<i>Background</i>. The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. <i>Objectives</i>. Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. <i>Patients</i>/<i>Methods</i>. A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. <i>Results</i>. 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76&#x0025; of patients with retrievable filters and 69&#x0025; of patients with permanent filters had an absolute contraindication to anticoagulation. 20&#x0025; of patients with retrievable filters and 24&#x0025; of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. <i>Conclusions</i>. The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.

Saba S. Shaikh

Suneel D. Kamath

Debashis Ghosh

Robert J. Lewandowski

Brandon J. McMahon

Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population

<i>Introduction</i>. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI. <i>Methods</i>. Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. <i>Results</i>. 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M1" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-111" d="M495 86L479 114C446 82 419 66 409 66C401 66 401 72 406 97C420 166 436 231 453 297C489 435 454 448 428 448C406 448 384 439 354 422C305 394 222 327 161 247H159L183 345C200 415 194 448 173 448C143 448 82 410 23 351L38 325C64 349 95 371 105 371C111 371 116 365 109 336L25 -4L31 -12C50 -4 77 3 107 9C119 69 132 122 145 168C197 254 321 381 370 381C387 381 393 374 378 305L329 95C309 17 320 -12 345 -12C372 -12 430 19 495 86Z"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.838pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 17.838 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,27.663,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,33.903,0)"><path id="g113-48" d="M368 703H309L44 -163H104L368 703Z"/></g></svg><span class="isep"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.002pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="39.2141838 -9.28833 19.002 11.439"><g transform="matrix(.013,0,0,-0.013,39.264,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,45.504,0)"><use xlink:href="#g113-56"/></g><g transform="matrix(.013,0,0,-0.013,51.746,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g></svg></span> vs. EAR <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M2" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-111"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.838pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 17.838 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><use xlink:href="#g113-56"/></g><g transform="matrix(.013,0,0,-0.013,33.903,0)"><use xlink:href="#g113-48"/></g></svg><span class="isep"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.002pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="39.2141838 -9.28833 19.002 11.439"><g transform="matrix(.013,0,0,-0.013,39.264,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,45.504,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,51.744,0)"><use xlink:href="#g113-55"/></g></svg>,</span></span> OR 0.93 [95% CI 0.36-2.36], <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M3" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.918pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 21.918 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-56"/></g></svg>).</span></span> Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M4" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-111"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.836pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 17.836 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><use xlink:href="#g113-53"/></g><g transform="matrix(.013,0,0,-0.013,33.901,0)"><use xlink:href="#g113-48"/></g></svg><span class="isep"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.004pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="39.2121838 -9.28833 19.004 11.439"><g transform="matrix(.013,0,0,-0.013,39.262,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,45.502,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,51.742,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span> vs. <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M5" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-111"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.837pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 17.837 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.013,0,0,-0.013,33.902,0)"><use xlink:href="#g113-48"/></g></svg><span class="isep"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="12.74pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="39.213183799999996 -9.28833 12.74 11.439"><g transform="matrix(.013,0,0,-0.013,39.263,0)"><use xlink:href="#g113-55"/></g><g transform="matrix(.013,0,0,-0.013,45.504,0)"><use xlink:href="#g113-49"/></g></svg></span> OR 0.16 [95% CI 0.07-0.36], <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.6370001pt" id="M6" height="9.2729pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 9.2729"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.182pt" style="vertical-align:-0.6370001pt" height="9.2729pt" version="1.1" viewBox="22.8711838 -8.6359 28.182 9.2729"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.605,0)"><use xlink:href="#g113-50"/></g></svg>).</span></span> There was no significant difference in the amputation rate between the surgical treatments (ISR <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M7" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-111"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="11.597pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 11.597 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><use xlink:href="#g113-58"/></g><g transform="matrix(.013,0,0,-0.013,27.662,0)"><use xlink:href="#g113-48"/></g></svg><span class="isep"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.98pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="32.9731838 -9.28833 18.98 11.439"><g transform="matrix(.013,0,0,-0.013,33.023,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,39.263,0)"><use xlink:href="#g113-53"/></g><g transform="matrix(.013,0,0,-0.013,45.504,0)"><use xlink:href="#g113-50"/></g></svg></span> vs. EAR <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="17.789pt" style="vertical-align:-2.15067pt" id="M8" height="11.439pt" version="1.1" viewBox="-0.0498162 -9.28833 17.789 11.439"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-111"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="11.596pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="21.3711838 -9.28833 11.596 11.439"><g transform="matrix(.013,0,0,-0.013,21.421,0)"><use xlink:href="#g113-57"/></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><use xlink:href="#g113-48"/></g></svg><span class="isep"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="12.718pt" style="vertical-align:-2.15067pt" height="11.439pt" version="1.1" viewBox="32.972183799999996 -9.28833 12.718 11.439"><g transform="matrix(.013,0,0,-0.013,33.022,0)"><use xlink:href="#g113-57"/></g><g transform="matrix(.013,0,0,-0.013,39.262,0)"><use xlink:href="#g113-51"/></g></svg>,</span></span> OR 0.75 [95% CI 0.07-8.39], <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M9" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.918pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 21.918 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-57"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-51"/></g></svg>).</span></span> <i>Discussion</i>. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.

O. S. Niaz

A. Rao

D. Carey

J. R. Refson

A. Abidia

P. Somaiya

Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair

<i>Purpose</i>. A previous meta-analysis has conducted nonrandomized trials for mechanochemical ablation (MOCA). Since medium-term follow-up data from randomized clinical trials (RCTs) are becoming available, we chose to perform a meta-analysis of RCTs to assess the efficacy and safety of MOCA for saphenous vein insufficiency. <i>Methods</i>. A systematic search of all RCTs comparing the anatomical success of MOCA for saphenous vein insufficiency to thermal ablation was performed using the PubMed and Cochrane Library databases. We employed the Mantel-Haenszel random-effects meta-analysis of outcomes using RevMan 5.3. <i>Results</i>. Four studies (615 patients) were included in this meta-analysis. The MOCA group had 93.4% and 84.5%, whereas the thermal ablation group had 95.8% and 94.8% of anatomical success rate at 1 month (short-term) and a period of more than 6 months but less than 1-year follow-up (mid-term), respectively. According to intention-to-treat analysis, there were similar anatomical successes in MOCA and thermal ablation groups at the short-term follow-up (low-quality evidence; relative risk <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="36.465pt" style="vertical-align:-2.26807pt" id="M1" height="11.5564pt" version="1.1" viewBox="-0.0498162 -9.28833 36.465 11.5564"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-41" d="M300 -147C201 -63 143 98 143 270S200 602 300 686L282 710C136 610 70 450 70 271V270C70 89 136 -72 282 -170L300 -147Z"/></g><g transform="matrix(.013,0,0,-0.013,4.498,0)"><path id="g190-83" d="M631 18C609 24 585 35 559 65C534 91 514 117 478 169C448 214 406 281 389 313C462 346 516 399 516 485C516 545 490 590 449 616C412 641 363 650 290 650H42V622C120 615 128 612 128 527V125C128 40 120 34 38 28V0H300V28C221 34 212 40 212 125V284H244C295 284 312 272 329 244C359 195 395 133 430 84C475 19 516 -3 592 -7C603 -8 615 -8 627 -8L631 18ZM212 316V563C212 591 215 602 223 607C231 613 248 617 277 617C352 617 423 577 423 469C423 415 407 375 368 345C343 324 310 316 260 316H212Z"/></g><g transform="matrix(.013,0,0,-0.013,12.571,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.013,0,0,-0.013,20.705,0)"><path id="g113-42" d="M275 270C275 450 212 609 64 710L45 686C145 604 203 442 203 270S147 -63 45 -147L64 -170C213 -68 275 89 275 270Z"/></g><g transform="matrix(.013,0,0,-0.013,28.834,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.928pt" style="vertical-align:-2.26807pt" height="11.5564pt" version="1.1" viewBox="40.0471838 -9.28833 21.928 11.5564"><g transform="matrix(.013,0,0,-0.013,40.097,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,46.337,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,49.301,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.013,0,0,-0.013,55.542,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g></svg></span> (95% CI, 0.94–1.03); <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M2" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.918pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 21.918 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-53"/></g></svg>;</span></span> <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.776pt" style="vertical-align:-0.4673996pt" id="M3" height="12.0588pt" version="1.1" viewBox="-0.0498162 -11.5914 21.776 12.0588"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-74" d="M405 650H141L135 622C222 616 230 610 215 535L133 116C118 41 113 33 29 28L23 0H289L295 28C209 33 205 40 219 116L298 535C312 609 317 616 399 622L405 650Z"/></g><g transform="matrix(.0091,0,0,-0.0091,5.567,-5.741)"><path id="g50-51" d="M414 144C384 79 371 75 317 75H135L276 221C367 316 408 376 408 465C408 570 327 635 237 635C179 635 131 609 100 575L42 494L67 471C94 510 138 565 205 565C277 565 321 517 321 435C321 348 258 270 195 195C146 137 88 81 33 26V0H411C423 44 433 88 446 135L414 144Z"/></g><g transform="matrix(.013,0,0,-0.013,14.145,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="22.538pt" style="vertical-align:-0.4673996pt" height="12.0588pt" version="1.1" viewBox="25.358183800000003 -11.5914 22.538 12.0588"><g transform="matrix(.013,0,0,-0.013,25.408,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.013,0,0,-0.013,31.649,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.013,0,0,-0.013,37.889,0)"><path id="g121-35" d="M594 629L561 652L159 -9L190 -32L594 629ZM194 635C92 635 49 534 49 453C49 374 92 272 193 272C295 272 338 374 338 454S295 635 194 635ZM193 605C257 605 265 504 265 453C265 405 257 302 194 302C133 302 122 403 122 454S133 605 193 605ZM567 351C465 351 421 250 421 169C421 90 465 -12 566 -12S710 90 710 170S667 351 567 351ZM566 322C628 322 637 221 637 169C637 121 628 18 567 18S494 119 494 170C494 223 506 322 566 322Z"/></g></svg>).</span></span> The estimated effect of MOCA on anatomical success showed a statistically significant reduction at the mid-term follow-up (moderate-quality evidence; <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="27.469pt" style="vertical-align:-0.2063904pt" id="M4" height="8.73137pt" version="1.1" viewBox="-0.0498162 -8.52498 27.469 8.73137"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.013,0,0,-0.013,8.073,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.013,0,0,-0.013,19.838,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.894pt" style="vertical-align:-0.2063904pt" height="8.73137pt" version="1.1" viewBox="31.0511838 -8.52498 21.894 8.73137"><g transform="matrix(.013,0,0,-0.013,31.101,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,37.341,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,40.305,0)"><use xlink:href="#g113-57"/></g><g transform="matrix(.013,0,0,-0.013,46.545,0)"><use xlink:href="#g113-58"/></g></svg></span> (95% CI, 0.84–0.95); <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M5" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="34.445pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 34.445 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,50.845,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g></svg>;</span></span> <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.776pt" style="vertical-align:-0.4673996pt" id="M6" height="12.0588pt" version="1.1" viewBox="-0.0498162 -11.5914 21.776 12.0588"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-74"/></g><g transform="matrix(.0091,0,0,-0.0091,5.567,-5.741)"><use xlink:href="#g50-51"/></g><g transform="matrix(.013,0,0,-0.013,14.145,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="16.274pt" style="vertical-align:-0.4673996pt" height="12.0588pt" version="1.1" viewBox="25.358183800000003 -11.5914 16.274 12.0588"><g transform="matrix(.013,0,0,-0.013,25.408,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,31.648,0)"><use xlink:href="#g121-35"/></g></svg>).</span></span> MOCA had fewer incidence of nerve injury, deep vein thrombosis, and skin burns compared to the thermal ablation procedure (low-quality evidence; <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="27.469pt" style="vertical-align:-0.2063904pt" id="M7" height="8.73137pt" version="1.1" viewBox="-0.0498162 -8.52498 27.469 8.73137"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.013,0,0,-0.013,8.073,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.013,0,0,-0.013,19.838,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.894pt" style="vertical-align:-0.2063904pt" height="8.73137pt" version="1.1" viewBox="31.0511838 -8.52498 21.894 8.73137"><g transform="matrix(.013,0,0,-0.013,31.101,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,37.341,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,40.305,0)"><use xlink:href="#g113-52"/></g><g transform="matrix(.013,0,0,-0.013,46.546,0)"><use xlink:href="#g113-52"/></g></svg></span> (95% CI, 0.09–1.28); <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="19.289pt" style="vertical-align:-0.2064009pt" id="M8" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 19.289 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.918pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="22.8711838 -8.6359 21.918 8.8423"><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,29.161,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-50"/></g></svg>;</span></span> <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.776pt" style="vertical-align:-0.4673996pt" id="M9" height="12.0588pt" version="1.1" viewBox="-0.0498162 -11.5914 21.776 12.0588"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-74"/></g><g transform="matrix(.0091,0,0,-0.0091,5.567,-5.741)"><use xlink:href="#g50-51"/></g><g transform="matrix(.013,0,0,-0.013,14.145,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="16.274pt" style="vertical-align:-0.4673996pt" height="12.0588pt" version="1.1" viewBox="25.358183800000003 -11.5914 16.274 12.0588"><g transform="matrix(.013,0,0,-0.013,25.408,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,31.648,0)"><use xlink:href="#g121-35"/></g></svg>).</span></span> <i>Conclusion</i>. MOCA offered fewer major complications but lesser anatomical success at the period of more than 6 months but less than 1-year follow-up than thermal ablation. <i>Trial Registration</i>. This trial is registered with UMIN Clinical Trial Registry (UMIN ID <a target="_blank" href="https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041849">000036727</a>).

Johanes Nugroho

Ardyan Wardhana

Cornelia Ghea

Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta-Analysis of a Randomized Trial

Acute aortic dissection (AAD) is among the most challenging cases for surgical treatment and requires procedural expertise for its safe conduct. Aortic surgery has undergone several changes over the last years, especially concerning cerebral protection. The brilliant results obtained with the aid of selective anterograde cerebral perfusion led to a progressive increase of circulatory arrest temperature, with the rise of safe time along with a reduction of the extracorporeal circulation time and hypothermia-related side effects. However, there is still no definitive consensus concerning the optimal range of temperature to be used during circulatory arrest. <i>Objectives.</i> This is a retrospective observational study, and we examined 16-year trends in the presentation, diagnosis, hospital outcome and treatment of A AAD type. In our Cardiac Surgery Unit in Policlinico Umberto I of Rome, our analysis focused on patients, who received ACP during aortic surgery and we analyzed the differences between two distinct groups based on the lowest temperature reached during CPB conduction: Lower Temperature Group (LT) (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.04981995pt" id="M1" height="9.01194pt" version="1.1" viewBox="-0.0498162 -8.96212 8.41168 9.01194" width="8.41168pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-85" d="M620 675H597C578 656 570 650 541 650H144C112 650 104 653 94 675H72C59 618 42 552 23 493L53 491C71 534 88 564 105 585C124 608 144 615 238 615H290L197 121C182 40 174 34 88 28L82 0H361L367 28C275 34 266 38 281 121L374 615H441C522 615 543 608 553 583C562 560 566 531 565 493L597 494C603 551 612 629 620 675Z"/></g></svg> &lt; 24°C) versus Higher Temperature Group (HT) (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.04981995pt" id="M2" height="9.01194pt" version="1.1" viewBox="-0.0498162 -8.96212 8.41168 9.01194" width="8.41168pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-85"/></g></svg> ≥ 24°C) arrest circulation temperature. <i>Methods.</i> Data from 241 patients enrolled between August 2002 and March 2018 were analyzed. Patients were divided according to the lowest temperature reached into 2 groups: Lower Temperature group (LT) (94 patients) and Higher Temperature Group (HT) (147 patients). <i>Results.</i> Our results showed a significant reduction of in-hospital mortality and in-hospital results in patients with higher CPB temperature. The global incidence of complications was statistically reduced in HT group: we found a statistical significant reduction of intestinal ischemia, and a similar trend also for other complications analyzed, such as infections. Since the two groups were similar for type of surgical procedures, we considered these differences depending on the lower temperature value reached, according to the current literature. Conclusions. We found a significantly higher mortality in patients with lower temperature during CPB and a global reduction of complications and in particular a significant reduction of intestinal ischemia in patients with higher temperature during CPB. We found a similar trend in other fields of investigations, so we can conclude that circulatory arrest performed at temperature ≥24°C nasopharyngeal temperature associated with ACP is a safe strategy for aortic surgery for AAD.

Francesco Macrina

Maria Cristina Acconcia

Luigi Tritapepe

Mizar D&#x2019;abramo

Wael Saade

Alessandra Capelli

Fabio Miraldi

Hypothermia during Surgical Treatment of Type A Aortic Dissection: A 16 Years&#x2019; Experience

<i>Background</i>. Chronic ulcers of the lower limbs are a socioeconomic health problem, having a high incidence in the adult population. Despite a correct etiological treatment, in addition to the multiple lesion management options available, healing percentage and speed remain low, which makes it a great therapeutic challenge. <i>Objective.</i> To describe the outcome and effectiveness of the use of PolyHeal® Micro in the granulation and epithelialization of chronic ulcers of the lower limbs. <i>Methods.</i> Descriptive observational case series of 19 patients with diagnosis of chronic vascular ulcers of the lower limbs, treated at Medical Center Nuestra IPS and Medical Center Juan Pablo II in Bogotá between March 2018 and December 2018, who received PolyHeal® Micro as topical treatment for their lesions. Patients were assessed taking into account age, sex, ulcer size, pain, wound exudate, as well as granulation and epithelialization response. <i>Results.</i> In this series, the mean age of patients was 67.9 years, they were mostly females (84%), and the most common location of ulcers was the internal malleolus (50%). In terms of wound severity, 47% were found to be severe, 43% moderate, and 10% mild. The median time of lesion onset was 28 weeks, with a maximum of 2080 and a minimum of 8 weeks. In total, 87% of the ulcers were of venous etiology. After 12 weeks of treatment with Polyheal, ulcers showed a significative improvement of Wollina score means: 0.80 ± 0.90–5.90 ± 1.47; <span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42947pt" id="M1" height="12.7178pt" version="1.1" viewBox="-0.0498162 -9.28833 59.8193 12.7178" width="59.8193pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-41" d="M300 -147C201 -63 143 98 143 270S200 602 300 686L282 710C136 610 70 450 70 271V270C70 89 136 -72 282 -170L300 -147Z"/></g><g transform="matrix(.013,0,0,-0.013,4.498,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,15.84,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.013,0,0,-0.013,27.103,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,33.343,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,36.307,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,42.547,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,48.787,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,55.027,0)"><path id="g113-42" d="M275 270C275 450 212 609 64 710L45 686C145 604 203 442 203 270S147 -63 45 -147L64 -170C213 -68 275 89 275 270Z"/></g></svg>.</span> Wound area mean at the start of treatment was 31.6 cm<sup>2</sup>, and at the end of treatment was 17.85 cm<sup>2</sup>, which is equivalent to a wound area surface reduction of 54.2%, with a statistically significant <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42943pt" id="M2" height="10.2124pt" version="1.1" viewBox="-0.0498162 -6.78297 7.83752 10.2124" width="7.83752pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g></svg> value. The interquartile range showed a reduction of 64.3% in the central means of wounds. Seventy percent of the patients reached a granulation percentage greater than 70%, 17% of the lesions exhibited an improvement of 30–70%, and there was an overall granulation improvement in 87% of the patients. Concerning epithelialization, 40% of patients reached a percentage higher than 70%, and 17% of patients between 30% and 70%. Treatment time was 12 weeks in 68% of cases, with an average response time of 8.1 weeks. Based on the visual analogue scale (VAS), a reduction in patients’ perception of pain was achieved, dropping from an average of 6 (moderate to severe pain) to 2 (little pain), demonstrating an improvement in this regard. Fifty percent of the ulcers showed decreased exudate, resulting in a dry state. The patient satisfaction rate at the end of treatment was 89%. <i>Conclusion.</i> The use of PolyHeal® Micro for an average of 8.1 weeks of treatment showed a high rate of granulation and epithelialization in chronic ulcers of the lower limbs, improving pain perception in these patients and generating a high degree of treatment satisfaction.

Mar&#x00ED;a Teresa Cacua S&#x00E1;nchez

Experience in the Management of Patients with Chronic Vascular Ulcers of the Lower Limbs Using Negatively Charged Polystyrene Microspheres

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<p><em>International Journal of Vascular Medicine</em> publishes articles focusing on vascular biology and physiology, vascular imaging, endovascular intervention, as well as prevention and treatment of vascular disease.</p>


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International Journal of Vascular Medicine publishes articles focusing on vascular biology and physiology, vascular imaging, endovascular intervention, as well as prevention and treatment of vascular disease.

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International Journal of Vascular Medicine

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International Journal of Vascular Medicine