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Steven S Gale

Publications and source records attributed to Steven S Gale.

6 recordsLinked to original sources
PubMed2006

Technique of contemporary iliofemoral and infrainguinal venous thrombectomy.

Patients with acute deep vein thrombosis involving the iliofemoral venous system experience the most severe postthrombotic sequelae. Treatment designed to reduce or eliminate the postthrombotic syndrome must necessarily remove thrombus to eliminate obstruction. Unfortunately, currently published guidelines do not recommend venous thrombectomy and actually recommend against its use because of the poor results initially reported. However, recent reports of venous thrombectomy and the long-term results of a large randomized trial confirm the significant benefit compared with anticoagulation alone. The technique of contemporary venous thrombectomy follows basic vascular surgical principles and offers patients the opportunity for complete or nearly complete thrombus extraction, thereby avoiding the significant morbidity of their anticipated postthrombotic syndrome. The techniques described herein represent the authors' approach to patients with few alternatives to clear the venous system. Because the patient benefit is well established, vascular surgeons should include contemporary venous thrombectomy as part of their routine operative armamentarium, offering this procedure to patients with extensive deep vein thrombosis involving the iliofemoral venous system, especially if other options are not available or have failed.

Femoral Vein↗
PubMed2004

Ultrasound findings after radiofrequency ablation of the great saphenous vein: descriptive analysis.

OBJECTIVE: As an emerging endovascular alternative to ligation and stripping of the incompetent greater saphenous vein (GSV), radiofrequency ablation was monitored with ultrasound scanning to evaluate anatomic results. Neovascularization and inflammation are potential consequences that lead to the appearance of small vessels. The natural history of the below-knee untreated GSV segment may be important in our understanding of ongoing chronic venous disease. An ultrasound follow-up study was conducted to determine the prevalence of small vessel networks, defined as veins and arteries less than 2 mm in diameter, adjacent to the saphenofemoral junction (SFJ); prevalence of small vessel networks adjacent to the treated GSV in the thigh; and fate of the below-knee untreated GSV distal to the ablated segment. METHODS: One hundred six extremities with radiofrequency ablation of the GSV for treatment of superficial venous insufficiency were followed up with high-resolution ultrasound imaging 4 to 25 months (median, 9 months) after the procedure. Ninety-three limbs had concomitant ligation and division of the SFJ and its tributaries, and 13 limbs underwent radiofrequency ablation without SFJ ligation. Ultrasound was used to evaluate patients for small vessel networks, and concomitant findings of small vessel networks and recanalization at the SFJ and adjacent to the treated GSV. The status of the below-knee segment of untreated GSV was evaluated for patency and reflux. Data analysis compared the findings in the ligation group with those in the no-ligation group, with the chi 2 test and Fisher exact test. RESULTS: We found small vessel networks in 65% (n = 69) of extremities: 15% (n = 16) at the SFJ only, 26% (n = 28) in the thigh only, and 24% (n = 25) at both the SFJ and thigh, resulting in a small vessel network prevalence of 39% (n = 41) at the SJF and 50% (n = 53) in the thigh. The prevalence of small vessel networks at the SFJ was significantly less after radiofrequency ablation with SFJ ligation (34%, 32 of 93) than after radiofrequency ablation without ligation (69%, 9 of 13; P = .035). Small vessel networks and GSV recanalization at the SFJ was more common in patients undergoing radiofrequency ablation without ligation (46%, 6 of 13) than after radiofrequency ablation with ligation (14%, 13 of 93; P = .014). The prevalence of small vessel networks in the thigh was not affected by SFJ ligation. The below-knee GSV was patent in 79% (84 of 106), and 58% (61 of 106) demonstrated reflux, a decrease from the pre-radiofrequency ablation rate of 71% (75 of 106), possibly because thrombosis extended distally beyond the ablated segment in 16% (17 of 106) of the legs. CONCLUSIONS: Small vessel networks were detected adjacent to or in connection with most of the radiofrequency ablation-treated GSVs. SFJ ligation was associated with fewer small vessel networks and proximal GSV recanalization. Most below-knee untreated GSV segments remained patent, and most exhibited reflux.

Adult↗
PubMedDate not supplied

Percutaneous venous valve bioprosthesis: initial observations.

Chronic deep venous insufficiency remains a major health problem in the United States and worldwide. Selected patients benefit from direct deep vein valve repair or valve transplantation; however, most are not candidates for these procedures. Experience with the bovine monocusp venous valve surgically inserted into the common femoral vein (CFV) demonstrates potential benefit and good long-term patency. A venous valve placed distal to the CFV via percutaneous access has great appeal and potential for further improving venous hemodynamics, as well as reducing ambulatory venous hypertension and ulceration. Two patients were treated with a percutaneous venous valve bioprosthesis as part of a Phase I trial. The primary objective was to evaluate the safety, patency, and efficacy of the percutaneous venous valve bioprosthesis to restore competency to the deep venous system.

Adult↗
PubMedDate not supplied

Fate of great saphenous vein after radio-frequency ablation: detailed ultrasound imaging.

Radio-frequency ablation (RFA) of the great saphenous vein (GSV) is an endovascular alternative to stripping. To determine long-term effectiveness, the fate of GSV treated for valvular insufficiency with RFA was evaluated in detail with ultrasound imaging (US). One hundred lower extremities were examined with high-resolution color flow US, an average of 8 months after RFA treatment of an incompetent GSV. For every cm of the RFA-treated segment, the US observation was classified as follows: absent, occluded, or recanalized. Lengths of vein segments in each class were added and percentages of absent, occluded, or recanalized segments were calculated. Five groups were identified. Group I (n = 15): segment of treated GSV was absent. Group II (n = 4): segment of treated GSV was visualized and occluded (these vein segments had no flow and were shrunk and "fibrotic" or thrombosed without clear evidence of significant shrinkage). Group III (n = 1): segment of treated GSV was recanalized. Group IV (n = 27): segment of treated GSV was obstructed (absent or occluded). Group V (n = 53): segment of treated GSV was partially recanalized, on average being 53% absent, 32% occluded, and 15% recanalized. Maximum recanalization was 50% of treated segment. RFA was successful in obliterating all of the GSV treated segment in 46% of veins (groups I, 15%, plus II, 4%, plus IV, 27%) and obliterated more than half of the treated vein segment in 53% of the cases (group V). A dynamic process of recanalization and thrombosis warrants further evaluation to determine if and how a collateral network may develop.

Adult↗
PubMedDate not supplied

Chronic venous insufficiency due to great saphenous vein incompetence treated with radiofrequency ablation: an effective and safe procedure in the elderly.

Chronic venous insufficiency (CVI) with the resultant clinical sequelae significantly reduces quality of life. Most elderly patients with CVI are treated nonoperatively owing to concerns of increased operative risk and therefore suffer more advanced disease. Radiofrequency ablation (RFA) has emerged as a minimally invasive procedure to treat patients with superficial venous insufficiency (SVI) due to great saphenous vein (GSV) incompetence. The purpose of this study was to review our experience using RFA of the GSV to treat CVI due to superficial disease in elderly patients compared to younger patients in terms of procedure-related morbidity and severity of disease at time of treatment. RFA treatment of the GSV was performed in 490 extremities of 421 patients with SVI between March 2001 and December 2002. Indications, medical history, and outcome (operative complications and hospital stay) were compared between 2 groups: Group I:41 extremities of 35 patients, 70 years if age or older (mean 75 +/-4); and Group II:449 limbs of 386 patients younger than 70 years (mean 47 +/-11). The incidence of skin pigmentation and healed/nonhealed ulcers (CEAP 4-6) was significantly higher in the elderly than in the younger group (41% vs 16%, p <0.05). Hypertension, diabetes, and previous myocardial infarction were 2.8, 5.4, and 6.7 times more prevalent in the elderly (p <0.05), respectively. There were no major postoperative complications in either group; 97% of all patients were discharged on the day of operation and there was no difference between the 2 groups in overnight hospital stay. There is a treatment bias against operative management in elderly patients with SVI, as evidenced by their more advanced disease at the time of definitive treatment than their younger cohort. However, operative morbidity is no different compared to the younger subset. RFA is a safe and effective procedure for older patients; therefore, the threshold for operative management of older patients should be lowered.

Age Factors↗