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Readers can search, reference, and bookmark current and archived content 24 hours a day on Indications for use the Neuroform Atlas Stent System is indicated for use with neurovascular embolization coils in the anterior circulation of the neurovasculature for the endovascular treatment of patients 18 years of age with saccular wide-necked (neck width 4 mm or a dome-to-neck ratio of < 2) intracranial aneurysms arising from a parent vessel with a diameter of 2. Contraindications Patients in whom the parent vessel size does not fall within the indicated range. The benefits may not outweigh the risks associated with device use in certain patients; therefore, judicious patient selection is recommended based on clinical practice guidelines or tools to assess the life time risk of intracranial aneurysm rupture. Safety Information Magnetic Resonance Conditional Warnings Potential adverse events Aphasia the potential adverse events listed below, as well as others, may be associated with the use of the Neuroform Atlas Stent System or with the procedure: Allergic reaction to Nitinol metal and medications Aneurysm perforation/rupture, leak or contrast extravasation Blindness Cardiac arrhythmia Coil herniation through stent into parent vessel Cranial neuropathy Death Embolus Headache Hemiplegia Hemorrhage. Reuse, reprocessing or resterilization may compromise the structural integrity of the device and/ or lead to device failure which, in turn, may result in patient injury, illness or death. After use, dispose of product and packaging in accordance with hospital, administrative and/or local government policy. A patient with the Neuroform Atlas Stent can be safely scanned immediately after placement of this implant, under the following conditions: Static magnetic field of 1. See additional precaution related to the image artifact from the implant in the "Precautions" section of this labeling. Stryker or its affiliated entities own, use, or have applied for the following trademarks or service marks: Neuroform Atlas, Stryker. The Medela Dominant Flex Pump is reusable, nonsterile, and intended to be utilized outside of the sterile environment. Reuse, reprocessing or resterilization may also create a risk of contamination of the device and/or cause patient infection or cross-infection, including, but not limited to , the transmission of infectious disease(s) from one patient to another. The use of these catheters for delivery of solutions other than the types that have been tested for compatibility is not recommended. Movement of the device against resistance could dislodge a clot, perforate a vessel wall, or damage the device. Adverse events Potential adverse events associated with the use of catheters or with the endovascular procedures include, but are not limited to: Access site complications Allergic reaction Aneurysm perforation Aneurysm rupture Death Embolism (air, foreign body, plaque, thrombus) Hematoma Hemorrhage Infection Ischemia Neurological deficits Pseudoaneurysm Stroke Transient Ischemic Attack Vasospasm Vessel dissection Vessel occlusion Vessel perforation Vessel rupture Vessel thrombosis Use of device requires fluoroscopy which presents potential risks to physicians and patients associated with x-ray exposure. The catheter shaft has a hydrophilic coating to reduce friction during use, includes a radiopaque marker on the distal end for angiographic visualization, and includes a luer hub on the proximal end allowing attachments for flushing and aspiration. The Rotating Hemostasis Valve and Tuohy Borst valve with sideport are used for flushing, insertion of catheters, and aspiration. Cerebral Damage after Carbon Monoxide Poisoning: A Longitudinal Diffusional Kurtosis Imaging Study Y. Regional Cerebral Blood Flow in the Posterior Cingulate and Precuneus and the Entorhinal Cortical Atrophy Score Differentiate Mild Cognitive Impairment and Dementia Due to Alzheimer Disease B. Lateral Posterior Choroidal Collateral Anastomosis Predicts Recurrent Ipsilateral Hemorrhage in Adult Patients with Moyamoya Disease J. Subscription rates: nonmember $410 ($480 foreign) print and online, $320 online only; institutions $470 ($540 foreign) print and basic online, $935 ($1000 foreign) print and extended online, $380 online only (basic), extended online $825; single copies are $35 each ($40 foreign). Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension A. Increased Diameters of the Internal Cerebral Veins and the Basal Veins of Rosenthal Are Associated with White Matter Hyperintensity Volume A. Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events L. Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study Y. A Multicenter Pilot Study on the Clinical Utility of Computational Modeling for Flow-Diverter Treatment Planning B. Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up F. Transforaminal Insertion of a Thermocouple on the Posterior Vertebral Wall Combined with Hydrodissection during Lumbar Spinal Radiofrequency Ablation R.
Study subjects were followed for 3 years, and for only 2 years after completion of a series of repeat sclerotherapy injections that were administered over 1 year. In addition, these studies do not include a comparable group of subjects treated with surgery, which has been the primary method of treating incompetent long saphenous veins. In reviewing the study by McDonagh (2002), Allegra (2003) commented: "Surgical treatment has a long history with 5-20 year follow-ups being routine. This study does not answer questions raised against ultrasound guided sclerotherapy. It would be important to have the relevant aspects of this study duplicated, reproduced, and verified. At 10 years, the occurrence of new veins was 56 % for standard sclerotherapy, 51 % for foam sclerotherapy, 49 % for Aetna 2015 Varicose Veins. Belcaro et al (2000) reported on the results of a randomized controlled clinical study comparing ultrasound-guided sclerotherapy with surgery alone or surgery combined with sclerotherapy in 96 patients with varicose veins and superficial venous incompetence. Although all approaches were reported to be effective in controlling the progression of venous incompetence, surgery appeared to be the most effective method on a long-term basis, and that surgery combined with sclerotherapy may be more effective than surgery alone. After 10 years follow-up, no incompetence of the saphenofemoral junction was observed in both groups assigned to surgery, compared to 18. Given the lack of good scientific evidence on the various treatments for primary varicose veins, the working group made recommendations based on professional agreement. They concluded that surgery is the treatment of choice for saphenous veins with reflux. An evidence review of surgical treatments for deep venous incompetence by the Alberta Heritage Foundation for Medical Research (Scott and Corabain, 2003) stated that "(s)clerotherapy is particularly effective in superficial venous incompetence when there is a large vein located in close proximity to the ulcer. However, surgery is indicated when there is substantial proximal incompetence in a saphenous vein. Evidence about these new techniques for treating patients with incompetence of the long saphenous vein is limited. Jia and colleagues (2007) evaluated the safety and effectiveness of foam sclerotherapy for varicose veins. The authors concluded that serious adverse events associated with foam sclerotherapy are rare. However, there is insufficient evidence to allow a meaningful comparison of the effectiveness of this treatment with that of other minimally invasive therapies or surgery. Kendler and associates (2007) noted that "(r)ecently the use of foam sclerotherapy had a renaissance. Several studies have documented the efficacy of foam sclerotherapy in selected patients. The possibility of treating patients in an outpatient setting, with low costs and rapidly, makes foam sclerotherapy very attractive compared to invasive and minimally invasive methods. However long-term follow-ups in properly controlled randomized trials are needed before foam sclerotherapy can be recommended as a routine Aetna 2015 Varicose Veins. As these small veins have not been demonstrated to cause symptoms, treatment of these small veins is considered cosmetic. A total of 501 adult patients with primary varicose veins were treated in a single center. The outcome measure was clinical recurrence within 5 years, assessed clinically by previously trained independent observers. Furthermore, when carrying out a stripping intervention, Duplex marking does not improve the clinical results of this ablative technique. Patients were examined with duplex imaging before surgery, and after 3 days, 1 month and 1 year. One patient developed a pulmonary embolus after foam sclerotherapy and 1 a deep vein thrombosis after surgical stripping. The median (range) time to return to normal function was 2 (0 to 25), 1 (0 to 30), 1 (0 to 30) and 4 (0 to 30) days, respectively (p < 0. Primary outcomes were recurrent varicosities, recanalization, neovascularization, technical procedure failure or need for re-intervention, patient quality of life (QoL) scores and associated complications.
Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Ultrasound-guided foam sclerotherapy in the treatment of varicose veins: Tips and tricks. Effectiveness and safety of ultrasound-guided foam sclerotherapy for recurrent varicose veins: Immediate results. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Systematic review of endovenous laser therapy versus surgery for the treatment of saphenous varicose veins. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Endovenous laser therapy for varicose veins: A review of the clinical and cost-effectiveness. Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: Clinical outcome and recurrence after 2 years. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Multicenter randomized trial comparing compression with elastic stocking versus bandage after surgery for varicose veins. Great saphenous vein radiofrequency ablation versus standard stripping in the management of primary varicose veins - a randomized clinical trial. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. Endovascular radiofrequency ablation for varicose veins: An evidence-based analysis. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. Clinical and hemodynamic significance of the greater saphenous vein diameter in chronic venous insufficiency. The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency. Diameter-reflux relationship in perforating veins of patients with varicose veins. Preoperative and intraoperative evaluation of diameter-reflux relationship of calf perforating veins in patients with primary varicose vein. Width of the great saphenous vein lumen in the groin and occurrence of significant reflux in the sapheno-femoral junction. Correlation between the intensity of venous reflux in the saphenofemoral junction and morphological changes of the great saphenous vein by duplex scanning in patients with primary varicosis. Great saphenous vein diameter at the saphenofemoral junction and proximal thigh as parameters of venous disease class. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Cosmetic: In this document, procedures are considered cosmetic when intended to change a physical appearance that would be considered within normal human anatomic variation. Cosmetic services are often described as those that are primarily intended to preserve or improve appearance. Symptoms of venous insufficiency or recurrent thrombophlebitis (including but not limited to: aching, burning, itching, cramping, or swelling during activity or after prolonged sitting) which: are interfering with activities of daily living; and persist despite appropriate non-surgical management, for no less than 6 weeks, such as leg elevation, exercise and medication; and persist despite a trial of properly fitted gradient compression stockings for at least 6 weeks or b. When performed at the same time as an endoluminal radiofrequency ablation procedure or endoluminal laser ablation procedure which meets the criteria above; or B. When performed for the treatment of residual or recurrent symptoms which meet the following criteria: 1. Surgical ligation and stripping, endoluminal radiofrequency ablation, or endoluminal laser ablation of the greater or lesser saphenous veins was previously performed; and 2. Symptoms of venous insufficiency or recurrent thrombophlebitis (including but not limited to: aching, burning, itching, cramping, or swelling during activity or after prolonged sitting) which: are interfering with activities of daily living; and persist despite appropriate non-surgical management for 6 weeks, excluding similar management prior to the required treatment of the greater or lesser saphenous vein; and persist despite a trial of properly fitted gradient compression stockings for at least 6 weeks, excluding similar management prior to the required treatment of the greater or lesser saphenous vein; or b.
About 70% of the total body store of iron (~ 5 g) is contained within erythrocytes. When these are degraded by macrophages of the mononuclear phagocyte system, iron is liberated from hemoglobin. Fe3+can be stored as ferritin (= protein apoferritin + Fe3+) or be returned to erythropoiesis sites via transferrin. A frequent cause of iron deficiency is chronic blood loss due to gastric/intestinal ulcers or tumors. Despite a significant increase in absorption rate, absorption is unable to keep up with losses and the body store of iron falls. The treatment of choice (after the cause of bleeding has been found and eliminated) consists in the oral administration of Fe2+compounds. The sequential activation of several enzymes allows the aforementioned reactions to "snowball" (symbolized in C by increasing number of particles), culminating in massive production of fibrin. Chelation of Ca2+ cannot be used in vivo for therapeutic purposes because Ca2+ concentrations would have to be lowered to a level incompatible with life (hypocalcemic tetany). These compounds (sodium salts) are, therefore, used only for rendering blood incoagulable outside the body. In vivo, the progression of the coagulation cascade can be inhibited as follows (C): 1. Hirudin and its derivatives (bivalirudin, lepirudin) block the active center of thrombin. Prophylaxis and Therapy of Thromboses Upon vascular injury, the coagulation system is activated: thrombocytes and fibrin molecules coalesce into a "plug" that seals the defect and halts bleeding (hemostasis). Unnecessary formation of an intravascular clot-a thrombosis-can be life-threatening. If the clot forms on an atheromatous plaque in a coronary artery, myocardial infarction is imminent; a thrombus in a deep leg vein can be dislodged and carried into a lung artery and can cause pulmonary embolism. Drugs that decrease the coagulability of blood, such as coumarins and heparin (A) are employed for the prophylaxis of thromboses. In addition, attempts are directed, by means of acetylsalicylic acid, at inhibiting the aggregation of blood platelets, which are prominently involved in intra-arterial thrombogenesis (p. For the therapy of thrombosis, drugs are used that dissolve the fibrin meshwork-fibrinolytics (p. An overview of the coagulation cascade and sites of action for coumarins and heparin is shown in (A). Conceivably, Ca2+ ions cause the adhesion of factor to a phospholipid surface, as depicted in (B). Carboxyl groups are required for Ca2+-mediated binding to phospholipid surfaces (p. There are several vitamin K derivatives of different origins: K1 (phytomenadione) from chlorophyllous plants; K2 from gut bacteria; and K3 (menadione) synthesized chemically. Structurally related to vitamin K, 4-hydroxycoumarins act as "false" vitamin K and prevent regeneration of reduced (active) vitamin K from vitamin K epoxide, hence the synthesis of vitamin Kdependent clotting factors Coumarins are well absorbed after oral administration. Synthesis of clotting factors depends on the intrahepatocytic concentration ratio between coumarins and vitamin K. Hydroxycoumarins are used for the prophylaxis of thromboembolism as, for instance, in atrial fibrillation or after heart valve replacement. However, coagulability of blood returns to normal only after hours or days, when the liver has resumed synthesis and restored suf cient blood levels of carboxylated clotting factors. Other notable adverse effects include: at the start of therapy, hemorrhagic skin necroses and alopecia; with exposure in utero, disturbances of fetal cartilage and bone for- Possibilities for Interference (B) Adjusting the dosage of a hydroxycoumarin calls for a delicate balance between the opposing risks of bleeding (effect too strong) and of thrombosis (effect too weak). After the dosage has been titrated successfully, loss of control may occur if certain interfering factors are ignored. If the patient changes dietary habits and consumes more vegetables, vitamin K may predominate over the vitamin K antagonist. If vitamin K-producing gut flora is damaged in the course of antibiotic therapy, the antagonist may prevail.
