OBJECTIVE: To evaluate the efficacy of TIPS (transjugular intrahepatic portosystemic shunt) for resolving clinical complications in patients with portal hypertension. MATERIALS AND METHODS: Forty-four caucasian patients, 30 men and 14 women, with a mean age of 52 years have been evaluated. Indication for TIPS has been gastrointestinal hemorrhage in 28 patients, and refractory ascites in 16. There has been 7 Child-Pugh A patients, 24 Child-Pugh B, and 11 Child-Pugh C. RESULTS: TIPS was successfully performed in all the patients (100%), with a decrease in the mean portosystemic pressure gradient of about 49.69% (from 18.98 mmHg to 9.55 mmHg). A clinical improvement was observed in 35 patients (79.55%). The general postoperative mortality rate was 13.64%, with higher incidence in Child-Pugh C patients (45.45%). The most relevant factors associated with a poor prognosis were increase in bilirubin and creatinine seric levels. The mean survival time was 11.5 months for Child-Pugh A patients, 10.97 months for Child-Pugh B patients, and just 5.9 months for Child-Pugh C patients. Complications directly related to the procedure have been observed in nine cases (20.44%). CONCLUSION: TIPS is efficient to reduce portosystemic pressure. TIPS-related complications and morbidity-mortality may be considered as acceptable. In the present study, mortality has been directly influenced by some clinical factors such as Child-Pugh class C, and increased bilirubin and creatinin seric levels.

Keywords: Portal hypertension, Cirrhosis, TIPS, Esophageal varices bleeding, Ascites

Objective: To describe the results of foam sclerotherapy in the treatment of chronic venous insufficiency. Materials and Methods: Longitudinal study of cases developed in the period between January of 2007 and November of 2009, with 18 patients with venous insufficiency treated with ultrasound-guided foam sclerotherapy in a private clinic. The Tessari’s method was utilized to produce the foam and the length of the patients’ follow-up varied from 4 to 44 months. Total occlusion of the treated vein and complete ulcer reepithelialization were the primary outcomes, and the secondary ones were vein caliber reduction, aesthetic improvement and patient’s satisfaction. Results: The rate of total or partial occlusion achieved 83.4% in the first review (55.6% total and 27.8% partial) and 66% (44.4% total and 22.2% partial) among the patients who underwent a second review. The rate of varicose veins occlusion achieved 80% and the rate of ulcer healing achieved 70%. Conclusion: Ultrasound-guided sclerotherapy has demonstrated to be a safe and effective procedure for the management of chronic venous insufficiency in this group of patients. The incidence of complications was minimal and most of the patients reported satisfaction with the results of the treatment.

Keywords: Varicose ulcer; Varicose veins; Venous insufficiency; Sclerotherapy.

OBJECTIVE: To assess changes in the great saphenous vein (GSV) after foam sclerotherapy for varicose veins. MATERIALS AND METHODS: This was a prospective study of 33 patients who were treated with polidocanol foam sclerotherapy after having had varicose veins with a clinical severity-etiology-anatomy-pathophysiology classification of C4-C6 for three months. The patients were evaluated by ultrasound before, during, and after the procedure (on post-procedure days 7, 15, 30, 60, and 90). The GSV diameter, the rate of venous occlusion, and the rate of reflux elimination were determined. Two patients were excluded for having a history of deep vein thrombosis history, and one was excluded for having bronchial asthma. RESULTS: Thirty patients (26 females and 4 males, with mean age of 62 years) completed the protocol. The mean pre-procedure GSV diameter was 6.0 ± 0.32 mm (range, 3.6-11.2 mm). During the sclerotherapy, the mean GSV diameter was reduced to 1.9 ± 0.15 mm (range, 0.6-3.8 mm). On post-procedure day 7, the mean GSV diameter increased to 6.3 ± 0.28 mm (range, 3.9-9.7 mm). On post-procedure day 90, the mean GSV diameter was 4.0 ± 0.22 mm (range, 1.9-8.2 mm). The rate of GSV reflux was significantly lower in the assessment performed on post-procedure day 90 than in the pre-procedure assessment (p < 0.0028). CONCLUSION: On the basis of our ultrasound analysis, we can conclude that foam sclerotherapy for varicose veins results in a significant reduction in GSV diameter, as well as in the elimination of GSV reflux.

Keywords: Ultrasonography; Varicose veins; Sclerotherapy; Saphenous vein; Venous insufficiency.