Angiologia

This International Society of Lymphology (ISL) Consensus Document is the latest revision of the 1995 Document for the evaluation and management of peripheral lymphedema [1]. It is based upon modifications: [A] suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain [2], discussed at the 1999 XVII ICL in Chennai, India [3], and considered/confirmed at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany [4]; [B] derived from integration of discussions and written comments ob­tained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina [5]; [C] suggested from comments, criticisms, and rebuttals as published in the December 2004 issue of Lymphology [6]; [D] discussed in both the 2005 XX ICL in Salvador, Brazil and the 2007 XXI ICL in Shanghai, China and modified at the 2008 Executive Committee meeting in Naples, Italy [7, 8]; [E] modified from discussions and written comments from the 2009 XXII ICL in Sydney, Australia, the 2011 XXIII ICL in Malmö, Sweden, the 2012 Executive Committee Meetings [9],and [F] from discussions at the 2013 XXIV ICL in Rome, Italy, and the 2015 XXV ICL in San Francisco, USA, as well as multiple written comments and feedback from Executive Committee and other ISL members during the 2016 drafting. The document attempts to amalgamate the broad spectrum of protocols and practices advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a “Consensus” of the international community based on various levels of evidence. The document is not meant to override individual clinical considerations for complex patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited; therefore the suggested treatments might be impractical. Adaptability and inclusiveness does come at the price that members can rightly be critical of what they see as vagueness or imprecision in definitions, qualifiers in the choice of words (e.g., the use of “may... perhaps... unclear”, etc.) and mentions (albeit without endorsement) of treatment options supported by limited hard data. Most members are frustrated by the reality that NO treatment method has really undergone a satisfactory meta-analysis (let alone rigorous, randomized, stratified, long-term, controlled study). With this understanding, the absence of definitive answers and optimally conducted clinical trials, and with emerging technologies and new approaches and discoveries on the horizon, some degree of uncertainty, ambiguity, and flexibility along with dissatisfaction with current lymphedema evaluation and management is appropriate and to be expected. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this 2016 version presents a Consensus that embraces the entire ISL membership, rises above national standards, identifies and stimulates promising areas for future research, and represents the best judgment of the ISL membership on how to approach patients with periph­eral lymphedema in the light of currently available evidence. Therefore, the document has been, and should continue to be, challenged and debated in the pages of Lymphology (e.g., as Letters to the Editor) and ideally will remain a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this “living document” will undergo further periodic revision and refinement as the practice and conceptual foundations of medicine and specifically lymphology change and advance.

Introduction. The aim of the study was to assess a presence of peripheral arterial disease risk factors in patients with symptomatic femoral and iliac lesions treated with use of Jaguar and Supera nitinol stents and to estimate potential relation between these factors and reintervention rate.

Material and methods. The study group consisted of 60 patients between 46 and 85 years of age who presented with typical symptoms of intermittent claudication or critical limb ischemia and underwent percuta­neous transluminal angioplasty with stenting. We examined and divided group into two subgroups — patients who experienced or did not experience need of reintervention in treated lesion.

Results. During the follow-up 24 (40%) of patients underwent reintervention in treated artery due to re­current symptoms of disease. Need of target lesion revascularization occurred more frequent in patients with hypertension (OR = 2.5), patient older than 68 (OR = 1.75) and smokers (OR = 1.75). Patency of all three arteries below knee protected from reintervention.

Conclusions. Jaguar and Supera self-expanding nitinol stents has several advantages and its use were char­acterized by high procedural success and moderate frequency of reintervention correlated to some clinical findings like hypertension. Further studies are necessary to estimate factors disturbing and interfering with long-term patency.

Introduction. Diabetes is not only an issue related to secretory organs or complications permanently attached to any ongoing disease process, but it is also an issue of public health as it is one of the four top priority non-contagious diseases the entire world is fighting against. The aim of this research was to assess the risk of possible diabetes incidence amongst a group of test subjects which may occur in the next decade. The study was based on a FINDRISC questionnaire.

Material and methods. The research group were comprised of 100 responders at the ages of 18 to 88, including 70 female and 30 male subjects. The mean age of the men was 47.6 ± 19.98 years, while for the women it was 53.61 ± 18.31 years.

Results. The results obtained in the questionnaire showed that the risk of diabetes incidence increased in subjects who turned 55 years of age in comparison to the younger responders. The risk of developing diabetes increased with the increase of BMI at the correlation coefficient 0.657 and p < 0.001.

Conclusions. Genetic affinity was determined to be an irrelevant variable in the risk of developing diabetes. Both BMI and the age were strong factors determining the future risk of diabetes incidence.

The decongestive lymphatic therapy is recommended by the International Society of Lymphology, the International Union of Phlebology and the International Lymphoedema Framework as the conservative treatment of choice in the lymphedema patients. This method enables effective treatment even in patients with difficult and complicated lymphedema. We present a case of a young man with a massive, primary right lower limb lymphedema, effectively treated with the DLT.

The aim of this paper is to present extremely rare case of 77-year old woman with free floating thrombus (FFT) in abdominal aorta obliterating superior mesenteric and right renal artery. The patient developed acute renal dysfunction. FFT was entirely removed surgically from aorta, renal arteries and celiac arteries obtaining good outflows. Appropriate treatment based on in-depth patient’s condition evaluation prevented severe, potentially fatal complications.

Scleroderma (systemic sclerosis, scleroderma) is a chronic, progressive autoimmune disease characterized by damage to blood vessels, the presence of autoantibodies, progressive hardening, atrophy of the skin and subcutaneous tissue and damage to many internal organs. In scleroderma we observe peripheral microcirculation disorders, in which small peripheral vascular abnormalities play an important role. Raynaud’s phenomenon is the most common manifestation of peripheral microcirculation disorders in the course of systemic sclerosis and concerns mainly the fingers. Treatment of patients with systemic sclerosis should be comprehensive and include education of patients, use of medication and rehabilitation. Drugs of first choice for the treatment of peripheral microcirculation disorders include calcium channel blockers, phosphodiesterase inhibitors, and prostaglandins. From our clinical experience gained in the treatment of microvascular disorders, sulodexide [a mixture of heparin (80%) and dermatan sulfate (20%)] seems to be a good and safe drug worth recommending. It works as an anticoagulant, pro-fibrinolytic, anti-inflammatory, inhibits the fibrosis process, and has protective effects on the vascular endothelial cells. Sulodexide is a safe rheological drug successfully used to treat a number of diseases accompanied by microcirculation disorders, including scleroderma.

Since the number of patients awaiting dialysis and survival time for kidney dialysis patients are on the increase, the issue of pre-emptive vascular access creation, care and use for hemodialysis is gaining importance. This paper summarizes the principles, policies and procedures aimed to achieve the longest survival time and the best possible quality of life in patients on renal replacement therapy.