Biomedical subjects
Neil Khilnani
Publications and source records attributed to Neil Khilnani.
Placement of subcutaneous chest wall ports ipsilateral to axillary lymph node dissection.
Without scientific evidence, practice has been to avoid placing chest wall ports ipsilateral to axillary lymph node dissection. Because the lymphatic system in the chest wall drains via both the internal mammary and axillary nodes, it seems that this practice might unduly restrict venous access options. Our study was designed to evaluate outcome after placement of chest wall ports ipsilateral to axillary lymph node dissection in patients with breast cancer. Twenty-eight patients were studied in this retrospective two-institution review. The incidence of lymphedema after port placement (3.6%) was no higher than that reported after axillary lymph node dissection alone.
Endovenous laser treatment of saphenous vein reflux: long-term results.
PURPOSE: To report long-term follow-up results of endovenous laser treatment for great saphenous vein (GSV) reflux caused by saphenofemoral junction (SFJ) incompetence. MATERIALS AND METHODS: Four hundred ninety-nine GSVs in 423 subjects with varicose veins were treated over a 3-year period with 810-nm diode laser energy delivered percutaneously into the GSV via a 600- micro m fiber. Tumescent anesthesia (100-200 mL of 0.2% lidocaine) was delivered perivenously under ultrasound (US) guidance. Patients were evaluated clinically and with duplex US at 1 week, 1 month, 3 months, 6 months, 1 year, and yearly thereafter to assess treatment efficacy and adverse reactions. Compression sclerotherapy was performed in nearly all patients at follow-up for treatment of associated tributary varicose veins and secondary telangiectasia. RESULTS: Successful occlusion of the GSV, defined as absence of flow on color Doppler imaging, was noted in 490 of 499 GSVs (98.2%) after initial treatment. One hundred thirteen of 121 limbs (93.4%) followed for 2 years have remained closed, with the treated portions of the GSVs not visible on duplex imaging. Of note, all recurrences have occurred before 9 months, with the majority noted before 3 months. Bruising was noted in 24% of patients and tightness along the course of the treated vein was present in 90% of limbs. There have been no skin burns, paresthesias, or cases of deep vein thrombosis. CONCLUSIONS: Long-term results available in 499 limbs treated with endovenous laser demonstrate a recurrence rate of less than 7% at 2-year follow-up. These results are comparable or superior to those reported for the other options available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser appears to offer these benefits with lower rates of complication and avoidance of general anesthesia.