostile neck, age over 80 years are not a controindication to conventional CEA.Keywords: Carotid endarterectomy, High risk patients OC2-3 HiGH preVaLeNCe OF peripHeraL arteriaLdiSeaSe: reSULtS OF tHe eVaLUatiON OF aNKLe/braCHiaL iNdeX iN HUNGariaN HyperteNSiVeS (erV) SCreeNiNG prOGramK. FARKAS1, Z. JÁRAI2, E. KOLOSSVÁRY1, A. LUDÁNYI3,I. KISS1

1 Department of Angiology and Nephrology of Internal Medicine, St. Imre Teaching Hospital, Budapest, Hungary2 First Department of Medicine, Semmelweis University, Budapest, Hungary3 EGIS Pharmaceuticals, Budapest, Hungary

Background and objective: Epidemiological data have shown that clinical, but also preclinical stages of peripheral arterial disease (PAD) are characterised by a high risk of cardiovascular mortality. PAD can be diagnosed already in the early, asymptomatic stage, with a simple, noninvasive test, the ankle/brachial index (ABI). A low ABI is an indicator of high cardiovascular risk in asymptomatic patients. The objective of the present study was to evaluate the prevalence of PAD in hypertensive patients. patients and method: Hypertensive patients (age 50-75 years) who were attended at 55 hypertension outpatient clinics from Hungary, during a 17 month period, were included in the prospective study. All patients had a clinical history, a physical examination, a blood analysis, and a measurement of the ankle-brachial index.results: A total of 21 892 patients (9162 males; mean age: 61.45 years), wereincludedinthestudy.58%ofthesubjectswereatlow(0-1%)ormoderate(2-4%)riskaccordingtothecalculatedSCORErisk.TheprevalenceofalowABI(<=0.9)was14.0%.Inthelow,moderateandhighSCOREriskgroups,theprevalenceoflowABIwas6.5%,9,7%and17.5%inmales;8.7%,11.9%and17.4%infemales,respectively.In a multivariate analysis, factors associated with a low ABI were age, smoking, diabetes, hypercholesterolemia, elevated serum uric acid level, a reduced glomerular filtration rate, blood pressure >140/90mmHg, microalbuminuria, the presence of myocardial infarction in the patient history and the presence of PAD in the family history.

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Conclusions: Prevalence of a low ABI is elevated in hypertensive patients. The use of ABI screening may improve cardiovascular risk predictionandthetreatmentcanbemodifiedaccordingtotheguidelinesfor high risk patients. Cardiovascular morbidity and mortality data will be evaluated after the 5 years long prospective phase of the ERV program.Keywords: Peripheral arterial disease, Ankle-brachial index, Hypertension

OC2-4 CrONOCOL impLaNt redUCeS SUrGiCaLSite iNFeCtiON aNd imprOVeS FiNaL OUtCOme iN iSCHemiC patieNtSC. COSTA ALMEIDA1, L. REIS1, L. CARVALHO1,C. COSTA ALMEIDA1

1 Centro Hospitalar de Coimbra, Coimbra, Portugal

Surgical site infection (SSI) in an ischemic patient after implantation of a prosthetic by-pass is a complication that can have catastrophic impact in the by-pass permeability and in the future of the limb, and it can happen after administration of prophylactic systemic antibiotic. Using a Cronocol implant (collagen matrix impregnated with gentamicin) in the groin incision of patients submitted to femoro-popliteal by-pass can be a viable option to reduce SSI. Objective: to compare SSI rate in patients operated on of femoro-popliteal prosthetic by-pass in whom a Cronocol implant was applied in the groin incision intra-operatively, with SSI rate in a control group operated on without that implant. Methods: in a group of 40 non-diabetic patients with lower limb ischemia with indication for femoro-popliteal by-pass graft (PTFE supported grafts were used), all treated with piperacilin plus tazobactam as systemic infection prophylaxis, 20 (chosen at random) had a Cronocol implant applied in the groin incision. All patients in both groups were operated by the same team. SSI signs and symptoms were evaluated duringthefirst30dayspos-op,andtheresultscompared.Results: SSI rate (no severe infection in none, but edema, redness, localpain,somepusaroundstitches)inthecontrolgroupwas25%(5patients), while in the Cronocol group there were no signs of SSI. No allergic reactions, either local or systemic, were noticed.Conclusions: by using a Cronocol implant intra-operatively it seems possible to reduce SSI rate in these operations, carrying no complications related to its use. These preliminary results are very favourabletotheprophylacticefficacyofCronocolimplantstowardsSSI, and that is why we are presenting them. More randomized studies and a larger group of patients in ours are needed, before its routine use can be advised in operations where a local infection can be disastrous.Keywords: Surgical Site Infection, Cronocol implant,PTFE prosthesis by-pass

OC2-5 eUrOpeaN biObaNK ON VaSCULar diSeaSeSM. CATALANO1, VAS-Scientific Team1, VAS-Biobank Working Group1-2

1 Vas-Vascular-Independent Research and Education-European Organization, Milan, Italy2 Research Center on Vascular Diseases and Angiology Unit University of Milan-H Sacco, Milan, Italy

Objectives: Advances in medicine and the discovering of how genetic variation influences disease can be achieved only by research onbig numbers of available samples, properly collected and stored by Biobanks. Vascular Diseases and their socio-economic impact are spreading mainly because of the increase in average-age. To improve the knowledge through a secure access to clinical data and biological resources which are essential in health-related researches the VAS- European-Biobank on Vascular Patients was defined. Besides theBiobankaimstocontributetoincreaseresearch’sscientificexcellenceand efficacy in life sciences linking both clinical and biomolecular

approaches, with close collaboration with non-European Countries. TheBiobankisaprojectfromVAS,EuropeanScientificAssociation,alargeno-profit-Networkofqualifiedresearchers,clinicians,Centresand Institutions of 23 European Countries, operating since 1991 in the area of Angiology/Vascular-Medicine funding on the triad Research-Education-Clinics.methods: The Biobank on Vascular has subprojects activated in succession.ThefirstongoingisonPAD(Vas-EBPp),high-riskdiseaseforacuteevents/mortality,sincetheasymptomaticstage.Thequalifiedpatient selection, data and sample collection procedure are standardised for participating Centres. Once the informed consent is signed the blood-samples are sent to the centralized biorepository in Milan after theresearchershavefilledinananonymizeddetailedonline-clinical-questionnaireonthepatient.Thequalitycertifiedorganizationisfullycentralized making the participation free and easy.results: The VAS-European-Biobank is already recognised in the European Network of Biobank of excellence for working with common methodologies(BBMRI,ISS),withthefinalaimtoimproveknowledgeand health in a near future. Short-term results: allowing biobanking to entertheeverydayclinicalpracticeofqualifiedCentres,strengtheningtheir excellence in the triad Clinic-Research-Education; make European patients active in researches for future generations. Conclusions: A wide call to join the European-Biobank on Vascular Disease has been launched.(www.vas-int-org/[email protected] )Keywords: Biobanking, Peripheral arterial diseases,Research

OC2-6 aSSeSSmeNt OF COLLateraL bLOOdFLOW iN iSCHemiC LOWer LimbO. ALBAZDE1

1 Imperial College, London, United Kingdom

Raised athermanous plaques are common in the lower abdominal aorta by early adult life. Progressive diseases at this site and in the vessels distal to it occur mainly in the second half of life, but usually remain asymptomatic. When symptomatic, patients usually present to the clinician with intermittent claudication. Several risk factors have been implicated in the progression of such disease, diabetes mellitus has been found to magnify the disease process, causing greater morbidity, (and mortality) in the form of macrovascular and microvascular complications.In order to quantitatively assess the contribution of the collateral circulationtothelowerlimbbloodflowandtoassesscapillaryfiltrationa total of 80 subjects were subjected to popliteal artery blood flowmeasurement, (using Duplex ultrasound) and total limb blood flowmeasurement using opto-electronic plethysmography.These subjects included 20 patients with peripheral arterial disease (PAD), [diagnosed by DSA as having occlusion of the superficialfemoral artery without popliteal disease and with ABPI < 0.9] 20 patients with PAD and NIDDM, 20 patients with PAD and IDDM and 20 control subjects of comparable age and risk factors. Therewasasignificantdifferenceinthemeans(P<0.05)oftotallimbbloodflowandpoplitealarterybloodflowinpatientswithPAD,whichcan be attributed to the development of their collateral circulation. The meanvaluesfortotallimbbloodflowandpoplitealarterybloodflowwere not markedly different in all other study groups. This means that in patients with NIDDM and IDDM, the popliteal artery is the main contributortothebloodflowtothelowerlimbandthesepatientshavelittlecollateralcirculationbloodflow.Themeasurements for capillaryfiltration revealed that patientswithIDDM and PAD have a markedly reduced rate compared to the other study groups.Keywords:Assessmentoftotalbloodflow,Toischemiclowerlimb

OC2-7 COmparatiVe StUddiNG OF HemOrHeOLO-GiCaL iNdeXeS iN patieNtS WitH CritiCaL Limb iSCHemiaN. ABUSHOV1, E. ZAKIRJAYEV1, Z. ALIYEV1, G. ZEYNALOVA1


1 Scientific Center of Surgery after M. TOPCHBASHOV, Baku, Azerbaijan

introduction: Successful treatment of patients with critical limb ischemia (CLI) is theoneof thedifficultyproblemofcontemporaryangiosurgery. The aim: to analyze the influence of alterations inhemostasis system to clinical course.material and methods: The hemorheological status (fibrinogenconcentration, fibrinolytic activity, prothrombin index, bloodcoagulation time, deformability of erythrocytes) in 25 patients with CLI was studied. The main group (n=15) was performed by patients with thromboangiitis obliterans (TAO), aged from 22 to 51 (median 40,0±0,7), control group (n=10)-arteriosclerosis obliterans, aged from 47 to 72 (median 61,0±0,5). The diagnosis of TAO is based on 5 criteria of Shionoya (smoking history, onset before the age of 50 years, infrapopliteal arterial occlusive disease, either upper limb involvement or phlebitis migrans, and absence of atherosclerotic risk factors other than smoking). Microcirculation was studied by transcutaneous oxygen pressure (tcpO2) for estimate the dependence of clinic-functional infringements in ischemic leg from hemostasis system.results: Main group (TAO) had a most tendency to hypercoagulation and aggravation of the blood hemorheological features as compared with control group. In basic group prothrombin index was improved median on 11,6±1,1% (ð<0,05), deformability of erythrocytes wasreduced median on 1,23±0,2 un. (p<0,05). Blood coagulation time was decreasedinmaingroup(2,1±0,4vers.3,1±0,3min.,ð<0,01).Therewerenosignificantlydifferencesinindexesoffibrinogenconcentrationandfibrinolyticactivity.ComparativeanalysisoftcpO2wasrevealedthe more clinic-functional infringements in ischemic leg at patients with TAO (22,1±2,2 vers. 27,4±1,6 mmHg, p<0,05).Conclusion: We consider, that medicamental therapy of hemorheologic abnormalities in patient with TAO and CLI must be direct to correction of abnormalities in all hemocoagulation system components. The best results of complex surgical treatment were recorded by combined employment of surgical operations (arterial reconstructions or lumbar sympathectomy), prolonged epidural analgesia and complex rheological therapy in perioperative period.Keywords: Critical limb ischemia, Thromboangiitis obliterans, Hemostasis system

OC3 - Venous thromboembolic disease

OC3-1 COmpariSON OF tHe CLiNiCaL HiStOry OF SymptOmatiC iSOLated mUSCULar CaLF VeiN tHrOmbOSiS VerSUS deep CaLF VeiN tHrOmbOSiSJ. GALANAUD1, M.A. SEVESTRE2,3, C. GENTY3,4, J.P. LAROCHE1, V. ZYZKA5, I. QUERE1,6, J.L. BOSSON3,4

1 CHU Montpellier, Montpellier, France2 CHU Amiens, Amiens, France3 TIMC, Grenoble, France4 CIC, Grenoble, France5 Cabinet de médecine vasculaire, Fort de France, France6 EA 2992, Montpellier, France

Objective: half of all lower limbs deep vein thromboses (DVT) are distal DVT that are equally distributed between muscular calf vein thromboses (MCVT) and deep calf vein thromboses (DCVT). Despite their high prevalence, MCVT and DCVT have never been compared so far, which prevents from a possible modulation of distal DVT management according to the kind of distal DVT (MCVT or DCVT). Our objective is to compare the clinical history of DCVT versus MCVT.design and methods: using data from the French, multicenter, prospective observational OPTIMEV study, we compared the clinical presentation, risk factors of 268 symptomatic isolated DCVT and 457 symptomatic isolated MCVT and the three-month outcomes of the 222 DCVT and 390 MCVT followed up.

results:86.5%ofDCVTpatientsand76.7%ofMCVTpatientsweretreated with anticoagulant drugs during the whole follow-up (P=0.003). MCVT was significantly more associated with localized pain thanDCVT (30.4%vs 22.4%,P=0.02) and less associatedwith swelling(47.9%vs62.7%,p<0.001).MCVTandDCVTpatientsexhibitedthesameriskfactorsprofile(exceptrecentsurgeryslightlymoreassociatedwith DCVT: OR= 1.70 [1.06 – 2.75]) and were equivalent in terms of co-morbidities (evaluated thanks to their Charlson index). At three months, there was no difference in terms of death, VTE recurrence and majorbleedingbetweenMCVTandDCVT(3.8%vs4.1%;1.5%vs1.4%;0%vs0.5%respectively,allstatisticallynotsignificant).Conclusion: isolated symptomatic MCVT and DCVT populations exhibit different clinical symptoms at presentation but affect the same population. Under anticoagulant treatment and in the short term, isolated distal DVT constitute a homogeneous entity. Therapeutic trials are needed in order to determine a consensual mode of care of MCVT and DCVT.Keywords: Distal deep-vein thrombosis, Muscular calf vein thrombosis, Deep calf vein thrombosis

OC3-2 bLeediNG COmpLiCatiONS iN patieNtS WitH CaNCer reCeiViNG aNtiCOaGULaNt tHerapy FOr VeNOUS tHrOmbOembOLiSm. FiNdiNGS FrOm tHe riete reGiStryA. VISONÀ1, P. DI MICCO2, J.A. NIETO3, J. TRUIJLLO SANTOS4, R. QUINTAVALLA5, P. PRANDONI6, M. MONREAL7

1 Angiology Unit Castelfranco Hospital, Castelfranco Veneto, Italy2 Internal Medicine Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy3 Department of Internal Medicine Hospital Virgen de la Luz, Cuenca, Spain4 Department of Internal Medicine Hospital Universitario Santa Maria de Rosell, Cartagena, Spain5 Department of Internal Medicine Azienda Ospedaliera Universitaria, Parma, Italy6 Germans Trias I Pujol Hospital, Badalona, Spain7 Department of Cardiothoracic and Vascular Sciences University of Padua, Padua, Italy

Background: Cancer patients with acute venous thromboembolism (VTE) have an increased incidence of anticoagulant related bleeding complications compared with those without cancer. methods: Using data from RIETE, an ongoing registry of consecutive patients with acute VTE, we assessed risk factors for fatal bleeding among consecutive patients with active cancer and symptomatic acute deep venous thrombosis (DVT) or pulmonary embolism (PE). results: Up to December 2009, 25,022 patients with acute VTE had been enrolled in RIETE, of whom 4,921 (20%) had active cancer.Of these 212 patients did not receive anticoagulant therapy, or it was stopped earlier than day 90 for reason other than bleeding. Thus, 4,709 receivedanticoagulanttherapyduringthefirstthreemonthsandwereconsidered for the purpose of this study.During the first three months of anticoagulant therapy, 200 (4,4%)patients developedmajor bleeding.Then, 38 (0.8%) further patientsbled beyond the first 90 days of therapy, 3 bled after withholdinganticoagulant therapy. The most common sites of bleeding were the gastrointestinal tract (118 patients, 49%), genitourinary system (43patients, 18%) and the brain (27 patients, 11%). In all 160 patients(66%)diedwithin30daysafterbleeding:88(55%)diedofbleeding,3(1,9%)diedofrecurrentpulmonaryembolism.Conclusions: Major bleeding is a frequent and severe complication in cancer patient with VTE, even beyond the third month. One in every three patients who bled died of the bleeding event. This information has to be validated in further studies in order to help clinicians to weigh the riskandbenefitsofprescribinganticoagulanttherapyinanindividualpatient.Keywords: Bleeding, Cancer, Anticoagulant Therapy

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OC3-3 FataL bLeediNG iN patieNtS reCeiViNGaNtiCOaGULaNt tHerapy FOr VeNOUS tHrOmbO-embOLiSm. FiNdiNGS FrOm tHe riete reGiStryA. VISONÀ1, P. DI MICCO2, A. NIGLIO3, M. AMITRANO4,M. CIAMMAICHELLA5, P. PRANDONI6, M. MONREAL7,J.A. NIETO8

1 Angiology Unit Castelfranco Veneto Hospital, Castelfranco Veneto, Italy2 Internal Medicine Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy3 Internal Medicine of Second University of Naples, Naples, Italy4 Angiology Unit San Giuseppe Moscati Hospital, Avellino, Italy5 Medicina Urgenza S Giovanni Addolorata Hospital, Rome, Italy6 Department of Cardiothoracic and Vascular Sciences University of Padua, Padua, Italy7 Department of Internal Medicine Hospital Germans Trias i Pujol, Badalona, Spain8 Hospital Virgen de la Luz, Cuenca, Spain

Background: Fatal bleeding is the most serious consequence of anticoagulant therapy, but the factors associated with fatal bleeding duringthefirst3monthsoftreatmentofacutevenousthromboembolism(VTE) are uncertain. methods: Using data from RIETE, an ongoing registry of consecutive patients with acute VTE, we assessed risk factors for fatal bleeding among all patients. We then used this information to derive a clinical model that would stratify a patient’s risk of fatal bleeding during the first3monthsoftreatment.results: Of 24,395 patients, 546 (2.24%) had a major bleed and135 (0.55%) had a fatal bleed. The gastrointestinal tract was themost common site of fatal bleeding (40%of fatal bleeds), followedby intracranial bleeding (25%). Fatal bleeding was independentlyassociated with the following factors at the time of VTE diagnosis: age >75 years (OR: 2.16), metastatic cancer (OR: 3.80), immobility§4 days (OR 1.99), a major bleed within the past 30 days (OR: 2.64), an abnormal prothrombin time (OR: 2.09), a platelet count <10/L (OR: 2.23), creatinine clearance <30 mL/min (OR: 2.27), anemia (OR: 1.54), and distal deep vein thrombosis (OR: 0.39). A clinical prediction rule for risk of fatal bleeding that included 9 baseline factors was derived. Fatalbleedingoccurredin0.16%(95%CI:0.11-0.23)ofthelow-risk,1.06%(95%CI:0.85-1.30)ofthemoderate-risk,and4.24%(95%CI:2.76-6.27) of the high-risk category.Conclusions: Patient characteristics and laboratory variables can identify patients at high risk for fatal bleeding during treatment of acute VTE. Keywords: Fatal Bleeding, Anticoagulant Therapy, Venous Thromboembolism

OC3-4 VeNOUS tHrOmbOembOLiSm iN tHeeLderLy: epidemiOLOGiCaL data OVerVieW baSed ON tHe prOSpeCtiVe OptimeV COHOrtG. PERNOD1, 2, M. A. SEVESTRE1, 3, C. GENTY4, J. LABARERE1,5, P. COUTURIER1,6, J. L. BOSSON1,4

1 ThEMAS, TIMC UMR 5525 CNRS Université Joseph Fourier, Grenoble, France2 Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France3 Department of Vascular Medicine Unit, Amiens University Hospital, Amiens, France4 Department of statistics, Centre of Clinical Investigation, Grenoble University Hospital, Grenoble, France5 Quality of Care Unit, Grenoble University Hospital, Grenoble, France6 Department of Geriatrics, Grenoble University Hospital, Grenoble, France

One of the strongest risk factor for VTE is age. Despite this high

incidence, there is surprisingly little known about VTE in elderly. Our aim was to focus on epidemiological information regarding VTE among old population.A total of 8256 patients suspected of VTE were included in the multicentre prospective cohort OPTIMEV study, among which the aged study population (> 75y) was 2149. A total of 655 patients (30.5%) were positive cases of VTE, including 203 isolated distalDVT (31%), and 452 (69%) proximalDVT+/- PE.Compared to acontrol group aged lower than 75 without VTE, bed rest (OR 1.43, 95%CI 1.09 – 1.87), acute cancer (OR 1.99, 95% CI 1.47 – 2.7),previoushistoryofVTE(OR1.71,95%CI1.36–2.14), cardiacorpulmonaryinsufficiency(OR1.91,95%CI1.4–2.62)andtravel(OR3.59,95%CI1.31–9.85)wereindependentriskfactorsforallformsofVTE.Toidentifypotentialspecificriskfactorsinelderly,wetestedby logistic regression the interaction between age (more or less than 75) and risk factors. Only male gender, lower limb immobilization and surgerywere found tobesignificantlydifferent risk factors forVTEaccording to age, and surprisingly, were more associated with VTE in younger patients. Our epidemiological data showed that severe medical disorders were strongly associated with the occurrence of VTE elderly. However, compared to young patients suffered from VTE, there is a fewreallyspecificriskfactorsinthisoldpopulation.Keywords: Venous thrombosis, Elderly, Epidemiology

OC3-5 tHrOmbOSiS OF atypiCaL LOCatiON, mayO SerieS: prOFiLe OF LOCaL CaUSeS iN OrGaN VeiN tHrOmbOSiSW. WYSOKINSKI1, R. MCBANE1

1 Mayo Clinic and Foundation, Rochester, USA

Objectives: Organ vein thrombosis represents relatively rare but often very serious medical condition. To challenge the common notion that thrombosis of this location is associated with the general prothrombotic status, etiology of organ venous thrombosis with particular attention to local causes was analyzed. patients and methods: We studied all patients with organ vein thrombosis: cerebral venous sinus thrombosis (CVST), portal, mesenteric, splenic, hepatic, renal, and ovarian vein thrombosis seen at the Mayo Clinic between 1990 and 2006. Etiology of thrombotic process was carefully reviewed. results: Number of patients included, mean age±SD, contribution of organ pathology provoking thrombosis, and the percentage of total patients with local cause of thrombosis including those with multiple potential etiologies are shown in Table.

Conclusions: With the exception of CVST, all other thromboses of organ veins are caused in the majority of cases by local factor: cancer, inflammation,surgery.Specificlocationofunderlyingcausedetermines


specificlocationofthromboticprocesswhilegeneralpredispositionisless important. Keywords: Venous thrombosis of atypical, Risk factors for thrombosis

OC3-6 eVaLUatiON OF a pNeUmatiC deViCe eF-FiCaCy tO preVeNt VeNOUS diSOrderS iN air traVeLF. FERNANDEZ1, I. CHIROSA2, M. MARTINEZ2,J.J. SÁNCHEZ-CRUZ3, E. ROS1

1 Hospital Universitario San Cecilio, Granada, Spain2 Universidad de Granada, Granada, Spain3 Escuela Andaluza de Salud Pública, Granada, Spain

Objectives: The WHO recognizes air travel related venous diseases as a global hazard for health; it may encompass from paresthesia to oedema and in serious cases can produce deep venous thrombosis and pulmonary emboli that can lead to fatal consequences. As causes we can emphasize immobilization in static and forced situation, hypobaric hypoxia and coagulation disorder related to low humidity and low pressure incabin.Inorder to test theefficacyofapneumaticdevicedesigned to prevent this pathology we have performed a randomized clinical essay with cross over groups.design and methodology: 60 healthy volunteers were assigned in randomized way to simulated air travel in hypoxia-hypobaric altitude at 2.400 meters high with space and conditions similar to those of a commercialflight.Wetookanthropometricdeterminations,echography,plethysmography and QOL questionnaire, after and before exposition and with and without induced exercise.We made evaluation of weight, echographic diameters of deep and superficial veins, distance dermis-fascial and dermis-periostial forestimatedoedema,venousocclusionplethysmography(venousoutflowand capacitance) and qualitative questionnaires (symptomatology and QOL).results: There were no differences in venous diameter, but we found significantdifferencesinoedemaevaluatedbymalleolarechographicdistances (p<.000), clear differences in plethysmographic parameters (p<.00) more acute in distal measures of venous return and there weren´tsignificance inqualitativesymptomatologyafterexposure toflightsimulatedconditions.Thoseeffectsarereversibleincontrolaftertwo weeks.Conclusion: Exercise mediated by pneumatic device can prevent venousdisorderscausedbyexperimentalsimulatedexposuretoflightconditions.Keywords: Prophylaxis venous disease, Prevention based in exercise, Traveller´s thrombosis

OC3-7 CaLF VeiN tHrOmbOSiS aNd riSK OFpULmONary embOLiSmP. L. ANTIGNANI1, C. ALLEGRA1

1 Department of Angiology St. Giovanni Hospital, Rome, Italy

The majority of the thrombi diagnosed by screening tests were confined to the calf, clinically silent, without any progression orembolic complications. However, approximately 10 to 20% of calfthrombi extend to proximal veins. The real incidence of symptomatic Isolated Distal Deep Vein Thrombosis (ID-DVT) is not clear, being reported in different studies between 9 and 46%. Symptomatic ID-DVT is associated with proximal progression, PE and post-thrombotic syndrome more frequently than asymptomatic ID-DVT.Recent studies reported that the risk of PE in patients with ID-DVT is similartotheriskofPEinpatientswithproximalDVT(24.6%).The TICT study (Treatment of Isolated Calf Thrombosis) is aimed to assesstheefficacyandsafetyofatreatmentregimenofID-DVTwithtwice-daily subcutaneous administration of full dose weight-adjusted of LMWH for 1 week, followed by half dose of LMWH administered once-daily for the 3 weeks. At the end of the 4 weeks of treatment a

CCDU assessment is scheduled and after 3 months patients are planned forafollow-upvisit.192outpatientswithobjectiveconfirmedID-DVTwere considered. 171 were eligible and were included in the study. 124 (72.5%)presentedonlythrombosisofthemuscularveins.62patients(36.2%)presentedanunprovokedID-DVT.Eventsduringfirstmonthoftreatment:Sixpatientsshowedprogressionthrombosis proximal deep veins (3.5%), 1 showed ID-DVT in theother leg. Six of them were unprovoked ID-DVT. There were no major bleeding(0%);twopatients(1.16%)sufferedaminorbleeding.After three months: Five patients demonstrated recurrence: 4 patients showed a proximal DVT.In our study, the majority of thrombotic progression, during the treatment period, was observed in patients with unprovoked ID-DVT. Weneedotherspatients todefinecorrectlythetreatmentofID-DVTbut our results showed the usefulness of a full prolonged treatment in unprovoked ID-DVT.Keywords: Deep venous thrombosis, Ultrasound, Pulmonary embolism

OC4 - Varicose veins

OC4-1 aNatOmiC preCONditiONS FOr reCUrreNt VariCeS iN SUrGiCaL treatmeNt OF primery VariCOSe VeiNSM. VAKHITOV1, O. BOLSHAKOV1, V. AMOSOV1, O. KOVALEVA1

1 St.Petersburg State I.P.Pavlov Medical University, Department of General Surgery, St.Petersburg, Russia

Theproblemofprimaryvaricoseveins(PVV)treatmentisnotfinallyestablished. The high percentage of complicated forms and recurrent varices(RV)(from20to80%)testifiestoit.TheprecisemechanismofPVV development, as well as RV remains unclear.It’sknown,thatdeepveins(DV)takeupto85%oftheoutflowblood.Logically clear, the pathological high venous volume and pressure in thesuperficialveinsareaneffectofinadequacybetweenthequantitiveneeds in the venous outflow and the DV capacity, caused by theiranatomic structure.aim: To study a role of DV in varicose veins recurrence. Materials and methods: Ultrasonography of 255 patients (339 lower limbs) with RV throughout different follow-up periods after radical operations were made. DV structure of 53 lower extremities in anatomic material has been studied. The research included latex injection of veins and a layer- by- layer section.results: In all 339 cases of RV pathologic reflux from the deep tosuperficialveinswere revealed: in42casesof339 through the longstump (1,0-2,5cm)with insufficient tributaries; in188cases throughthe Anterolateral and Posteromedial tributaries. In 255 cases of 339 therewas reflux through the perforator veinsmainly (94,5%) in thecalf.In147casesof339DVinsufficiencywasrevealed.In anatomic material 18 variants of venous structure were revealed, which reflect retiform, maturation stages of development and theirsimilar forms.Conclusions: Morphological bases, providing adequate venous outflow, are not the same in different individual forms of the DVstructure. A lack of compensatory possibility of the DV can explain DV hypertension, deep and perforator veins dilatation by pressure and reflux into theGreat and Small Saphenous veins system, leading tovenoushypertensioninthesuperficialveinsandtheirvaricosity,evenafter radical operations. Keywords: Varicose Veins, Recurrent Varices, Deep Veins Structure

OC4-2 CLOSUreFaSt CatHeter eNdOVeNOUSabLatiON - a tHree year eXperieNCeC. STUCKEY1, C. BARBIERI1, A. MARTIN2,1, K. MCDONALD3.2.1, C. CONROY2,1, R. MARTIN1, D. ROLLINS4

1 ACP, Overland Park, KS, USA

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2 RVT, Overland Park, KS, USA3 RDMS, Overland Park, KS, USA4 ORT, Overland Park, KS, USA

This presentation analyzes the three year experience developed in a private practice of Phlebology, from 05/01/2007 thrrough 04/30/2010. In that timeperiodwe treated359patients (83%female),using857ClosureFast catheters to ablate 886 vessels (1.03 vessels/catheter), using radiofrequency for our energy source. The average number of ClosureFast catheters used was 2.39 catheters per patient. We experienced no ClosureFast catheter failures.The treatment of these 886 vessels required 934 accesses (1.05 accesses/vessel). This larger number of accesses was primarilly the result of the failure of previous treatment (EVA with RF or EVLT) or segmental occlusion from previous episodes of idiopathic thrombophlebitis.The vessel being treated required only one access in 804 interventions. Fifty six (56) vessels required two (2) assesses and on six vessels, three accesses were utilized.We used 489,680 cc of tumescent analgesia in treating 45,652.2 cm (approx1500yd)ofincompetentrefluxingvaricosevein(10.73cc/cmof vein). The treatment time required was 30,258 min (504.3 hrs), as measured from the initial injection of local anesthesia to the closing of the access site(s). The time required for the application of the dressing or compression garment was not included. We averaged 1.51 cm of vein treated per minute of operative time.The distribution of vessels treated was GSV (467), SSV (215), SSV + GIA(99),AASV(88),GIA(9)andrefluxingbranches(8).We evaluated all of the patients throughout the three year period, and ourseriesshowedanablationrateofgreaterthan99%.Keywords: Endovenous Ablation, ClosureFast, Intervention

OC4-3 treatmeNt OF SUperFiCiaL VeNOUS iNSUF-FiCieNCy by eNdOVeNOUS LaSer tHerapy: LeSSONS FrOm a perSONaL triaL ON 1000 CaSeSP. SARRADON1, E. SLOTEMA2

1 Polyclinique les Fleurs, Toulon, France2 Dpt. of General and Endocrine Surgery, Hôpital la Timone, Marseille, France

aim:Treatmentofsuperficialvenousinsufficiency(SVI)ischangingrapidly in the last decade due to innovations in endoluminal technology, rendering aggressive surgical stripping out of date. We report the results a trial of 1002 saphenous axes (SA) treated by endovenous laser therapy (ELT) performed by a single surgeon and the lessons learnt to improve the technique.method:FromNovember2002toMay2009,1002SA(84.8%greatsaphenous vein (GSV), 15.2% small saphenous vein (SSV)) weretreated by ELT, using a 980nm diode laser on 745 patients (mean age 53years;female78%,male22%).Inthefirstyear(n=124)crossectomywas added to the procedure, but abandoned thereafter. The pulsed laser emission evolved in the third year to continuous laser emission with 1 to2millimeterspersecondretractionofthefiber.Phlebectomieswereperformed after the procedure if necessary. Perivenous tumescence was carried out using a solution of xylocaine 20ml, naropène 20ml-bicarbonate 1.4% in 250ml. Follow-up contained clinical andultrasound examination at one week postoperatively, 6 months and yearly. Different type of repermeationswere classified according toanatomical stage and clinical grade (clinical stage of repermeation: I= piecemealII=longIII=totalwithoutdilationorrefluxIV=totalwithdilationandreflux;clinicalgrades:A=asymptomaticB=symptomaticvenousinsufficiencyC=varicoseveins).results and discussion: With a follow-up of up to 6 years (1 to 79 months),thesuccessratewas96.8%.Significantrepermeation(gradesII to IV)werefound in32cases(3.2%);6(0.6%) lead toasurgicalreintervention (IIBC IVB¹C). No reperfusion was found after one year follow-up.Thefirstgroupoperatedwithcrossectomydidn’tshowanysuperior outcomes to ELT only. The continuous laser therapy group

had similar total repermeation rates (III&IV), but showed less partial repermeationrates,ecchymoses,pigmentationsorinflammation.Conclusion:ThisstudyconfirmstheefficacyofELTintreatmentofSVI. Subsequent studies remain necessary to determine its place among continuously developing endoluminal techniques.Keywords: Endovenous Laser Ablation, Varicose Veins,Venous Insuffisency

OC4-4 eNdOVeNOUS radiOFreQUeNCy-pOWered SeGmeNtaL tHermaL abLatiON (rSta) OF tHe Great SapHeNOUS VeiN: 2-year eUrOpeaN FOLLOW-UpO. PICHOT1

1 Service de Médecine Vasculaire CHU de Grenoble, Grenoble, France

Background: Radiofrequency segmental thermal ablation (RSTA) has become a commonly used technology for occlusion of incompetent great saphenous veins (GSVs). Mid-term results and data on clinical parameters are still lacking. methods: N=295 RSTA-treated GSVs were followed for 24 months inaprospectivemulticentertrial.Clinicalcontrolvisitsincludedflowand refluxanalysisbyduplex-ultrasoundandassessmentofclinicalparameters according to CEAP and VCSS. results: 280 of 295 treated GSVs (94.9%) were available for 24months follow-up. Utilizing Kaplan-Meier survival analysis, the probability of occlusionwas 94.5%and the probability of no refluxwas97.2%at24monthsaftertheintervention.Inaddition,98.6%oflegsremainedfreeofclinicallyrelevantaxialrefluxat24monthspost-procedure. If occlusion was present at 12 months follow-up, the risk ofdevelopingnewfloworrefluxuntil24monthsfollow-upwas3.7%and2.9%, respectively.Diametersof theGSVmeasured3cmdistalto the SFJ reduced from 5.6 ± 2.1 mm at screening to 2.1 ± 0.9 mm at 24-months follow-up. The average VCSS score improved from 3.9 ± 2.1 to 0.8 ± 1.5 at 3 months follow-up (p<0.0001) and stayed at an average below 0.7 during the complete 24 months follow-up. While only41.1%ofpatientswerefreeofpainbeforetreatment,at24months99.3%(n=278)reportednopainand96.4%(n=270)didnotexperiencepain during the 12 months before.Conclusion: RSTA showed a high and durable success rate in conjunctionwithclinicalefficacyandamoderateside-effectprofile.Keywords: Radiofrequency

OC4-5 CLiNiCaL COmpariSON OF tHiGH ONLyVerSUS eNdOVeNOUS LaSer abLatiON (eVLa) iN Great SapHeNOUS VeiN iNSUFFiCieNCy treatmeNtR. KIKUCHI1, E. ARCENIO2, C.M. OBA1

1 Clinica Miyake, Sao Paulo, Brazil2 EVAS, Londrina, Brazil

introduction: Recurrence of varicose veins in the leg occurs frequently after standard EVLA technique for great saphenous vein (GSV)insufficiency.ThepresentstudyaimstocompareefficacyandsideeffectsoftreatingGSVinsufficiencywithEVLAinthethighonlyand EVLA extended to the middle leg.methods:Fortylimbs(20patients)withGSVinsufficiency,randomlyseparated in two groups. The first group was submitted to EVLAstandard technique (S-EVLA), and the other group was submitted to EVLAextendedfromthethightothemiddleleg(E-EVLA).Efficacy,symptoms and side effects were assessed after 1, 4 and 8 weeks.results: One week after procedure, hypoesthesia was present in 6/20 E-EVLA group and absent in all patients of S-EVLA group. After two weeks only 2 of these patients still have hypoesthesia, with lower intensity. Residual varicose veins were present in 6/20 of E-EVLA and 16/20 of S-EVLA patients. GSV patency and skin hyperpigmentation were similar in both groups.Conclusion: E-EVLA is more effective if compared to S-EVLA. E-EVLA side effects exist but are usually mild and temporary.


Keywords:Endovenouslaser,Venousinsufficiency,Varicosevein

OC4-6 a SeVeN FOLd iNCreaSe iN VOLUme FLOW iNtHe Great SapHeNOUS VeiN dUriNG appLiCatiON OF a beLOW KNee StOCKiNG: a pOteNtiaL HaZard FOLLOWiNG FOam SCLerOM. AZZAM1, C. R. LATTIMER1, E. KALODIKI1, G. GEROULAKOS1

1 Department of Vascular Surgery, Ealing Hospital and Imperial College, SW7 2AZ., London, United Kingdom

Objective: Bolus foam displacement into deep veins has been associated with systemic side effects following Ultrasound Guided Foam Sclerotherapy (UGFS). Since the Great Saphenous Vein (GSV) is a primary target for foam sclerotherapy, the objective was to measure the Peak Systolic Velocity (PSV) and Volume Flow (VF) within the GSV before and during the application of an Elastic Graduated Compression Stocking (EGCS).design and method: Twelve consecutive symptomatic patients (12 legs,medianage47years,range24-76)withGSVreflux(>0.5ml/sec) were recruited. The average GSV diameter (d) in the thigh, PSV and the Time Averaged Mean Velocity (TAMV) were recorded with the patient supine. Duplex measurements were taken at baseline and during the application of the EGCS. Cross-sectional area (A) was calculated using:πxd2/4.TheVF(ml/min)wasderivedusing:TAMVxA.results: The median GSV diameter was 6.9mm (range 5.0 – 9.1) which reduced to 5.8mm (range 3.5 - 8.4) after the stocking was applied (p < 0.001). During the application of the EGCS there was a median 17.7 fold increase in PSV (range 6.0 - 42.3, p < 0.001) within the GSV and a median 7.2 fold increase in VF (range 1.9 – 12.2, p < 0.001). Conclusions: This study demonstrates that the application of a stockingresultsinsignificantincreasesinVFandPSVwithintheGSV.If the GSV contains foam this may increase the incidence of systemic side effects by its potential displacement into deep veins. The initial application of an EGCS up to the level of the access site is proposed before foam is injected as this could minimize complications. Validation of this hypothesis with clinical endpoints will require large numbers of patients and such a study, statistically powered, in our view is unlikely to be performed.Keywords: Foam, Compression Stockings

OC4-7 tHe rOLe OF FOam SCLerOtHerapy iNeLderLy patieNt (OVer 70) WitH SeVere diSabLiNG CVdC. ALLEGRA1, P. L. ANTIGNANI1, M. GALLUCCI1

1 Department of Angiology - St.Giovanni Hospital, Rome, Italy

Factors like age, active leg ulcers and a high cost often turn into a limitation for conventional stripping procedure. Foam sclerotherapy, as a minimally invasive, repeatable, inexpensive and safe procedure, seems to be a promising option among this group of patients. Our study aimedatevaluatingtheefficacy,safety,patient’ssatisfactionandabilityto make elderly patients autonomous after such procedure.Between December 2005 and December 2009 we performed ultrasound guided foam sclero-therapy in 57 patients with C4-C6 of CVD. All patients were evaluated before and after treatment (6-12-24-36 months) through the Venous Severity Score System (VSSS) and quality of life questionnaire(SF12).Seventeenpatients(34.6%)hadbeensufferingfrom leg ulcers for an average period of 3.6 years. Eighteen patients underwent internal or external saphenous trunk treatment; as to the remaining 31 patients, incompetent perforating veins and relapsing collateral varices accounting for ulcers were treated. At the end of treatment, all patients were followed up with objective clinical exams, CDU, VCSS, VDS and SF12 questionnaire at 6-12-24-36 months.During the 6-36 months follow-up period symptoms improved or disappeared in all patients. Ulcer healing was observed in 12 out of 17 patients (70.5%) with an average treatment time of 2.7 months.On average, VCSS improved from a baseline value of 12.7 to an

after-treatment value of 4.3; VDS score improved from 2.1 to 0.6. We obtained a complete success in 53 patients, a partial success in 3 patients and 1 failure. No systemic side effects have been observed. All patients expressed their gratitude and a high level of satisfaction; especially patients with a more severe CVI (C5-C6) could achieve a significantimprovementintheirqualityoflife(SF12).Keywords: Echo guide foam sclerotherapy, Varicose veins, Elderly patients

OC5 - atherosclerosis

OC5-1 eaSy aSSeSSmeNt OF dietary patterN FOratHerOSCLerOSiS diSeaSeS iN CLiNiCaL praCtiCeG. MAHE1, M. CARSIN2, J. P. DE BOSSCHERE2, M. ZEENY3

1 Laboratoire d’explorations fonctionnelles vasculaires, centre hospitalier universitaire, Angers, France2 Médecine générale, Rennes, France3 Université Saint Joseph, Beirut, Lebanon

Objectives: Nutrition is one of the modifiable risk factors ofatherosclerosis vascular diseases. We aimed to (1) evaluate dietary pattern associated with vascular diseases in clinical practice using a validated food frequency questionnaire (FFQ), (2) determine potential independent socio-demographic and behavioural factors that are involved in such dietary.Design: Cross sectional study.Setting:GeneralPractitioners’officein2009.Subjects: 250 French subjects (from 18 to 84 years old).Main outcome measure: Vascular Dietary Score (VDS ranges from-17 to 19).results: 21% had a favourable vascular diet (VDS> or = 8), 79%neededtoimprovetheirdiet(VDS<8)and21%hadariskyvasculardiet(VDS < or = -1). A step-by-step multivariate linear-regression analysis with stepwise selection was performed using the VDS as the dependent variable.Significantvariableswere:age(beta=0.495,P<0.0001),men(beta=-0.282, P<0.0001), “Sport, > or = 1 hour/week” (beta=0.253, P=0.001), “Walking, 20 minutes/day” (beta=0,161, P=0.012), “Former smoker” (beta=0.118, P=0.029), and previous nutritional advice (beta=0.105, P=0.049), “Alcohol, > or = 20g/day” (-0.216, P<0.0001), “Primaryschool”(-0.156,P=0.010)).TheR2coefficientofthismodelwas 0,347 (P<0.0001). 88.7%of subjects found the evaluation veryinterestingand89.6%thattheGPsshouldperformit.Conclusion: Simple dietary assessment for vascular diseases prevention can be easily done in clinical practice to allow physicians to give objective and rapid advice for each patient. Age, educational-status, alcohol-consumption, gender, and physical-activity are associated with the VDS. Compliance with such evaluation was found to be very high, which should encourage larger dietary screening in the population in order to reduce the impact of vascular diseases.Keywords: Nutrition, Food frequency questionnaire, Atherosclerosis

OC5-2 mediCaL maNaGemeNt aNd prOGNOSiS OFpatieNtS WitH atHerOtHrOmbOtiC diSeaSe reQUiriNG a reVaSCULariSatiONC. LE HELLO1, R. MORELLO1, S. FRADIN1, O. COFFIN1,D. MAÏZA1, M. HAMON1

1 CHU, Caen, France

Objective: Real-world evaluation of medical management and prognosis of patients with atherothrombotic disease (ATD) addressed for revascularisation.design and method: Prospective observational study of 956 patients followed during 3 years (primary outcome: all-cause death, composite secondary outcome: cardiovascular death and major adverse vascular events) in the University Hospital of Caen (France).results: Duringaperiodof6years,956patients(82.6%men,meanage 64.5+/-10.1 years) were enrolled for supra-aortic vessels disease

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(SVD) (24.6%, of which 38.3%were symptomatic), coronary heartdisease(CHD)(40.4%,ofwhich19.4%hadmyocardialinfarctionand67.4%3-vessel disease), peripheral artery disease (PAD) (34.2%, ofwhich26.0%hadchronicischemia)andvisceralarterydisease(1.7%).After paraclinical evaluation, >2 vascular territories were involved in 85.0%. Vascular risk factors profiles were: previous tobaccouse (65.7%), current tobacco use (10.6%), hypertension (64.3%),hypercholesterolemia(75.4%),diabetes(25.8%),overweight(43.8%)and obesity (25.2%).LDL cholesterolwas>2.58mmol/L (>100mg/dL)for38.2%ofpatientsandfor29.2%ofthosetreatedwithastatin.HbA1c levels were >6.5% for 16.9% of patients and for 53.8% ofdiabetic patients. Patients were undertreated with antiplatelet agents (86.1%),statins(73.2%),renin-angiotensinsysteminhibitors(61.1%),and triple combination of at least an antiplatelet agent, a statin and a renin-angiotensin system inhibitor (45.1% forPAD,48.1% forSVDand65.9%forCHDamongpatients includedafterJune2006).Witha mean follow-up of 22.3+/-10.8 months, primary and secondary outcomes were higher for PAD (11.3%, p=0.012; 47.4%, p<0.001),diabetic patients (11.6%, p=0.021; 36.8%, p=0.001), HbA1c >6.5%(14.5%, p=0.004; 35.8%, p=0.016). Secondary outcome was higherinhypertensivepatients(30.1%,p=0.036)andthosewith>2involvedterritories(31.9%,p=0.002).Conclusions: Even at the time of revascularisation, medical management of ATD was not optimal. The need for clinical education of physicians and patients remains necessary to improve prognosis of ATD.Keywords: Atherosclerosis, Real-world evaluation, Medical management

OC5-3 maNaGemeNt OF VeSSeL WaLL diSeaSe iSbetter tHaN tHe maNaGemeNt OF riSK FaCtOrSG. H. R. RAO1,2, V. SRIRAM2, G. MURALIDHARA2, A. FENSTER3

1 Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA2 South Asian Society on Atherosclerosis and Thrombosis, USA3 Robarts Research Institute, University of Western Ontario, London, Ontario, Canada

Objective: Framingham Studies provided evidence to support the role of risk factors such as increased blood pressure and altered blood lipids, for promoting acute vascular events. Based on these results, management strategies for these risk factors were developed. Recent studies with Computerized Tomography (CT) providing calcium scoring for coronary arteries and Magnetic Resonance Imaging (MRI) giving vessel volume measurements, have demonstrated that using conventionalmethodsformonitoringrisk,mayexcludemorethan30%of the individuals from further screening for high-risk. design and method: One such new methodology for monitoring quantitative measurements of the progression (or regression) of carotid plaque is the use of 3D ultrasound. results: Studies from the Robarts Research Institute at London Ontario, have demonstrated that similar to total intima media thickness (IMT) measurements, total plaque volume (TPV) or total plaque area (TPA) measurements, also could be used to monitor the progress of atherosclerosis. Furthermore, they have demonstrated that aggressive lipid lowering with drugs such as Lipitor, could reduce the TPV significantly inas shortaperiodas threemonths.Thismethodologyhas been shown to be sensitive enough, to monitor the diet-induced changes in the total vessel volume. 3D Ultrasound studies also have demonstrated that evenafter significant loweringofblood lipids theprogression of TPV may still be persistent, suggesting the need for further aggressive treatment. Conclusion: Evidence from recent studies suggests, that monitoring the progression or regression of the disease is far superior to the management of known conventional risk factors. Keywords: Risk, IMT

OC5-4 COmpUted tOmOGrapHiC aNGiOGrapHyFOr tHe eVaLUatiON OF CarOtid artery SteNOSiSF. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2

1 Department of Vascular Surgery, University of Naples, Naples, Italy2 Department of Interventional Radiology, Bari, Italy

aim: Stroke is the third leading cause of mortality in the word and the stenosis degree is considered a fundamental parameter for the definition of the therapeutic approach. With the development ofmulti-detector-Row CT (MDCTA) scanner, computed tomography has become a widely used imaging technique for categorizing carotid artery stenosis degree. The purpose of this paper is to compare two CT post-processing procedure, maximum intensity projection (MIP) and multi planar reconstruction (MPR) in order to evaluate their sensitivity and inter technique agreement.methods: For the purpose 45 patients (35 males and 10 females), that underwent MDCTA for carotid artery evaluation, have been retrospectively evaluated. Data set were processed with the study group’s workstations, by using MPR and MIP algorithms. Each patient was assessed for stenosis degree by using North American Symptomatic Carotid Endarterectomy Trial method. Statistic analysis was performed to determine the sensitivity of the used procedure. The Cohen Kappa test was applied to assess the level of intra-observer agreement. Image quality was also evaluated.results:MPRsensitivitywas87.8%(95%confidenceinterval[CI]81-94.5%)andMIPsensitivitywas91.1%(95%CI85.2-97%).Agreementin MPR was 0.792 with a standard error (SE) of 0.066, and agreement in MIP was 0.836, with a SE of 0.072.Conclusion: Results of the study indicate the MIP algorithms is more sensitive than MPR. Best intra-observer agreement and image quality results were also observer in the MIP. Data suggest also that MIP should be the post-processing procedure to be utilized in the evaluation of carotid artery stenosis degree, when using MDCTA. Presence of big calcified plaque can determine difficulties inMIP evaluation ofstenosis degree.Keywords: Carotid stenosis

OC5-5 perCUtaNeOUS treatmeNt WitH drUG-eLUtiNG SteNt iN diabetiC patieNtSF. POLLICE1, P. POLLICE1, T. GROVER1, I. CHRISTENSEN1

1 Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands Antilles

Background: Recent pivotal randomised clinical trials underscored the salutary effects of drug-eluting stents (DES) in diabetics who underwent percutaneous-coronary revascularization (PCR). These trials documented lower incidence of adverse cardiovascular events and angiographic restenosis with DES usage in comparison with bare metal stents. Although these enthusiastic results, it should bear in mind that clinical trials do not reflect real clinical practice as they enrolhighly selected patients with relative non-complex lesions. aim: The aim of the current study is the evaluation of clinical outcomes in unselected diabetic patients usually encountered during everyday interventional cardiology practice who underwent coronary stenting with drug-eluting stent(DES)implantation.methods: 878 patients (1451 lesions)underwent PCR with DES implantation. Patientswere classified into three groups according todiabetes mellitus(DM)status:1) No-DM (578 patients/937 lesions); 2) non-insulin requiring DM(No.IrDM) (171 patients/301 lesions); 3) insulin requiring DM (iRDM)(129 patients/213 lesions).results: Procedural success was high overall. In-hospital myocardial infarction(MI)washigherinIrDMthaninno—IrDMpatients(10.9%,4.1%,2.6%,respectively;p<0.001).IrDMpatientsshowedhigherin-hospitalcardiacdeaththanno-IrDMandno-DMpatients(3.9%,0.6%,0.5%,respectively;p=0.002).oneyeartargetlesionsrevascularization(TLR) and target vessel revascularization (TVR) rates were not statistically different. IrDM patients compared with both No-IrDM


andNO-DMpatientsshowedlowerone-yearsurvival(92.3%,97.1%,98.4%respectively;p=0.002%),lowerone-yearevent-freesurvival(71.,80.2%,86.3%respectively:p=0.001),andhigherincidenceofone-yearMI(15.5%,6.4%,3.9%,respectively;p<0.001)multivariateanalysisdemonstrated that DM was an independent predictor of one-year MI and one-year MACE.Conclusion: Despite the positive effects of DES on TLR, diabetics, especially IrDM, as compared with No-DM, showed worse immediate and long-term clinical outcomes.Keywords: Diabetes 2

OC5-6 LOW aNKLe braCHiaL iNdeX iS a riSKFaCtOr FOr reVaSCULariZatiON iN COrONary patieNtSM. MAUFUS1, J. B. GUITTON1, G. VANZETTO2, L. BELLE3,B. IMBERT1, P. CARPENTIER1, G. PERNOD1

1 Department of Vascular Medicine, CHU Grenoble, Grenoble, France2 Department of Cardiology, CHU Grenoble, Grenoble, France3 Depatment of Cardiology, CH Annecy, Annecy, France

Objective: PeripheralArtery Disease defined as anAnkle BrachialIndex (ABI) < 0,90 is associated with high risk of Coronary Artery Disease (CAD), stroke and mortality. The aim of our study was to assess the positive predictive value of the ABI regarding CAD requiring a revascularization procedure.design and methods: We conducted a prospective monocentric study. All patients admitted in the cardiology unit for suspected CAD requiring a coronary artery angiography were consecutively included. Patients were assessed for cardiovascular risk factors, claudication history, rest pain or ulcer, and ABI was calculated. Patients were divided into two groups (ABI < 0.90 or 0.90 < ABI < 1.30). The primary endpoint was the number of coronary artery revascularization procedure (CARP), coronary artery bypass graft of percutaneous transluminal coronary angioplasty, according to ABI group.results: 171 patients were consecutively included during 4 months. 109patients (63.7%)hadCAD,and50(29.3%)hadanABI<0.90.Among the50patientswithABI<0.90,43 (86%)neededaCARP.Amongthe121patientswith0.90<ABI<1.30,66(54.5%)neededaCARP. The Odd ratio for CAD revascularization among patients with ABI<0.90is5.12[95%CI;2.13to12.28,p<0.001].Conclusions: Our prospective study has shown that among patients with suspected CAD, an ABI < 0,90 is associated with a 5,12 relative risk for CARP. Thus ABI is a useful non-invasive non-expansive tool thatidentifiesasubgroupofpatientsatrisktorequireaCARP.Keywords: Peripheral vascular disease, Coronary arteyr disease, Ankle brachial index

OC5-7 prOGreSSiON OF peripHeraL arteriaL diSeaSe iN type 2 diabetiC patieNtS: iNFLUeNCeOF FibriNOGeN aNd CrpM. BOSEVSKI1, L. J. GEORGIEVSKA-ISMAIL1

1 University Cardiology Clinic, Faculty of Medicine, Skopje, Makedonija

The aim of studywas to determinate the influence of inflammatorymarkers:fibrinogen(F)andC-reactiveprotein(CRP)ontheprogressionof peripheral atherosclerosis in type 2 diabetic pts. patients and methods: 62 pts with type 2 diabetes and diagnosed coronary artery disease were enrolled in a cohort prospective study. We measured in them, at all, progression of peripheral arterial disease, defined as change of ankle-brachial index (ABI) after 36 months.Multiple linear regression analysis was built to define predictivityof continuous variables: F, CRP, lipid fraction, urea, creatinin, fast glycemia, duration of diabetes, age on to ABI value. results: Study population was on age 60,28 + 27 years and mean diabetesdurationof8,58+6,17years.Meanplasmafibrinogenlevel

was 4,12 + 0,85 g/L. Multivariate analysis showed F value has been determinate with non HDL - cholesterol (â = 1,093, p = 0,027). Linear regressionanalysisdefinedFaspredictor forminimalvalueofABI,found at the end of investigation (â = 0,469, p = 0,007). Value of CRP determinate change of minimal value of ABI and change of mean ABI per year (ABImin and ABIx/y). Conclusion:OurresultsindicatethatplasmadeterminationoffibrinogenandCRPhasclinicalutilityindefiningtheprocessofprogressionofperipheral atherosclerosis in type 2 diabetic population. Keywords: ABI, CRP, Fibrinogen

OC6 - rare vascular diseases and progress in vascular diagnosis

OC6-1 a NeW diaGNOStiC CriteriON WitH OLOUr dUpLeX SCaNNiNG iN pUdeNdaL NeUraLGiaby eNtrapmeNtM. MOLLO1, E. BAUTRANT1, J. EGGERMONT1, A. K. ROSSI-SEIGNERT2

1 Pelvi-perineal Rehabilitation Dpt, Private Med Centre L’Avancee, Aix-en-Provence, France2 Physical and Readaptation Physical Med Dpt, Pays d’Aix Hospital Centre, Aix-en-Provence, France

Objective: to confirm diagnostic accuracy of a newColourDuplexScanning (CDS) criterion, the Pudendal Artery Ratio (PAR) described by Mollo et al*, in Pudendal Neuralgia by Entrapment (PNE).design and methods: a prospective study on a consecutive series brought up-to-date to 667 unselected patients, all evaluated by both CDS and Neurological Criteria (NC) (Diagnostic Score (DS) and Electroneuromyography (ENMG)) and, when surgery was indicated, by an Intra-Operative Score (IOS). CDS examinations were performed by an operator who was unaware of NC and IOS, and in the same way, NC and IOS established by practitioners unaware of CDS findings.Inadequate examinations were neither repeated nor removed from the analysis. Results of CDS were compared to those of NC and of IOS for surgical cases (Student t test) and diagnostic values (Sensitivity and Specificity)wereevaluated.results:inthisconsecutiveseries,CDSexplorationshoweda99.6%Feasibility. PNE was diagnosed with NC in 217 patients. For 115, surgerywasfinallyindicated,sincethefirststageoftreatmentwasnotsufficientforrecovery.Comparativestudywasbasedon154operatednerves(76unilateral,39bilateral).Ofthe154PNEidentifiedbyNC,137 Pudendal Vascular Entrapment (PVE) were detected by CDS. Comparison with IOS obtained during surgical procedures led to a 95.5%Sensitivityanda66.7%Specificity,fordiagnosisofPNE.Conclusions: this study validates our new CDS criterion, the PAR, very strong at diagnosing PNE, involving a great advance in the patients’ care for this pathology. (*) Mollo M. et al. Evaluation of diagnostic accuracy of Colour Duplex Scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in Pudendal Neuralgia by entrapment: A prospective study on 96 patients. PAIN; 142: 159-63 (2009).Keywords: Pudendal Neuralgia, Pudendal Nerve Entrapment, Alcock’s Canal Syndrome

OC6-2 LONG term FOLLOW-Up OF GiaNt CeLLarteritiS-reLated Upper/LOWer Limb VaSCULitiS. a SerieS OF 36 patieNtSC. ASSIE1, A. JANVRESSE1, D. PLISSONNIER1, H. LEVESQUE1, I. MARIE1

1 Département de Médecine interne, CHU Rouen, 76031 Rouen Cedex, France

introduction: The aims of this retrospective study were to evaluate clinical features and long-term outcome of patientswith giant cell arteritis (GCA) exhibiting upper/lower limb vasculitis.methods: 36 consecutive patients received a diagnosis of symptomatic

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upper/lower limb vasculitis related to GCA. Diagnosis of upper/lower limb vasculitis was made using duplex arterial ultrasonography, helical computed tomography (CT)-scan or angiography.results: The patients were 30 women and 6 men with a median age of 68.5 years. Upper/lower limb vasculitis preceded the initial GCA diagnosis in 7 patients. GCA clinical manifestations was severe resultinginischemiccomplicationsofthelimbsin10patients(27.8%).GCA-related large vessel involvement was located on: the upper limb alone(58.3%),thelowerlimbalone(19.4%)andbothupperandlowerlimbs(22.2%).ThedistributionofarterialinvolvementinGCApatientswithupperlimbvasculitiswasasfollows:subclavian(55.6%),axillary(47.2%) and brachial (22.2%) arteries; the localization of arterialinvolvement in GCA patients with lower limb vasculitis included: internaliliacartery(11.1%);commonfemoralartery(13.9%);superficialfemoral artery (33.3%), deep femoral artery (5.6%), popliteal andanteriortibialarteries(5.6%).Allpatientsweregivensteroidtherapy.Reconstructive studywas performed in 10 patients (27.8%): venousbypass graft (n=6), angioplasty (n=1), thromboendarteriectomy (n=2) or thrombectomy (n=1); two other patients with limb ischemia underwent amputation. The median observation time was 32 months; the outcome of upper/lower limb vasculitis was as follows: 1) disappearance of clinicalsymptoms(44.4%);2)improvementofclinicalmanifestations(44.4%);and3)deteriorationofclinicalmanifestations(11.2%).Conclusion: Our study indicates that upper/lower limb vasculitis is not uncommon in GCA. Indeed, yearly clinical vascular examination may be adequate to screen upper/lower limb vasculitis in GCA patients. Our series also underlines that early diagnosis of GCA-related is crucial in patients, resulting in decrease of severe ischemic complications.Keywords: Giant cell arteritis, Upper and lower limb vsculitis, Long term outcome

OC6-3 diGeStiVe arterieS diSSeCtiON iN aretrOSpeCtiVe mONOCeNtriC SerieSC. BELIZNA1, A. GHALI1, C. LAVIGNE1, A. BEUCHER1,F. THOUVENY2, S. WILLOTEAUX2, J. PIQUET3, B. ENON3

1 Internal medicine, CHU Angers, Angers, France2 Radiology, CHU Angers, Angers, France3 Vascular surgery, CHU Angers, Angers, France

Digestive arteries dissection could have sometimes a severe outcome, further complicated by difficulties in performing an etiologicaldiagnosis.Hence, a complete screening for etiological diagnosis allows a fast clinical management and the scheduling of the follow-up.We report a retrospective monocentric series of 47 patients diagnosed duringafiveyearperiod(2005-2009)inInternalMedicineandVascularSurgery Department.methods: 47 cases could be included in the current study with the aid of two medical tools: the French medical disease coding PMSI, and informatised patient medical recording.Data regarding the etiological diagnosis, treatment, outcome, follow-up, could have been collected. results: Patients’ s mean age was 41 years old, and the sex ratio males to females 2:1.Digestive arterial localisation was either unique: superior mesenteric artery (49%), or coeliac artery (42%), or concernedmore than oneterritory(9%).The etiological diagnosis was found as follows: Marfan syndrome (3 cases), Ehler- Danlos (3 cases), panarteritis (2 cases), Wegener granulomatosis (2 cases), Churg-Strauss syndrome (2 cases).Arterial dysplasia was reported in 35 patients.Meantimebeforeperformingfinaldiagnosiswas3months.22 patients had emergency surgery, and 25 had only radiological and clinical regular follow-up. Among these 25 patients, 7 had surgery after a mean follow-up time of 6 months.Immunosuppressive therapy allowed arterial lesional stabilisation in 4/6casesofvasculitis.Fataloutcomeappearedin10cases(21%)after

a mean delay varying from 24 hours (one patient) to 6 months.In conclusion, the correct approach of the etiological diagnosis when dealing with digestive arterial dissection, is essential, in order to detect elastic and conjonctif tissue arterial disease, and some vasculitis with elective tropism for digestive arteries.Keywords: Digestive arteries, Arterial dissection

OC6-4 eVaLUatiON OF tHrOmbiN GeNeratiON aSSay iN tHe mONitOriNG OF treatmeNt WitHVitamiN K aNtaGONiStS, eNOXapariN aNdFONdapariNUXG. GEROTZIAFAS1, V. GALEA1, M. CHAARI1, M. SASSI1,H. BACCOUCHE1, I. ELALAMY1

1 Thrombosis Center, Service Hématologie Biologique. ER2 UPMC, Hôpital Tenon, Paris, France

Background/Aim: Thrombin generation (TG) assay is sensitive but not standardized for monitoring anticoagulant treatment. We sought to establish therapeutic ranges of thrombogram parameters in patients treated with vitamin K antagonist (VKA), enoxaparin or fondaparinux.materials and methods: We studied plasma of 234 consecutive patients receiving VKA (n= 148), enoxaparin (n=36), fondaparinux (n=50) and 30 healthy individuals. Patients onVKAwere stratifiedaccording to INR value (<2,2-3,>3) and patients on enoxaparin or fondaparinux were stratified according to the administered dose(prophylactic or therapeutic). Prothrombin time (PT) was determined using human thromboplastin (Thromborel S, Dade Behring; Marbourg, Germany) and anti-Xa activity using a standardized chromogenic assay (Coamatic Heparin from Chromogenix, Milan, Italy). Callibration curves were constructed by spiking normal pool plasma with enoxaparin of fondaparinux. TG was assessed in citrated platelet poor plasma with Calibrated Automated Thrombogram (CAT, Stago, France). results: TG was significantly inhibited in patients receivingantithrombotic treatment compared to controls. Thrombogram parameters showed different sensitivity to the antithrombotic effect andtothetreatmentintensity.Asignificantinter-individualvariabilityof Endogenous Thrombin Potential (ETP) and Mean Rate Index (MRI) of the propagation phase of TG was observed in VKA subgroups with INR>2 as well as in patients receiving enoxaparin or fondaparinux. MRI andPeakwerethemostsensitivethrombogramparametersreflectingantithrombotic effect of enoxaparin. MRI was the most accurate tool allowing the distinction of prophylactic and therapeutic fondaparinux doses. Conclusion: Each parameter of CAT thrombogram had a different sensitivity to the antithrombotic effect depending on the type and the treatment intensity. It is not correlated with the INR or the anti-Xa activity. The clinical relevance of such a monitoring needs to be prospectively investigated.Keywords: Thrombin generation, Fondaparinux, Low Molecular Weight Heparin

OC6-5 appLiCatiON OF 3 teSLa bLOOd OXyGeNLeVedepeNdeNt (bOLd) maGNetiC reSONaNCe imaGiNG (mri) tO StUdy OXyGeNatiON OF tHe KidNey iN reNOVaSCULar diSeaSeM. L. GLOVICZKI1, J. GLOCKNER2, J. P. GRANDE3,L. O. LERMAN1, S. C. TEXTOR1

1 Nephrology and Hypertension Department, Mayo Clinic, Rochester, Minnesota, USA2 Radiology Department, Mayo Clinic, Rochester, Minnesota, USA3 Laboratory Medicine and Pathology Department, Mayo Clinic, Rochester, Minnesota, USA

Background: BOLD MRI provides noninvasive measurement of regional tissue oxygenation based upon the paramagnetic properties of deoxyhemoglobin. We sought to examine patients with atherosclerotic


renal artery stenosis for whom reduced blood flow to the kidneysultimately leads to renal tissue damage.methods: BOLD MRI evaluation was performed in 24 patients with essential hypertension, 19 patients with moderate atheromatous renal artery stenosis (ARAS) and 14 patients with severe ARAS. Studies were done under baseline conditions and after intravenous administration of furosemide (20 mg) to examine changes in R2* resulting from suppression of oxygen consumption linked to medullary tubular solute transport. For each kidney the hilum level was chosen for analysis, including 3 individual segments (anterior, lateral and posterior). Each segment was defined by cortical and medullary region of interest(ROI). results:

ModerateARAS reduced blood flow and GFR, but was associatedwith preserved medullary and cortical R2* as compared to essential hypertension. More severeARAS (stenosis >90%) led to elevationof cortical R2* values and changes after furosemide were smaller for medullary ROIs. The ratio of cortical to medullary R2* after furosemide administration rose in severe ARAS. Many atrophic poststenotic kidneys demonstrated patchy distribution of zones with elevated medullary R2*.Conclusion: These results demonstrate substantial adaptation of kidneys to decreased blood flow, kidney volume and GFR despiteprogressive ARAS. However, tissue oxygenation and medullary function deteriorate in more severe stenosis, consistent with results observed after acute vascular occlusion in animal studies. Regional tissue examination using 3 T BOLD MR appears to be a valuable non-invasive tool to detect the limits of renal adaptation to reduced perfusion. This test may be helpful to decide which patients need renal revascularization.Keywords: Renal artery stenosis, Kidney, Bold MRI

OC6-6 dUpLeX GUided aNGiOpLaSty OF arteriO-VeNOUS FiStULae FOr HemOdiaLySiS: retrOS-peCtiVe StUdy OF 45 patieNtS iN a FreNCH UNiVeriStary HOSpitaLA. DESSI1, C. SEINTURIER1, O. PICHOT1, E. COCHET2,P. H. CARPENTIER1, C. SESSA2

1 Vascular Medicine Department, CHU Grenoble, Grenoble, France2 Vascular Surgery Departmeent, CHU Grenoble, Grenoble, France

Venous stenosis amount to the major part of the complication of arteriovenous fistulae for hémodialysis. Consequences are highvenouspressures,bleedingatthepuncturepointandlowvolumeflow.Treatment of these complications are usually performed by angioplasty withcontrastmaterialunderfluoroscopy.Thisproceduremayalsobeperformed with duplex scan guidance.design and method: we describe a retrospective serie of 45 cases of patients treated by venous angioplasty guided by duplex scan and detail technics and results.results: 45 patients (mean age 68) received a venous angioplasty underduplexscanguidance.60%weremenand47%werediabetic.

69%offistulaewerelocatedinthearm,31%intheforearm.In40%of patients, procedure was completed with stenting.Immediat results were good. In 6 cases there was a resident moderate stenosis and in two cases procedure failed.Conclusions: Angioplasty under duplex scan guidance is effectible and safe and rarelynecessits adjunctionoffluoroscopy tobeperformed.This technic has many advantages: less irradiation for staff and patients, no toxicity of iodine. Duplex scan may be considered the key exam for preoperative evaluation, surveillance and treatment of complications of arteriovenousfistulae.Keywords:Duplexscan,Arteriovenousfistulae,Angioplasty

OC6-7 KLippeL-treNaUNay-Weber SyNdrOme aNdepitHeLiOid aNGiOSarCOma. a rare aSSOCiatiONJ. PEREIRA ALBINO1, A. SIMAS2, C. MATOS3, G. SOBRINHO1,V. BROTAS2, N. MEIRELES1, G. CLARA3

1 Vascular Surgery Service 2 H. Pulido Valente - CHLN, Lisbon, Portugal2 Medicine 2 Service H. Capuchos - CHLC, Lisbon, Portugal3 Medicine 3 Service H. Pulido Valente - CHLN, Lisbon, Portugal

Klippel-Trenaunay-Weber syndrome is a rare congenital disorder of the peripheral vascular system that is characterized by haemangiomas, soft tissue and/or osseous hypertrophy, venous and lymphatic anomalies, as well as arterio-venous malformations. Although this syndrome is rarely associated with tumors sometimes this association occurs. The authors describe the case of a 22 year old black male from Guiné-Bissau who had shown signs of complications of a Klipppel-Trenaunay-Weber syndrome since the age of 14, including ulcerations an bleeding, He was referenced to our Hospital, and on arrival showed gigantic hemihypertrophy of his right lower limb, with multiple variegated and grape-likered,purpleandfirmsubcutaneousnodules in thecalfandthigh, pinpoint red macules, and multiple infected skin ulcers with excessive bleeding. Laboratory tests revealed a ferropenic anemia. After several complementary examinations (MRI and AngioCT) an arteriography was performed, that revealed multiple pelvic and lower limb arteriovenous fistulae. Because of uncontrolled bleedingof the lower right limb, he was submitted to limb disarticulation with controlled hypotension. The histopathologic examination of a nodule revealed an epihelioid angiosarcoma, which was also confirmed inother nodules. Although the patient improved, the pulmonary CT scan revealed the existence of lung metastases. The patient was submitted to chemotherapy with thalidomide and doxorubicin. At the 12 month follow-up the patient was doing well, and a PET scan revealed no more new lesions, except in the amputation stump. However, 32 months after the diagnosis, the patient came back to our department withnewmodularlesionsandmoreavfistulasinthestump.Tumoraldissemination was detected and he died 42 months after the diagnosis (3 months after new chemotherapy treatment had begun). Our case illustrates a rare association and also an unexpected survival for a patient with an epithelioid angiosarcoma.Keywords: Klippel-Trenaunay-Weber S., Epithelioid Angiosarcoma

OC7 - Venous disorders

OC7-1 treatmeNt OF VeNOUS StaSiS ULCer, tHrOUGH CeLL tHerapy WitH KeratiNOCyte aUtOGraFt iN patieNtS USerS OF miCrONiZeddiOSmiN aNd HeSperidiNA. GUILLAUMON1, C. BOSNARDO1, M. B. PUZZI1, J. RHEDER1

1 State University of Campinas, Campinas, Brazil

introduction: The venous stasis ulcer is the most severe complication of chronic venous insufficiency, affecting adults and keeping themaway from work and from normal social life. Objective: To demonstrate a new therapeutic method for accelerating healing. methods:Twenty-five(25)patientswithvenousstasisulcers,CEAP

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VI, who have not healed with conventional treatments were selected from the Clinic of Peripheral Vascular Diseases, Faculty of Medical Sciences, UNICAMP – were treated with autograft keratinocytes, grown in the skin cell culture laboratory, CIPED-FCM – UNICAMP. They were divided into two groups, Group I-11 patients, 10 female and 1 male, Group II-14 patients, 11 female and 3 male. Both groups were treated with autograft keratinocytes on the clean ulcer bed, and group II, was also given a dose of micronized diosmin hesperidin every 12 hours. All the patients were asked to take a 30-minute rest in the Trendelenburg position for two hours of usual activity. results: After the evaluation of data with statistics methods no parametricHealingand/orimprovementoftheulcerswithsignificantreduction of the bed in both groups were observed, with Group II obtaining precocious results. Conclusion: This method proves to be a good therapeutic option to help in the healing of stasis ulcersKeywords: Ulcer, Keratinocites, Venous Estatis

OC7-2 aSSeSSiNG meSOGLyCaN treatmeNt eFFiCa-Cy iN 1483 OUtpatieNtS WitH CHrONiC VeNOUS iNSUFFiCieNCyC. ALLEGRA1, P. L. ANTIGNANI1

1 Department of Angiology St. Giovanni Hospital, Rome, Italy

Background:Mesoglycanisanantithromboticagent,apro-fibrinolyticdrug and restores the endothelium’s physiologic selective-barrier properties that include anti-edematous activity as shown by numerous clinical and experimental studies. methods: In the present investigation we studied the effect of Mesoglycan in patients with chronic venous disorders (presence of overtClass2venousdisordersasdefinedbytheCEAPguidelinesforthe diagnosis and therapy of vein and lymphatic disorders). The study comprised a 30-day treatment period with 50 mg b.i.d. Mesoglycan (Prisma, Mediolanum Farmaceutici, Milan) administered p.o., followed by a 30-day wash-out period. results: Between March and August 2008, 1559 patients were enrolled in the study involving 98 centers. The analysis population comprised 1483patients.74.4%ofpatientswerefemaleandthemeanagewas55.2years. At the end of the study, the improvements recorded from baseline werestatisticallysignificantforeachoftheeightdomainsoftheSF-36 Health Status questionnaire, indicating an improvement in patients’ general condition. Already by day 15 from the start of treatment, pigmentation and eczema severity score and lower limb circumference hadfallensignificantly.Thesechangeswerealsoconfirmedat30daysafter withdrawal of Mesoglycan treatment. Conclusions: The present results show that, in patients with chronic venous disorders, clinical manifestations of venous disease and quality of life improved after Mesoglycan therapy administered according to the described protocol.Keywords: Treatment, Venous ulcers, Symptoms and signs

OC7-3 CLiNiCaL aNd HaemOdyNamiC SeQUeLaeOF deep VeNOUS tHrOmbOSiSF. POLLICE1, P. POLLICE1, M. SANSONE1

1 Department of Medicine and Thrombosis - l’Aquila University, l’Aquila, Italy

Objective:Postthromboticsyndrome(PTS)developsin40%to60%of patients with deep venous thrombosis. Factors that are important in thedevelopmentofPTSincludevenousreflux,deepveinobstruction,and calf muscle pump dysfunction (CMD).methods: RefluxandCMDinrelationshiptotheseverityofPTSwereevaluated in a 2-years follow-up study of patients with acute deep venousthrombosis.Duplexscanningwasusedtomeasurereflux.Thesupine venous pump function test (SVPT) measures CMD with strain-gauge plethysmography. The base-line examination was performed within 1 to 5 days after diagnosis. The next examination were scheduled

3, 6, 12, and 24 months. results: The study include 86 leg, and the 2-year follow-up period was completed for 70 legs. Significantly more reflux was found inpreviously thrombosed vein segments, with an odds ratio of 1.8 after 3 months, of 2.1 after 6 months, of 2.5 after 12 months, and 3.2 after 24 months. Multiple regression results showed that the most important risk factorforearlyclinicalsignsofPTSwassuperficialrefluxinmonths3,6and12(<-.02).deeprefluxdidnothaveasynergisticrelationshipwithsuperficialrefluxincorrelationwiththeclinicalsignsofPTS.TheSVPT was not able to predict the development of PTS. Conclusion: More reflux develops in previously thrombosed veinsegments.Asearlyasafter the thirdmonth,patientswithsuperficialrefluxhaveanincreasedriskofdevelopmentofthefirstclinicalsignsof PTS. Within 2 years, SVPT shows no relationship with clinical signs of PTS.Keywords: Post thrombotic syndrome

OC7-4 pOSt-SUrGiCaL VeiN tHrOmbOSiS aNd ONSet OF pOSt-tHrOmbOtiC SyNdrOme: iNFLUeNCe OF4G/5G pOLymOrpHiSmF. FERRARA1, C. AMATO1, F MELI1, I. MURATORI1,M. LUNETTA2, I. R. ALCAMO1, S. NOVO2

1 Divion of Angiology, Palermo, Italy2 Division of Cardiology, Palermo, Italy

The purpose of this study was to investigate whether the presence of a Plasminogen Activator Inhibitor type 1 (PAI-1) promoter polymorphism 4G/5GandincreaseofPAI-1activitymayhaveaprognosticsignificancein patients with persistence of post-surgical vein thrombosis and in onset of post-thrombotic syndrome in spite of anticoagulant treatment in patients with DVT.The PAI-1 promoter polymorphism 4G/5G can induce a reduced fibrinolyticactivitywithpersistencethrombosismethods: We included in a prospective 36 months follow-up study 168 patients with post-surgical femoral and/or popliteal vein thrombosis subdivided in the following groups:85 patients with 4G/5G polymorphism and increase of PAI-1 activity.83 patients without 4G/5G polymorphism and normal PAI-activityWe evaluated the persistence of thrombotic lesion after 3 and 12 months (short-term) and the occurence of post-thrombotic syndrome after 36 months by echocolordoppler examination.results: We observed that 65 patients with 4G/5g polymorphism had a persistence of deep vein thrombosis after three months and in 62 patients after 12 months; 61 patients presented a persistence of thrombosis and post-thrombotic syndrome at the end of the study (after 36 months) ; while in patients without 4G/5G polymorphism 39 patients had a persistance of deep vein thormbosis after three months and 19 patients after 12 months; 14 patients shown persistence of thrombosis and post-thrombotic syndrome at the end of the study. From a multivariate analysis of data we observed that 4G/5G polymorphism was a predictor for the persistence of thrombosis after short-term analysis and for incidence of post-thrombotic syndrome in the following controls.Conclusion: Patients with 4G/5G genotype in the promoter of the PAI – 1 gene with increase of PAI-1 activity present a higher risk of persistence of vein thrombosis and onset of post-thrombotic syndrome.Keywords: Polymorphism 4G/5G, Post-thrombotic syndrome, Deep vein thormbosis

OC7-5 aNatOmiCaL deSCriptiON OF tHe OStiaLVaLVe iN tHe SapHeNOFemOraL JUNCtiONC. TASCH1, L. LARCHER2, E. BRENNER3

1 Division for Surgery, Clinic Weilheim-Schongau, Schongau, Germany2 Division for Plastic Surgery, Hospital Feldkirch, Feldkirch, Austria3 Department of Anatomy, Medical University Innsbruck, Innsbruck, Austria


Background: Venous valves have been classified into parietal andostial valves. Most of the literature deals with the parietal valves (PVs), which are situated within the lumen of the veins, whereas ostial valves (OVs)aresituateddirectlyattheconfluenceoftwoveins.OVsoccurless frequently, and they consist usually of a single cusp, sometimes of two cusps. Within the common femoral vein (CFV), the most prominent PVs are the suprasaphenic and infrasaphenic valve, within the great saphenous vein (GSV) these are the terminal and preterminal valve. Especially in French literature, this terminal valve of the GSV is called “valvule ostiale”. While PVs were well studied, there is almost no literature on the OVs, especially on the OV of the GSV. methods: Ninety-eight isolated specimens consisting of the CFV and the attached tributary veins including the GSV, were investigated for the presence of OVs. All specimens derived from bodies bequested by informed consent to the Division for Clinical and Functional Anatomy, Medical University Innsbruck. Fromthese98specimensfivepossessedanOVconsistingofasinglecusp (5.1%), six had an OVwith two cusps (6.1%); additional tenspecimensshowedremnantsofanOV(10.2%).discussion: The distinction between PVs and OVs is not always clear in literature, and in consequence misinterpretation may occur. Very often the terminal valve of the GSV, a real PV, is called “ostial valve”. In patients presenting symptoms of chronic venous disease, saphenous vein reflux is the most common haemodynamic abnormality andsapheno-femoral junction involvement has been cited as responsibel for varicose vein formation. Thus especially the competence as well as theexactlocationrespectivelycorrectidentificationofthevalvesofthesaphenofemoral junction gain in importance in ultrasound scanning. It is important to identify OVs and consequently differentiate saphenous from non-saphenous trunk pathology before surgical intervention with regard to preserve the main GSV for its potential use in coronary bypass grafting and other vascular procedures. To avoid misinterpretation our anatomical data provides a clear distinction to the terminal valve of the Great Saphenous Vein.Keywords: Venous Valves

OC7-6 meta-aNaLySiS apprOaCH OF tHe eFFeCtOF VeNOaCtiVe drUG ON aNKLe CirCUmFereNCe iNCVd patieNtSF. ALLAERT1

1 Chair of medical evaluation Ceren ESC, Dijon, France

Objectives: to describe and compare the effects of venoactive drugs on ankle circumferences in CVD patients through a meta-analysis of grade A publication issued from 1975 to 2009.methods: All papers dealing with randomized double-blind clinical trials, comparing active drug versus placebo or active drug versus active drug on ankle circumferences were extracted from Medline and checked according Jadad and Cucherat evaluation grid.results: Ten papers with a Jadad score> 3 including 1010 patients were introduced in the matanalysis. Studied drugs were MPFF, hydroxyethylrutoside, ruscus aculeatus extracts and placebo. The ankle perimeter reduction was - 0,80 ± 0,53 cm for MPFF, -0,58 ± 0,47 cm for ruscus aculeatus extracts, - 0,58 ± 0,31 cm for hydroxyethylrutoside, and -0,11 ± 0,42 cm.for placebo. Statistical comparison show that the three drugs are more active than placebo (p<0.0001), than MPFF was superior to ruscus aculeatus extracts and hydroxyethylrutoside and do not show difference between the two last one. Meta-analytic results showalso that statisticallyoedemawill be reducedof 1 cm in35%ofthepatienttreatedwithMPFF,17%withruscusaculeatusextracts,13%withhydroxyethylrutosideand2%withlacebo.Conclusion:ThismetanalysisconfirmsthegradeArankattributedtoMPFF by the Sienna conference consensus through the demonstration of its predominant effect on oedema, one of the most frequent symptoms forwhichpeoplepresentingvenousinsufficiencyareconsulting.Keywords: Oedema, Venoactive drug, Metanalysis

OC7-7 iNFLammatiON – patHOGeNetiC meCHaNiSm OF VeNOUS tHrOmbOSiSM. JEZOVNIK1, P. POREDOS1

1 Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia

Background: The role of inflammation in the pathophysiology ofarterial thrombosis has been well elucidated. Little is known about the relationshipbetween inflammationandvenous thrombosis.Recently,inflammation has been accepted as a possible mechanism throughwhich risk factors trigger thrombus formation in veins. The aim of study wastoinvestigatetheinflammatorymarkersandtheirrelationshiptoidiopathic venous thrombosis. materials and methods: 49 patients with first idiopathic venousthrombosis and 48 age matched control subjects were included in the study. Patients were studied 2-4 months after the acute event. Patients and control subjects did not differ in the classical risk factors of atherosclerosis, except in body mass index. In both groups, blood markersofinflammation,namelyhighsensitiveC-reactiveprotein(hsCRP), interleukins (IL-6, IL-8, IL-10) and tumour necrosis factor alpha (TNF-α), andcirculatingmarkersof endothelialdysfunction/damagenamely von Willebrand factor (vWF), P-selectin and the vascular adhesion molecule (VCAM-1) were measured.results: Incomparison tohealthysubjectspatientshadsignificantlyhigherlevelsofinflammatorymarkers:hsCRP:2.58mg/L(1.37-6.61),vs 1.67 mg/L (0.97-3.24) p=0.044, IL-6: 2.37 pg/mL (1.59-4.10), vs 2.03 pg/mL (1.45-2.59), p=0.025, IL-8: 3.53 pg/mL (2.94-5.3), vs 2.25pg/mL(1.77-2.90)p=<0.0001.Thelevelsofanti-inflammatoryIL-10weresignificantlylower1.81pg/mL(1.53-2.21)vs2.71pg/mL(1.84-3.65), p<0.001. Patients had higher levels of circulating markers of endothelial dysfunction: vWF 150.0 g/L (121.0-195.0) vs 91.5 g/L (70.5-104.0), p=<0.0001, P-selectin 39.5 pg/L (34.0-40.6) vs 34.8 pg/L (32.5-38.6)p=0.009.Thelevelsofsomeinflammatorymarkerswererelated to markers of endothelial dysfunction. Conclusions: Patients with idiopathic venous thrombosis have increased levels of circulating markers of inflammation and bloodmarkers of endothelial dysfunction. Higher levels of investigated markers indicate that patients in the stable phase of the disease have an increased systemic inflammatory response and consequentlydeteriorated endothelial function.Keywords: Venous thrombosis, Inflammation, Endothelialdysfunction

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POSTERS

PS1 - Atherosclerosis

PS1-1 ASSOCIATION BETWEEN SERUM URIC ACID,CAROTID INTIMA-MEDIA THICKNESS AND TARGETORGAN DAMAGE IN HYPERTENSIVE PATIENTSC. SERBAN1, S. DRAGAN2, I. MOZOS1, R. MATEESCU3,L. SUSAN4, A. CARABA4, A. PACURARI4, G. SAVOIU5,I. ROMOSAN4

1 University of Medicine and Pharmacy Victor Babes -Pathophysiology Department, Timisoara, Romania

2 University of Medicine and Pharmacy Victor Babes - Preventive Cardiology and Cardiovascular Rehabilitation Clinic, Timisoara,

Romania3 University of Medicine and Pharmacy Victor Babes - Physiology

Department, Timisoara, Romania4 University of Medicine and Pharmacy Victor Babes - IVth Medical

Clinic, Timisoara, Romania5 University of Medicine and Pharmacy Victor Babes - Anatomy,

physiology and pathophysiology Department, Timisoara, Romania

Objective: Clinical evidence supported the possibility that serum uric acid (SUA) may lead to hypertension. Carotid intima–media thickness (carotid IMT) measured noninvasively by ultrasonography is now widely used as a surrogate marker for atherosclerosis. The purpose of this study was to investigate the association of SUA and carotid IMT with target organ damage (TOD) in hypertensive patients. Design and method: One hundred and eighty two hypertensive patients, after underwent extensive clinical, laboratory, and ultrasonographic investigations searching for cardiac, vascular and renal TOD, were divided into four groups as follows: no TOD (Group I, n=24); 1 TOD (Group II, n=50); 2 TOD (Group III, n=40); and > or=3 TOD (Group IV, n=48). Carotid IMT was performed using high-resolution B-mode ultrasonography according with Mannheim Consensus.Results: Uric acid was directly associated with the number of affected organs. Uric acid was higher in the patient groups with > or=3 TOD (Group IV: 8.38±0.31mg/dl vs Group III: 8.24±0.42 mg/dl, P<0.001), 2 TOD (Group III: 8.24±0.42 mg/dl vs Group II: 7.91±0.76 mg/dl, P<0.001) and 1 TOD as compared with patients with no TOD (Group II: 7.91±0.76 mg/dl vs Group I: 6.04±0.41, P<0.001). Carotid IMT was also directly associated with the number of affected organs. The value of carotid IMT was higher in the patient groups with > or=3 TOD (Group IV: 1.30±0.04 mm vs Group III: 1.29±0.04 mm, P<0.001), 2 TOD (Group III: 1.29±0.04 mm vs Group II: 1.22±0.11 mm, P<0.001) and 1 TOD as compared with patients with no TOD (Group II: 1.22±0.11 mm vs Group I: 0.84±0.03 mm, P<0.001). We obtained a strong significantly correlation between SUA and carotid IMT (r=0.86, p<0.001).Conclusions: These findings suggested that increased values of SUA and IMT were associated with the number of TOD and may be considered indicators for evaluating TOD.Keywords: Hypertension, UltraSound, Hyperuricemia

PS1-2 ARTERIAL ELASTICITY - CAROTID ARTERYE-TRACKING VERSUS ARTERIOGRAPH METHOD ON BRACHIAL ARTERYZ. MIOVSKI1, L. J. BANFIC1, M. VRKIC KIRHMAJER1

1 University Hospital for Cardiovascular Diseases - Zagreb, Zagreb,Croatia

Introduction: The evaluation of peripheral arterial elasticity became popular method in primary and secondary prevention of cardiovascular diseases.Aim: The study was designed to compare two similar method used for arterial elastic properties evaluation ; arteriopgraph method for evaluation on brachial artery, and e-TRACKING ultrasound method

on common carotid arteries. Healthy volunteers were compared with coronary patients. Coronary angiography was done to all patients with symptom of angina pectoris while control group was not submitted to coronary angio because of ethical reasons. The aim was to establish the applicability of the two similar methods used to evaluate the elasticity of the arterial wall in healthy individuals as well as in patients that suffer from coronary artery disease (CAD).Methods: Prospectively were evaluated 49 individuals (20 healthy volunteers and 29 CAD patients). The average age was 28.62±9.51 years for healthy individual and 61.5±8.06 years for coronary patients. Both groups were subjected to two non invasive measurements of artery elasticity. E-TRACKING on common carotid artery 1 to 2 centimeters before the bifurcation was done by using ALOKA alfa 100 ultrasound., beta index, augmentation index ( AI ) and the speed of pulse wave velocity ( PWV ) were evaluated. TensioMedTM arteriograph was used on brachial artery. Augmentation index of the brachial artery (AI brah), augmentation index of aorta ( AO aortic ) and the speed of pulse wave velocity were measured thereafter in the same conditions.Results:

Conclusion: Parameters given from the e-TRACKING method comparing to the results of Arteriograph discriminate healthy individuals from CAD population significantly better. Arteriograph as the method did not show any significant difference in the arterial wall elasticity between healthy and patient population. Nominal values according to the two different population exist but the difference was not statistically significant.Keywords: Arteriograph, e-tracking, CAD

PS1-3 ENDOTHELIAL FUNCTION IN HEALTHYINDIVIDUALS AND PATIENTS WITH CORONARY ARTERYDISEASEL. J. BANFIC1, Z. MIOVSKI1, K. PUTAREK1,M. VRKIC KIRHMAJER1, M. STROZZI1

1 Department of Cardiovascular Diseases - University Hospital Center Zagreb, Zagreb, Croatia

Introduction: Endothelial function and arterial elasticity create the new insight in vascular function with the potential for risk evaluation. Echo tracking (e-TRACKING) offers accurate evaluation of vascular elasticity even before atherosclerotic vessel changes occur.Aim: The investigation was designed to compare the elasticity of carotid artery in healthy individuals and in coronary patients confirmed by coronary angiography. Non-invasive (e-TRACKING) method was used in testing arterial endothelial function and elasticity. ß index, AI and PWV are used to evaluate arterial elasticity. Methods: 49 individuals (20 healthy volunteers and 29 coronary patients) were tested. Beta index, augmentation index (AI) and the speed of pulse wave velocity progression (PWV) were evaluated in both groups. The endothelial function and the e-TRACKING parameters from carotid artery insonifications were evaluated by using Aloka 100 ultrasound with the linear probe (10MHz). Results: Average age of the healthy individual was 28,62±9,5 years and in coronary artery disease group was 61.5± 8,05 years.


Conclusion: Endothelial function expressed as parameters that present arterialelasticproperties(betaindex,AIandPWV)couldsignificantlydifferentiate healthy population from symptomatic patients with coronary artery disease.Keywords: CAD,e-tracking,endothel

pS1-4 riSK prOFiLe OF CardiOVaSCULar diSeaSeSaNd SUbCLiNiCaL atHerOSCLerOSiS iN HiV pOSitiVe pOLiSH patieNtSW. KWIATKOWSKA1, B. KNYSZ2, M. CZARNECKI2,J. GASIOROWSKI2, J. DRELICHOWSKA-DURAWA1,M. BUBALA3, J. KWIATKOWSKI3, W. WITKIEWICZ1,A. GLADYSH2

1 Regional Specialist Hospital, Research and Development Centre, Dpt of Angiology, Wroclaw, Poland2 Department of Infectious Diseases Wroclaw Medical University, Wroclaw, Poland3 Wroclaw University of Technology, Wroclaw, Poland

Objective: The aim of the study was to evaluate the independent risk factors of CVD and early atherosclerosis in HIV positive Polish subpopulation.design and method: We assessed risk factors for CVD and carotid intima media thickness (cIMT) of common carotid artery/bulb by ultrasound (LOGIQ 7) in 72 HIV(+) mostly treated with ARV and 24 control individuals matched for age and sex without pre-existing CVD. results:CVDwasdiagnosedin5%ofHIV(+)patients.InHIV(+)patients the prevalence of heavy cigarette smoking is more frequent (62,5%vs.37,5%),theyaresignificantly:lessobese(BMI23,6vs.25,6,p=0,0019) with higher waist/hip ratio (0,92 vs. 0,84, p=0,0006), with significantlylower:LDL-C(100,9vs.116,8mg/dL,p=0,0034),HDL-C(56,8vs.65,0mg/dL,p=0,005),fibrinogen(2,49vs.3,04g/l,p=0,0001),withsignificantlyhigher:triglicerydes(169,2vs.113,0mg/dlp=0,005),and homocysteine (13,9 vs 11,0µmol/l, p=0,001) concentrations. Mean cIMT was 0,703mm +/- 0,183 and 0,523mm +/- 0,095 respectively in HIV (+) and control group (p=0,0001). In HIV (+) vs. control - mean bulb cIMT value was 0,800mm vs. 0,578mm and common carotid cIMT 0,606mm vs.0,470mm (p=0,0001). Carotid plaques > 1,5mm were observed in 28 HIV positive patients vs. 1 participant of control group. Conclusions: In HIV positive patients more extensive atherosclerosis measured by cIMT was observed. The strongest classical risk factor of CVD in Polish HIV(+) patients is cigarette smoking. Constitution features and biochemical profile of these patients tend tometabolicsyndrome. Both, HIV infection and antiretroviral therapy are important predictive factors of premature atherosclerosis. Further longitudinal studiesinthefieldofsubclinicalatherosclerosisinPolishHIVpositivepopulation are necessary.Supported by European Regional Development Fund, Polish Government (Operational Programme Innovative Economy 2007-2013),under the grant “WROVASC - Integrated Cardiovascular Centre”Keywords: Atherosclerosis, IMT, HIV infection, Risk factors

pS1-5 eNdOtHeLiaL prOtHrOmbOtiC marKerS iNdySLipidemiC patieNtSD. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D. JACKULIAKOVA1, D. NOVOTNY2, L. SLAVIK3

1 University Hospital Olomouc - 3rd Department of Internal Medicine, Olomouc, Czech Republic

2 University Hospital Olomouc - Department of Clinical Biochemistry, Olomouc, Czech Republic3 University Hospital Olomouc - Department of Hematooncology, Olomouc, Czech Republic

Objective: The aim of this study was to evaluate the plasma levels of prothrombotic markers: von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) in asymptomatic subjects with dyslipidemia. design and methods: Asymptomatic subjects with dyslipidemia and their relatives (n=234) were assessed for lipids and prothrombotic markers. Individuals were divided into four dyslipidemic phenotypes (DLP) according to apolipoprotein B (apoB) and triglycerides (TG): DLP1 (n = 58, apoB < 1.2g/l and TG < 1.5mmol/l), DLP2 (n = 47, apo B < 1.2g/l and TG > or = 1.5mmol/l), DLP3 (n = 31, apoB > or = 1.2g/l and TG < 1.5mmol/l) and DLP4 (n = 98, apoB > or = 1.2g/l and TG > or = 1.5mmol/l). Associations between prothrombotic markers and risk factors for atherosclerosis, markers of insulin resistance, and the intima-media thickness of the common carotid artery (IMT) were assessed too.results: Significant differences in PAI-1 between normolipidemicphynotype - DLP1 (62.5 [35.9-82.9] ng/ml) and hypertriglyceridemic phenotypes - DLP2 (82.2 [61.1-122.1] ng/ml, p<0.01) and DLP4 (91.4 [63.5-111.8] ng/ml, p<0.001) after adjustment for age, sex and body mass index, were found. Levels of t-PA were different only between DLP1 and DLP4 (1.9 [0.9-3.3] ng/ml versus 5.3 [2.5-8.6] ng/ml, p<0.05).Therewere no significant differences of vWFbetweenDLPs. PAI-1 and t-PA correlated with lipid parameters, markers of insulin resistance, blood pressure and obesity. VWF was independently associated with IMT, which was increased in DLP4.Conclusions: Individuals with hypertriglyceridemic phenotypes showed increased levels of PAI-1 in comparison with normolipidemic subjects. The elevation of t-PA was presented only in patients with simultaneously elevated TG and apoB. The significant increase ofIMTconfirmedinthepatientswithDLP4revealsindividualswiththehighest risk for atherosclerosis manifestation.Supported by grant IGA MZCR NS/10284-3Keywords: Von Willebrand factor, Tissue plasminogen activator, Intima-media thickness

pS1-6 SOLUbLe iNterCeLLULar CeLL adHeSiONmOLeCULe-1 aNd VaSCULar CeLL adHeSiON mOLeCULe-1 iN aSymptOmatiC dySLipidemiC SUbJeCtSD. KARASEK1, H. VAVERKOVA1, M. HALENKA1, Z. FRYSAK1, D. JACKULIAKOVA1, D. NOVOTNY2, J. LUKES2

1 University Hospital - 3rd Department of Internal Medicine, Olomouc, Czech Republic2 University Hospital - Department of Clinical Biochemistry, Olomouc, Czech Republic

Objective: The plasma levels of soluble intercellular cell adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule-1 (s-VCAM-1) were assessed in clinically asymptomatic subjects to compare them between normolipidemic and various dyslipidemic phenotypes. The associations between soluble cell adhesion molecules (s-CAMs) and risk factors for atherosclerosis, markers of insulin resistance, and the intima-media thickness of the common carotid artery (IMT) were evaluated, too.design and methods: 234 asymptomatic subjects were divided into four dyslipidemic phenotypes (DLP) according to apolipoprotein B (apoB) and triglycerides (TG): DLP1 (n = 58, apoB < 1.2g/l and TG < 1.5mmol/l), DLP2 (n = 47, apoB < 1.2g/l and TG > or = 1.5mmol/l), DLP3 (n = 31, apoB > or = 1.2g/l and TG < 1.5mmol/l) and DLP4(n = 98, apoB > or = 1.2g/l and TG > or = 1.5mmol/l). DLP1 (normo-apoB /normo-TG) served as a control group. results:Asignificantdifferenceins-ICAM-1betweenDLP1(502.0

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[457.1-568.2] ng/ml) and DLP4 (567.9 [502.8-692.1] ng/ml, p<0.001) was found. No significant differences in s-VCAM-1 betweenDLPswere apparent. S-ICAM-1 was independently predicted by HDL-cholesterol, non-HDL-cholesterol, proinsulin, C-peptide, waist, systolic and diastolic blood pressure. S-VCAM-1 was predicted only by age and systolic blood pressure. Both s-CAMs were detected as independentpredictorsforIMT,whichwassignificantlyincreasedinDLP 4. Conclusions: The elevation of s-ICAM-1 was presented only in patients with simultaneously elevated TG and apoB (DLP4) in comparison with normolipidemicsubjects.PatientswithDLP4hadsignificantlyincreasedIMT, which was independently predicted by levels of s-ICAM-1 and of s-VCAM-1.ThesefindingspointedoutDLP4subjectsasindividualswith the highest risk for early manifestation of atherosclerosis.Supported by grant IGA MZCR NS/10284-3.Keywords: Soluble cell adhesion molecule, Intima-media thickness, Dyslipidemia

pS1-7 HyperteNSiON iN patieNtS WitH SyStemiC LUpUS erytHematOSUS (SLe)M. BOUCELMA1, H. CHAUDET, A. BERRAH1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, Algeria2 Statistical Department, North Hospital, University of Aix Marseille, Marseille, France

Mortality in SLE patients is increasing due to cardiovascular disease.Objectives: To determine the prevalence of hypertension in our SLE patient cohort, and to establish the factors which contribute to their development of hypertension.patients and methods: We studied 150 SLE patients (149 women, 4 men).Blood pressure was mesured in all patients three times, with a separation of 5 minutes. We inquired about cardiovascular risk factor and treatment (immunosuppressives drugs, corticoids).Results: The mean age was 37±10 years and the mean duration of SLEwas11.3±6.2years.35.2%ofpatientssufferedhypertension,5%diabetes, 48% hypercholesterolemia, 42.5% moderate hyperhomo-cysteinemia. 87% had taken corticoids. From hypertensive patients59.2%had a renalflare and at the timeof study renal functionwasnormal.Hypertensionwassignificantlylinkedtonephritis(p<0.02),and cumulative dose of corticosteroids (p < 0.001).Keywords: Systemic lupus erythematosus, Hypertension, Vascular event

pS1-8 impaCt OF WHite matter CHaNGeS ONaCtiVitieS OF daiLy LiViNG iN miLd tO mOderate demeNtiaS. MOON1, D. L. NA2

1 Ajou University School of Medicine, Suwon, South Korea2 Samsung Medical Center, Seoul, South Korea

We investigated the association between white matter changes and activities of daily living (ADL) in a large, well-defined cohort ofpatients with mild-to-moderate dementia (either Alzheimer’s disease or subcortical vascular dementia). We divided a total of 289 patients into three groups (140 mild, 99 moderate, and 50 severe) depending on the degree of white matter changes on their brain MRIs and analyzed the three groups’ performances on basic and instrumental ADL. The degree of white matter changes was associated with greater age, hypertension, previous history of stroke, higher Hachinski Ischemic Score, worse global cognitive status and functional status, and more impaired basic ADL and IADL. The severe group’s more impaired performance on both thebasicandinstrumentalADLremainedsignificantafteradjustmentfor age and hypertension. Tasks involving physical activities were most significant.ThisisthefirststudyinvestigatingtheassociationbetweenwhitematterchangesandADLinalarge,well-defineddementiacohort.The present study suggests that severe white matter changes might be

associated with more impaired basic and instrumental ADL.Keywords: White matter changes, Dementia, Activities of daily living

pS1-9 SimULtaNeOUS eVaLUatiON OF COrONary artery diSeaSe aNd aOrtiC atHerOSCLerOSiS USiNG mULtideteCtOr Ct iN aCUte iSCHemiC StrOKe patieNtSH. KIM1, H. CHO1, J. LEE1, Y. KIM1

1 Department of Neurology, Konkuk University Hospital, Seoul, South Korea

Backgrounds: Coronary artery disease (CAD) is a major determinant of the outcome in ischemic stroke patients. Aortic atherosclerosis (AA) is a potential embolic source in ischemic stroke patients. We investigated effectiveness of simultaneous evaluation of CAD and AA in acute ischemic stroke patients with multiple vascular risk factors.methods: We simultaneously evaluated CAD and AA using 64-slice MDCT with single sequence in consecutive acute ischemic stroke patients with multiple vascular risk factors admitted Konkuk university hospitalfromMarch,2008toNovember,2009.Morethan50%stenosisinoneormorecoronaryarteriesonMDCTwasdefinedashavingCAD.AAwasclassifiedintoAAinproximalaorta(ascendingaortaincludingarch) or descending aorta by location, and simple or complicated by plaquenature.Complicatedaorticplaque(CAP)wasdefinedasplaquethickness more than 4mm, mobile or ulcerated plaque in proximal aorta. Individual vascular risk factors and Framingham Risk Scores (FRS) were evaluated.results: Of 274 patients (male 165, mean age 66.2 year-old), CAD was foundin61(22.3%)ofpatients.ForCAD,CAP(OR:2.39,95%CI:1.14-4.97)wasindependentpredictor.AAwasfoundin209(76.3%)patientsincluding147(53.6%)patientswithplaqueinproximalaortaand59 (21.5%)patientswithCAP.ForCAP,CAD (OR:2.69, 95%CI:1.22-5.90),previoushistoryofischemicstroke(OR:2.30,95%CI:1.00-5.28), and stroke subtype (OR: 0.25, 95%CI: 0.08-0.72)wereindependent predictors. FRS was also modest predictor for both CAD (OR: 1.04, 95%CI: 1.01-1.06) andCAP (OR: 1.02, 95%CI: 0.99-1.04).Conclusion: Simultaneous evaluation of CAD and AA using MDCT in acute ischemic stroke patient with multiple risk factors was useful. CAD or CAP was independent predictor to either. FRS was also usefulness in predicting presence of CAD or CAP in acute ischemic stroke patients.Keywords: Ischemic stroke, Coronary artery disease, Aortic atherosclerosis

pS1-10 StrOKe iN tHe yOUNG: reLatiON WitHtHrOmbOCytemiaM. BOUCELMA1, S. LASSOUAOUI1, D. ZEMMOUR1,H. BOUDJELIDA1, N. OUADAHI1, A. BERRAH1

1 Department of internal medicine, Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, Algeria

introduction: One of the hematological causes of stroke is essential thrombocythemia (ET). It is one of the proliferative syndromes of the hematopoietical system. Patient with ET have an increased risk of thrombosis and/or hemorrhage of veins and arteries. Few clinical reports have been published describing the clinical onset of ET in the clinical onset of ET in the form of a vascular accident.Case report: A 46 year old man, smoker, with no known hematological pathology, was admitted for investigation of left common carotid thrombosis. In his past medical history, we noticed a high blood pressure since 06 months and a transient ischemic stroke. Clinical exam were normal. Monitoring ECG, transoesophagal echocardiography, chest-Xrays, abdominal ultrasonography show no abnormalities. Platelet count was high: 1000.000/mm3.Marrow biopsy describes a hyperplastic megacaryocytopoiesis.


Conclusion: Myeloproliperative disorders, including ET, must be suspected in al stroke patients with an elevated platelet count, even in those who have potential causes of reactive thrombocytosis. Keywords: Hematologics disorders, Stroke

PS2 - Peripheral arterial disease (1)

pS2-1 HaS mra repLaCed CONVeNtiONaL aNGiOGram iN tHe iNVeStiGatiON OF peripHeraL VaSCULar diSeaSe? a diStriCt GeNeraL HOSpitaLS perSpeCtiVeT. HALL1, J. V. BARANDIARAN1, N. EL-BARGHOUTI1,E.P. PERRY1

1 Scarborough Hospital, Scarborough, United Kingdom

introduction: Magnetic resonance angiogram (MRA) has lower rates of morbidity and mortality when compared to the invasive catheter insertion required in conventional angiography. We conducted a study looking at the change of clinical practice in our departments’ initial investigation of peripheral vascular disease (PVD).method: Data was collected prospectively between January 2001 and Dec 2009. Multi-disciplinary team meeting outcomes were evaluated from our database as intervention (surgery/angioplasty) or no intervention. results: Data per year is shown in table 1.

*Surgery and/ or AngioplastyConclusion: MRA has replaced conventional angiography as the initial investigation of PVD. There still remains a need for conventional angiography for selected patients for investigation and for all patients undergoing angioplasty. The total number of patients investigated has increased as MRA has become more established but the percentage of interventions undertaken has decreased.Keywords: MRA,Peripheral vasucalr disease,Angiography

pS2-2 arteriOmeGaLy iN FemaLe SUbJeCtST. HALL1, J. V. BARANDIARAN1, N. EL-BARGHOUTI1,E. P. PERRY1


introduction: Arteriomegaly is described as tortuous, ectatic and irregular vesselswith prolonged blood flow and is predominantly adisease of males. We present the cases of two arteriomegalic female subjects. We stress the rarity of such presentation and discuss its management. Case reports: 1: TC presented aged 84 in 2004 with right leg rest pain and tissue loss. She was hypertensive, emphysematous and a heavy ex-smoker. The patient underwent conventional angiography. This demonstrated Type 3 arteriomegaly with aneurysmal degeneration of the aorta, right femoral and bilateral iliac arteries. In addition there wascompleteocclusionoftheleftsuperficialfemoralartery(SFA)andright distal SFA. She had failed attempted angioplasty of the right SFA duetoheavycalcification.Bypasssurgerywasdeclinedbythepatient.The patient died in 2006 without further vascular intervention.2: JS, aged 83 in 2007 following a fall and the development of ischaemia of the right lower limb. Comorbidities comprised previous stroke and atrial fibrillation. The subject underwent conventional angiography.Type 3 arteriomegaly was diagnosed in combination with aneurymal degeneration of the aorta, bilateral iliacs and ectatic vessels down to the popliteal area. A thrombosed right popliteal aneurysm was suspected and confirmed on ultrasound duplex scan.During her inpatient stayshe developed a further stroke and was discharged without vascular intervention. She died 3 months later.

Conclusion: True arteriomegaly is predominantly a disease of males. It israreinfemalesbutstillcauseslateproblemswhichprovedifficulttotreat. Operative treatment in male patients proves more successful than endovascular procedures.Keywords: Arteriomegaly, Female

pS2-3 diFFereNt beHaViOUr OF pULSe WaVeVeLOCity aNd aUGmeNtatiON iNdeX iN patieNtS WitH peripHeraL arteriaL diSeaSeG. SCANDALE1, G. DIMITROV1, G. CARZANIGA1, M. MINOLA1, M. CINQUINI2, M. CAROTTA1, M. CATALANO1

1 Research Centre on Vascular Diseases and Angiology Unit - University of Milan - L. Sacco H, Milan, Italy2 Mario Negri Institute for Pharmacological Research, Milan, Italy

Objective: Age-related increased arterial stiffness is facilitated by arteriosclerotic disease. Both the aortic pulse-wave velocity and the aortic augmentation index are used as direct and indirect markers of arterial stiffness. It has not been determined whether these parameters exhibit the same behaviour in patients with Peripheral Arterial Disease. methods: The aortic augmentation index of 43 subjects with an ankle-arm pressure index of <0.9 and of 49 sex-matched controls was measured using central pulse-wave analysis and aortic stiffness techniques applied to the carotid-femoral pulse-wave velocity.results: The age, height, heart rate and mean arterial pressures did not differ between the two groups (p=0.87; p=0.29; p=0.25; p=0.63). The aortic augmentation index was higher (p<0.01) in the PAD group but the aortic pulse-wave velocity did not differ as compared with the controls (p=0,36). In the univariate and multivariate regression analysis models the aortic augmentation index was inversely related to heart rate (p= 0.0001; 0.002) but not to PWV. (p=0.74), age (p=0.52) or height (p=0.97). The aortic pulse-wave velocity was related directly to age (p=0.05), to heart rate (p=0.03) and to systolic pressure (p=0.02).Conclusions: In PAD patients, commonly used arterial stiffness parameters exhibit a different behaviour, suggesting different underlying pathophysiological mechanisms. This observation might haveimplicationsforcardiovascularriskstratification.Keywords: Peripheral arterial disease,Arterial stiffness,Aortic indexes

pS2-4 iNCreaSed aOrtiC aUGmeNtatiON iNdeXiN peripHeraL arteriaL diSeaSeG. SCANDALE1, A. ACERANTI1, G. CARZANIGA1, M. MINOLA1, M. CINQUINI2, M. CAROTTA1, M. CATALANO1

1 Research Centre on Vascular Diseases and Angiology Unit - University of Milan - L.Sacco H., Milan, Italy2 Mario Negri Institute for Pharmacological Research, Milan, Italy

Objective: A low ankle-arm pressure index (<0,9) is associated with increased cardiovascular complications. This observation suggests a relationship between Peripheral Arterial Disease and the heart, which can be investigated by means of a descriptive analysis of the central pulse-wave form. The aim of this paper is to compare parameters of the ventricular and vascular patterns in patients with and without PAD. methods: The following parameters were measured in 92 male patients (43 with PAD and 49 controls) having an average age of 68 ± 7: aortic augmentation index, ventricular ejection time and that of return of the wavereflectionusingthewave-pulsetechniqueaftertonometrictestingfor recording the radial artery. results: For matching age, sex, height, heart rate and diastolic pressures, the aortic augmentation index and the ventricular ejection time were higher in the PAD group (p=0.01; p=0.03) while the return time of the reflectedwavewas lower (p=0.02).According to the univariate andmultivariate regression analysis models, the aortic augmentation index was inversely related to heart rate (p= 0.0001; 0.002) but not to age (p=0.52), height (p=0.97) or diastolic pressure (p=0.97).Conclusions: Male PAD patients exhibit significant changes in

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parameters that are indicative of the relationship between their hearts and their arteries. Further studies are required in order to determine the physiologicalandclinicalsignificanceoftheseobservations.Keywords: Increased aortic augmentation, Peripheral arterial disease, ABI

pS2-5 metabOLiC drUGS iNCreaSe eFFeCtiVeNeSSOF mediCaL treatmeNt iN SmOKerS WitH iNtermitteNt CLaUdiCatiONM. S. BOGOMOLOV1, V. M. SEDOV1, G. Y. SOKURENKO1,L. N. EDOVINA1, V. V. SLOBODYANYUK1

1 Pavlov’s State Medical University, Department of Vascular Surgery, Saint-Petersburg, Russia

Objective: Modern approach to treatment of patients with peripheral arterial disease (PAD) suggests administration of antiplatelet and vasodilating agents. Effectiveness of metabolic correction of claudication is still underestimated. design and method: In accordance with Inclusion criteria (painfree walking distance (PWD) <200 meters and ankle-brachial index (ABI) <0.95), 34 nondiabetic and diabetic patients were included in the study. They were divided on two groups. GROUP 1 – 13 non-smokers (mean age – 67.7 years; mean PWD – 65.9 meters). GROUP 2 – 21 smokers (mean age – 59.4 years; mean PWD – 66.9 meters). At the beginning of the study - 10 everyday intravenous infusions of Cytoflavin(combinationof succinicacid, inosine,nicotinamideand riboflavin).Treatment during the study: aspirin, nicotinic acid and drotaverine. results: Walking ability was improved in all of the patients: just after the last cytoflavin infusionaverage increaseofPWDwas62.0%, inonemonth–82.9%,andinthreemonths–82.5%.In3monthsaftercytoflavininfusionsincreaseofABIinGroup1wasinaveragetwicemorethaninGroup2(7.0%and3.4%,respectively).Inspiteofthisfact, in nonsmoking group improvement of walking ability was less significant: justafter the last infusionaverage increaseofPWDwas37.3%, in onemonth – 49.8%, and in threemonths – only 49.7%.IncreasingofPWDinGroup2was, inaverage,77.2%,104.4%and102.6%,respectively.In3monthsmorethan50%accretionofPWDwas registered in 5 (38.5%) of 13 patients from Group 1 (PWDincreasing-from52.6%to140.9%)andin10(47.6%)of21patientsfromGroup2(PWDincreasingfrom64.4%to688.9%).Conclusions: Complex treatment of patients with limb ischemia should include medicine, which improve metabolism. This treatment is more effective in smoking patients.Keywords: Intermittent claudication, Medical treatment, Metabolic drugs

pS2-6 iNFLUeNCe OF metabOLiC drUGS ONperiFeraL HemOdyNamiCS OF tHe LeGS iN patieNtS WitH iNtermitteNt CLaUdiCatiONL. EDOVINA1, M. BOGOMOLOV1, Y. LUKYANOV1,V. SLOBODYANYUK1

1 Pavlov’s State Medical University, Saint-Petersburg, Russia

Objective: Peripheral arterial disease (PAD) is an important manifestation of atherosclerosis. One of the main goals of treatment for patients with claudication is to improve their walking capacity. The overall approach to the medical treatment of patients with intermittent claudication was extensively reviewed in recent publications. These reviewsweremostlyfocusedonrisk-factormodificationandantiplatelettherapies. Unfortunately, potential effectiveness of using of metabolic drugs for symptomatic relief in patients with peripheral arterial disease is still underestimated.design and method: In the study 21 non diabetic patients with PAD were included (maximal walking distance (MWD) <200 meters and ankle-brachial index (ABI) <0.95). GROUP 1 – 11 non-smokers: mean age – 69.1 years; mean ankle-brachial index (ABI) – 0.60, mean peak systolic velocity (PSV) of the blood in the posterior tibial artery of

the affected leg – 15.4 cm/sec; mean MWD – 98.0 meters. GROUP 2 – 10 smokers: mean age – 58.7 years; mean ABI – 0.70, mean PSV – 11.7 cm/sec; mean MWD – 135.8 meters. Measurements of ABI, PSV, and MWD were performed before and 1-3 days after 10 everyday intravenous infusions of Cytoflavin (combination of succinic acid,inosine,nicotinamideandriboflavin).results: Measurements after the treatment demonstrated moderate increase ofABI (mean – 12.3%) and PSV (mean – 31.3%) amongnon-smoking patients. However, average increase of MWD in that groupwasonly27.4%.InGroup2changesofABIwerenotsignificant(-0.8%,ontheaverage),butPSVandMWDinsmokersincreasedverysubstantially(meangrowing–56.0%and42.8%,respectively).Conclusions: Administration of antioxidant and metabolic substances for treatment of chronic limb ischemia leads to improvement of the peripheral hemodynamics. Increasing of peak systolic velocity of the blood in the tibial arteries and improving of patients’ walking capacity afterthistreatmentaremoresignificantinsmokingpatients.Keywords: Intermittent claudication, Metabolic drugs, Hemodynamics

pS2-7 iNtima-media tHiCKNeSS iNCreaSe aNdatHerOSCLerOtiC pLaQUeS iN aSymptOmatiC patieNtSM. CAZAUBON1, F. A. ALLAER2

1 Department of angiology american hospital, Paris, France2 Chair of medical evaluation, Dijon, France

Objective: Describe and analyse the frequency of Intima-media thickness (IMT) increase and of atherosclerotic plaques (AP) when a Doppler (D) ultrasound is conducted in asymptomatic patients consulting in daily practice of community angiologists. methods: an Doppler ultrasound examination was systematically conducted to study the posterior wall, 1 cm far from the carotid bifurcation in all asymptomatic patients presenting at list one cv risk factor.. results: 80 patients (53,7% women), 58years old were examined.67.5%weredyslipidemic,47.5%havea familialpasthistoryofCVdisease,37.5%aresmokerorformersmokers,36.3%arehypertensiveet 12.5% have a diabetes. IMT is standard in 31.3% of them andincreasedin45.0%.23.7%arepresentingatheroscleroticplaques.Thefrequencyof increased IMTandAPare respectively42.1%et5.3%inpatients<50y,44.4%and25.9%between50to60y,55.0%and35.0%between60to70y,35.7%and28.6%>70y(p<0,001).Theirfrequenciesare50,0%and29,6%whendyslipidemia,50.0%and20,0%in diabetics, 51.7% and 27.6% in case of hypertension, 43.3% and26.7%insmokerset44.7%and24.7%inpatientswithpasthistoryofCV disease. Logistic analysis shows an increase of the risk of having an augmentation of IMT or of having an AP in 60 to 70 years old patients (OR : 12,8 vs < 50 y), in patients older than 70 y (OR : 6,9 vs < 50 y) and in dyslipidemic patients (OR : 6,7 vs absence).Conclusion: This study shows an increase of the IMT and of AP in asymptomatic patients and especially when older than 60 and dyslipidemic. It point out the interest of a systematic DP carotid examination in asymptomatic patients presenting at least a major cardiovascular risk factor after 40 years old.Keywords: Intima media, Atheroslerosis, Asymptomatic patients

pS2-8 SeLF-repOrted maXimaL WaLKiNGCapaCity iN arteriaL CLaUdiCatiON: CaN tHe WaLKiNG impairmeNt QUeStiONNaire be SeLF-COmpLeted?P. ABRAHAM1, N. OUEDRAOGO1, G. MAHE1, M. VASSEUR1,G. LEFTHERIOTIS1

1 University Hospital, Angers, France

Background: The walking impairment questionnaire (WIQ) allows for a standard estimation of self-reported exercise capacity in patients


with peripheral artery disease (PAD). If the WIQ questionnaire is to be completedwithoutmedicalsupervision,inordertoavoidanyinfluenceof the physician on patient’s answers, a potential issue is its relative complexity.Weaimedtoestimatethedifficultiesencounteredbythepatients to self-complete the WIQ. methods: We prospectively studied 73 patients with claudication. The French version of the WIQ was self-completed by the patients at arrival with a blue or black pen and then corrected with a red pen by a technician or a nurse in case of missing (no answer), duplicate (multiple answers to a single question) or paradoxical answers (e.g.: lowerdifficultyforahighertasklevel)oneachofthethreesub-scalequestionnaires: distance (D), Speed (S), climbing stair capacity (C). Thereafter patients performed a constant load treadmill walking tests (maximized to 750 m) blinded to the results of the WIQ questionnaire.results: Half of the questionnaires (37 out of 73) had to be corrected for missing (n=23, 24 & 24), duplicate (n=3, 0 & 1) or paradoxical (n=5, 6 & 1) answers within the D, S & C sub-scales respectively. Median [25-75°centiles] distance on treadmill was 171 m [109-376]. Oncethequestionnairecorrected,thecoefficientofcorrelationoftheWIQ-score (mean of the 3 subscale) to treadmill maximal walking distance was r=0.652; p<0.05.Conclusion: The WIQ correlates fairly with objective estimation of maximal walking distance. It is a useful tool to estimate self-reported exercise capacity in the clinical or research context but it is hardly self-completed by the patients. It is quite complex with 14 questions and a choice among 5 possible answers (70 boxes). Supervised administration of the WIQ appears necessary in most cases.Keywords: Questionnaires, Maximal walking distance

pS2-9 reLatiONSHip OF SymptOmS WitH NON-abiHemOdyNamiC iNVeStiGatiONS ON treadmiLL iN patieNtS WitH SUSpeCted CLaUdiCatiONP. ABRAHAM1, G. MAHE1, N. OUEDRAOGO1, G. LEFTHERIOTIS1, M. VASSEUR1

1 University Hospital, Angers, France

Background: We aimed to study the relationship between symptoms on treadmill and a hemodynamic parameter, different from ABI, independent from arterial stiffness and that can detect both proximal and distal regional blood flow impairment (RBFI) respectively:exercise-induced transcutaneous oxygen pressure (tcpO2)-changes. When concordant with pain location on treadmill, RFBI can provide objective evidence for the arterial origin of exercise-induced pain. methods:ABIatrestwasdefinedasa9-categoryvariable.TheSanDiego Claudication Questionnaire assessed both proximal (hip, thigh, buttock) and distal (calf) exertional leg pain experienced on treadmill and analysed with the results of exercise tcpO2 for each ABI caterogy. Exercise-related vascular-type pain was considered of vascular origin when underlying concordant RFBI was observed.results: We studied 600 patients suspected of claudication. Of these, 81 were treated for diabetes, 203 had a past history of lower limb peripheral arterial surgery or angioplasty. ABI could not be measured in 10 legs due to arterial incompressibility. Among the 1190 studied legs, the proportion of legs with pain of vascular origin decreased in astepwisemanner from84.1%forABIs0.50-&-lowerdownto8.1% forABIs in the1.21-to-1.30 intervals.ForABIs1.31-&-over, theproportion of legs with pain assumed of vascular origin increased to 40.9%.Conclusions: There is no abrupt ABI cut-off point to predict the concordance of pain at exercise to underlying exercise-induced RBFI in patient with suspected PAD. The proportion of concordant pain and underlying RBFI decreases linearly with the increase in ABI up to an ABI ranging 1.21-to-1.30 and increases when ABI further increases. The relationship of ABI categories to pain associated with concordant exercise-induced RBFI, follows the expected U-shaped pattern.Keywords: Exercise, Transcutaneous oxygen pressure, Ankle to brachial index

pS2-10 VariabiLity aNd SHOrt-term deter-miNaNtS OF WaLKiNG CapaCity iN patieNtS WitH iNtermitteNt CLaUdiCatiONP. ABRAHAM1, A. LE FAUCHEUR2, B. NOURY-DESVAUX2,G. MAHE1, T. SAUVAGET2, J. L. SAUMET3, G. LEFTHERIOTIS1

1 University Hospital, Angers, France2 IFEPSA, Le sponts de Cé, France3 University Cl Bernard, Lyon, France

Objective: Global positioning system (GPS) recordings can provide valid information on walking capacity in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) during community-based outdoor walking. This study used GPS to determine the variability of the free-living walking distance between two stops (WDBS), induced by lower-limb pain, which may exist within a single stroll in PAD patients with IC and the potential associated parameters obtained from GPS analysis. methods: This cross-sectional study of 57 PAD patients with IC was conducted in a university hospital. The intervention was a 1-hour free-living walking in a flat public park with GPS recording at 0.5 Hz.GPS-computed parameters for each patient were WDBS, previous stop duration (PSD), cumulated time from the beginning of the stroll, andaveragewalkingspeedforeachwalkingbout.Thecoefficientofvariation of each parameter was calculated for patients with the number of walking bouts (NWB) >5 during their stroll. A multivariate analysis was performed to correlate WDBS with the other parameters.results: Mean (SD) maximal individual WDBS was 1905 (1189) vs 550 (621) meters for patients with NWB <5 vs NWB > 5, respectively (P<.001).Inthe36patientswithNWB>5,thecoefficientofvariationforindividualWDBSwas43%.OnlyPSDandcumulatedtimewerestatistically associated with WDBS in 16 and 5 patients, respectively.Conclusions: A wide short-term variability of WDBS exists and likelycontributestothedifficultiesexperiencedbypatientswithICtoestimate their maximal walking distance at leisurely pace. Incomplete recovery from a preceding walk, as estimated through PSD, seems to dominantly account for the WDBS in patients with IC.Keywords: Global positioning system, Claudication, Community based recordings

pS3-peripheral arterial disease (2)

pS3-1 mOrtaLity aNd ampUtatiON rate OF tHe CONSerVatiVe pHarmaCOLOGiCaL treatmeNt iN patieNtS WitH CritiCaL LeG iSCHemia UNSUitabLe FOr reVaSCULariSatiONR. MARTINI1, R. CORDOVA1, G. M. ANDREOZZI1

1 U.O.C. Angiologia - Azienda Ospedaliera-Università di Padova, Padova, Italy

In spite of the recent progress in revascularization and in anaesthesiology procedures, today in vascular centres there are still patients considered not suitable for revascularization. In these patients non interventional treatment such as pain treatment, prostanoids, spinal cord stimulations or hyperbaric oxygen treatment associated or not with wound management treatment are used to avoid amputation. In this work we describe the natural history of a group of 90 patients with Critical Limb Ischaemia, considered not suitable for revascularization, treated not interventionally. The rate of amputation and mortality were observed over a 24-month period. Patients with CLI and end-stage general conditions, or needing immediate primary amputation were excluded from this study. Sixteen patients were not revascularized because of poor functional status (37.7%); seventy-six patients(64.4%)hadinadequateoutflowvessels.Amongclassicalriskfactorsfor amputation and mortality in CLI, the level of independence, i.e. the capacity of the patients to have an independent life, was assessed. Toe amputations or other foot-sparing surgical procedures were performed duringtreatmentin13%oflimbs.Revascularisationwasattemptedin

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12patients(10.6%)within8monthsbecauseasignificantworseningofCLI.Majoramputationwasnecessaryin8patients(9.3%):4patientshad primary amputation and 4 had secondary amputation after a failed revascularization attempt. Twenty-one patients (23.2%) died duringthe 24-month period four of these had needed revascularization. The logistic regression showed that restricted level of independence (RLI) was independently associated with amputation and death at 24 months (P< 0.001). In conclusion our study reports that in patients, with not limb or life threatening skin lesions, if treated in specialised vascular centres, made possible to achieve good result in terms of amputation ad death rate.Keywords: Critical leg ischemia, Peripheral arterial disease

pS3-2 Crp LeVeLS aS a prediCtOr OF reSteNOSiSFOLLOWiNG SFa reVaSCULariSatiONP. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3,A. KELLY4

1 Department of Vascular Medicine, Mater Hospital, Sydney, Australia2 Department of Vascular Surgery, Mater Hospital, Sydney, Australia3 Department of Anaesthetics, Mater Hospital, Sydney, Australia4 Sydney Endovascular Specialists, Sydney, Australia

Objective:Superficialfemoralartery(SFA)stenosisrepresentsoneofthe most common sites of peripheral vascular obstruction. Restenosis continues to be a frequent complication of angioplasty (PTA) at this site despite the initial technical success. C-reactive protein (CRP) is an acute phase reactant and pts with elevated basal levels of CRP are at an increased risk of cardiovascular disease.The objectives of this study were to determine whether CRP levels could be utilised as a predictor of restenosis in patients with claudication undergoing SFA PTA.design and method:100pts[males=65(65%),meanage64(range34-80)] underwent PTA to SFA alone (n=75) or in combination with PTA to popliteal (n=25). CRP levels were measured 12-24 hours prior to PTA. Allptshadtargetstenosesof70to100%and>2vesselinfrapoplitealrunoff.Clinicalrestenosiswasdefinedbya>50%stenosis(increaseinflowvelocityby>100%)onduplex.Averagefollow-upattainedwas12 months.results: Baseline resting ABI’s ranged from 0.60 to 0.83 and post-exercise ABI’s ranged from 0.27 to 0.70. CRP levels pre-procedure were <1mmol/L (35%), 1-2mmol/L (32%) and >2mmol/L (33%).No restenosis or only minimal intimal hyperplasia was observed in 75(75%)at12months.Revascularizationwasrequiredin25(25%)pts (PTA=5, PTA/stent=20) for clinical restenosis. Of pts requiring revascularisationCRPlevelswere1-2mmol/L(25%)and>2mmol/L(95%).Conclusions: These results may be cautiously interpreted to indicate that elevated CRP levels prior to SFA intervention may be used as a predictor of restenosis following SFA PTA. Further strategies to decrease restenosis can thereby be implemented.Keywords:Restenosis,CRP,Superficialfemoralartery

pS3-3 pLaSma HOmOCySteiNe LeVeL prediCtiVe OF pOteNtiaL FOr reSteNOSiS aFter SFa reVaSCULariSatiON FOr OCCLUSiVe FemOrO-pOpLiteaL diSeaSeP. VALE1, S. DUBENEC2, D. CATINELLA1, S. HANNING3,A. KELLY4

1 Department of Vascular Medicine, Mater Hospital, Sydney, Australia2 Department of Vascular Surgery, Mater Hospital, Sydney, Australia3 Department of Anaesthetics, Mater Hospital, Sydney, Australia4 Sydney Endovascular Specialists, Sydney, Australia

Objective: Patients with peripheral arterial disease (PAD) have

significantlyhigherplasmahomocysteine(Hcy)levelsthanunaffectedcontrols. Restenosis continues to be a frequent complication of percutaneous revascularisation (PR) of the femoropopliteal artery (FPA) despite the initial technical success. The objectives of this study were to determine whether elevated Hcy level can predict restenosis in patients with claudication undergoing PR of FPA for total occlusions.design and method: 113pts[males=67(59%),meanage77(range53-95)] underwent PR to FPA. Plasma Hcy levels were measured 12-24 hours prior to PR. All pts had total occlusions (range 2cm-40cm) of FPA and >2 vessel infrapopliteal runoff. Clinical restenosis requiring repeatPRwasdefinedbya>75%stenosisonduplexultrasoundand/or recurrent disabling claudication with a fall in ABI. Follow-up was attained at 6 months.results: Mean baseline Hcy level was 11.8±3.2mmol/L (7.6mmol/L–19.2mm/L). Baseline resting ABI’s ranged from 0.53 to 0.79. No restenosis or only minimal intimal hyperplasia was observed in 76(67%)ptsat6months.RestenosisrequiringrepeatPRwasobservedin37(32%).Restenosiswasindependentoflengthofocclusion.Hcylevelwassignificantlyhigherintherestenosisgroup(16.5±1.5mmol/L,p<0.005).Conclusions: These results indicate that an elevated homocysteine level may predict restenosis that requires repeat revascularisation following PR of FPA total occlusions. Studies investigating strategies to lower homocysteine levels in patients with PAD are underway and may result in reduced restenosis rates at 6 months for PR of FPA occlusions.Keywords: Homocysteine, Restenosis, SFA

pS3-4 SterNaL WOUNd aNGiOGeNeSiS iN diabetiCaNd NON diabetiC patieNtS UNderGOiNG CardiaC VaLVe repLaCemeNt SUrGeryP. BHASKARAN1, N. J. STANDFIELD1, T. GOURLAY2

1 Hammersmith Hospital, Imperial College, London, United Kingdom2 University of Strathclyde, Glasgow, United Kingdom

Background: In this study we propose to assess the sternal wound healing process following cardiac valve replacement patients. Pathological and mechanical factors affect the collateral vessel formation and angiogenesis. In diabetic patients acute and chronic arterial changes prolong the recovery process from the insult. There is no interruption of arterial blood supply in these patients as the internal thoracic arteries are not mobilised in these patients.aim: To establish the difference in healing process of sternal wound following diabetic and non diabetic cardiac valve replacement patients using Laser Doppler Imager.methods: Sternal area of diabetic and non diabetic patients were scanned at 5 time points (pre-induction and 72 hours after surgery) by measuring doppler shift of laser light caused by blood cell movements. results: The neovascularisation and wound healing were steady and faster in non diabetic patients. The tissue perfusion was steadily increased thorough out on both sides of sternum. There was a decreased perfusion on left side compare to right side.In diabetic patients the perfusion was dropped slightly following surgery and increased after 24 hours. At 48 hours the process of angiogenesis was decreased below the baseline and increased after that.Here we established the difference in the process of formation collaterals and angiogenesis in diabetic and non diabetic patients, which is steady in nature through out. Summary: There was a reduced neovasculirisation process following cardiac valvular surgical patients secondary to chronic pathological arterial changes in diabetic patients.Keywords: Angiogenesis, Diabetic, Non diabetic

pS3-5 aSSeSSmeNt OF SterNaL WOUNd HeaLiNGFOLLOWiNG diabetiC aNd NON diabetiC COrONary artery bypaSS GraFt SUrGiCaL patieNtS USiNG


LaSer dOppLer imaGerP. BHASKARAN1, N. J. STANDFIELD1, T. GOURLAY2


Background: Disturbances in sternal wound healing following coronary artery bypass graft (CABG) surgeries is a major problem. The reasons for the delayed healing are different. Regional blood supply by internal thoracic and intercostal arteries, operative technique, infection control and post operative management are important factors affecting the sternal healing process. In CABG patients, left internal thoracic artery is used to establish anastomosis with the coronary artery. Wound healing of the left side requires collateral vessel formation in the process of wound healing.aim: To establish the role of internal thoracic and intercostals arteries in collateral formation and angiogenesis in both sides of the sternum following CABG surgeries using Laser Doppler Imager. methods: Left and right parasternal tissue perfusion of 30 diabetic and non diabetic patients were measured at 5 time points (pre-induction to 72 hours after bypass). LDI laser Doppler imaging system measures the frequencyofthebloodcellspassingthroughthelaserlightfield.Results: In diabetic patients, the tissue perfusion was dropped significantly bilaterally immediately after surgery, but more on leftside. The collateral vessel formation and angiogenesis were increased bilaterallyinfirst24hoursfollowingsurgeryandkeptsamepacewiththe right side after 48 hours. After 72 hours the tissue perfusion was droppedtobaselineandnoticedsignificantdroponleftside.In non diabetic patients, the perfusion was gradually increased on the right side and dropped on the left side immediately after surgery. After 48 hours the perfusion was equalled bilaterally and dropped to the base line. Summary: The new vessel formation was delayed on left side secondary to mobilization of left internal thoracic artery in both groups of surgical patients.The differencewasmore significant in diabeticpatients. Keywords: Angiogenesis, Diabetic, Sternum

pS3-6 CLiNiCaL SiGNiFiCaNCe OF LaSer dOppLerSCaNNer iN peripHeraL VaSCULar diSeaSeP. BHASKARAN1, M. ASLAM1, N. J. STANDFIELD1, T. GOURLAY2


Background: In peripheral vascular disease (PVD), skin perfusion is an important factor in the management of acute and chronic disease process. It is very difficult to manage the hypoxic cellular changesand require more extensive investigations and aggressive treatment to prevent progression of the disease.aim: To evaluate the skin hypoxic changes secondary to different disease processes in the management of PVD by using laser doppler scanner. methods: 170 diabetic (DM) and non diabetic (Non DM) patients wereselectedwithsymptomaticoflowerlimbPVD.Thebloodflowofthe area of interest was estimated by Moor LDI laser doppler imaging system. Measurement of the doppler shift of laser light caused by blood cellspassingwithinthelaserlightfieldofthedistaldorsalpartofthefoot were taken in standing and lying down positions to establish the extend of the severity of the PVD.results: The skin perfusion measured in DM standing and Non DM lying down groups showed statistically significant increase inmicrocirculation. Other groups such as hypercholesterolemic (HC), smokers (S) and hypertensive (HT) patients did not establish any significant changes in both positions except there was an increaseperfusion in non HC, S and non HT patients. Angiogenesis secondary to collateral circulation is affected by the etiological factors and

pathology of the disease process.Summary: This study established the positional difference in tissue perfusion in DM and Non DM patients secondary to narrowing of the arteries, formation of collaterals and angiogenesis. Other groups showed different disease process and pathology. This helps to treat the patients depends on the skin perfusion.Keywords: Diabetic, Non diabetic, Hypoxic

pS3-7 CritiCaL Limb iSCHaemia iN diabeteS:deFiNitiON, aSSeSSmeNt, prOGNOSiSF. POLLICE1, P. POLLICE1, V. DELGADO1

1 Department of Cardiology - Leiden University Medical Center, Leiden, Netherlands Antilles

Background: We sought to establish risk factors predicting the out come of foot lesions in longstanding diabetic patients with critical foot ischaemia(CFI).patients and methods: We investigated retrospectively 98 consecutive diabetic patients with ischaemic foot lesions. The patients (mean age 70 years, duration of diabetes 21 years)were jointly cared for by specialised diabetologists and vascular surgeons; 75 patients were treated by arterial revascularisation.results: Good outcome (lesions healing) was observed in 53 patients (54%).Badoutcomewasobservedin45patients:nothealinglesions(n=5), major amputation (n=19), and death in relation to the foot lesions (n=21). Patients with good and bad outcome did not differ regarding age, sex, smoking status, type, duration and treatment of diabetes mellitus, presence of neuropathy, coronary heart disease, stroke, previous amputations, current revascularization, and localization, of the foot lesions. The risk of bad outcome was increased 8.9 times in patients an dialysis for end –stage renal disease; 7.0 times if surgical complications were present; and 5.4 times with C-reactive protein(CRP) above the second quintile ( cut-off value 8 mg/dl).Conclusion: Management of longstanding diabetic patients with ischaemic foot lesions leaves room for improvement. Dialysis treatment, elevated CRP levels and surgical complications were strongly predictive of non-healing lesions, major amputation and death.Keywords: Diabetes

pS3-8 aSSOCiatiON betWeeN miCrOaLbUmiNUriaaNd eLeVated LeVeLS OF prOiNFLammatOry eNdOtHeLiUm-deriVed mediatOrS iN HyperteNSiVe diabetiC patieNtSC. SERBAN1, S. DRAGAN2, I. MOZOS1, R. MATEESCU3,L. SUSAN4, A. PACURARI4, A. CARABA4, G. SAVOIU5,I. ROMOSAN4

1 University of Medicine and Pharmacy Victor Babes - Patho- physiology Department, Timisoara, Romania2 Preventive Cardiology and Cardiovascular Rehabilitation Clinic, Timisoara, Romania3 University of Medicine and Pharmacy Victor Babes - Physiology Department, Timisoara, Romania4 University of Medicine and Pharmacy Victor Babes - IVth Medical Clinic, Timisoara, Romania5 University of Medicine and Pharmacy - Anatomy, physiology and pathophysiology Department, Timisoara, Romania

Objective: Microalbuminuria, an early indicator of chronic kidney disease is also a well-established risk factor for atherosclerosis in patientswithcardiovasculardisease.Inflammatorymarkersareknownto be sensitive predictors of atherosclerotic disease. The purpose of this study was to study the association between microalbuminuria and inflammatory markers (high-sensitivity C-reactive protein-hsCRP,plasmafibrinogen)inhypertensivetype2diabeticpatientscomparedto hypertensive patients.design and method:We compared the levels offibrinogen, hsCRPand 24-h urine microalbuminuria of 71 patients with both arterial

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hypertension and type 2 diabetes mellitus (mean age 60 ± 4.84 years) with those of 50 patients with arterial hypertension (mean age 56 ± 5.60 years). For the measurement of microalbuminuria and hsCRP it was used the immunoturbidimetric method. results: The level of microalbuminuria was found to increase significantlyinhypertensivediabeticpatients,comparedtothatofthehypertensive patients (117 ± 15.51 mg/l vs 45 ± 37.65 mg/l, P < 0.001). Hypertensivepatientswith type2diabetesmellitushadsignificantlyincreased values of plasma hsCRP (6.95 ± 0.44 mg/l vs 4.02 ± 1.53 mg/l,P<0.001)andfibrinogen(5.04±0.30g/lvs3.33±0.81g/l,P< 0.001), compared to hypertensive patients. Microalbuminuria was significantlycorrelatedwithhsCRP(r=0.71,P<0.001)andfibrinogen(r = 0.72, P < 0.001).Conclusions: Microalbuminuria is associated with elevated levels of proinflammatory endothelium-derived mediators like hsCRPand fibrinogen, in hypertensive patients with diabetes mellitus.Microalbuminuria screening and effective treatment to reduce blood pressure and microalbuminuria in hypertensive patients, particularly those with existing diabetes may improve cardiovascular and renal outcomes.Keywords: Microalbuminuria, Hypertension, Diabetes mellitus

pS3-9 SUSCeptibiLity OF baCteriaL CULtUreS tOtOpiCaL aNtiSeptiCS iN diabetiC FOOtL. MASLOWSKI1, M. BARTOSZEWICZ2, K. CHECKA2,W. KWIATKOWSKA1, W. WITKIEWICZ3

1 Regional Specialist Hospital, Research and Development Center, Department of Angiology, Wroclaw, Poland2 Medical University, Department of Microbiology, Wroclaw, Poland3 Regional Specialist Hospital, Research and Development Center, Department of General and Vascular Surgery, Wroclaw, Poland

Topical antibacterial treatment is important therapeutic method in diabetic foot. Aim of the study was the evaluation of susceptibility of bacteria cultured from necrotic and purulent tissues collected from patients with diabetic foot to usual topical antiseptics. Study group: 15 patients with type 2 diabetes with diabetic foot (11 male, 4 female; mean age 65,7years; mean diabetes duration 15,5 yrs). In 10 patients obliterative atherosclerosis was diagnosed, in 6 of them endovacular procedures were performed. Necrosis was observed in 11 patients, ulcers in 2 pts; in 5 cases incision and drainage was done; 7 pts have had radiological signs of osteolisis. In 3 pts primary femoral amputation was performed and distal foot amputations in next 3 pts.method: In all patients tissue specimens was obtained for bacterial cultures. results: In all samples bacterial colonization was ascertained with critical value above 105 CFU/g of tissue. In 9 pts mixed G+ and G- infection was recorded, G+ infection in 3, G- infection in 3. Cultures were positive for Staphylococcus aureus, Staphylococcus. epidermidis, Staphylococcus auricularis, Enterococcus sp., Pseudomonas sp., Stenotrophomonas maltophilia, Acinetobacter baumani, E.coli, Citrobacter freundi and Serratia species. The in vitro susceptibility of cultured germs to usual topical antiseptic as povidone-iodine, ethacridine lactate, chlorhexidine and octenidine hydrochloride in clinically used concentrations was examined; studies were done using microbiological cultures either in plankton or in biofilm forms. In plankton culturesG+ bacterial species showed diminished susceptibility to povidone-iodine;inbiofilmculturesthesebacteriawereresistanttothisantisepticagent. All Pseudomonas aeruginosa biofilm cultures were resistantto all examined antiseptics; formerG- biofilm cultures also showeddiminished susceptibility to all topical antiseptics. G+ bacterial cultures were susceptible to ethacridine lactate, chlorhexidine and octenidine hydrochlorideeitherinplanktonorinbiofilmforms.Conclusion: chlorhexidine and octenidine hydrochloride should be recommended as basic topical antiseptic agents.

Keywords: Diabetic foot, Topical treatment

pS3-10 imprOViNG Limb SaLVaGe iN CritiCaL Limb iSCHemia WitH iNtermitteNt pNUematiC COmpreSSiON: a CONtrOLLed StUdy WitH eiGHteeN mONtHS FOLLOW UpS. KAVROS1, N. TURNER1, A. VOLL1, D. LIEDL1, P. GLOVICZKI1


Background: The purpose of this study was to evaluate the clinical role of IPC in the treatment of patients with chronic critical limb ischemia (CCLI), tissue loss and non-healing wounds of the foot on whom peripheral arterial revascularization had been exhausted. methods: This study comprises 2 groups: group 1 consisted of 24 patients, median age 70 years, who received IPC for tissue loss and non-healing wounds of the foot secondary to CCLI, in addition to wound care; group 2 consisted of 24 patients, median age 69 years, who received wound care for tissue loss and non-healing wounds of thefootsecondarytoCCLI,withoutthebenefitofIPC.Outcomewasconsidered favorable if complete healing and limb salvage occurred, and adverse if the patient had to undergo a below knee amputation subsequent to failure/deterioration of wound healing. results:IntheControlGroup20patients(83%)failedtohealtheirfootwoundsandunderwentaBKA;theremaining4(17%)hadcompletehealing and limb salvage. In the IPCGroup 14 patients (58%) hadcompletefootwoundhealingandlimbsalvage.Tenpatients(42%)inthis group underwent BKA after failing healing of the foot wounds. BothwoundhealingandlimbsalvageweresignificantlybetterintheIPC group (p<0.01). Conclusion: Our study data reveal that IPC implementation used as an adjunct to wound care in patients with chronic CLI and chronic non-healing wounds/tissue loss improves the likelihood of wound healing and limb salvage, when established treatment alternatives in current practice are lacking. Keywords: Chronic Critical Limb Ischemia, Intermittent Pnuematic Compres, Limb Salvage

pS4 - Vascular Surgery (1)

pS4-1 COmpariSON OF eNdOLUmiNaL VerSUS OpeNrepair iN tHe treatmeNt OF abdOmiNaL aOrtiC aNeUrySmSF. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2

1 Department of Vascular Surgery, University of Naples, Naples, Italy2 Department of Interventional Radiology, Bari, Italy

purpose: Endovascular abdominal aortic aneurysm (AAA) repair is reported to result in less initial patient morbidity and a shorter hospital length of stay(LOS) when compared with conventional AAA repair. We sought to examine the durability of this result during the intermediate follow-up interval.methods: The records of all admissions for all patients who underwent AAA repair during a 26-month interval were reviewed.results: Three –hundred thirty-seven (337) patients underwent procedures to repair AAAs (163 open and 174 endovascular). Endovascular procedures were performed with a variety of devices and configurations. The mean follow-up period was 10.6 months(endovascular repair) and 12.3 months (open repair). LOS did not significantlyvarybydevice(P=.24toP=.92)orconfiguration(P=.24).The initial median LOS for procedures was significantly shorter(P=.009) for endovascular repairs (5 days) than for open procedures (8days). The readmission-free survival rate after AAA repair at 12 months was 95% for patients for openAAA repair versus 71% forpatients for endovascular repair (P<.001). If the total hospital days were compared, including the initial and all subsequent AAA-related admissions, there was no significant difference for mean LOS for


patients who underwent endovascular versus open AAA procedures (11 days versus 13.6 days; P=.21). Although women had similar LOS to men for endovascular repair, (P=.44), they had longer initial LOS for open AAA repair (15 versus 10 days; P=.03). After endovascular repair, womenweremorelikelythanmentobereadmittedby12months(51%versus71%readmission-freesurvivalrate;P=.03)andtheyhadlongerLOS on readmission (13.2 versus 5.2 days; P=.006Conclusion: Although initial LOS was shorter for the patients who underwent endovascular as compared with conventional AAA repair, this advantage was lost during the follow-up interval because of frequent readmission for the treatment of procedure-related complications, chieflyendoleak.Keywords: Aneurysm

pS4-2 eNdOVaSCULar tHOraCiC aOrtiC aNeUrySmrepair iN a patieNt WitH SeVere aOrtOiLiaC diSeaSe aNd eCtOpiC SiNGLe KidNeyM. KAFEZA1, V. PSARROS1, K. PAPOUTSIS1, G. KOUVELOS1, A. KOUTSOUBELIS1, C. BAKOYIANNIS1, S. GEORGOPOULOS1, C. KLONARIS1, E. PAPALAMBROS1

1 University of Athens, Laiko General Hospital, First Department of Surgery, Vascular Division, Athens, Greece

introduction: While endovascular repair of thoracic aortic aneurysm is rapidly emerging, an increasing number of complex cases and challenging access related problems are encountered. A variety of techniques have been developed to overcome these limitations.Case report: This report presents a patient with descending thoracic aneurysm of 6,4cm diameter, with concomitant severe aortoiliac disease. Preoperative imaging revealed a single ectopic right kidney, with the right renal artery arising near aortic bifurcation.A temporary extra-corporeal, subclavian-femoral bypass was used to maintain kidney perfusion while device access was obtained through an aortomonoiliac graft.The device was deployed successfully and the patient had no deterioration of his renal function at discharge and follow up. Conclusion: Nowadays, endovascular endografting continues to evolve, while the use of alternative approaches and new techniques expand the number of patients eligible for endovascular repair. Keywords: TEVAR, Access, iliac, Kidney perfusion

pS4-3 Late SeCONdary prOCedUreS dUe tO aNeUrySm rUptUre aFter eVar: teN yearS eXperieNCeM. KAFEZA1, V. PSARROS1, A. KOUTSOUBELIS1,G. KOUVELOS1, K. PAPOUTSIS1, C. BAKOYIANNIS1,C. KLONARIS1, S. GEORGOPOULOS1, E. BASTOUNIS1,E. PAPALAMBROS1

1 University of Athens, Laiko General Hospital, First Department of Surgery, Vascular Division, Athens, Greece

Introduction-Objective: Endovascular aneurysm repair (EVAR) is applied with increasing frequency the last two decades having proved its low perioperative mortality and morbidity. However, mid- and long- term durability of the procedure has been challenged by late aneurysm rupture. In this study we present our experience on late secondary procedures after EVAR.design and methods: We report six cases of patients presented with rupture onemonth to five years after EVAR.More specifically, wereporttwopatientspresentedwithruptureandaortocavalfistula,threepatients with endoleak type I or III and rupture and one patient with type II endoleak and contained rupture. All patients were treated with complete or partial removal of the endograft and interposition of an aortic graft, except one case of type I endoleak which was sealed by an aortic cuff.Conclusions: Late rupture of a previously treated aneurysm by EVAR is quite uncommon; however a favorable outcome requires adequate

experience in open repair. Surveillance can be crucial in preventing late complications.Keywords: EVAR, Reintervention, Rupture

pS4-4 tiSSUe FaCtOr patHWay aNd tHrOmbiN-aNtitHrOmbiN COmpLeX iN bLOOd OF patieNtS WitH abdOmiNaL aOrtiCaNeUrySm dUriNG SteNt-GraFt impLaNtatiONR. GRENDZIAK1

1 Regional Specialized Hospital, Department of Vascular Surgery, Wroclaw, Poland

Objective: Tissue factor (TF)pathway is the key initiator of trombin-generation and thrombo-embolic complications.TF takes also part in inflammatoryprocessesandtogetherwithvascularendothelialgrowthfactor (VEGF) in proliferation and migration of vascular endothelial and muscle cells.Tissue factor pathway inhibitor (TFPI ) inhibits thrombogenesis and thrombus formation and prevents the artery stenosis.Thrombin-antithrombin complexes (TAT) reflect trombin-generation occuring in blood.desing and methods: The aim of the study was to evaluate the concentration of TF, TFPI,VEGF and TAT complexes in blood of patients with abdominal aorta aneurysym (AAA) during stent-grafts implantation. Twenty six patients (22 men and 4 women) in mean age 71 years with AAA and implanted stent-grafts were enrolled in this study. Blood was drawn 3 times: before, just after and 24 hours after stent graft implantation. The concentration of TF, TFPI, VEGF, and TAT complexes were measured with with commercial kits,using enzyme immunoassay (ELISA).results: In plasma of patients with AAA the concentration of TF weresignificantlyhigherthanincontrolsi.e.241±164pg/mlversus133±79pg/ml, also higher were TFPI levels 101±18 ng/ml versus 63±18 ng/ml. VEGF concentration were similar in examinated both groups.Just after stent-grafts implantation TAT complexes were four times higher and after 24 hours decreased to the level before operations Conclusion: Stent-graft implantation to patients with AAA caused asignificiantdecreaseofplasmaTFlevelprobablybyadsorbtionofthis protein on implanted prothesis where thrombin –generation was activated. Keywords: Tissue factor, Aortic aneurysm, Thrombin-generation

pS4-5 a NOVeL SUtUre-LeSS deViCe (byFiX) FOrVaSCULar aNaStOmOSiS- tHe reSULtS OF preCLiNiCaL aNd CLiNiCaL StUdieSB. YOFFE1,2

1 Y. Urin HDH, HAIFA, Israel2 M.Schneider, MD, Klinik, Erfurt, Germany

Despite the development of EVAR (endovascular aneurysm repair) in the last decade, open surgery is still the treatment of choice for elective and emergency patients with low-risk abdominal aortic aneurysms and long life expectanciesThe successful performance of vascular anastomosis requires a high level of skill, a long learning curve, and a substantial amount of time. The creation of a facilitated mechanical vascular anastomosis should not compromise quality or patency rates and produce at least the same results as those obtained with standard suturing techniques.The next study we performed was for laparoscopic aortic surgery on pigs using HDH device also showed very good results.We received in all cases safe and reliable anastomosis and all procedures were completed laparoscopically.Clinical trails are in progress now and we did 6 operation on abdominal aortic for AAA and aortic iliac occlusion without complications at Barzilay Medical center and 2 femoro popliteal bypasses were performed in Germany with excellent results.The patients are continuing the follow up and the midterm results are very good.

68 ~

All studies showed that this anastomotic device is reliable for fast, easy and safe anastomosis perfomance in aortic and peripheral arteries.The routine usage of the BYFix device facilitates the surgeon’s work and promotes the patient’s recovery. We have developed a new medical device for performing of sutureless anasthomosis that can be attached to any kind of prosthetic grafts available on the market. After the attachment performed the device withthegraftisinsertedintotheAortaoranothervesselandisfixedtothe vessel’s walls by the barbs.Keywords: EVAR

pS4-6 SpONtaNeOUS aOrtOCaVaL FiStULa: CaSerepOrt aNd LiteratUre reVieWH. RAVARI1, M. MOINI2, M. VAHEDIAN2, M. ALIAKBARIAN1

1 Imam Reza Hospital, Department of vascular surgery, Mashhad, Iran2 Sina Hospital, Department of vascular surgery, Tehran, Iran

Spontaneous aortocaval fistula is a rare complication of abdominalaortic aneurysms. We describe two cases of spontaneous aortocaval fistula.Thefirstpatientisa67-year-oldwomanwhowasadmittedtoour hospital complaining of abdominal pain. Positive findings werepulsatile abdominal mass and tachycardia. Computed tomography (CT) scan showed an infra-renal abdominal aortic aneurysm of 7 cm in transverse diameter, indicative of contrast material in the inferior vena cava. Another patient was a 59-year-old man with a compliant of progressive abdominal pain and hypotension initiated two days prior to admission. After initial hemodynamic stabilization, an abdominal computed tomography (CT) scan was obtained with oral and intravenous contrast. The CT scan showed an infrarenal aortic aneurysm of 8 cm in transverse diameter, as being suspicious for retroperitoneal leak. The Simultaneous contrast enhancement in the inferior vena cava was also identified. Both patients underwent anurgentlaparotomyinwhomthediagnosisofanaortocavalfistulawasconfirmed.Wereviewtheliteratureonspontaneousaortocavalfistulaasaconsequenceofcomplicatedaorticaneurysms,andbrieflydiscussits clinical presentation and surgical management.Keywords: Aortocaval fistula, Abdominal aortic aneurysm,Arteriovenousfistula

pS4-7 tHe rOLe OF arteriaL aNd VeNOUS SHUNtiNGiN tHe COmpLeX VaSCULar traUma OF tHe arterieS OF tHe LOWer LimbSG. MARCUCCI1, A. SIANI1, R. ANTONELLI1, A. G. GIORDANO1, F. ACCROCCA1

1 San Paolo Hospital, Civitavecchia, Rome, Italy

Objective: Complex lower limb vascular injuries are associated with a high degree of limb loss and an high mortality rate The aim of this studywas todetermine thepossiblebenefitsof routineuseofatemporary intraluminal arterial shunt in patients with complex vascular traumaofthearteriesofthelowerlimbtosignificantlyreducestotalischemic time, complications, repeated operations, amputation, and hospitalization.design and method: From January 2004 to December 2009 13 complex blunt and penetrating vascular trauma, with arterial, venous and bone involvement that required stabilization, with complete lower limb ischemia or bleeding were subjected to emergency operation. Over2yearssevenarteryinjuries(4popliteal,3superficialfemoralarteries) were managed with insertion of a shunt at the initial phase of the operation ( Group B). Data from these procedures were analyzed and compared with collected data from six complex vascular trauma ( 4popliteal,2superficialfemoralarteries),treatedwithoutshuntduringthe preceding 3 years ( group A). results: Comparisons between the group A and group B showed that early shunting of both artery and vein in both penetrating and blunt injuriessignificantlyreducedtheincidenceoffasciotomies,contracture,

nerve palsy, postoperative complications, repeated operations and the incidence of amputation and the mortality rate (p<0.05). Mean ischemic time for preoperative, intraoperative, and total ischemic time inthegroupAandBwererecordedanddifferencewassignificantforintraoperative (P <.001) and total (P <.05) ischemic time.Conclusions: The use of early shunting of artery and vein after lower limb trauma can lead to great advantage in terms of significantlyimproved outcomes, reducing total ischemic time, ischemic contracture, need to fasciotomy, ischemic nerve palsy and amputation and mortality rates. Keywords: Arterial and venous shunt, Complex vascular trauma

pS4-8 tHe perCUtaNeOUS aNGiOpLaSty aNdSteNtiNG treatmeNt iN patieNtS WitH SUbCLaViaN SteaL SyNdrOmeF. FERRARA1, I. MURATORI1, F. MELI1, C. AMATO1,M. LUNETTA2, R. ALCAMO1, S. NOVO2

1 Division of Angiology, Palermo, Italy2 Division of Cardiology, Palermo, Italy

Subclavian steal syndrome (SSS) is a complication of the atherosclerotic disease or of arteritis which can lead to manifestations of cerebral vascularinsufficiency.Theaimofthisreportistoevaluatethebenefitsof subclavian stenosis PTA corrective treatment in patients who had vertebral-subclavian steal syndrome, subdivided according to the haemodynamic type of steal. We performed a retrospective study using data previously collected in Doppler ultrasound exams register and then retrospectively reviewed. 72 patients with SSS were observed; 45 of these patients were symptomatic. Patients with positive ultrasound test for SSS were then examined withanangiographicstudythatconfirmedthepresenceofastenosisor occlusion of the subclavian artery and, when present, the vertebral-subclavian steal syndrome. Patients included in the study were subdivided in the following groups:- the 1st group included patients with a degree of subclavian stenosis, rangingbetween50%and70%,whopresented an intermittentSSS;this group was composed of 15 patients aged between 51 and 73 years old. - the 2nd group included patients with a degree of subclavian stenosis thatrangedbetween75%and90%,whopresentedacompleteSSS.Wealso compared the difference in the probability of restenosis Fourteen patients in the 1st group remained asymptomatic. One patient presented subclavianrestenosisfifteenmonthsafterPTA.Eighteen patients in the 2nd group remained asymptomatic, while nine patients showed a subclavian restenosis and three patients a subclavian occlusion.Attheendoffollowup71,10%ofallthepatientswereasymptomaticand their echocolordoppler and angiographic controls were normal whileinthesecondgroupofpatientsapercentageof40%ofrestenosiswas found. We believe that our data are only preliminary because of the limited number of cases involved and further studies are required to verify our hypothesis.Keywords: Subclavian steal syndrome, Doppler ultrasound, Vertebal reversalflow

pS4-9 diaGNOStiC prOCedUreS: tHe timiNGOF FOLLOW-Up OF SUrGiCaL aNd eNdOVaSCULar treatmeNt OF arteriaL diSeaSeSP. L. ANTIGNANI1, C. ALLEGRA1

1 San Giovanni Hospital, Department of Angiology, Rome, Italy

Aproperdefinitionoftheindicationsandcriteriaregulatingtheaccessto instrumental procedures should have the following goals: improve the appropriate use of the procedure, reduce waiting times for the performance of the procedure by discouraging inappropriate use to


foster the access of those who are most in need and prevent vascular disease and complications by a greater capacity of the outcome to influencethemedicaland/orsurgicaltherapeuticdecision,asstatedina number of proceedings published by the Health Councils of several Italian regions. In patients with an aneurysm of the abdominal aorta, the timing of follow-up depends on the diameter of the aorta, the type of aneurysm, and the attitudes of the vascular team. According to recent studies all patients over 65 years should undergo a screening of the abdominal aorta. For aortic ectasias under 3 cm, a follow-up must be carried out after 3 years, while for aneurysms between 3.2 and 3.4 cm, follow-ups should be performed every two years, and for aneurysms above 3.5 every year. In patients subjected to aortic or aorto-iliac-femoral surgical revascularization, an ECD is indicated within 30 days; then every three monthsinthefirstyear,sixmonthsinthesecond,andiftherearenocomplications only if they arise or if they are suspected as of the third year.In the cases treated with aortic endoprosthesis, a follow-up is performed at discharge, at 3, 6, 9, and 12 months and then annually with CT angiography.At the present time, there is no evidence for a periodical follow-up of steno-obstructive femoral-distal lesions. There are no differences in the controls on the basis of the material employed.In patients subjected to surgical femoral-distal revascularization, a study is indicated at 3 - 6 –9-12 months, and then every 6-12 months.Keywords: Ultrasound evaluation, Diagnosis, Follow up

pS4-10 beLOW tHe KNee bypaSS USiNG CryO-preSerVed arteriaL HOmOGraFtS FOr CritiCaL LOWer Limb iSCHaemia: LONG term reSULtS iN a SiNGLe CeNterS. AMIOT1, C. PEROT1, R. SPEAR1, R. JASHARI2,D. MASSOUILLE1, J. LANCELEVEE1, J. P. CHAMBON1

1 CHRU de Lille, Lille, France2 European Homograft Bank, Bruxelles, Belgium

From january 2001 to december 2009, 32 patients (15 male) underwent surgical revascularization using a cryopreserved arterial homograft at the level or below the popliteal artery for critical lower limb ischaemia. No patient was treated for acute ischaemia or for graft infection. All ofthemwereonstage4or5accordingtoRutherfordclassification.Aprevious popliteal-level revascularization had already been performed atleastoncein25(78%)cases.Nogreatsaphenousveincouldbeused,wether already harvested or unsuitable. The proximal bypass site was distalexternaliliacarteryin1case(3.1%),commonfemoralarteryin21cases(65.6%),deepfemoralarteryin4cases(12.5%),superficialfemoralarteryin5cases(15.6%),andproximalpoplitealarteryin1case (3.1%). The distal site was infra-articular popliteal artery in 7cases(22%),proximalanteriortibialarteryin9cases(28%),proximalposterior tibial artery in 6 cases (18.8%), tibio-peroneal trunk in 4cases, peroneal artery in 5 cases (15.6%) and dorsal pedal artery in1 case (3.1%).Bypasseswere exclusivelymade fromcryopreservedarterial homografts. Mean follow-up was 30 months (1 to 110 months), and 1 patient was lost to follow-up.30-daymortalitywas0%.Oneearlybypassthrombosisledtoamid-thigh amputation. In the end of the study 10 bypasses were patent without reintervention. During the study 22 bypasses were occluded, 16 embolectomy were performed, allowing to keep 7 bypasses patent. A major amputation was required in 11 cases. One arterial homograft had to be replaced by another homograft to treat a sepsis. At the end of the study 7 patients had died (4 cardiovascular causes, 1 cancer, 2 miscellaneous).Lower limb revascularization using cryopreserved arterial homografts is an acceptable option in critical ischeamia when great saphenous vein is lacking. Careful follow-up is mandatory and reintervention are

frequent.Keywords: Critical limb ischaemia, Arterial homografts

pS5 - Vascular Surgery (2)

pS5-1 iNtraOperatiVe aOrtiC embOLiSm aFtermiddLe LObe LObeCtOmy FOr reNaL LeyOmiO-SarCOma metaStaSeSP. AMORIM1, C. RODRIGUES2, A. RITA MATOS2, T. VIEIRA1,F. FÉLIX2, J. PEREIRA ALBINO1

1 Vascular Surgery Service 2, Pulido Valente Hospital - CHLN, Lisbon, Portugal2 Thoracic Surgery Service, Pulido Valente Hospital - CHLN, Lisbon, Portugal

introduction: Acute occlusion at the aortic bifurcation by tumor embolusisararefinding.Thepotentialforarterialembolismofatumorinvading the pulmonary veins or right atrium has been recognised before and may be the presenting picture of a pulmonary malignancy. However, the occlusion of the aortic bifurcation is a rare event. On the otherhand,therenalleyomiosarcomaconstituted0,12%ofallinvasiverenal malignancies and has a similar prognosis to the transitional cell carcinoma that is better than that of clear cell carcinoma.Case report: We present a rare case of intraoperative infra renal aortic acute emboli, while performing a middle lobe lobectomy for renal leyomiosarcoma metastases. The patient was promptly diagnosed, underwent emergency vascular surgery, and was done an aortic thromboembolectomy by aorto iliac approach, she recovered without disabilities.methods: In the literature review, we found only 11 case reports associated with lung malignancy and arterial embolism, none due to a renal leyomiosarcoma. The treatment of choice is embolectomy within thefirst6hourswhenthereisacompleteocclusion.However,inourcase,thistechniquewasnotpossible.Mortalitycanbeashighas70%if the diagnosis is delayed, although cases have been described, like the one we have treated, as successful surgery.Conclusion: Neoplastic diseases of the lung can be associated with pulmonary vein or right atrium tumors. Symptoms of acute arterial occlusion should always prompt a search for an arterial embolus. Surgical management offers the best results.Keywords: Aortic embolism, Leyomiosarcoma

pS5-2 eNdOLUmiNaL SteNtiNG FOr SUperFiCiaLFemOraL artery OCCLUSiON OFFerS SymptOmatiC imprOVemeNt FOr patieNtS WitH peripHeraL VaSCULar diSeaSeJ. MAKANJUOLA1, V. M. PATEL1, M. MOBASHERI1, T. HUSSAIN1

1 Northwick Park Hospital, London, United Kingdom

aims: The aim of this study was to assess the immediate and early occlusion rates of endoluminal superficial femoral arterial stents forocclusive atherosclerotic disease.methods: This prospective study enrolled all patients over a two year period that required endoluminal stenting following failed angioplasty for mid superficial femoral artery occlusion. The procedures wereperformed by two consultant radiologists after discussion at a multi-disciplinary meeting. Bare metal stents were inserted in all patients. Clopidogrel was prescribed for 3 months in addition to aspirin. Stent patencywasassessedwithacolourflowduplexscanperformedbyavascular scientist the day after the procedure and 6 months later.results: 20 patients presented with claudication (12) and critical ischaemia (8). The median age was 75 years (range: 57- 94) and 11 (55%)weremale.Themedianocclusion lengthwas16cms (4 -29cms).Therewerenoimmediatestentocclusions;16(80%)stentswerepatent at early follow up (median 6 months (1 - 12 months)). Of these patients therewas significant improvement in resting ankle brachialpressure index (median 0.50 (0.00 – 1.01) vs. 0.87 (0.00 – 1.14), p <

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0.02, Mann-Whitney U test). There were no other complications.Conclusion: Superficial femoral arterial stents have an adequatepatency rate at 6 months with patients achieving symptomatic improvement. Further research is required to evaluate the long term patency of these stents.Keywords:Endoluminalstenting,Superficialfemoralartery

pS5-3 eNdOLUmiNaL reVaSCULariZatiON OF NONembOLiC iLiaC OCCLUSiON FOr iNFeriOr Limb aCUte iSCHemia: aN aLterNatiVe tO SUrGeryF. MERCIER1, A. AYMARD1, H. BENAMER1, X. GUILLOTTE1,E. LOUVARD1, R. MAGUEMOUN1, M. C. MORICE1

1 Hôpital Européen de Paris la Roseraie, 120 av. de la République, Aubervilliers, France

Endoluminal revascularization is proposed in grade D iliac occlusion of TASC II classification, rather than a surgical approach usuallyapproved, for acute ischemia of inferior limb.Procedures were performed in three patients with moderate (2) or severe (1)ischemiainstadeIIbRutherfordclassification.PatientshadapastmedicalhistoryofclaudicationstadeIIbinFontaineclassification(3),no cardiac embolic etiology, smoking (3), HTA (3). Intervals between symptoms and interventions were one day (1) and two weeks (2). All patients had duplex Doppler ultrasound evaluation with ankle-brachial pressure index (< 0,6), angiographic computed axial tomography (1), angiographic magnetic resonance imagery (1). Femoral catheterisms were ispilateral (3) with introducer 6F, hydrophilic 0.035 guide wire, nitinol stents (7 mm x 80 mm and 8 mm x 100 mm), balloon expandable stents (7 mm x 58 mm), balloon (6 x 80 mm, 7 x 40 mm), pigtail 5F. Endoluminal iliac position was controlled by visualisation oftheopeningofthenitinolstent.Complementaryballooninflationforiliac artery stenosis was mandatory in all patients. All iliac arteries were revascularized. One clot migration occured in an ipsilateralprofundafemoralafterinflationofballoonexpandablestent.To avoid it and control the endoluminal position it was choosed after thefirstcasethatthenitinolstentshouldbegentlyopenedbeforeanyinflation.OnecalfaponevrotomiawasmandatoryLengthofstaywere2, 7and 21 days. Permeability was controlled clinically and with duplex Doppler at 6 months.Endoluminal revascularization is a possible alternative to surgery in acute grade D iliac artery occlusion and treats simultaneously occlusion and underlying iliac stenosis. Main risk is migration of the recent iliac clot during the recanalization. The permeability at long term should be compared to chronic iliac grade D subintimal revascularization.Keywords: Endoluminal revascularisation, Iliac artery occlusion, Acute inferior limb ischemia

pS5-4 CarOtid aNGiOpLaSty. deteCtiON OFembOLiC SiGNaLS dUriNG aNd aFter tHe prOCedUreF. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2

1 University of Naples, Department of Vascular Surgery, Naples, Italy2 Department of Interventional Radiology, Bari, Italy

purpose:Toevaluateandcomparetheefficacyofproximalversusdistalembolus protection devices (EPD) during carotid artey angioplasty/stenting (CAS) based on diffusion-weighted magnetic resonance imaging (DW-MRI).methods: Forty-four patients (31 men; mean age 68 years, range 48-85) underwent protected CAS and had DW-MRI before and after the intervention. The cohort was analyzed according to the type of EPD used:aproximalEPDwasdeployedin25(56,8%)patients(17men)meanage66years,range48-85)andadstalfilterin19(14men;meanage 70 years, range 58-79). Fifteen (60.0%) patients with proximalprotection were symptomatic of the target lesion; in the distal protection group,10(52,6%)weresymptomatic.

results: New lesions were seen on the postintervantional DW-MRI in 28.0%(7/25)oftheproximalEPDgroupversus32.6%(6/19)ofthosewith a distal filter (p=NS). Themajority were clinically silent. Thenew lesions in the vascular territory of the stented carotid artery in the group as a whole and per patient were fewer in the proximal EPD group (p=NS).NosignificantdifferenceswerenotedintheT2appearanceofthe new lesions or the number of new lesions observed away from the vascular territory of the stented artery.Conclusion:Proximalembolusprotectiondevicesshowanonsignificanttrend toward fewer embolic events, which warrants large-scale studies. Furthermore, proximal protection devices can be useful to control and treat acute in-stent thrombosis.Keywords: Stenosis

pS5-5 iNFLUeNCe OF aGe UpON COmpLiCatiON OFCarOtid artery SteNtiNGF. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2


introduction: To asses the impact of age on technical success and complications of carotid stenting in a prospective single-center cohort study.methods: One hundred eleven consecutive patients (74 men; median age 70 years) with >- 70% symptomatic(n=33) or >-90%asymptomatic(n=78) internal carotid artery(ICA) stenosis underwent carotid artery stent implantation. Primary technical success and periprocedural complications were compared in patients aged>75 years (n=28) to patients <75 years (n=83).results: Patient groups below and above 75 years compared well with respect to baseline demographic and clinical data. Successful stenting was achieved in 108 (97%) patients. The combined neurologicalcomplicationratewas7%(n=8),with1(1%)majorstroke,1(1%)minorstroke, and no 30-day mortality. Technical angiographic complications occurredin8(7%)patients.Nosignificantdifferencesbetweenpatients> 75 years and those <75 years were observed for primary success rates (100%[28/28]versus96%[80/83];p=0.8),overallcomplications(14%[4/28] versus 16% [13/83]; p=1.0), neurological complications (7%[2/28]versus7%[6/83];p=0.6).Conclusion: Elective carotid stenting can be performed safely in older patients with several comorbidities. Patients age does not seem to be an independent risk factor for poor outcome after endovascular treatment of internal carotid artery stenosis.Keywords: Stenosis

pS5-6 iNterNaL CarOtid aNd biLateraLVertebraL arterieS diSSeCtiON: a CaSe repOrtM. BOUCELMA1, T. BOUNZIRA1, D. BENSALAH1, D. HAKEM1, A. BERRAH1

1 Mohamed Lamine Debaghine Hospital, Bd Said Touati, Algiers, Algeria

Cervicocerebral arterial dissections (CAD) are an important cause of strokes in younger patients accounting for nearly 20%of strokes inpatients under the age of 45 years. Extracranial internal carotid artery dissectionscomprise70%-80%andextracranialvertebraldissectionsaccount for about 15% all CAD. Aetiopathogenesis of CAD isincompletely understood, though trauma, an underlying arteriopathy are considered important. We report a case of 39 years old woman suffered a dissection of her left internal carotid artery and bilateral cervical vertebral arteries after facial plastic surgery. This observation discusses recent developments in understanding of the epidemiology, the pathogenesis, the methods of diagnosis and the approaches to treatment.Keywords: Stroke, Young patients, Vertebral artery dissection


pS5-7 SUrGery FOr CarOtid bOdy tUmOr iNpatieNt WitH eiSeNmeNGer SyNdrOme (CaSe repOrt)K. KANALIKOVA1, J. TOMKA1, K. KANALIKOVA2, I. SIMKOVA2, Z. ZITA1, L. PRETIOVA3

1 NUSCH - Department of Angiosurgery, Bratislava, Slovak Republic2 NUSCH - Department of Cardiology, Bratislava, Slovak Republic3 NUSCH - Department of Anaesthesiology and Intensive Care, Bratislava, Slovak Republic

Eisenmenger syndrome represents clinical status, developing in patients with advanced pulmonary hypertension associated with shunt congenital heart disease. It is characterized by cyanosis, secondary erythrocytosis and all related multiorgan symptoms. Surgery in patients with Eisenmenger syndrome is associated with extremly high perioperative risk. Carotid body tumors (chemodectomas) are rare neck lesions, originating from neuroendocrine tissue in carotid body.They can be for a long time asymptomatic, main signs and symptoms being slow growing pulsatile mass, at the level of carotid bifurcation and a peripheral cervical neuropathy related to largest tumors.Diagnosis is made, beside physical examination, by different imaging modalities (CCDS,CTA,MRA). Angiography is used for detail description of tumor vascularity and for performing Matas test.Treatment in most cases is surgical. In some patients percutanous embolisation is considered. Authors present the case of 47-years old patient with truncus arteriosus communis Collet-Edwards I, unoperable, with severe irreversible pulmonary hypertension, in whom pulsatile mass formation on the left side of neck was diagnosed. It turned out to be a chemodectom, Shamblin II, completely surrounding external carotid artery. Because of rapid progression in growth and clinical symptoms appearing, patient was indicated for surgery. After preparation surgery was performed in general anestesia.Tumorous mass was extirpated from carotid bifurcation and resection of involved external carotid artery was performed. Perioperative care was leaded by experienced team of specialists.No adverse complication in perioperative period was noticed, neither in long-term follow-up.Conclusion:Carotid body tumor has a random occurence (0,03%ofall neoplasm).Patients with Eisenmenger syndrome are at high risk for developing complications during surgery. Noncardiac surgery should be provided by professionals experienced in care of patients with pulmonary hypertension and experted surgeons. Presence of both random diagnoses in one patient is unique. Review of literature describes only few case reports of carotid body tumor occurence in patients with cyanotic congenital heart disease.

Keywords: Carotid body tumor, Eisenmenger syndrome, Surgery

pS5-8 a rare CarOtid-JUGULar FiStULa OFCONGeNitaL etiOLOGyJ. PEREIRA ALBINO1, P. AMORIM1, L. CASTRO E SOUSA1, K. RIBEIRO1, G. SOBRINHO1, T. VIEIRA1, N. MEIRELES1,F. PINTO2

1 Vascular Surgery Service 2, Pulido Valente Hospital - CHLN, Lisbon, Portugal2 Pediatric Cardiology Service, Santa Marta Hospital - CHLC, Lisbon, Portugal

The arterio-venous fistulas of the neck vessels are extremely rareclinical situations. In review of the literature are described about 30 cases, with carotid involvement. The authors present a case of a 7-year-old boy, born in Cape Verde, with pulsatile preauricular mass, with no other symptoms, referred to our department for evaluation. The mass existed since birth and had been gradually increasing in volume. Theclinicstronglysuggeststheexistenceofarteriovenousfistula,andanangiographicstudyconfirmedthepreoperativediagnosisalthoughremaining doubt about the involvement of the internal carotid. Conventional open surgery is decided as afirst choice of treatment,whichhasconductedtohighligationofthefistulaandoftheexternalcarotid as well as all its branches, which immediately solved the situation. The postoperative period was uneventful. Although they have been discussed as possible alternatives endovascular techniques were rejected by existing doubts in the anatomy of the malformation and patient’s age. The immediate result of this surgical option does not provide certainty astothepotentialhealingofthefistula.Soat12monthsoffollow-upwasdecidedtoperformaMRI,whichshowednoevidenceoffistula.The patient is well, with excellent weight gain, and periodic monitoring on our query. The early surgical alternative should be seen as a priority choice in this typeof congenitalfistulasof the cervical area and it is important toresist the temptation of making a proximal ligation of the vessel.Keywords:Carotid,Jugularfistula

pS5-9 diaGNOSiNG CarOtid-JUGULar arteriO-VeNOUS FiStULa: iS COLOr dOppLer SONOGrapHy eNOUGH?R. CATALINI1, G. PAGLIARICCIO2, L. GIANTOMASSI1,O. ZINGARETTI1

1 Vascular medicine - Department of internal medicine, Ancona, Italy2 Vascular surgery, Ancona, Italy

An arteriovenous carotid-jugular fistula, which/ is usually a rareclinical event, becomes more likely after a traumatic or iatrogenic event after catheterization of a jugular vein. When characterized by congenitalorigin,itisoftenidentifiedwhileperformingacolorDopplersonography prescribed for other reasons. We describe the clinical case of a 74 years old man who was subjected to color Doppler sonography of the carotid arteries for the clinical evidence of carotid bruit.Duringtheexaminationwasfoundeda60%stenosisoftherightcarotidbifurcation and, in the distal segment of the right internal extracranial carotid, a flow pattern characterized by very high diastolic velocityandflow turbulencewhile the adjacent internal jugularvein showedpulsatile“arterial-like”flow.While we could not direct image the arterio-venous throughput, the above evidence pointed us towards the diagnosis of arteriovenous fistula.Later,duetotheemergenceofoccasionaltinnitus,thepatientwassubjectedtoanAngioTCexam,whichconfirmedthecolorDopplerreport, while at the same time showing that the focal arterio-venous throughput did not require a correction.Currently the patient is clinically asymptomatic and is followed up regularly by color Doppler sonography, showing no instrumental evolutionofthefistula.

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Ourexperienceconfirmspreviousfindingsintheliteraturewhereitisclear that the color Doppler sonography is the examination of choice inthediagnosisofcarotid-jugularfistula,asitallowstoobtainallthenecessary information without resorting to second level contrast tests.Whenever it appears clinically or instrumentally necessary to treat the fistula, it is possible to proceed with a direct contrast exam(angiography) to program the correction to be performed preferably with endovascular technique (placement of stent graft).Moreover, the non-invasive nature and easy reproducibility of the Color Doppler sonography allow for easy monitoring of the evolution ofthefistulaovertime.Keywords:Arteriovenousfistula,Carotid,Dopplersonography

pS5-10 rUptUred iLiaC artery aNeUrySm aFterabdOmiNaL aOrtiC aNeUrySm reSeCtiON: a CaSe repOrtT. JANUSAUSKAS1, E. JANUSAUSKAS2, V. KAZLAUSKAS2,D. TRIPONIENE1, V. TRIPONIS1

1 Vilnius University, Vilnius, Lithuania2 Vilnius City University Hospital, Vilnius, Lithuania

Objective: To present a case of ruptured iliac artery aneurysm after abdominal aortic aneurysm resection.methods: We report a case of ruptured iliac artery aneurysm in 62 year old man with acute pain of abdomen and shock. Abdominal aortic aneurysm resection and aortic reconstruction with bifurcated vascular graft was performed seven months previously. Both common iliac arteries were ligatured, but internal iliac arteries were left functional. Abdominal aortic aneurysm and aneurysms of both common iliac arteriesweredetectedona routineultrasoundscanfiveyearsbeforethe reconstruction. The size of the aneurysm and the location of a haematomaafterrupturewerespecifiedonCT.results: The treatment involved the urgent open resection of ruptured left common iliac artery aneurysm and right common iliac artery aneurysm and ligature of iliac arteries. The patient died two hours after the operation due to shock complications.Conclusions: Appealing to this fact we recommend total aneurysm sac exclusionofbloodflow.

Keywords: Abdominal aortic aneurysm, Ruptured iliac artery aneurysm

pS6 - arteritis, Vasculitis, therapeutic

pS6-1 GeNeriC arGatrObaN preparatiONSdiFFer iN tHeir aNtiCOaGULaNt aNd aNtiprOteaSe reSpONSeS iN patieNtS WitH LiVer diSeaSe. dOSiNG impLiCatiONSD. HOPPENSTEADT1, O. IQBAL1, S. MASOOD1, J. FAREED1

1 Department of Pathology, Maywood, IL, USA

Objectives: Argatroban is a synthetic antithrombin agent currently approved for anticoagulation management of HIT patients, in particular those requiring percutaneous intervention (PCI). Generic versions of argatroban, slovastan, gartban and argaron available in Japan are at various developmental stages. They have been shown to produce different anticoagulant effects in the ACT and iSTAT ACT assays. In the iSTAT ACT assay gartban showed a very high anticoagulant response, whereas argaron shows a weaker effect.design and method: To further investigate the differential anticoagulant

responses, the three generics were compared with argatroban in human plasma of normals and liver disease patients.results: Assay dependent variations were observed among the generics in the normals. When the generics were supplemented to plasma from liver disease patients, free of any other anticoagulant drugs, marked differences were noted in the PT and APTT responses. In the PT studies supplementation of these agents resulted in a comparable response between argatroban and argaron (122+7 vs 134+8 secs). Slovastan produced a much higher response (188+12 secs) and gartban only produced a modest increase (24+4 secs). Interestingly, in the APTT assay, argatroban and argaron produced similar responses (32+4 vs 30+3 secs). Whereas, slovastan produced a much higher response (138+10 secs) and gartban (84+6 secs). In the thrombin time assays all three generics produced much higher anticoagulant response (140-160 secs) in contrast to argatroban which only produced 60+3 secs. In the amidolytic anti-IIa assays, all generics produced comparable inhibition ofthrombin(6-8%)whereasargatrobanproducedahigherinhibition(12+3%).Allofthesestudieswerecarriedoutat1µg/ml.Conclusion: In comparison to normals, the liver disease patients showed a much wider variation in the anticoagulant responses with different generics, suggest that generic argatroban may exhibit marked differences in different disease. This may have safety and efficacyimplications.Keywords: Argatroban

pS6-2 preVaLeNCe OF Free metHyL CHLOride aSaN impUrity iN GeNeriC CLOpidOGreL preparatiONS. SaFety impLiCatiONS iN CardiO-VaSCULar patieNtSA. DUGUOT1, H. BELVA-BESNET1, C. CONOCAR1,M. DAUMAS1, G. RAO2, I. MOHAN THETI2

1 Sanofi Research, Paris, France2 South Asian Atherosclerosis & Thrombosis, Bangelore, India

Objective: Several generic versions of clopidogrel hydrochloride have recently become available through out the world. They include Clopilet, Ceruvin, Clopigrel, Clopivas, Clopitab, Clavix, Deplatt and Plagril in India. Additional generics are marketed in Europe by Consilient (UK), Sandoz (Belgium) and Mylan (Germany). Some of these have been reported to contain methyl chloride which is formed from the hydrolysis of ester in the presence of hydrochloride as counter ion. In the European products the reported levels of methyl chloride were 40-50 ppm, which are well above the threshold of toxicologic concern (TTC), which is considered to be 20 ppm, considering a daily dose of 75 mg, expressed as clopidogrel base. Various salts of clopidogrel are known to degrade by two main pathways which include racemization and hydrolysis of methyl ester, which lead to the formation of methyl chloride in the case of clopidogrel hydrochloride. The alkyl halogenides such as methyl chloride are known to exhibit genotoxic properties. design and method: The aim was to compare the methyl chloride impuritylevelsinthesepreparations.Amodifiedgaschromatographicmethodisemployedusingtheflameionizationdetectiontoquantitatemethyl chloride. results: In the European preparations the amount of methyl chloride was found to be between 40-50 ppm., whereas in the preparations marketed in India this ranged from 10-110 ppm. Although the shelf life of the preparations from India are not known, these levels are likely to increase to a higher level at higher temperatures.Conclusion: These studies clearly underscore the substandard nature of generic clopidogrel hydrochloride preparations and warrant additional analytical studies to check the purity of generic versions of clopidogrel hydrochloride. More over, the effect of these impurities in the generic products need further investigations and are likely to contribute to the observed variations in the pharmacodynamic responses.Keywords: Clopidogrel


pS6-3 LOW adHereNCe tO aNtitHrOmbOtiCiNdiCatiONS aNd GeNder diFFereNCeS iN aSpiriN USe iN patieNtS WitH preViOUS miNOr bLeediNGA. MATTIOLI1, A. FARINETTI2, R. LONARDI2, S. PENNELLA1,3, G. TAZZIOLI2, G. MATTIOLI3

1 University of Modena and Reggio Emilia, Department of Sc, Modena, Italy2 University of Modena and Reggio Emilia, Department of Surgery, Modena, Italy3 Istituto Nazionale di Ricerca Cardiovascolare, Modena, Italy

Aspirin is use in widely mode to prevent cardiovascular disease. Patients (pts) presenting a previous episode of minor bleeding have high risk for recurrence. The aim of the study was to evaluate the adherence to guideline in aspirin prescription in pts with previous minor bleeding.design and method: Data were analyzed from 1.100 patients: [504men (45.8%)and596women (54.2%),meanage54±12yrs]referred for minor hemorrhage. All patients were followed for 1 year. The use of aspirin was evaluated: dose, time, other bleeding episodes (major and minor), and indication according to guidelines and gender. Cardiovascular and hemorrhagic risk factors were assessing. We found 131 pts treated with aspirin and 89 pts treated with oral anticoagulants;65ptshadapreviousepisodeofatrialfibrillationand/or a myocardial infarction. The daily aspirin dosage ranges from 80 to 500mg.Hemoglobinwassignificantly lower inpatients takingASAand anticoagulants (9.8 ± 3.5 vs 14 ± 4.1).results: We evaluate adherence to guideline in prescription aspirin in cardiac patients with previous minor bleeding: 456 patients had cardiac indicationforaspirinand/oranticoagulants(includingatrialfibrillation)butonly238ofthem(52.19%)weretreated,womenwerelesslikelytobe treatedwithaspirin (30%vs67%).Recurrenceofhemorrhagewashigherinptstakingaspirin(42%versus23%incontrol),withatrend to even greater incidence in pts taking high dosage of aspirin and anticoagulants(40%vs60%).Conclusions: A previous minor bleeding discourages the use of aspirin although indicated to guideline and that women were under treated with respect to men. Aspirin was associated with a higher rate of recurrences of minor bleeding, without important hemodynamic effects. Pts taking high dosage of aspirin or anticoagulants were more likely to develop bleedingKeywords: Aspirin, Bleeding

pS6-4 tHe pHarmaCOGeNetiC apprOaCH tO tHeaNtiCOaGULaNt tHerapyY. NOVIKOVA1, A. SHEVELA1, G. LIFSHITZ1, K. SEVOSTYANOVA1, E. VORONINA1

1 Institut de biologie chimique et medecine fondamentale, Novosibirsk, Russia

purpose: to study the frequency of occurrence of the warfarin metabolism gene in patients with deep venous thrombosis, to determine the optimal dosage of the drug depending on the genotype. methods: a study of CYP2C9 and VKORC1 genes with the help of PCR/RFLP method of diagnostics was conducted on 159 patients with deep venous thrombosis in lower extremities. Results: «Poor» metabolizers with the gene CYP2C9*2 variant Ñ/Ñ among patients in the researchgroupwerefoundin108(68%)ofcases,whereasCYP2C9*3variantA/A-wasfoundin157(98,7%)andtheheterozygousvariantofpolymorphismCYP2C9*3C/Twas registrated in2 (1,3%)of thepatients. The polymorphous variant CYP2C9*2 C/T was detected in 50(31,4%),whereasthegeneCYP2C9*2substitutionT/T–onlyin1(0,6%)ofthecases.While investigating the frequency of occurrence of different polymorphous variations of the VKORC1 gene it was discovered, that among patients the heterozygous C/T variation is found more often than the “wild typeKeywords: Pharmacogenetic, Warfarin, Personolized therapy

pS6-5 mULtiFaCtOriaL treatmeNt eFFeCtiVNeSSOF dySLipidemia, type 2 diabeteS meLLitUS aNd arteriaL HyperteNSiON iN patieNtS WitH CHdK. KAPANADZE1, N. N. KIPSHIDZE1

1 Acad. Nodar Kipshidze National Center of Therapy, Tbilsi, Georgia

The aim of the study was to estimate multifactorial treatment effectiveness of dyslipidemia, type 2 diabetes mellitus and arterial hypertension.materials and methods: We studied 58 patients (mean age 49±14, male/female 26/32) with dyslipoproteinemia, type 2 diabetes mellitus and arterial hypertension II (JNC VII). Their mean indices of T-C, HDL-C, LDL-C and TG were: 247.28±26.1 mg/dl, 29.09±4.1mg/dl, 158.25±22.8mg/dl and 225.9±19.8mg/dl respectively), HbA1c varied from6.5%to7.0%andthelevelsofcreatininevariedfrom120to150µmol/l. Patients were randomly assigned and divided into two groups (Gr.): Gr.1 patients received hypolipidemic drugs (statin), hypotensive drugs (ACE inhibitors, Ca-antagonists, duretics) and metmorphine, gliclazide during 8 weeks. And Gr.2 patients received only hypotensive and antidiabetic drugs. results: In theGr.1 target levelsof lipidprofile,glucose levelsandarterialpresurewerereachedin62%,65%and70%respectively.AsforGr.2lipidprofiledidnotchangein84%,andtargetlevelsofarterialpressure andglucose concentrationswere reached in50%and52%,respectively.Conclusion: As a result, all patients with type 2 diabetes, should be treated with the above mentioned scheme at the early stage of the disease, in order to reach target levels of lipid profile. Treatmentmust be aimed not only at dyslipidemia, but the risk factors of type 2 diabetes and arterial hypertension as well as these conditions create vicious circle and aggravate one another. Multifactorial treatment of the above mentioned pathologies facilitates their management and provides better prognosis. Keywords: Dyslipoprotenemia, Ttype 2 diabetes mellitus, Arterial hypertension

pS6-6 HyperbariC OXyGeN tHerapy iN reFraC-tOry iSCHemiC CUtaNeOUS LeSiONS iN VaSCULitiS aNd CONNeCtiVe VaSCULar diSeaSeC. BELIZNA1, D. HENRION2, V. SOUDE3, B. BIENVENU4,F. MAILLOT5, E. ANDRES6, C. LAVIGNE1, A. GHALI1,A. MERCAT3, P. ASFAR3

1 Angers CHU, Internal medicine, Angers, France2 Inserm 771, Angers, France3 Angers CHU, Medical reanimation, Angers, France4 Caen CHU, Internal medicine, Caen, France5 Tours CHU, Internal medicine, Tours, France6 Strasbourg CHU, Internal medicine, Strasboug, France

Hyperbaric oxygen therapy is currently used in ischemic cutaneous arterial ulcers resistant to classical therapy.Nowadays, only few data have been reported concerning the use of this form of treatment in ischemic lesions found in vasculitis and connective vascular disease.We present the retrospective experience of few medical centers that currently employ hyperbaric oxygen. Data from patients with vasculitis and connective vascular disease presenting with ischemic cutaneous ulcers and that have received hyperbaric oxygen therapy have been retrospectively recorded (2005-2009).Measures of transcutaneous oxymetry (TcpO2) have been performed in these patients before starting the treatment based on hyperbaric oxygen, in order to detect local ischemia. The classical treatment programme consisted in a two times a day hyperbaric oxygen therapy every day, 5 days per week for a total length of treatment of three weeks.18 patients, mean age 56.5 years old, have been treated with hyperbaric

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oxygen (retrospective experience between 2005-2009). Among them, 10 patients have presented systemic sclerosis, two patients had pan-arteritis, three patients Wegener granulomatosis and two patients Buerger‘s disease. Measures of transcutaneous oxymetry have been repeated at the end of hyperbaricoxygentherapyandhavebeenfoundasimproved(>50%)in all patients (p<0.001). Complete cicatrisation of ulcers have been obtained in 14 patients. In two patients local improvement have been noticed. Pain complaints have been totally disappeared in 15 patients andhavebeensignificantlyimprovedintheothertwopatients(morethan50%ontheanalogicalpainevaluationscale)andpersistedafter12 months.In conclusion, we suggest that hyperbaric oxygen therapy could represent an alternative therapy in refractory in refractory ischemic cutaneous lesions in vasculitis and connective vascular disease. The high cost of the hyperbaric oxygen therapy should not represent an obstacle in the treatment choice, because of the rapid and constant clinical improvement obtained with this form of therapy.Keywords: Vasculitis,Hyperbaric oxygen therapy

pS6-7 diGitaL iSCHemia aNd myeLOprOLiFeratiVe diSOrderSB. IMBERT1, N. KHERAT1, I. MARIE2, H. DESMURS-CLAVEL3, P. CARPENTIER1

1 CHU de Grenoble, Clinique de medecine vasculaire, Grenoble, France2 CHU de Rouen, Service de médecine interne, Rouen, France3 Hopital Edouard Herrriot, Service de médecine interne, Lyon, France

Arterial and venous thrombotic events are frequent in myelo-proliferativedisorders(MPD)(50%),andoftenindicativeofdisease.On the other hand, microvascular damage, including ischemia and digital necrosis, which are the most severe forms, often appear to be a source of wandering and delay to diagnosis. We report a retrospective multicenter study of 18 cases of severe ischemiaornecrosisoffingerortoe,associatedwithMPD,including9polycythemia vera (PV) and 9 essential thrombocythemia (ET). They are 16 men and 2 women, average age 55 years, for which we collected clinical, laboratory and monitoring data. results: The microcirculatory damage was indicative of the MPD in 75%cases(14/18)intheformofdistalischemia,necrosis,including10digital and 4 necrosis immediately preceded by other microcirculatory events (purpura, pseudo- chilblain, livedo, severe Raynaud’s phenomenon).Thetoesaremorefrequentlyaffectedthanthefingers(72%vs.28%)anddamagewasbilateral4times.TimetodiagnosisofSMPisgreaterthan6monthsin64%ofcaseswithan average of 11 months.Blood count showed hemoglobin less than 170g/l and platelets less than 700G/l in half of cases. Finding the JAK2 mutation or culture hematopoieticprogenitorsledtothediagnosisin80%ofcases.Theoutcomewasveryfavorablein90%ofcases,withhealinginnineweeks with antiplatelet treatment and / or Iloprost, sometimes even before cytoreductive treatment. However, amputation was performed 2 times. discussion: The delay in diagnosis of ET or PV is common before ischemic events often dragging, which is all the more regrettable that the prognosis of this condition is good. Differential diagnoses are numerous. The CBC may be normal or subject to minimal disturbance whichshouldattractattention.Ifdoubt,tofindaJAK2mutationallowsdiagnosisin80-90%ofcases.Keywords: Digital ischemia, Myeloproliferative disorders, Microvasculature

pS6-8 prOpHyLaXiS OF SUSpeCted SeCONdaryrayNaUd’S pHeNOmeNONC. COSTA ALMEIDA1,, L. CARVALHO1, L. REIS1, J. FORTUNA1,

C. COSTA ALMEIDA1

1 Centro Hospitalar de Coimbra, Coimbra, Portugal

Raynaud’s phenomenon secondary to collagen diseases, in special systemic scleroderma, being present for a long time before other manifestations take place, produces severe, painful, recurrent lesions of the extremities, with patient’s bad quality of life and the frequent need for minor surgical interventions or even amputations. Treatment of vasospasticischemicepisodesinthissituationcanbedifficult,andtheirclinical importance is based on their frequency and duration, as well as their intensity. An antagonist of endothelin’s receptors, bosentan, has been used, successfully, to prevent these episodes, making them at least less frequent, improving patients’ quality of life. Case of a 63-year old lady with a Raynaud’s phenomenon for more than 20 years and increasing severity, with pain and recurrent development of distal necrosis points and sub-ungueal abcesses in hands and feet, with a terrible quality of life, is presented, for which it was never possible tofindaprimary cause.Classifiedas “suspected secondaryRaynaud’s phenomenon” (or suspected Raynaud’s syndrome), having to be admitted to hospital 3 or 4 times a year, for one month of intravenous treatment with iloprost (prostaciclin I2 analog, the only treatment that has been able to reverse her severe ischemic episodes and prevent amputation). After last one month-stay in hospital, June 2009, she was put on oral intake of bosentan.She has been taking bosentan in the dose for systemic sclerosis, under adequate laboratory controls, with no adverse effects. Since the beginning of the treatment – for almost one year now – she has nod had any vasospastic ischemic digital episodes.Conclusion: bosentan was very effective as a prophylactic measure in this case of severe Raynaud’s phenomenon, only suspected of being secondary because there is not any prove of this patient suffering of a collagen disease so far (more than 20 years of evolution).Keywords: Bosentan, Raynaud phenomenon prophylaxis, Distal necrosis

pS6-9 abdOmiNaL aOrtitiS aNd dOXyCyCLiN: CaSe repOrtM. SPRYNGER1, C. NIZET1, L. A. PIERARD1

1 CHU, Liege, Belgium

Background and purpose: This case report describes the use of doxycyclin in a patient with abdominal aortitis and peri-aortitis.Case description: A 66-year-old male patient presented with chronic night-lombalgy and painful palpation of the abdominal aorta despite long-lasting nonsteroidal antiinflammatory therapy. Symptoms hadbegan 2 1/2 months earlier. CT-scan revealed atherosclerosis and calcificationsofabdominalarteries,thickening(7mm)oftheanteriorwall of the infrarenal aorta and intraluminal aortic thrombus. The maximal diameter of the aorta was 37 mm. Ultrasounds showed echolucentthickeningoftheaorticwall(6,5mm),confirmedbyMRI.Fibrinogen was elevated (5.66 g/l) and CRP was <1 mg/l. 18FDG-PET-scan showed intense hypermetabolism in front of the infrarenal aorta and common iliac arteries. Chlamydophila pneumoniae antibodies (IgG and IgA) were elevated. The patient received doxycyclin 100 mg/d during 3 months. Valsartan was continued. Pain quickly disappeared after we started the therapy and 2 months later, PET-scan showed excellent regression of hypermetabolism. The infrarenal aortic wall thickness slowly regressed down to 2.7 mm. Anti-Chlamydophilia pneumoniae IgA remained positive.discussion:Aortitismaybeduetoinflammation,infectionormaybeidiopathic. Corticotherapy can aggravate an active infectious process and even cause life-threatening dissection. We describe the case of a 66-year old male patient with abdominal aortitis and peri-aortitis and chlamydophila pneumoniae infection who received doxycyclin with a successful outcome. Doxycyclin inhibits matrix metalloproteinase-9. A recent human study showed that this drug also selectively inhibits specific cellular (aorticwall neutrophil and cytotoxicT-cell content)


and molecular (cytokines IL-6, IL-8, transcription factors AP-1, C/EBP, STAT3 and neutrophil-derived proteases) aspects of vascular inflammation in abdominal aortic aneurysms.This antiinflammatoryeffect of doxycyclin might participate in the favourable outcome of our patient.Toourknowledgethisrepresentsthefirstcaseofinflammatoryaortitis treated by doxycyclin.Keywords: Abdominal aortitis, Abdominal aortic aneurysm, Doxycyclin

pS6-10 treatmeNt OF NON-HeaLiNG WOUNdS WitHaUtOLOGOUS bONe marrOW CeLLS, pLateLetS, FibriN GLUe, aNd COLLaGeN matriXH. RAVARI1, D. HAMIDI ALMADRAI1, M. SALIMIFAR1,S. H. BONAKDARAN1

1 Mashhad University of Medical Siences, Mashhad, Iran

Objective: Foot ulcerations in diabetic patients are associated with increased morbidity and mortality, and they have a negative impact on the quality of life. Management of diabetic foot ulcers presents a major clinical challenge. There are several new approaches which are separately using for treatment of non-healing wounds such as bone marrow stem cells injection along with their topically applying, plateletsgrowthfactorsandfibringlue.design and method: 10 diabetic patients (7 males and 3 females with mean age 53 years) presenting with a chronic foot ulcer (mean duration 5 months) were included in a prospective study. The marrow-derived cells were injected into lower extremity chronic wounds along with platelets, fibrin glue andbonemarrow-impregnated collagenmatrix.The patients were followed up regularly one, two and four weeks later for all relevant parameters.results: The wounds showed a steady overall decrease in wound size/surface77%after2weeksand88%after4weeks.Completewoundhealingoccurredin30%patientsafter4weeks.Conclusions: Our study suggests that the combination of mentioned components (stem cells, platelets,fibrin glue and collagen matrix)could be used safely in order to synergize the effect of each others for ultimate closure of chronic diabetic wounds.Keywords: Diabetic Foot, Stem Cell, Wound healing

pS6-11 aSSOCiatiON OF HepariN-pF4 aNtibOdieSWitH iNtima-media tHiCKNeSS OF CarOtid arterieSA. MATTIOLI1, A. FARINETTI2, R. LONARDI2, S. PENNELLA1,3, G. MATTIOLI3

1 University of Modena and Reggio Emilia, Department Biomed Sc, Modena, Italy2 University of Modena and Reggio Emilia, Department of Surgery, Modena, Italy3 Istituto Nazionale di Ricerca Cardiovascolare, Modena, Italy

Serologic evidence of heparin-PF4 antibodies in patients (pts) with an otherwise unexplained thrombocytopenia and new thromboembolic events suggest the occurrence of heparin-induced thrombocytopenia (HIT). The aim of the study was to evaluate the prevalence of carotid thrombosis in pts treated with heparin that developed PF4/heparin/IgG complexes. design and method: Study population included 400 pts (mean age 65 ± 10 yrs) treated with unfractionated heparin. An immunoassay ELISA test was used to detect anti-heparin/PF4 antibodies. Blood samples were taken after 8 ± 2.3 days from the start of heparin treatment. Platelets, CRP, hemoglobin, serum iron, transferrin, ferritin and nutritional status were measured. All pts underwent Doppler ultrasound evaluation of carotid intima/media (I/M) thickness at day 8 and after 6 months. We compared pts who developed antibodies (group A) with pts who did not develop antibodies (group B). results:Heparin/PF4antibodieswerefoundin112pts(28%),meanoptical density was 1.236 ± 0.489 (range 1.956-0.50). In Group A

mean platelets value was 234 ± 66 at baseline, reduced to 100 ± 60 at day 6th (p<0.001), while in group B the mean value was 233 ± 61 at baseline and 199 ± 65 at day 6th (p=n.s.). At baseline, pts who tested positive had a slight increase I/M Thickness (0.80± 0.06 vs 0.84 ± 0.054). After 6 months pts with antibodies developed 2 cases of major peripheral thrombosis, one pulmonary embolism and 10 cases of minor thrombosis. The I/M thickness was slightly increased in pts of Group A (0.84 ± 0.054 to 0.86 ± 0.1). Conclusions: We reported an increase in I/M thickness in pts developing antibodies, suggesting an atherosclerotic thickening due to interaction between PF4 immunocomplexes and heparan sulphate on endothelium, inducing an immunoinjury to the endotheliumKeywords: Heparin, Antibodies, Carotid arteries

pS6-12 a COLLabOratiVe mULti-diSCipLiNaryCOmmUNity apprOaCH tO a StreptOCOCCUS pyOGeNeS iNFeCtiONG. HANCOCK1, J. V. BARANDIARAN1, T. C. HALL1,N. EL-BARGHOUTI1, E. P. PERRY1


introduction: Streptococcus pyogenes (group A) is one of the most common pathogens in humans and virulent strains of this bacterium can lead to cellulitis and toxicity of the layers of the skin. Assessing extensive wounds caused by streptococcus pyogenes is unusual for Community Tissue Viability Nurses as often such wounds are referred for vascular and plastic surgery. We discuss the management of such a patient using a collaborative approach to promote healing in the community of this complex condition. Case Study: A 33 year old male was admitted to hospital septic, with a sudden onset of a spreading necrotic wound which resembled necrotising fasciitis as it caused sporadic ulcerated lesions of the foot and leg. The patient needed emergency debridement and multiple surgical excision of necrotic tissues as the antibiotic therapy showed slow response. On discharge he was managed jointly between vascular surgery, plastic surgery and the community Tissue Viability Teams. Despite large wounds, he was successfully treated in the community using moist wound healing and compression therapy by the community tissue viability team.Conclusion: Multi-disciplinary working between a team of vascular and plastic surgeons, the community Tissue Viability Nurse and the patient, encouraged appropriate care planning. Through optimum wound care, compression therapy and patient education, the wound reduced in size without the need for plastic or further surgery.Keywords: Streptococcus pyogenes, Compression therapy

pS7-Chronic venous disorders / Lymphedema

pS7-1 are tHere iNCUrabLe LeG ULCerS?F. ZERNOVICKY1, K. SAMELOVA2, F. ZERNOVICKY Jr.3

1 ANGIO, Bratislava, Slovak Republic2 University Hospital, Geriatric clinic, Bratislava, Slovak Republic3 National Cardiovascular Institute, Clinic of Vascular Surgery, Bratislava, Slovak Republic

Leg ulcers present a serious problem as for the patients, so for healthcare system and for the whole society. Expenses for their treatment are astronomically high. The key to the success is the correct diagnosis with exactdefinigoftheetiology.Thecorrecttreatmentmustbyspecific.Authors present their material: 351 leg ulcers treated in 2002 - 2009.19 ischemic - 17 of them healed, 11 vasculitic - 9 of them healed, 4 lymphatic - all healed,but 1 repeatedly recurred, 3 were malignant - 1 healed, 1 refused surgery, 1 died. 314 were of venous origin - 284 (90%)ofthemhealed,butwith8,5%recurrencyrate!Authors demonstrate the most common, but also some curious diagnostic and therapeutic errors- having serious, sometimes fatal consequences.

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Closing the authors constate, that there are much more wrongly treated, as really incurable leg ulcers.Keywords: Etiologic diagnosis, Differentiated treatment, Conditions of success

pS7-2 pHLebOLOGiCaL paSSpOrtT. ALEKPEROVA1, A. TRUXANOV2, S. MUSAEVA3,O. ALEKPEROV4

1 Medical Post-Graduate Academy, Moscow, Russia2 National association of experts of regenerative medicine, Moscow, Russia3 Privat Moscow Medical Centre Seguall, Moscow, Russia4 Moscow Medical University, Moscow, Russia

Objective: To create a common medical language for ÑVD, developed a universal document - phlebological passport, which meets all the necessary for the process of treatment and rehabilitation.Design: Develop a universal document of rehabilitation assistance CVD.methods: Phlebological passport has three sections - diagnostic, therapeutic, informational. The methodological basis of the diagnostic section isCEAP.Thehealth section reflectsmadeappointments andmedicalmanipulations and recorded their effectiveness is confirmedby ultrasound data-mapping with posttherapeuticaly monitoring. In information submitted to the department all of the necessary information forthepatient,identifiedindividualriskofCVDand/oritsrecurrence,formed by the activitiesKeywords: CEAP classification, Phlebopassport, Prevention andrehabilitation

pS7-3 eLeCtrO-StimULatiON WitH VeiNOpLUS®

a NeW metHOd FOr tHe treatmeNt OF CHrONiC VeNOUS iNSUFFiCieNCy OF tHe LOWer LimbSV. Y. BOGACHEV1, O. V. GOLOVANOVA1, A. H. KUZNIETOV1, A. O. STCHEKOIAN1

1 Russian State Medical University, Department of Angiology & Vascular Surgery, Moscow, Russia

Background: Electro-stimulation with VEINOPLUS® has recently emerged as a new technique to activate the calf muscle pump and improve symptoms of venous disease. The aim of this study was to determineinpatientssufferingfromvenouschronicedema,theefficacyof this treatment in terms of reduction of evening edema, diminution of pain, improvement of quality of life and evaluate the durability of the treatment.method: 30 patients (32legs) aged 19-50 classified CEAP C3withchronic evening venous edema wererecruited. All patients were treated with CE-registered VEINOPLUS® neuromuscular stimulator during 30 days: (each session: 20 minutes). Main criteria was the circumference of the supramaleoal shin segment, measured with a tape in the evening, before treatment, daily and as control 5 days after treatment. As secondary criteria, patients were assessed on day 0 and 35 regarding pain on the Visual Analog Scale, Quality Of Life (QOL) according to CIVIQ questionnaire and venous Refilling Time (RT) measured byPhotoplethysmography. Three months after the treatment, evaluation of symptoms was made again. RESULTS: Total or partial reduction of evening edema was shown in 93.8% of limbs, circumference ofthe supramalleolar shin diminished by 20,3mm (p<0.001), number of painful legs reducedfrom 28 to 12 and severity score was cut from 8.3±1.1 to 3.8±0.9 (p<0.001), QOL score dropped from 34.5±7.8 to 17.2 points ±4.6 (p<0.001) and RT increased from 17.1±0.9 to 21.5 seconds ±1.1 (p<0.001). Conclusion: Electrostimulation with VEINOPLUS® is an effective and well-tolerated therapeutic method for the treatment of chronic venous disease when it comes to treatment of chronic edema, for reducing pain and improving QOL. It can be used as additional means in the treatment and the prevention of symptoms of chronic venous

insufficiency.Stimulation with VEINOPLUS® could also impovevenous hemodynamics.This finding should be investigated andconfirmedinfurtherstudies.Keywords: Veinoplus, Edema, Calf muscle pump

pS7-4 ObSerVatiONaL StUdy OF tHe SyNerGybetWeeN SCLerOtHerapy aNd a Grade a VeiNOtONiC iN CHrONiC VeNOUS diSeaSe OF tHe LOWer LimbSF. ALLAERT1, J. P. GOBIN2

1 Chair of medical evaluation, Dijon, France2 Phlebologists, Lyon, France

Objective: To describe the evolution of physical and functional symptoms of venous disease under the combined effects of sclerotherapy and a grade A venotonic.methods: This observational study was conducted among phlebology, angiology and vascular medicine patients presenting with venous disease at CEAP stages C1S to C3S. Patients were being treated simultaneously with a grade A venotonic and sclerotherapy consisting of at least two injections at three week intervals. The main criterion was the evolution of physical and functional symptoms as assessed by visual analog scales from 0 to 100. Secondary criteria consisted of CIVIC questionnaire assessed quality of life and patient satisfaction.results: The study included 1004 mainly female patients (89.4%)aged 50.4 ± 14.1.Of these, 13.2%wereC1s, 31.8%wereC2s and55.1% were C3s. Among these patients 72.0% were treated withliquid sclerotherapy, 24.2%with foam sclerotherapy and 3.8%witha combination of the two. After one month, pain went from 35.4 to 19.3 (p<0.001), heaviness from 44.4 to 21.5 (p<0.001), occurrence ofoedemafrom55.1%to40.0%(p<0.001)andCIVICquestionnaireitemsalsoalteredsignificantly:mentaloutlookfrom18.8to12.5,painfrom 40.9 to 26.7, social factors from 31.4 to 22.0 and physical factors from 22.0 to 14.9. Patients assessed their satisfaction as 68.5 on a scale from 0 to 100.Conclusion:Patientspresentingforsclerotherapyexperiencesignificantvenous symptomatology which must be alleviated. Combination of sclerotherapy and a proven phlebotonic (grade A) reduces patient discomfort and increases satisfaction.Keywords: Varicosis, Sclerotherapy, Synergy

pS7-5 LeG ULCerS aNd HydrOXyUrea: HaS tHetreatmeNt tO be diSCONtiNUed?U. MICHON-PASTUREL1, I. LAZARETH1, A. BOUCHAREB1,P. PRIOLLET1

1 Hopital Paris Saint Joseph, Paris, France Objective: Leg ulcers have been reported in patients undergoing long- term hydroxyurea therapy for a myeloproliferative disease. Drugwithdrawalisoftenrequired,neatherhydroxyureaefficiencyonmyeloprolifrative disorders is the best recognized therapeutic option. To demonstrate that hydroxyurea hydroxyurea can be purchased in most of the cases, we report this observational study.Hydroxyurea-induced leg ulcers are usually painful and characterized by a poor response to traditional local and systemic therapies. We also describe our experience with whole thickness pinch grafts (according to the Reverdin’s method) in this indication.design and method: All patients treated by long term hydroxyurea and having leg ulcers, hospitalized in our vascular medicine unit, were involved. Cardiovascular risk factors, history of arterial or venous disease, clinical, haemodynamical and biological data were registered. A complete vascular assessment, with arterial and venous Doppler ultrasonography, was performed for all the patients. results:Tenconsecutive(fivemenandfivewomen)patientsseeninourvascular medicine unit from 2005 to 2009 were involved. All received long-term hydroxyurea treatment and have painful and refractory leg ulcers. Mean age was 78.2 years (59- 92) and mean therapy duration 9 years.


8/10 had an underlying venous disease, 7/10 an arterial disease.In half of patients (5/10), hydroxyurea was purchased and leg ulcers healed in 4/5 patients. In half of patients, hydroxyurea was stopped and leg ulcers healed in 2/5. 2 to 6 skin grafts by patient were performed. 2/10 patients had an arterial revascularization and 1/10 a venous crossectomy.Finally,60%ofthepatientshealedtheirulcersand40%wereimproved.100%werepainless.Conclusion: Leg ulcer is a polyfactorial disease which require a complete cardiovascular assessment and a vascular global management. Anexhaustivevascularcheckingisnecessary.Skingraftsareefficientinthisindication,leadingto60%healinginourexperience.Keywords: Leg Ulcer, Hydroxuurea, Skin graft

pS7-6 prediCtOrS OF tHe pOSt-tHrOmbOtiCSyNdrOme dUriNG LONG-term treatmeNt OF prOXimaL deep VeiN tHrOmbOSiSF. POLLICE1, P. POLLICE1, B. DI RENZO1

1 L’Aquila University, Department of cardiology, L’Aquila, Italy

Summary: Background. The post-thrombotic syndrome is a chronic, poorly understood complication of deep venous thrombosis(DVT). Objectives: To evaluate predictors of the post-thrombotic syndrome, including intensity of long-term anticoagulation, and to assess the impact of the post thrombotic syndrome on quality of life. patients and methods: The setting was 10 italian hospitals. One hundred and forty-five patients with an unprovoked episode ofproximal DVT who were initially treated with 3 months of conventional intensity warfarin then participated in a trial comparing two intensities of long-term warfarin therapy. Post-thrombotic syndrome was assessed at the end of the trial using a validated clinical scale generic and venousdisease-specificqualityof lifewas compared inpatientswithand without the post-thrombotic syndrome. Multivariable regression analyses were performed to identify predictors of the post-thrombotic syndrome and of its severity. results: After an everage follow-up of 2.2years, the prevalence of post-thrombotic syndrome was 37% and of severe post-thromboticsyndromewas4%.Qualityoflifewasworseinpatientswiththepost-thrombotic syndrome compared with patients who did not have it. The presence of factor(F)V Leiden or the prothrombin gene mutation was an independent predictor of both a lower risk (P=0.006) an reduced severity (P=0.045) of the post-thrombotic syndrome. Intensity of anticoagulation did not influence the risk of developing the post-thrombotic syndrome. Conclusion: The post-thrombotic syndrome is a frequent and burdensome complication of proximal DVT, even among patients maintained on long-term oral anticoagulation. While the presence of FV Leiden or prothrombin gene mutation appears to be associated withareducedriskofpost-thromboticsyndrome,thisfindingsrequiresfurther evaluation in prospective studies.Keywords: Diabetic

pS7-7 treatmeNt OF LOW-FLOW VaSCULarmaLFOrmatiONS by eCHO-SCLerOtHerapy WitH pOLidOCaNOL FOam: 24 CaSeS aNd LiteratUre reVieWS. BLAISE1, M. CHARAVIN-COCUZZA1, H. RIOM2, M. BRIX3,C. SEINTURIER1, J. M. DIAMANT4, G. GACHET5,P. H. CARPENTIER1

1 CHU Grenoble, Vascular Medicine Department, Grenoble, France2 Vascular Office, Grenoble, France3 CHU Grenoble, Maxillo Facial Surgery Department, Grenoble, France4 Vascular Office, Grenoble, France5 Vascular Office, Voiron, France

Objectives:Treatmentwithsclerotherapyhasbeensuggestedasfirst

linetreatmentoflow-flowvascularmalformations.Thisstudyreportsthe treatment experience by echosclerosis polidocanol foam in low-flowmalformationsofVascularMedicineDepartmentofGrenoble.Design: Retrospective single-center seriesmaterials and methods: The records of all patients with symptomatic vascular malformation type low-flow veno-venous or lymphatic orcomplex type Klippel-Trenaunay syndrome (KTS) echosclerosis treated between January 2006 and December 2009 were analyzed. The therapeutic indication was always previously validated by the Consultative Committee of vascular malformations of the University Hospital of Grenoble. All vascular malformations were classifiedaccordingtotheClassificationofHamburg.Thesclerosantpolidocanolwas used as a foam.results: 24 patients 7-78 years were treated (19 venous malformations, 3 venous malformations KTS and 2-nodes). The concentrations of polidocanol used ranged from 0.25 to 3%. The average number ofsitting was 2.3 [1-16]. After a median follow-up of 9.5 months [1-58], 23 of 24 patients notaient a decrease in pain in 9 cases, a reduction of over50%oftheinitialvolumewasobtainedand58.3%reductionlessthan50%oforiginalvolume.Twominorsideeffectswerereported.Conclusions: Treatment with echosclerosis using polidocanol foam seems to be well tolerated. This treatment will improve the symptoms of abnormalities in slow flows without the risk of more aggressivesclerosing products such as ethanol.Keywords: Vascular malformation, Foam sclerotherapy

pS7-8 iNteNSiVe reHabiLitatiON prOGram FOrLympHedema: ONe Or tWO WeeKS?B. VILLEMUR1, F. VELLUT, J. Y. BOUCHET, B. BUCCI, V. EVRA, M. P. DE ANGELIS, A. MARQUER, D. PERENNOU1 CHU Grenoble, Cliqnue MPR, Vascular rehabilitation unit, Echirolles 38434, France

introduction: Severe lymphoedema responds very well to an intensive rehabilitation program performed in a vascular rehabilitation unit (Gironet et al 2004). Such programmes usually consist in: manual lymphatic drainage, intermittent pneumatic compression, multi-layer inelastic and elastic bandaging, patient education and physical exercise. The optimal duration of these programs remains to be determined. Objectives: Quantifying the efficiency of an intensive vascularrehabilitation program for the treatment of lymphoedema. Testing the hypothesisthat2weeksismoreefficientthanoneweek.method: Twenty female patients (62,6±5,6 years) with idiopathic (7) or secondary (13) lymphedema of the upper (10) and the lower (10) limb were recruited for this study, and assessed before treatment (W0), after one week (W1) or two weeks(W2) of inpatient treatment. Three criteria were used: an index of limb circumference (average of 8 different circumferential measurements for the same limb), the range of motionforpassiveflexionofelbowandknee;anadhoctestofactivemobility. Non parametric statistics were used. results:Ifanefficiencywasobtainedafteroneweek,thisefficiencywas better after 2 weeks of intensive rehabilitation: decrease of limb circumference = 2 cm at W1 and 2,6 cm at W2 (p<0.001) ; the gain ofpassiveflexionwas10°atW1and13°atW2(p=0.01);theactivemobility test was increased to 2,6 at W1 and 3,6 at W2 (p=0,03). Conclusion: A program of two weeks of intensive lymphoedema rehabilitationismoreefficientthanaone-weekprogram.Bibliographie: 1. Gironet N et al. Lymphedema of the limb: predictors of efficacy of combined physical therapy. Ann Dermatol Venereol2004;131:775-9Keywords: Lymphedema, Intensive rehabilitation

pS7-9 prOGNOStiC VaLUe OF LympHOSCiNti-GrapHy FOr prediCtiON OF pOStmaSteCtOmy LympHedemaM. MYASNIKOVA1, N. GORDEEV1

1 Pavlov’s State Medical University, Saint-Petersburg, Russia

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Objectives: Development of postmastectomy lymphedema of the upper limb is usually explaned by certain risk factors such as axillary surgery, radiotherapy, obesity, venous outflow obstruction, delayedwound healing, and infection. According to published reports, the incidence of lymphedema of the arm in patients with breast cancer after radicalsurgeryvariesfrom5to50%.Thepurposeofthecarriedstudywastoevaluateefficiencyoflymphoscintigraphyforidentifyingthoserisk factors that may result in secondary lymphedema after surgical treatment for breast carcinoma in a large patient series.design and method: Using dynamic lymphoscintigraphy we performed intravital visualization of functionally active lymph collectors of 600 upper extremities: 300 in healthy subjects, 80 in patients with breast cancer before treatment, 70 in operated patients without postmastectomy edema, and 150 – in patients with postmastectomy edema.results:Threevariantsofnormal lymphflowpatternwere revealedinhealthysubjects:collector(62%),diffuse(18%)andnodular(20%).In patients that undergone mastectomy collector pattern was found in56,2%andedemawasveryseldom in thesepatients;diffuse– in10%ofpatientswithoutedemaandin42%ofthepatientswithedema;nodular– in25%ofpatientswithoutedemaandpracticallynever inpatients with edema.Conclusions:Diffusepatternoflymphflowcouldbeestimatedasanunfavorable prognostic sign. In these patients complex conservative treatment should be started in advance, before clinical appearance of the edema.Keywords: Postmastectomy lymphedema

pS7-10 eFFeCtiVeNeSS OF mULtiLayer baNdaGe iNHeaLiNG VeNOUS ULCerSF. FERRARA1, I. MURATORI1, F. MELI1, C. AMATO1,M. LUNETTA2, R. ALCAMO1, S. NOVO2

1 Division of Angiology, Palermo, Italy2 Division of Cardiology, Palermo, Italy

The multi-layer high compression system is described as the current gold standard for treating venous ulcers. A recent meta-analysis of bandaging systems found that multi-layer compression bandages appeared to be superior to single-layer bandages in promoting venous ulcer healing. The aim of this study is to compare the in patients with chronic venous ulceration compared to standard short stretch (SS) compression bandaging. An open, randomized, prospective, single-center study was performed in order to determine the healing rates of VLU when treated with different compression systems and different sub-bandage pressure values. Patients aged at least 18-years-old with leg ulceration of suspected venous etiology were screened for inclusion in the trial. Before inclusion in the study, all patients underwent a color Duplex scan (CS) examination and ankle-brachial pressure index measurements. Patients were randomized into two groups: 30 patients who were treated using a heel-less, open-toed, elastic class III compression device knitted in tubular 30 patients treated with a multi-layer bandaging system comprised of single stretch compression bandage and inelastic bandage impregnated with oxide paste and coumarin. Group A patients were medicated every two days while group B patients were medicated every ten days. Of the 63 patients, 60 completed the protocol. Two patient received multi layer bandage had local allergic reaction, and one patients with stretch bandage discontinued the study for poor compliance. After 12 weeks in patients in group A was not observed a complete recovery, while all patients in group B had achieved complete ulcer healing. The results obtained in this study indicate that better healing results are achieved with multi-component compression systems than with single-component compression systems and that a compression system should be individually determined for each patient according to individual characteristics of the leg and Calf Circumference.Keywords: Venous ulcers, Multi-layer compression system, Short stretch compression

pS8-Varicose veins

pS8-1 VeiN – term CLaSSiFiCatiON/ VeNOUS reFLUXpatterNS aNd Great SapHeNOUS VeiN SpariNGF. TOSCANO1, C. PEREIRA ALVES1, J. NEVES1, A. FORMIGA1

1 Hospital Santo António dos Capuchos, Lisbon, Portugal

Objective: Detailed analysis of reflux patterns of 94 consecutivepatients operated on by the same surgical team following the VEIN TermClassificationcriteria.methodology: Computer registry of CEAP, Reflux patterns (Axial[Ra]/Segmental[Rs]), typeofsurgery(Axialreflux=classicsurgery;Segmentalreflux=GSVsparing)results:35patientsclassifiedasAxialreflux;59patientsclassifiedasSegmentalreflux.3differentpatternsofsegmentalrefluxwereconsidered.R(S1;S2;S3)S1-involvingsuperficialvaricoseveinsonly-17patients S2- involving varicose branches plus adjacent segments of GSV - 13 patients S3- involving varicose branches plus the SFJ and a shorter or longer segment of GSV – 29 patientsCEAP distribution: Ra: C2 – 17; C4a – 6; C4b – 8; C5 – 4 Rs: C2 – 41; C4a – 13; C4b – 3; C5 - 2Clinical follow-up showed no recurrence so far. 10 - S3 sub group randomized patients were subjected to pos-op eco-doppler monitoring revelling recovery of normal flow of previously refluxive GSVsegments.Conclusions:1-Segmentalrefluxwasfrequent,63%ofpatients.2-PreservationofGSVevenifarefluxivesegmentexisted(butwithnocontinuous involvement) doesn’t seem to conditionate recurrence but instead is followed by recovery of normal GSV function.3-OurCEAPdataconfirmedmoresevereclinicalclassesamongaxialthansegmentalrefluxes.Keywords: Varices, Saphenous, Sparing

pS8-2 CLiNiCaL eXperieNCe OF SaLem eNdOtHe-LiaL StrippiNG OperatiON FOr tHe SUrGiCaL treatmeNt OF primary VariCOSe VeiNS OF tHe LOWer LimbSM. SALEM1, A. SALEM2, T. SALEM3

1 Faculty of Medicine, Department of Vascular Surgery, Alexandria, Egypt2 Medical Research Institute, Department of Surgery, Alexandria, Egypt3 Faculty of Medicine, Department of Internal Medicine, Alexandria, Egypt

Objective: New instrument Salem Stripper & operation Salem Endothelial Stripping Operation are described. The operation & the Stripperwereinvented&designedbythefirstauthorforthesurgicaltreatment of primary varicose veins of the lower limbs to avoid the complications of vein stripping operation.design & method: 500 patients with primary varicose veins of the lower limbs were studied. All cases were collected at random in 14 years (from Jan. 1991 – Jan.2005). The diagnosis was done by history & clinical examination. No patient gave past history of deep vein thrombosis.Routine laboratory investigations were done. Duplex Ultrasound was done to all cases. All cases were treated surgically by Salem Operation using Salem Stripper.results & conclusions: The age incidence was between 20 -56 years with a mean of 32 years. Female sex represented 58%. The mostcommon presentations of primary varicose veins of the lower limb were: varicosities, heaviness of the limb, dull aching pain, burning pain& disfigurement.The great saphenous veinwas affected in all


cases,unilateralinvolvementwasin460patients(92%),whilebilateralinvolvementwasin40patients(8%)&associationofshortsaphenousvarices was in 12 patients (2.4%).The hospital stay after operationranged between 5-10 hours with a mean of 7 hours (one day surgery). Postoperative residual varicosities were managed by sclerotherapy. Postoperative ultrasound showed obliteration of the varices. Follow up of the patients was done for a period of 5 years from time of operation with a total recurrence of 39 limbs (7.22%). InConclusion: Salem Operation is simple, safe, cheap & easy operation. The results were excellent with no hemorrhage, no hematoma, no saphenuos neuritis, no hospital stay & early return back to work Award winner, San Francisco, USA.US Patent 1991.Keywords: Varicose veins, Salem Operation, Treatment of varicose veins

pS8-3 earLy reSULtS FrOm SCLerOtHerapy FOrtreatmeNt OF VariCOSe VeiNSD. LUKANOVA1, I. LOZEV2

1 National hospital of Cardiology, Clinic of Vascular surgery and Angiology, Sofia, Bulgaria2 Ministry of Internal Affairs, Clinic of Surgery, Medical Institute, Sofia, Bulgaria

Sclerotherapy is a non-surgical method for treatment of varicose veinsbyinjectionofacorrosiveagentthatcausesfibrosisofthevein.The injection is performed under visual or ultrasonographic control. Sclerosing solutions and foams are in use.The aim was to observe our early results from sclerotherapy for treatment of reticular varicose veins and teleangiectasiae.Material and method: We treated 230 out-patients, mainly women, in one or several sessions. In all of them we did previous Doppler ultrasonography. Follow up examination was performed one month later.results: Theearlyaestheticandtherapeuticresultsareexcellentin90%of cases.They were the same after a month. Only mild complications wereobserved,likehyperpigmentations,in3%ofpatients.Conclusion: The advantages of sclerotherapy are that it can be performed inaphysician,soffice, inpatientsonanticoagulantsor inelderlypatientsthataredifficulttooperateon.Thissafeprocedurecanbe repeted after time.Keywords: Sclerotherapy, Varicose vein, Sclerosing solutions

pS8-4 preOperatiVe aNd iNtraOperatiVe tripLeX SONOGrapHy iN SUrGiCaL treatmeNt OFVariCOSe VeiNSI. LOZEV1, N. SMILOV1, P. LOZEV1, D. DARDANOV1, G. KIROV1

1 Ministry of Interior, Medical Institute, Sofia, Bulgaria

inroduction: Rate of recurrence after surgical treatment of patients with varicose disease causing CVI remains high, the most common causes are incorrect diagnosis and poor surgical technique.Objective: Using prospective analysis, to assess the impact of preoperative and intraoperative triplex sonography on the radicality of surgical treatment and the reduction of recurrence in patients with varicose disease.design and method: Surgery for varicose veins (VV) was performed in 159 patients (167 limbs - Group ND) without using of preoperative and intraoperative triplex sonography - when the diagnosis is given by clinical examination and bi-directional Doppler.254 patients (276 limbs - Group D) were operated using preoperative and intraoperative triplex sonography. Patients in group D and ND, two years after the operation were examined clinically and with triplex sonography.Results: Based on the results of preoperative triplex sonography study of superficial veins anddeepvenous system, sixmodelsof valvularrefluxaremadeofLSVandSSV.

TheoccurrenceofpostoperativerecurrentVV(aftertwoyears)in35%oftheNDgroupandin7%ofDgroup,mostoftenisduetoinappropriateselection,incorrectinitialdiagnosis,poorcorrectionofvenousreflux,bad intraoperative technique and improper postoperative treatment or progression of the disease.Conclusions: CVI causing varicose disease is the result of venous hypertensionmost often caused by a primary valvular reflux in thesuperficial veins. The disease develops in different reflux models.Preoperative and intraoperative triplex sonography gives objective information about the overall condition of the superficial and deepvenous system, the presence of varicose and valvular reflux. Thisallowsdevelopmentofaccurate,functionalmorphologicrefluxmodel,which allows for choosing the correct surgical approach - removing valvularrefluxandvaricoseveinsatalllevelsandlocations.Keywords: Preoperative intraoperative, Intraoperative, Triplex sonography

pS8-5 treatmeNt OF SymptOmatiC VariCOSeVeiNS aNd SmaLL SapHeNOUS VeiN reFLUX WitHeNdOVeNOUS LaSer abLatiON dOeS NOt reQUireCONCOmitaNt pHLebeCtOmyJ. LAREDO1, J. KWOCK1, B. B. LEE1, R. F. NEVILLE1

1 Georgetown University Medical Center, Washington, USA

Objective:Thisstudyassessedtheefficacyofofficebasedendovenouslaser ablation therapy (EVLT) in treating symptomatic varicose veins and incompetence of the Small Saphenous Vein (SSV). All procedures were performed under local anesthesia without sedation and all patients were assessed for the need for post EVLT sclerotherapy. methods: Patients with symptomatic varicose veins and venous duplexultrasounddocumented refluxof theSSVandCEAPclinicalclassificationof2orgreaterunderwentEVLToftheSSVwithtumescentanesthesia. Concomitant phlebectomy of symptomatic varicose veins was not performed. Post procedure follow-up included venous duplex ultrasound and multiple clinical evaluations of symptomatic varicose veins. results: From December 2005 to June 2008, 95 SSVs were ablated in 95 limbs in 82 patients (57 women, 25 men, mean age = 55.2 yrs). Two patients had previous EVLT of the ipsilateral greater saphenous vein (GSV) and 6 patients had previous GSV stripping in the ipsilateral leg.CEAPclinicalclassificationwasC2n=18,C3n=43,C4n=11,C5 n = 3, C6 n = 20. Post procedure venous duplex ultrasound showed completeablationof98.8%of treatedSSVswithone recanalization(2 wks: 63/63, 3 mos: 19/20, 6 mos: 5/5). Subsequent sclerotherapy for residual symptomatic varicose veins was required in 29 of 95 treatedlimbsin29patients(30.5%).Onepatient(1.1%)developedacalf DVT post procedure and was treated with anticoagulation. Minor complications were limited to phlebitis and cellulitis seen in two patients (2.2%)andonepatient(1.1%)respectively(outof82patients).Conclusion: EVLT of the SSV in patients with symptomatic varicose veinsandincompetenceoftheSSVisefficaciousandisassociatedwithminimal complications. The majority of patients undergoing EVLT of the SSV do not require additional treatment of residual symptomatic varicose veins.Keywords: Small Saphenous Vein, Endovenous Laser Ablation, Phlebectomy

pS8-6 eNdOVeNOUS LaSer abLatiON OF tHe aNteriOr aCCeSSOry Great SapHeNOUS VeiNJ. LAREDO1, S. SHIN1, B. B. LEE1, R. F. NEVILLE1

1 Georgetown University Medical Center, Washington, USA

Background: The Great Saphenous Vein (GSV) is the most commonly affected vein in patients with superficial venous insufficiency.Incompetence of the Anterior Accessory Great Saphenous Vein (AAGSV)isestimatedtooccurinapproximately10%ofpatientswithsymptomaticvaricoseveinsandsuperficialvenousinsufficiency.The

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aimofthisstudywastodeterminetheincidenceofAAGSVrefluxinthispatientpopulationandtoassesstheefficacyofendovenouslaserablation (EVLT) of AAGSV.methods: From December 2006 to June 2008, patients with symptomatic varicose veins underwent clinical evaluation and venous duplexscanning.AAGSVrefluxwastreatedbyEVLTwithtumescentanesthesia. Patients with GSV and AAGSV reflux underwentsimultaneous ablation of both veins. Post procedure follow-up included venous duplex ultrasound and clinical evaluation. If necessary, sclerotherapy or stab phlebectomy of symptomatic varicose veins was staged in the follow-up period.results:Atotalof313limbsin255patientshadrefluxinvolvingtheGSV, AAGSV and Small Saphenous Veins. The incidence of AAGSV refluxwas11.5%(36limbs,35patients).EVLTablations(n=36)oftheAAGSV were performed in these patients (30 women, 5 men, mean age=51.8 yrs). Six patients had previous EVLT of the ipsilateral GSV and ten patients had prior GSV stripping in the ipsilateral leg. The remaining 20 limbs had a competent GSV which was not treated. The incidenceofconcomitantAAGSVandGSVrefluxwas1.6%(5limbs).Post procedure venous duplex ultrasound showed complete ablation of100%of treatedAAGSVsat9months.Subsequent sclerotherapyfor residual symptomatic varicose veins was required in 11 of 36 treatedlimbsin35patients(30.6%).Nosignificantcomplicationswereobserved.Conclusion: Isolated incompetence of the AAGSV occurs in approximately 10% of patients with symptomatic varicose veins.EVLT of the AAGSV efficacious and is associated with minimalcomplications.Keywords: Anterior Accessory Saphenous, Endovenous Laser Ablation,VenousInsufficiency

pS8-7 a piLOt raNdOmiSed triaL OF CatHeterdireCted FOam SCLerOtHerapy WitH tUmeSCeNCe VerSUS LaSer abLatiON iN patieNtS WitH LarGe SapHeNOUS diameterS: a NC. R. LATTIMER1, E SHAWISH1, E. KALODIKI1, M. AZZAM1,G. GEROULAKOS1

1 Ealing Hospital and Imperial College, Department of Vascular Surgery, SW7 2AZ London, United Kingdom

Objective: Ultrasound-Guided Foam Sclerotherapy (UGFS) alone is less effective in obliterating veins in patients with Great Saphenous Vein (GSV) diameters at or above 8mm when compared to Endovenous Laser Therapy (EVLT). We propose Catheter-Directed Tumescence-assisted Ultrasound-Guided Foam Sclerotherapy (CDT-UGFS) as a new technique to improve GSV obliteration by reducing saphenous calibre and controlling foam deployment.design and method: Twenty-six symptomatic patients were randomized into CDT-UGFS (mean venous diameter 9.1mm, range 8mm - 12mm) or EVLT (mean venous diameter 9.7mm; range 8.3mm - 12mm). Assessments were performed before and at three weeks after treatment (23 legs) using: The Aberdeen Varicose Vein Questionnaire (AVVQ) and a full duplex examination. Time to return to normal activities, treatment times and seven-day post-procedural visual analogue pain scores were also recorded. results: In the CDT-UGFS group GSV obliteration was complete in 10/11 patients, with one patient demonstrating an incomplete occlusion withmild reflux. In theEVLTpatients, obliteration of the veinwascomplete in 11/12 patients while in one there was GSV patency but withoutreflux.Post-proceduremorbidityintheEVLTgroupincludedathrombophlebitisrequiringadmission,agroinhaematomaanda30%non-occlusive femoral vein thrombosis. In the CDT-UGFS group there was less average post-procedural pain (31/100 [2-99/100] vs 9/100 [1- 80 /100], p = 0.012), a trend towards improved median quality of life (12.0 [5.5 – 34.5] vs 18.6 [10.6 – 66.9], p = 0.106), shorter median treatment times (48min [35 – 60] vs 90 min [65 – 132], p <0.001) with a trend towards earlier return to normal activities (2 days [0 – 21] vs 7

days [1 - 21], p = 0.134).Conclusions: Wehaveshowninthispilotstudysignificantadvantagesof CDT-UGFS versus EVLT in a background of a comparable obliteration of the main trunk of the GSV (>8mm diameter). Keywords: Foam, Laser, Quality of life

pS8-8 perSONaL eXperieNCe iN preSerViNG tHeGreat SapHeNOUS VeiNI. BIHARI1

1 A + B Clinic, Budapest, Hungary

aim: What is the aim of great saphenous vein preservation? Was it successful over the last 30 years? Methods: Sapheno-femoral junction ligature, plasty, wrapping, distant sclerotherapy.results: Wrapping and distant sclerotherapy gave good results only fortwoyears,ligatureandplastywereefficientfor5years.Afterthistime patients require varicose vein surgery because of recurrency. Two successful coronary bypass operations were performed with saved great saphenous veins. Conclusion: The aim of great saphenous vein preservation is for it to be used later as a bypass material. Any debate centres on the femoral part of the great saphenous vein, because the crural part in most cases is healthy and should be saved intact. It seems that the time span, about 20 years between varicose vein and bypass surgery, is too long to save a non-healthy vein in a patient who is prone to varicose vein disease. In many cases the saphenous vein requires further operations in order to maintain the necessary quality for bypass surgery. We recommend femoral part preservation if the patient’s atherosclerosis is known at the time of varicose vein surgery. Keywords: Great saphenous vein, Preservation, Bypass material

pS8-9 iNCOmpeteNt perFOratOrS - tHe UNSeeN ViLLaiNC. STUCKEY1, C. BARBIERI1, A. MARTIN2,1, K. MCDONALD3,2,1, C. CONROY2,1, R. MARTIN1, D. ROLLINS4

1 ACP, Overland Park, USA2 RVT, Overland Park, USA3 RDMS, Overland Park, USA4 ORT, Overland Park, USA

Phlebologists have accepted the role of incompetent perforators in the development of venous stasis ulcers. With the advent of portable, high resolution duplex ultrasound, the identification of the elusiveincompetent perforators has been greatly facilitated. Given the minimally invasive nature of the radiofrequency endovenous ablation, the villain can now be seen and treated. This presentation analyzes only the results of treatment of incompetent perforators, in a private phlebology practice, over a 30 month period (05/17/07 - 11/17/09). In our practice, all radiofrequency endovenous ablations accomplished at one setting constitute an intervention. The 415 patients treated, required 1322 interventions to ablate 3381 incompetent perforators (2.6 Pi/intervention). During the first 20 months analyzed, 2041 Piwere treated with an average time of 14.6 minutes/Pi. Over the last 10 months, 1340 Pi were treated and required an average of 12.2 minutes/Pi. This reduction of requisite treatment time represents a 16.4%reductionintime,andacommensurateimprovementintheefficiencyof our practice. It also demonstrates the learning curve associated with the radiofrequency endovenous ablation procedure. Our initial ablation rate remains greater than 99.75%, and the sustained ablation rate,evolvingfromthistreatmentperiodof30months,remainsover99.5%.As the number of patients increases, the number of Pi per patient has decreased from 10.1per patient, down to 8.1 Pi per patient.Keywords: Radiofrequency endovenoua abla, Incompetent perforator, Intervention


pS8-10 eNdOVeNOUS LaSer abLatiON iN treat-meNt OF VariCOSe VeiNSM. VAKHITOV1, D. SEMENOV, A. ZSIBIN, Z. ULIMBASHEVA1 St. Petersburg State I.P.Pavlov Medical University, Department of General Surgery, St. Petersburg, Russia

Crossectomy and stripping (CS) are considered as standard procedures forsapheneousveininsufficiency.Endovenouslaser therapy(EVLT)has been implemented over the last years as an alternative to CS. EVLT for ablation of the Great Saphenous vein (GSV) is supposed to minimize postoperative morbidity. Aim: To compare endovenous laser ablation versus crossectomy and stripping of the GSV in a prospective randomized trial.methods: 138 patients suffering from GSV insufficiency wererandomly assigned for EVLT or CS. 82 patients (90 lower extremities) were treated with a 810-nm Diode laser (Quanta-Italy) with spinal anaesthesia. Continuous emission, 15 W, variable retraction speed (approx.1mm/sec) were used. The speed of laser fiber retractiondepends on calibre of a vein. Parameters of laser coagulation were determined by results of our own clinical and morphological researches. 22 specimens of proximal GSV were excised and studied by light microscopy for venous wall changes after thermal damage. All cases were combined with crossectomy, mini-phlebectomy (Muller technique) and compression. Duplex ultrasound examinations were performed at baseline and followed up for 1 week, as well as for 3, 18 and 21 months post treatment.56 patients (66 lower extremities) were treated by surgical operation. Crossectomy, stripping of GSF, and phlebectomy of varicose veins were made with spinal anaesthesia.results: Both study groups were well balanced concerning age, sex and CEAP (C2-C5). EVLT and CS were equally safe. CS induced muchmorepostoperativehematomas(9,8%)anddysaesthesia(14,7%)than EVLT, while EVLT patients had more bruising and ecchymosis (43%).Forpatients,treatedwithEVLA,uncompletedocclusionwasin6,7%andpainfulphlebitisin2,3%inGSV>10mm.12patientshadrefluxinthegroinofaside-branchoriginatingfromthefemoralvein.Neither deep vein thromboses nor skin burns were observed during EVLT treatment. Keywords: Varicose veins, Laser ablation, Crossectomy and stripping

pS8-11 eNdOVaSCULar aNd SUrGiCaL tHreat-meNt OF peLViC CONGeStiON SyNdrOmeI. IGNATYEV1, R. BREDIKHIN1, E. FOMINA1, M. MIIKHAILOV2

1 Interregional Clinical and diagnostic center, Kazan, RUSSIA2 State Medical Academy, Kazan, Russia

aim: Creation of optimal strategy of treatment patients with pelvic congestion syndrome.methods: 103 women with pelvic congestion syndrome were examined and treated. All women underwent transvaginal and transabdominal color duplex scanning. 52 women underwent multislice CT, pelvic phleboscintigraphy and phlebography.results: In 51 cases dilatation of ovarian veins till 5 mm, not accompanied by a syndrome of chronic pelvic pain was revealed. This woman were treated conservatively. 17 women had aorto-mesenteric compression of the left renal vein (nutcracker syndrome). In all that cases ovarian vein diameter was more than 8 mm (mean 0,88 mm). Reconstructive operation were performed on this patients: 10 applications of the proximal ovarian-iliacal anastomoses, 5 - safenal-ovarian anastomoses. One prosthetics of left renal vein was made. And one more woman underwent transposition of the left renal vein. In the caseofidiopathicrefluxandpresenceofclinicalpelviccongestion19patients underwent one-or two-sided embolization of ovarian veins. In one case the hemangioma in the origin of the left internal iliac vein was detected as a cause of widespread sexual and pelvic varicose. Set of embolization therapy on the branches of the internal iliac vein was realized.

15 patients underwent resection surgery. Major and satisfactory results were obtained in 47 (90,1%) cases.Recurrence of symptoms was diagnosed in 4 patients after resection operations and one patient after reconstructive surgery. In 3 cases pain syndrome was observed after embolization of ovarian veins. In 2 cases the pain syndrome was treated conservatively, in one case it was an open surgery. There was no cases of recurrence of disease.Conclusion: In case of nutcracker syndrome the most effective methods are reconstructive operations for elimination of venous hypertension in the left renal vein. In the case of idiopathic dilatation of gonadal veins the most effective method is endovascular embolization of ovarian veins.Keywords: Pelvic congestion syndrome, Reconstructive surgery

pS9 - Venous thromboembolic disease

pS9-1 VeNOUS diSeaSeS iN iNJeCtiNG drUG USerSM. CZARNECKI1, B. KNYSZ1, W. KWIATKOWSKA2,J. GASIOROWSKI1, A. GLADYSZ1

1 Medical University of Wroclaw, Department of Infectious Diseases, Wroclaw, Poland2 Regional Specialist Hospital, Research and Development Centre, Department of Angiology, Wroclaw, Poland

Objective: The purpose of our study was to estimate the prevalence of venous diseases (VD) in intravenous drug users (IDUs). methods and design: Anonymous questionnaire (structured by authors)focusingonVD,filledby73IDUsattendingthesuperviseddrug consumptions clinics in the region of Lower Silesia (Poland). results: 19 women and 54 men, med.age - 34 years, 32 HIV (+) and 41 HIV (-) were enrolled into the study. 45 (61,6%) asked patients have experienced VD: venousthromboembolism, superficial thrombophlebitis (ST) and/or chronicvenousdisorders(CVD).17(23,3%)patientssufferedfromdeepveinthrombosis(DVT)ofthelowerlimbs,4(5,5%)–pulmonaryembolism(PE),14 (19,2%)–ST,6 (8,2%) -both:DVTandST.Nobodywasdiagnosed for upper limb VD. Recurrent DVT was reported by 10 patients and ST - by 12. All patients with DVT injected drugs into lower limb veins, including femoral veins. The mean length of time since the first injecting intogroin topresentationofDVTwas5,6years,mostoften–1year.44(60,1%)patientscomplainedofvarioussymptomsofCVD. 24 persons had venous leg ulcerations in the past. At the moment ofstudy10(13,7%)patientssuffered fromthechroniculceration.11patients were hospitalized because of VD, mainly due to DVT (6) or PE (2). We have registered higher prevalence of VD among HIV (+) comparing withHIV(-)subgroup.65,6%ofHIV(+)patientsexperiencedDVT/PEorST,81,3%ofthemsufferedfromCVD,whereasinHIV(-)subgroupthesevalueswere:34,1%and24,4%,respectively.Conclusions: Prevalence of venous thromboembolism and chronic venous disorders in IDUs is significantly higher than in generalpopulation. The major risk factors for venous diseases in IDUs are: punctions of the lower limb’s veins and HIV infection. Keywords: Chronic venous disorders, Venous thromboembolism, Intravenous drug addiction

pS9-2 eVaLUatiON OF OUtCOmeS FOLLOWiNGeNdOVaSCULar reCaNaLiZatiON aNd SteNtiNG OF CHrONiCaLLy OCCLUded iLiaC aNd COmmON FemOraL VeiNSA. KURKLINSKY1, H. BJARNASON1


design and methods: Retrospective case-series review of 89 consecutive patients (62 women; median age 46.16 years) from March 03, 2003 through December 01, 2008. Results and Conclusions: Median primary patency for the duration of

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study was 11.31 months. It was 43.27 months for the patients in the firstyearofthestudyreflectinglongerfollow-uptime.Therewasnosignificantdifferenceofprimarypatencydurationwhencontrolledforthe year of the inclusion in the study, age, or gender. Primary patency problemsweredetectedmostcommonlyduringthefirstyearoffollow-up.Irreversiblelossofprimarypatencyoccurredin4.5%ofthecases(only one attempted recanalization). Primary assisted patency was establishedin11%ofcases;allremainedpatientwithameanfollow-up of 25.32 months (IQ range 24.3 – 39.32). Secondary patency was established in 3.4% cases (all lost to follow-up). Venous pressuregradientsacross lesionweresignificantlyreducedfrom5.63mmHgto 0.71 mm Hg (p<0.0001; n=28). Non-invasive vascular laboratory assessment data were insufficient to draw statistical conclusionsregardingchangesinvenousobstructionorinsufficiency.Weconcludethat stenting of chronically occluded iliac and common femoral veins may provide long term patency of the vessels for over one year in the majority of patients, in accord with earlier studies.Keywords: Venous obstruction, Venous stenting, Postphlebitic syndrome

pS9-3 impOrtaNCe OF LONG term FOLLOW Up OFdVt reCaNaLiSatiONZ. PÉCSVÁRADY1

1 Flór Ferenc Teaching Hospital, Kistarcsa, Hungary

The recent practice in Hungary to diagnose DVT is compression ultrasonography ( CUS ) in the acute phase. However no regular follow up to check the recanalisation of the thrombus what is not even advised by the current international guidelines. Some paper already followed the recanalisation rate and found that the completion of this process is about ½-1 year. It is also known that the incomplet recanalisation is one of the source of the recurrent DVT. The author detailes the pathomechanism and the time course of the recanalisation and draws attention the importance of the follow up, showing some special cases. It is also disccused that the rate of recanalisation has to influence our daily practice to the periodof anticoagulation. Finally preliminary data are shown from the recanalisation effect of novel anticoagulant agents.Keywords: Deep venous thrombosis (DVT), Ultrasound diagnosis of DVT, DVT treatment, Recanalization of thrombus

pS9-4 tHe GeNetiC prediCtS OF tHe deep VeNOUStHrOmbOSiSY. NOVIKOVA1, A. SHEVELA1, K. SEVOSTYANOVA1,E. VORONINA1

1 Institut de biologie chimique et medecine fondamentale, Novosibirsk, Russia

The aim of present study is the determination of the thrombophilia genetic markers among the patients with acute deep venous thrombosis with the purpose of conservative therapy prescription, recurrence and complicationprofilaxis.methods: by this moment we studied 195 patients with deep venous thrombosis of the lower limbs. Genome DNA patterns` was received fromvenousbloodbyphenol-chloroformextraction.Thedefinitionofallelic variants of the haemostasis system`s genes was carried out by the PCR/RFLP method.results: The heterozygous polymorphism of the thrombocytic glycoproteingeneGp1a-integrin-alpha-2807C->Twasfoundin42,6%of the cases, whereas the homozygous variant of the same gene was registeredinthe8,1%patients.TheheterozygousmutationsofthegenePAI-1 substitution6755G->4G(58,3%of thecases), thegeneFGBsubstitutionG-455A Promoter (33,9%) and the gene FXII 46 C->Tpolymorphism (26%)was coming acrossmost often. In 47%of theexeminees the gene MTHFR, heterozygous polymorphous substitution 677 C->T was detected. The homozygous mutation of the folate cycle`s enzyme methylenetetrahydrofolate dehydrogenase – MTHFD

substitution1958G->Awasfoundin29,2%.Thetreatmentofpatientswith deep venous thrombosis was carrying out with consideration of genotyping data. Folic acid and anti-aggregating drugs were including in baseline therapy in patients with polymorphous variants of folate cycle`s and thrombocytic haemostasis`.Conclusion: The application of molecular-genetics methods in patients with deep venous thrombosis makes treatment and prophilaxis more effective, it helps to individualize the therapeutic tactic.Keywords: Deep venous thrombosis, System haemostasis genes, Personolized therapy

pS9-5 CLiNiCaL SiGNS aNd riSK FaCtOrS OFdeep VeiNS tHrOmbOSiS OF LOWer eXtremitieS. eFFiCieNCy aNd SaFety OF aNtiCOaGULaNt tHerapyV. MISHALOV1, E. N. AMOSOVA1, N.Y. LITVINOVA1

1 National Medical University, Kyiv, Ukraine

The purpose of our research was to conduct the retrospective analysis of clinical signs and risk factors for patients with diagnosis of acute deep veins thrombosis (ADVT) of lower extremities, treating oneself in the departments of vascular surgery and to compare effectiveness and safety of therapy.materials and methods: For period from 2004 to 2009 the diagnosis ofADVTwassetfor518patients,amongthem256(49,4%)menand262 (50,6%) women.All of patients withADVT got therapy withanticoagulants. Enoxaparin sodium was prescribed in 428 (82,6%)cases,UFH in58 (11,2%)and in20 (3,9%)–othersLMWH.Werehave analysed efficiency and complications after antithromboticaltherapy in a hospital period.results and their discussion: Therapy of UFH and LMWH was effective (on the average a good result is got inmore than in 86%cases) enough. Enoxaparin treatment was related to considerably less ofhemorrhagiccomplications, than treatmentofUFH(ð<0,05), thatconcerned all of types of such complications. Conclusions: 1.Among patients with ADVT with primary localization in ileofemoral and popliteal segments which treated in the departments of vascular surgery prevailed senior persons more than 60 years old (52,7%).2.In 83,8% cases the most frequent symptoms of disease are anedemaof extremity (in 80,1%) andpain syndrome75,1%,which atamonosymptomalvariant(34,4%patients)aremarkedin64,6%and45,4%accordingly.3. Efficiency of anticoagulant therapy was identical at enoxaparinandUFHgroupsandwasachievedin95,6%and91,3%accordingly,however in cases of enoxaparin application regress of clinical signs in wasrapid67,4%cases,whileifUFHusedonlyin55,1%cases.4. Treatment of with enoxaparin accompanied with reduced frequency of all hemorrhagic complications in 1,8 times, serious in 2,4 times and moderate in 2,8 timesKeywords: Clinical signs and risk factor, Acute deep veins thrombosis, Anticoagulant therapy

pS9-6 preVeNtiON OF tHrOmbOtiC diSOrderS iNCaNCer patieNtS UNderGOiNG CHemOtHerapyF. POLLICE1, P. POLLICE1, L. DE GIULI1

1 L’Aquila University, Department of Cardiology and Medicine, L’Aquila, Italy

purpose:Theroleofprophylacticvenacavafilters(VCF)inpatientswith cancer is debated. Although VCF are often placed in patients with cancer after recurrence of venous thromboembolic events (VTE), identificationofthissubsetofpatientshasnotbeenwell-defined.Thisstudy was undertaken to assess factors associated with increased risk for recurrent VTE. methods: All patients with a history of thromboembolism or malignant disease and who required a VCF because of failure of or


contraindication to anticoagulation therapy were abstracted from the Registry of 10 italian hospitals. results: Ninety-nine patients (49 men, 50 women) with a mean age of 58yearswereincludedinthestudy.Newmetastasesoccurredin55%ofpatients,and12%ofpatientshadahistoryofVTEbeforecancerdiagnosis.Corticosteroidagentswereusedduringtherapyin48%ofpatients.AcuteVTEwaspresentin52%ofpatientsatcancerdiagnosis,and in 34% of patients VTE was associated with new metastases.RecurrentVTEoccurredin40%ofpatients,andsignificantriskfactorsincluded presence of new metastases (odds ratio [OR], 3.3; 95%confidence interval[CI], 1.16-9.09; P=.02) and history ofVTE (OR,10.6; CI, 1.98-57.2; P=.006). Whereas a single episode of neutropenia didnot reachsignificance (OR,1.1;CI,0.97-1.35;P= .11),multipleneutropenicepisodesweresignificantlyassociatedwithrecurrentVTE(P=.04). Smoking, hormone replacement therapy, decreased mobility, post-surgical state, and obesity were not independently associated with increased risk. Mean survival in this series was 30 months, and was significantlyworseinpatientswithVTEatcancerdiagnosisandwithinability to tolerate anticoagulant therapy in conjunction with VCF.Conclusion: Patients with malignant disease may be at increased risk for recurrent VTE after development of new metastases or multiple episodes of neutropenia, especially those patients with a history of VTE. Keywords: Diabetic

pS9-7 VaLidatiON OF a deep VeiN tHrOmbOSiS prediCtiON rULe iN primary CareM. MAUFUS1, J. L. BOSSON2, C. GENTY2, A. DELLUC3,P. IMBERT4, P. GAGNE5, C. ROLLAND2, L. BRESSOLLETTE3, G. LE GAL3

1 Universite Europeenne de Bretagne; EA3878 IFR 148; Departement de medecine interne, pneumologie et medecine vasculaire, Brest, France2 CHU Grenoble, Centre Investigations Cliniques, Grenoble, France3 CHU de la Cavale Blanche, Universite Europeenne de Bretagne; INSERM CIC 05-02, IFR148, Brest, France4 Universite Joseph Fourrier, Departement de Medecine Generale, Grenoble, France5 Private medical office, Plaintel, France

Objective: Suspected Deep Vein Thrombosis (DVT) of Lower Limbs (LL)mayrequiredifferenttoolstoruleoutorconfirmthediagnosis.Clinical probability provides help to select useful tests, interpret their results, and decide to treat the patient meanwhile. Prediction rule that riskstratifiespatientwithsuspectedDVTarevalidatedforinpatients,such Wells’score, but not for outpatients. We previously derived and internally validated such a prediction rule: Brest’score. The aim of this study is to externally validate this score.design and methods: Brest’score was applied to OPTIMEV outpatients with suspected LL-DVT, and without suspected pulmonary embolism.Sensitivityandspecificitywerecalculatedforproximalanddistal DVT, according to each score. The area under the ROC curve was calculated for each kind of DVT, in order to assess the validity of Brest’score on pedicting the presence or absence of DVT.results: Among 3 523 outpatients prospectively included in the OPTIMEV study for suspected LL DVT, overall prevalence of DVT was29.7%(n=1046),rangingfrom21.7%inthenon-highBrest’scoreprobability,to61.4%inthehighBrest’scoreprobability.TheareaundertheROCcurvewas0.7870[CI95%;0.7713-0.8028].Withsubgroupanalysis,theareaundercurvewas0.8340[CI95%;0.8162-0.8518]forproximalDVT(n=465),and0.7494[CI95%;0.7284-0.7705]fordistal DVT (n=581). Conclusions:Brest’scorereliablyidentifiesoutpatientswithLLDVT,weather proximal or distal.Keywords: Deep Vein Thrombosis, Primary health care, Diagnosis

pS9-8 deep VeiN tHrOmbOSiS iN iNtraVeNOUSdrUG USerS FrOm eXperieNCe OF aNGiOLOGiC Ward aNd OUtCLiNiCW. KWIATKOWSKA1, D. KOTSCHY1, J. PRZYTULSKA1, J. DRELICHOWSKA-DURAWA1, L. MASLOWSKI1, W. WITKIEWICZ1, M. CZARNECKI2, J. GASIOROWSKI2,B. KNYSZ2

1 Regional Specialist Hospital, Research and Development Centre, Wroclaw, Poland2 Medical University of Wroclaw, Department of Infectious Diseases, Wroclaw, Poland

Objective: In the 90thies the number of intravenous drug users (IDUs) has increased. Main etiopathogenetic factors for DVT (Deep Vein Thrombosis) among IDUs are: multiple vein injuries, unsterilized injection needles, intravenous intake of insoluble particles. IDUs are up to21%ofallofthepatientsadmittedtohospitalswithDVTdiagnosisand50%ingroupunder40yearsofage.Since2004wetreated5youngpatients-IDUs diagnosed for DVT, 3 of them in the last year. We present 2 cases of IDUs (heroine) with the proximal DVT. design and method: presentation of cases.28 years old female, 8 years of addiction, HCV and HIV positive, admitted to ward with symptoms of DVT, after treatment of right groin fistula. In physical examination: no fever, traces of puncturesonextremities includingplantar sideof feet, scar fromgroinfistula,miscolored string-like veins, skin ulcerations, oedema and cyanosis of right lower limb. High D-dimer concentration, femoral vein thrombosis confirmedinultrasoundexamination.29 years old male, 5 years of addiction, HCV-positive, admitted with symptoms of DVT. In physical examination: fever, massive oedema and cyanosis of left lower limb, traces of vein punctures, groin lymphadenopathy, skin ulcerations and abscesses of both lower limbs. High D-dimer concentration. Thrombosis of iliac, femoral, popliteal and superficial veins confirmed in ultrasound examination, femoralarterypseudoaneurysmfilledwithclots.InbothcasesLowMolecularWeight Heparin (LMWH), antibiotics and compression therapy were administered. The patients were discharged with advise to continue treatment with LMWH.Conclusions: Taking into account medical reports, escalation of addiction and observed DVT cases in IDUs, in spite of lack of EBM data, addiction from intravenous drugs should be taken under consideration as a risk factor for DVT in young patients. Lack of therapeutic guidelines for this group is also a problem to solve. Supported by European Regional Development Fund, Polish Govern. the grant WROVASC Integrated Cardiovascular Centre, Wroclaw, POLANDKeywords: Deep vein thrombosis, Intravenous drug users

pS9-9 FaCtOrS iNFLUeNCiNG tHe deVeLOpmeNtOF tHe pOSt-tHrOmbOtiC LimbF. POLLICE1, P. POLLICE1, R. ROSSI1, G. CONTEGIACOMO2


purpose: This study was designed to determine whether patients having underlying venous disease in their contralateral limbs indicates a more severe long-term clinical outcome in the ipsilateral limb after a deep vein thrombosis (DTV) and to determine what other factors may influencethelong-termoutcome.methods: An acute DVT was initially diagnosed by means of duplex ultrasound scanning. Follow-up clinical examinations and bilateral duplexrefluxstudieswereperformedforameanperiodaslongas3years. The patients were divided into two groups: group I, those with no history of a contralateral DVT, and group II, those with a history of a contralateralDVT.Thepatientswereclassifiedattheirfinalexaminationaccording to the Clinical, Etiology, Anatomic, Pathophysiologic,

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(CEAP)classification.Andtheipsilateralandcontralaterallimbswerecompared. results: Sixty-three patients were monitored in a mean follow-up periodof3years.Therewasasignificantdifferenceintheincidenceofsymptoms between the ipsilateral limbs(P>.001) and the contralateral limbs (P<.001) for both groups.Therewas no significant differencebetweentheincidenceofsuperficialrefluxbetweentheipsilateralandcontralaetral limbs, but the deep venous system and perforator veins were involved more often in the ipsilateral limbs. In group I, only six patients(10%)hadnoevidenceofvenousdysfunction(CEAP=0)intheiripsilateralorcontralateral limbsat the timeof thefinalexamination,and all patients had reversible risk factors. Of patients who had a mild clinicaloutcome(CEAPscore,1to3),64%hadahealthycontralaterallimb,andtheremaining36%hadmildtomoderatedisease.Conclusion: There are a significant number of patients with anacute DVT who had an underlying venous disease in the uninvolved contralateral limb. An ipsilateral post-thrombotic limb is more likely to developinpatientswithprimaryvenousrefluxafteranacuteDVT.Keywords: Thrombosis

pS9-10 iVUS iVC FiLter depLOymeNt - a metHOd FOr iNteGratiON OF iVUS iNtO daiLy praCtiCeD. KASSAVIN1, G. CONSTANTINOPOULOS1

1 Monmouth Medical Center - Department of Surgery, Long Branch, NJ, USA

The use of IVUS for diagnostic and therapeutic procedures provides many advantages to the vascular specialist. Studies performed with IVUS accurately correlate with those obtained with angiography and in certain circumstances are better able to evaluate the severity of vessel disease while avoiding the risks of prolonged radiation exposure, nephrotoxic contrast agents and potential allergic reactions. IVUS has been implemented for a variety of diagnostic and therapeutic vascular procedures, ranging from intraprocedural device deployment to follow up surveillance. We review our experience with the deployment of one hundred IVC filtersusingIVUSwherebyatransitionwasmadefromthecombineduse of IVUS and traditional roadmapping techniques (venography or renal vein cannulation) to the sole use of the IVUS as the roadmapping toolforIVCfilterinsertion.Ourexperiencewith the IVUSfor IVCfilterdeploymenthasservedas a bridge for its incorporation into other vascular procedures. IVUS has the potential to become a standard in the vascular specialists’ armamentarium.Keywords:IntravascularUltrasound,Inferiorvenacavafilter


aUtHOr’S iNdeX

aABOYANS V. SY4-1ABRAHAM P. PS2-8, PS2-9, PS2-10, SY11-1ABUSHOV N. OC1-7, OC2-7ACCROCCA F. OC2-2, PS4-7ACERANTI A. PS2-4AGHAMOHAMMADZADEH R. SY15-2ALBAZDE O. OC2-6ALCAMO I. R. OC7-4ALCAMO R. PS4-8, PS7-10ALEKPEROV O. PS7-2ALEKPEROVA T. PS7-2ALEXANDRESCU V. SY14-3ALIAKBARIAN M. PS4-6ALIYEV E. OC1-7ALIYEV Z. OC2-7ALLAER F. A. PS2-7ALLAERT F. OC7-6, PS7-4ALLAIRE E. SY1-1ALLEGRA C. OC3-7, OC4-7, OC7-2, PS4-9ALSAIGH T. SY9-4AMATO C. OC7-4, PS4-8, PS7-10AMIOT S. PS4-10AMITRANO M. OC3-3AMORIM P. PS5-1, PS5-8AMOSOV V. OC4-1AMOSOVA E. N. PS9-5ANDERCOU A. SY14-1ANDERCOU O. SY14-1ANDREI M. SY14-1ANDREOZZI G. M. PS3-1, SY11-2ANDRES E. PS6-6ANTIGNANI P. L. OC3-7, OC4-7, OC7-2, PS4-9ANTONELLI R. OC2-2, PS4-7ARCENIO E. OC4-5ASCHER E. SY10-1, SY13-3ASFAR P. PS6-6ASLAM M. PS3-6ASSIE C. OC6-2AVGERINOS E. OC1-4AYMARD A. PS5-3AZZAM M. OC4-6, PS8-7

bBACCOUCHE H. OC6-4BAKOYIANNIS C. PS4-2, PS4-3BANFIC L. J. PS1-2, PS1-3BARANDIARAN J. V. PS2-1, PS2-2, PS6-12BARBIERI C. OC4-2, PS8-9BARBOS O. SY14-1BARTOSZEWICZ M. PS3-9BASTOUNIS E. PS4-3BAUMGARTNER I. SY13-1BAUTRANT E. OC6-1BECKER F. SY1-4BELCH J. SY13-1BELIZNA C. OC6-3, PS6-6BELLE L. OC5-6BELVA-BESNET H. PS6-2BENAMER H. PS5-3BENSALAH D. PS5-6BERGAUER A. OC1-5BERRAH A. PS1-7, PS1-10, PS5-6BEUCHER A. OC6-3BHASKARAN P. PS3-4, PS3-5, PS3-6BIALEK P. OC2-1BIENVENU B. PS6-6BIHARI I. PS8-8BJARNASON H. PS9-2BLAISE S. PS7-7BOGACHEV V. Y. PS7-3BOGOMOLOV M. S. PS2-5, PS2-6BOLSHAKOV O. OC4-1

BONAKDARAN S. H. PS6-10BOSEVSKI M. OC5-7BOSNARDO C. OC7-1BOSSON J.L. OC3-1, OC3-4, PS9-7BOUCELMA M. PS1-7, PS1-10, PS5-6BOUCHAREB A. PS7-5BOUCHET J. Y. PS7-8BOUDJELIDA H. PS1-10BOUNZIRA T. PS5-6BOUTOUYERIE P. SY15-3BREDIKHIN R. PS8-11BRENNER E. OC7-5BRESSOLLETTE L. PS9-7BRIX M. PS7-7BROTAS V. OC6-7BROUTZOS I. OC1-4BUBALA M. PS1-4BUCCI B. PS7-8BUDIU O. SY14-1

CC. HOMORODEAN C. SY14-5CARABA A. PS1-1, PS3-8CARITÀ P. SY4-2CAROTTA M. PS2-3, PS2-4CARPENTIER P. OC5-6, OC6-6, PS6-7, PS7-7, SY2-1, SY5-1, SY9-3, SY12-1, SY12-3, SY13-2CARSIN M. OC5-1CARVALHO L. OC2-4, PS6-8CARZANIGA G. PS2-3, PS2-4CASTRO E SOUSA L. PS5-8CATALANO M. OC2-5, PS2-3, PS2-4CATALINI R. PS5-9CATINELLA D. PS3-2, PS3-3CAZAUBON M. PS2-7CHA S. OC1-2CHAARI M. OC6-4CHAMBON J. P. PS4-10CHARAVIN-COCUZZA M. PS7-7CHAUDET H. PS1-7CHECKA K. PS3-9CHIROSA I. OC3-6CHO H. PS1-9CHOROSTOWSKA-WYNIMKO J. OC2-1CHRISTENSEN I. OC5-5CIAMMAICHELLA M. OC3-3CINQUINI M. PS2-3, PS2-4CLARA G. OC6-7CLEMENT D. L. SY4-3COCHET E. OC6-6COFFIN O. OC5-2COMEROTA A. J. SY8-4CONOCAR C. PS6-2CONROY C. OC4-2, PS8-9CONSTANS J. SY12-1CONSTANTINOPOULOS G. PS9-10CONTEGIACOMO G. OC5-4, PS4-1, PS5-4, PS5-5, PS9-9CORDOVA R. PS3-1CORRADO E. SY4-2COSTA ALMEIDA C. OC2-4, PS6-8COUTURIER P. OC3-4CUTOLO M. SY12-2CZARNECKI M. PS1-4, PS9-1, PS9-8

dD. OLINIC D. SY14-5DALAINAS I. OC1-4DARDANOV D. PS8-4DASKALOPOULOS M. OC1-4DAUMAS M. PS6-2DE ANGELIS M. P. PS7-8DE BOSSCHERE J. P. OC5-1DE GIULI L. PS9-6DECAMPS LE CHEVOIR J. SY12-1

86 ~

DELGADO V. PS3-7DELLUC A. PS9-7DEREZINSKI T. OC1-3DESMURS-CLAVEL H. PS6-7DESSI A. OC6-6DI MICCO P. OC3-2, OC3-3DI RENZO B. PS7-6DIAMANT J. M. PS7-7DIMITROV G. PS2-3DRAGAN S. PS1-1, PS3-8DRELICHOWSKA-DURAWA J. PS1-4, PS9-8DRIVER V. SY13-1DROC I. SY14-3DUBENEC S. PS3-2, PS3-3DUGUOT A. PS6-2DUNCAN A. OC1-2

eEDOVINA L. N. PS2-5, PS2-6EGGERMONT J. OC6-1EL-BARGHOUTI N. PS2-1, PS2-2, PS6-12ELALAMY I. OC6-4ENON B. OC6-3EVRA V. PS7-8

FFAREED J. PS6-1, SY8-2FARINETTI A. PS6-3, PS6-11FARKAS K. OC2-3FÉLIX F. PS5-1FENSTER A. OC5-3FERNANDES E FERNANDES J. SY3-1FERNANDEZ F. OC3-6FERRARA F. OC7-4, PS4-8, PS7-10FLIS V. OC1-5FOMINA E. PS8-11FORMANKIEWICZ B. OC1-3FORMIGA A. PS8-1FORTUNA J. PS6-8FRADIN S. OC5-2FRYSAK Z. PS1-5, PS1-6

GGACHET G. PS7-7GAGNE P. PS9-7GALANAUD J. OC3-1GALEA V. OC6-4GALLUCCI M. OC4-7GASIOROWSKI J. PS1-4, PS9-1, PS9-8GENTY C. OC3-1, OC3-4, PS9-7GEORGIEVSKA-ISMAIL L. J. OC5-7GEORGOPOULOS S. PS4-2, PS4-3GEROTZIAFAS G. OC6-4GEROULAKOS G. OC4-6, PS8-7GHALI A. OC6-3, PS6-6GIANNAKOPOULOS T. OC1-4GIANNOPOULOS A. OC1-6GIANTOMASSI L. PS5-9GILLOT C. SY7-2GIORDANO A.G. OC2-2, PS4-7GLADYSH A. PS1-4GLADYSZ A. PS9-1GLOCKNER J. OC6-5GLOVICZKI M. L. OC6-5GLOVICZKI P. OC1-2, PS3-10, SY9-1GOBIN J. P. PS7-4GOLOVANOVA O. V. PS7-3GORDEEV N. PS7-9GOURLAY T. PS3-4, PS3-5, PS3-6GRANDE J. P. OC6-5GREENSTEIN A. S. SY15-2GRENDZIAK R. PS4-4GROVER T. OC5-5GUILLAUMON A. OC7-1GUILLOTTE X. PS5-3

GUILMOT J.-L. SY12-1GUITTON J. B. OC5-6

HHAKEM D. PS5-6HALENKA M. PS1-5, PS1-6HALL T. PS2-1, PS2-2, PS6-12HAMEL-DESNOS C. SY10-3HAMIDI ALMADRAI D. PS6-10HAMON M. OC5-2HANCOCK G. PS6-12HANNING S. PS3-2, PS3-3HEAGERTY A. M. SY15-2HENRION D. PS6-6HOPPENSTEADT D. PS6-1HUSSAIN T. PS5-2

iIGNATYEV I. PS8-11IMBERT B. OC5-6, PS6-7IMBERT P. PS9-7IQBAL O. PS6-1

JJACKULIAKOVA D. PS1-5, PS1-6JAGUS P. OC2-1JAKUBOWSKI G. OC1-3JANUSAUSKAS E. PS5-10JANUSAUSKAS T. PS5-10JANVRESSE A. OC6-2JÁRAI Z. OC2-3JASHARI R. PS4-10JAWIEN A. OC1-3JEZOVNIK M. K. OC7-7, SY4-4

KKAFEZA M. PS4-2, PS4-3KALODIKI E. OC4-6, PS8-7, SY8-2KALRA M. OC1-2KANALIKOVA K. PS5-7KAPANADZE K. PS6-5KARASEK D. PS1-5, PS1-6KARIMOV M. OC1-7KASSAVIN D. PS9-10KAVROS S. PS3-10KAZLAUSKAS V. PS5-10KEDZIOR M. OC2-1KELEKIS N. OC1-4KELLY A. PS3-2, PS3-3KERN P. SY2-3KHERAT N. PS6-7KIKUCHI R. OC4-5KIM H. PS1-9KIM Y. PS1-9KIPSHIDZE N. N. PS6-5KIROV G. PS8-4KISKINIS D. OC1-6KISS I. OC2-3KLONARIS C. PS4-2, PS4-3KNYSZ B. PS1-4, PS9-1, PS9-8KOBILICA N. OC1-5KOLOSSVÁRY E. OC2-3KOTSCHY D. PS9-8KOUTSOUBELIS A. PS4-2, PS4-3KOUVELOS G. PS4-2, PS4-3KOVALEVA O. OC4-1KTENIDIS K. OC1-6KURKLINSKY A. PS9-2KUZNIETOV A. H. PS7-3KWIATKOWSKA W. PS1-4, PS3-9, PS9-1, PS9-8KWIATKOWSKI J. PS1-4KWOCK J. PS8-5

LLABARERE J. OC3-4


LANCELEVEE J. PS4-10LARCHER L. OC7-5LAREDO J. PS8-5, PS8-6LAROCHE J.P. OC3-1LARRUE V. SY3-3LASSOUAOUI S. PS1-10LATTIMER C. R. OC4-6, PS8-7LAUNAY J. SY12-1LAVIGNE C. OC6-3, PS6-6LAZARETH I. PS7-5, SY12-1LAZARIDIS I. OC1-6LE FAUCHEUR A. PS2-10LE FLOCH E. SY2-2LE GAL G. PS9-7LE HELLO C. OC5-2LE NOBLE F. SY15-1LEE B. B. PS8-5, PS8-6LEE J. PS1-9LEFTHERIOTIS G. PS2-8, PS2-9, PS2-10LEGER P. SY5-2, SY12-1LERMAN L. O. OC6-5LEVESQUE H. OC6-2LIAPIS C. OC1-4LIEDL D. PS3-10LIFSHITZ G. PS6-4LINDHOLT J. S. SY1-2LITVINOVA N.Y. PS9-5LONARDI R. PS6-3, PS6-11LONDON G. SY15-4LOUVARD E. PS5-3LOZEV I. PS8-3, PS8-4LOZEV P. PS8-4LUDÁNYI A. OC2-3LUKANOVA D. PS8-3LUKES J. PS1-6LUKYANOV Y. PS2-6LUNETTA M. OC7-4, PS4-8, PS7-10

mM. OBER M. SY14-5MAGUEMOUN R. PS5-3MAHE G. OC5-1, PS2-8, PS2-9, PS2-10MAILLOT F. PS6-6MAÏZA D. OC5-2MAKANJUOLA J. PS5-2MALIK R. A. SY15-2MARCUCCI G. OC2-2, PS4-7MARIA OLINIC M. SY14-5MARIE I. OC6-2, PS6-7MARQUER A. PS7-8MARTIN A. OC4-2, PS8-9MARTIN R. OC4-2, PS8-9MARTINEZ M. OC3-6MARTINI R. PS3-1MAS J. L. SY3-2MASLOWSKI L. PS3-9, PS9-8MASOOD S. PS6-1MASSOUILLE D. PS4-10MATEESCU R. PS1-1, PS3-8MATOS C. OC6-7MATTIOLI A. PS6-3, PS6-11MATTIOLI G. PS6-3, PS6-11MAUFUS M. OC5-6, PS9-7MCBANE R. OC3-5MCDONALD K. OC4-2, PS8-9MEIRELES N. OC6-7, PS5-8MELAS N. OC1-6MELI F. OC7-4, PS4-8, PS7-10MERCAT A. PS6-6MERCIER F. PS5-3MICHON-PASTUREL U. PS7-5MIGDALSKI A. OC1-3MIIKHAILOV M. PS8-11MILOTIC F. OC1-5MINOLA M. PS2-3, PS2-4

MIOVSKI Z. PS1-2, PS1-3MISHALOV V. PS9-5MOBASHERI M. PS5-2MOHAN THETI I. PS6-2MOINI M. PS4-6MOLLO M. OC6-1MONREAL M. OC3-2, OC3-3MOON S. PS1-8MORELLO R. OC5-2MORICE M. C. PS5-3MOSCHOU M. OC1-4MOULAKAKIS K. OC1-4MOZOS I. PS1-1, PS3-8MRDZA B. OC1-5MURALIDHARA G. OC5-3MURATORI I. OC7-4, PS4-8, PS7-10, SY4-2MUSAEVA S. PS7-2MYASNIKOVA M. PS7-9

NNA D. L. PS1-8NEVES J. PS8-1NEVILLE R.F. PS8-5, PS8-6NICOLAIDES A. SY3-4, SY7-1NICOLINI P. SY9-2NIETO J.A. OC3-2, OC3-3NIGLIO A. OC3-3NIKOL S. SY13-1NITKOWSKI P. OC2-1NIZET C. PS6-9NORGREN L. SY13-1NOURY-DESVAUX B. PS2-10NOVIKOVA Y. PS6-4, PS9-4NOVO G. SY4-2NOVO S. OC7-4, PS4-8, PS7-10, SY4-2NOVOTNY D. PS1-5, PS1-6

OOBA C.M. OC4-5OUADAHI N. PS1-10OUEDRAOGO N. PS2-8, PS2-9

pPACURARI A. PS1-1, PS3-8PAGLIARICCIO G. PS5-9PAPALAMBROS E. PS4-2, PS4-3PAPAPETROU A. OC1-4PAPASIDERIS C. OC1-4PAPOUTSIS K. PS4-2, PS4-3PATEL V. M. PS5-2PÉCSVÁRADY Z. PS9-3PENNELLA S. PS6-3, PS6-11PEREIRA ALBINO J. OC6-7, PS5-1, PS5-8PEREIRA ALVES C. PS8-1PERENNOU D. PS7-8, SY11-3PERNOD G. OC3-4, OC5-6, SY8-1PEROT C. PS4-10PERRY E .P. PS2-1, PS2-2, PS6-12PICHOT O. OC4-4, OC6-6, SY9-3, SY10-2PIERARD L. A. PS6-9PINTO A. SY11-4PINTO F. PS5-8PIOTROWICZ R. OC1-3PIQUET J. OC6-3PISTORIUS M.-A. SY12-1PLISSONNIER D. OC6-2POCOCK E. S. SY9-4POLANSKA M. OC2-1POLANSKI J. OC2-1POLLICE F. OC5-4, OC5-5, OC7-3, PS3-7, PS4-1, PS5-4, PS5-5, PS7-6, PS9-6, PS9-9POLLICE P. OC5-4, OC5-5, OC7-3, PS3-7, PS4-1, PS5-4, PS5-5, PS7-6, PS9-6, PS9-9POREDOS P. OC7-7, SY4-4POSTACCHINI I. OC2-1

88 ~

POSTACCHINI M. OC2-1POWELL J. T. SY1-3PRANDONI P. OC3-2, OC3-3PRETIOVA L. PS5-7PRIOLLET P. PS7-5, SY12-1, SY12-4PRIOR M. SY11-5PROCZKA R. OC2-1PRZYTULSKA J. PS9-8PSARROS V. PS4-2, PS4-3PTOHIS N. OC1-4PUTAREK K. PS1-3PUZZI M. B. OC7-1

QQUERE I. OC3-1, SY8-3QUINTAVALLA R. OC3-2

rR. HIATT W. SY13-1RAO G. PS6-2RAO G. H. R. OC5-3RASTEL D. SY2-2RAVARI H. PS4-6, PS6-10REIS L. OC2-4, PS6-8RHEDER J. OC7-1RIBEIRO K. PS5-8RIOM H. PS7-7RITA MATOS A. PS5-1RODRIGUES C. PS5-1ROLLAND C. PS9-7ROLLINS D. OC4-2, PS8-9ROMOSAN I. PS1-1, PS3-8ROS E. OC3-6ROSSI R. OC5-4, PS4-1, PS5-4, PS5-5, PS9-9ROSSI-SEIGNERT A. K. OC6-1

SSALEM A. OC1-1, PS8-2SALEM M. OC1-1, PS8-2SALEM T. OC1-1, PS8-2SALIMIFAR M. PS6-10SAMELOVA K. PS7-1SÁNCHEZ-CRUZ J.J. OC3-6SANSONE M. OC7-3SARATZIS A. OC1-6SARATZIS N. OC1-6SARRADON P. OC4-3SASSI M. OC6-4SATGER B. SY5-3SAUMET J. L. PS2-10SAUVAGET T. PS2-10SAVOIU G. PS1-1, PS3-8SCANDALE G. PS2-3, PS2-4SCHMID-SCHÖNBEIN G. W. SY9-4SEDOV V. M. PS2-5SEINTURIER C. OC6-6, PS7-7SEMENOV D. PS8-10SENET P. SY12-1SERBAN C. PS1-1, PS3-8SESSA C. OC6-6SEVESTRE M.A. OC3-1, OC3-4SEVOSTYANOVA K. PS6-4, PS9-4SHAWISH E. PS8-7SHEVELA A. PS6-4, PS9-4SHIN S. PS8-6SIANI A. OC2-2, PS4-7SIMAS A. OC6-7SIMKOVA I. PS5-7SINTES P. SY12-1SLAVIK L. PS1-5SLOBODYANYUK V. V. PS2-5, PS2-6SLOTEMA E. OC4-3SMILOV N. PS8-4SOBRINHO G. OC6-7, PS5-8SOKURENKO G. Y. PS2-5

SOLANILLA A. SY12-1SOUDE V. PS6-6SPEAR R. PS4-10SPRYNGER M. PS6-9SRIRAM V. OC5-3STANCU B. SY14-1STANDFIELD N. J. PS3-4, PS3-5, PS3-6STCHEKOIAN A. O. PS7-3STIRN B. OC1-5STROZZI M. PS1-3STUCKEY C. OC4-2, PS8-9SUSAN L. PS1-1, PS3-8

tTAGIZADE G. OC1-7TASCH C. OC7-5TAZZIOLI G. PS6-3TEXTOR S. C. OC6-5THOUVENY F. OC6-3TOMKA J. PS5-7TOSCANO F. PS8-1TRIBOUT L. SY12-1TRIGONIS C. OC1-6TRIPONIENE D. PS5-10TRIPONIS V. PS5-10TRUIJLLO SANTOS J. OC3-2TRUXANOV A. PS7-2TURNER N. PS3-10

UUHL J.- F. SY2-4, SY7-2ULIMBASHEVA Z. PS8-10

VVAHEDIAN M. PS4-6VAKHITOV M. OC4-1, PS8-10VALE P. PS3-2, PS3-3VAN BELLE E. SY13-1VANZETTO G. OC5-6VAS-BIOBANK WORKING GROUP OC2-5VAS-SCIENTIFIC TEAM OC2-5VASSEUR M. PS2-8, PS2-9VAVERKOVA H. PS1-5, PS1-6VAYSSAIRAT M. SY12-1VELLUT F. PS7-8VIEIRA T. PS5-1, PS5-8VILLEMUR B. PS7-8, SY11-3VISCONTI C. SY4-2VISONÀ A. OC3-2, OC3-3VOLL A. PS3-10VORONINA E. PS6-4, PS9-4VRKIC KIRHMAJER M. PS1-2, PS1-3

WWILLOTEAUX S. OC6-3WITKIEWICZ W. PS1-4, PS3-9, PS9-8WYSOKINSKI W. OC3-5

XXIROMERITIS K. OC1-4

yYOFFE B. PS4-5

ZZAKIRJAYEV E. OC1-7, OC2-7ZEENY M. OC5-1ZEMMOUR D. PS1-10ZERNOVICKY F. PS7-1ZERNOVICKY JR. F. PS7-1ZEYNALOVA G. OC2-7ZINGARETTI O. PS5-9ZITA Z. PS5-7ZSIBIN A. PS8-10ZYZKA V. OC3-1


General information

Dates and Congress venue19th EuroChapSeptember 24 to 26, 2010Maison de la Chimie - 28, rue Saint-dominique75007 Paris / FrancePhone: +33 (0)1 40 62 27 00 - Fax: + 33 (0)1 45 55 98 62www.maisondelachimie.com

AccessSubway: Lines 8 and 13 (Invalides), Line 12 (Assemblée nationale) rErLine C (Esplanade des Invalides)

BUSBus 69 (Esplanade des Invalides)Bus 63, 73, 83, 84, 94 (Assemblée nationale)

Official LanguageOfficiallanguageisEnglish.Allpresentations,discussionsand questions must be in English. no simultaneous translation is organised.

Administrative and Scientific SecretariatWelcome deskhall 28 bis – level 0

the congress secretariat is open:- on Friday, September 24 from 07:45 to 19:00- on Saturday, September 25 from 07:45 to 18:00- on Sunday, September 26 from 07:45 to 18:00

AIM France - AIM Group International52, rue Bichat - 75010 Paris - France

Phone: +33 (0)1 40 78 38 00Fax: +33 (0)1 40 78 38 10

E-mail: [email protected]

Badgesthe wearing of the badge is mandatory inside the Congress Center:

- red: Speakers, Moderators, Guests- Participants and authors of oral and posters communi-cations:w transparent: 3 days registrationw yellow: one day registration, September 24, 2010w White: one day registration, September 25, 2010w Black: one day registration, September 26, 2010

- Blue: Exhibitors- Green: Press

Congress Dinner on Saturday,September 25 at 19:30the Congress dinner will be held at Le Cercle National des Armées which is located Place St Augustin, in the heart of Paris.the building was inaugurated in 1928, by the President of the republic Gaston doumergue.the building of the Place Saint-Augustin is due to the chief architect of the Palais nationaux, Charles Lemaresquier, member of the institute.thierry Chevalier, the Chef, worked in the kitchens of the largest luxury hotels, the Crillon and the ritz. In addition, thierry Chevalier continues to train with thegreats: Marc Veyrat, Michel Bras, Pierre hermé, Alain ducasse, Peter Gagnère.

Cercle national des Armées8, place Saint Augustin - 75008 ParisPhone: + 33 (0)1 44 90 26 26 Fax: +33 (0)1 45 22 17 75

SubwayLine 9, station Saint Augustin Line 14, station Gare Saint Lazare (5 mn)

ExhibitionAn exhibition is held at room 8 – level 0 of the Maison de la Chimie.Exhibition is opened:

- on Friday, September 24 from 07:45 to 19:00- on Saturday, September 25 from 07:45 to 18:00- on Sunday, September 26 from 07:45 to 18:00

Participants’ listthe list of participants is available and can be viewed at the welcome desk.

Cloakroomhall 28 bis - level 0A cloakroom is available during opening hours of the congress secretariat. It is located near the welcome desk. Please make sure that no personal belongings are left after secretariat’s closing each day.

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Scientific Information

PostersPosters are displayed in room 8, level 0 of the Congress Centre.Posters must be displayed for the two first days of themeeting.Posters set up: - Friday 24 September, 2010 from 07.30 to 11.00(Beforethefirstcoffeebreak)Dismantling:- Saturday 25 September, 2010 from 15.30 to 16.00(After the coffee break)

Yourposterhasbeengivenanumberandshallbefixedonthe poster board marked with the same number. Pins and tape are at your disposal at the welcome desk.the Organizing Secretariat will not be responsible forposters that have not been collected at the end of the meeting. Guided visit session of the posters:Presenting authors are requested to stand close to their poster during the guided visit sessions as follows:

- Friday 24, September 2010 from 14:00 to 15:30presentation of the posters on the themes:w PS1- Atherosclerosisw PS2 - Peripheral arterial disease (1)w PS3 - Peripheral arterial disease (2)w PS4 - Vascular Surgery (1)w PS5 - Vascular Surgery (2)

- Saturday 25, September 2010 from 14:00 to 15:30presentation of the posters on the themes:w PS6 - Arteritis, vasculitis, therapeuticw PS7 - Chronic venous disorders / Lymphedemaw PS8 - Varicose veinsw PS9 - Venous thromboembolic disease

Preview roomroom 103 - level 1All the speakers have to come to the preview room. We advise all the speakers to provide to the preview room their presentation a half-day minimum before the beginning of the session.Computers (PC and Mac) are available in the preview room.

CME Accreditation«the event “19th EuroChap European Chapter Meeting of the IUA” is accredited by the European Board for Accreditation in Cardiology (EBAC) for “18” hours of External CME credits.

Each participant should claim only those hours of credit that have actually been spent in the educational activity. EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS).”

In compliance with EBAC/ EACCME guidelines, all speakers/ chairpersons participating in this programme have disclosed potential conflicts of interest that might causea bias in the presentations. the Organising Committee is responsible for ensuring that all potential conflicts ofinterest relevant to the programme are declared to the audience prior to the CME activities.

Presentationand composition:Micronized, purifiedflavonoid fraction 500 mg:diosmin 450 mg; hesperidin50 mg. Therapeutic proper-ties: Vascular protector and veno-tonic. Daflon 500 mg acts on the returnvascular system: it reduces venous disten-sibility and venous stasis; in the microcircula-tion, it normalizes capillary permeability and rein-forces capillary resistance. Pharmacokinetics: Microniza-tion of Daflon 500 mg increases its gastrointestinal absorp-tion compared with nonmicronized diosmin (urinary excretion 57.9%vs 32.7%). Thera peutic indications: Treatment of organic and idio-pathic chroni c venous insufficiency of the lower limbs with the followingsymptoms: heavy legs; pain; nocturnal cramps. Treatment of hemorrhoids andacute hemorrhoidal attacks. Side effects: Some cases of minor gastrointestinal andautonomic disorders have been reported, but these never required cessation of treatment.Drug interactions: None. Precautions: Pregnancy: experimental studies in animals have notdemonstrated any teratogenic effects, and no harmful effects have been reported in man to date. Lac-tation: in the absence of data concerning the diffusion into breast milk, breast-feeding is not rec-ommended during treatment. Contraindications: None. Dosage and administration: In venous dis-ease: 2 tablets daily. In acute hemorrhoidal attacks: the dosage can be increased to up to 6 tabletsdaily. As prescribing information may vary from country to country, please refer to the complete datasheet supplied in your country.

Les Laboratoires Servier - France. - Correspondent: Servier International - 35, rue de Verdun - 92284 Suresnes Cedex - France. Website: www.servier.comDaflon 500 mg (MPFF) is also registered under various trade names, including: Detralex,Arvenum 500, Elatec, Alvenor, Ardium, Capiven, Variton

phlebotropic drugworldwide

No.1phlebotropic drug

worldwide

No.1

A unique action at the core of chronic venous disease

2 tablets dailyChronic venous disease

1 - Ramelet AA, Clin Hemorheol Microcir. 2005;33:309-319. 2 - Nicolaides A, Int Ang. 2008;27:1-60.

Documents

Eurochap2010 final program