Aims: The main objective is to compare the effectiveness of three graduated elastic stockings in reducing pain related to ultrasound-guided foam sclerotherapy of the great saphenous vein, in an exploratory trial. Secondary objectives are to compare, between the three devices, the rate of successful sclerosis, the incidence of serious and unserious adverse events, the ease of putting on and removal the compression hosieries as well as the compliance. Patients and methods: 115 patients were randomized into three product groups: 1) class I (10-15 mmHg); 2) class Ill (with pressure centered at 25 mmHg); 3) class III (20-36 mmHg). Compression stockings were worn for 21 days. Pain was evaluated each day using a visual analog scale (VAS) and consumption of analgesics was reported by the patient. The rate of successful great saphenous sclerosis, either in one or more procedures, and the occurrence of serious and unserious adverse events were also evaluated. Finally, the comfort of the three stockings and their ease of putting on and removal were all assessed using a VAS score. Results: The sclerosis with post-treatment compression I using graduated stockings was successful in 93% patients. The need for additional sclerosis after the first procedure was inversely proportional to the pressure exerted by stockings (close to the significant threshold between 20-36 mmHg and 10-15 mmHg: p = 0.07). Inflammation rate was inversely correlated to the pressure level, in a significant manner between 20-36 mmHg and 10-15 mmHg devices (p = 0.03). The pain experienced during the study was low and the difference between the stockings was not significant. Analgesics intake for venous pain was minor but remained nevertheless significantly lower in the class III group with pressure centered at 25mmHg compared to class III (20-36 mmHg), with respectively 11% and 31% (p = 0.038). The ease of putting on and removal was inversely related to the compression level. Conclusion: Wearing compression stockings seems to enhance the efficacy of foam sclerotherapy of the great saphenous vein. Sclerotherapy followed by compression has a high success rate at 21 days and appears almost painless, whatever the pressure exerted by the stockings. Class III (micro fiber) with pressure centered at 25 mmHg appears to have the best safety/efficacy ratio, owing to a fewer inflammation rate than "regular" class III (20-36 mmHg), a lower analgesics intake than both classes I and III, and easier putting on and removal. Among the three stockings tested, it seems best suited for foam sclerotherapy of the great saphenous vein. Further investigations may be required to confirm these results.

Objectives: Treatment by sclerotherapy has been suggested as a first-line treatment of low-flow vascular malformations. This study reports our experience in treating low-flow vascular malformations by ultrasound-guided sclerosis with polidocanol foam at the Vascular Medicine Department in Grenoble, France.Design: Retrospective single-centre consecutive series.Materials and methods: Between January 2006 and December 2009, we analysed the complete records of patients with symptomatic low-flow vascular malformations of venous, lymphatic or complex type (Klippel-Trenaunay syndrome, KTS) treated by ultrasound-guided sclerosis. The therapeutic indication was always validated by the Consultative Committee for vascular malformations of the University Hospital of Grenoble. All vascular malformations were classified according to the Hamburg Classification. The sclerosing agent was polidocanol used as foam.Results: A total of 24 patients between 7 and 78 years were treated (19 venous malformations, three KTSs and two venous-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25% to 3%. The average number of sessions was 2.3 (1-16). After a median follow-up at 5 months after the last session, 23 out of 24 patients reported a decrease in pain; in nine cases (37.5%), over 50% reduction in size was observed, and in 14 cases (58.3%), a reduction of less than 50% of the original size was obtained. Two minor side effects were reported.Conclusions: Treatment by ultrasound-guided sclerosis using polidocanol foam seems to be well tolerated and can improve the symptoms of low-flow malformations without the risks of more aggressive sclerosing agents, such as ethanol. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Aims: Sclerotherapy has been suggested as a treatment for slow-flow vascular malformations and especially venous malformations. This article reports on our experience of echosclerotherapy using polidocanol foam in slow-flow malformations at the Vascular Medicine Department of Grenoble University Hospital. Materials and methods: This is a single-centre retrospective study of the medical records of a continuous series of all patients presenting with a symptomatic slow-flow venous, or veno-lymphatic or Klippel-Trenaunay-syndrome (KTS)-type complex vascular malformation treated by echosclerotherapy between January 2006 and December 2009. The therapeutic indication was always validated beforehand by the Grenoble University Hospital multidisciplinary committee for vascular malformations. All of the vascular malformations were classified according to the Hamburg Classification. Polidocanol foam was the sclerosing agent used. Results: 24 patients from 7 to 78 years were treated (19 venous malformations, 3 KTS and 2 veno-lymphatic malformations). The concentrations of polidocanol used ranged from 0.25 to 3%. The mean number of sessions was 2.3. After a median follow-up of 5 months after the last visit, 23 patients of the 24 reported a decrease in pain; in 9 cases, a reduction of more than 50% in the initial volume was achieved, and in 58.3% a reduction of less than 50% in the initial volume. Two cases of minor adverse side effects were reported. Conclusions: Echosclerotherapy with polidocanol foam appears to be well tolerated, improves the symptoms of slow-flow malformations and does not carry the risks of more aggressive sclerosing agents such as ethanol.

Longtemps, la chirurgie a ete le pilier du traitement des varices saphenes mais l’essor des traitements endovasculaires avec notamment l’utilisation de mousses fibrosantes a profondement change la donne en phlebologie. Face a ce bouleversement des pratiques, il nous est apparu indispensable d’elaborer un referentiel, definissant un cadre scientifique et medico-legal opposable a l'HAS, L'AFSSPS, la CNAM, l'ONM, aux associations de malades, assureurs, etc. Il fournira, pour les confreres desireux de se former a la methode, un document de reference issu de l’experience cumulee des auteurs et des donnees scientifiques actualisees. Enfin, il permettra d’etablir des referentiels d’evaluation des pratiques professionnelles (EPP). Ce guide de bonnes pratiques est le fruit du travail collectif d’un groupe de medecins vasculaires pratiquant la phlebologie, issus majoritairement du club mousse de la region Rhone-Alpes qui en est donc le promoteur. Ce consensus a ete concu sur le mode formalise selon les criteres de l’HAS. Les chapitres traitent de la formation, du materiel, de la confection de la mousse, des indications/contre-indications, des examens echo-Doppler, des injections, des controles apres traitement, de la securite, des comptes-rendus et aspects reglementaires notamment de l'information et du consentement du patient.

For a long time, the basic treatment of saphenous varices has been surgical but the development of endo vascular techniques in phlebological practice, particuliarly with the use of sclerosing foam, has profoundly changed the situation. In the face of this radical change in practice, it seemed essential to elucidate recommendations defining the scientific and medicolegal background of this technique in response to the "HAS" ["Haute Autorite de Saute" = Higher Health Authority], the "AFSSPS" ["Agence Francaise de Securite Sanitaire des Produits de Sante" = French Agency for Sanitary Security of Health Products], the CNAM ["Caisse Nationale d'Assurance Maladie" = National Fund for Health Insurance], the ONM ["Ordre National des Medecins" = General Medical Council], the patients' associations, the insurance companies, etc. To colleagues wishing to learn this method, it provides a text of reference born of the cumulated experience of the authors and of up to date scientific facts. Furthermore, it will form the basis of Assessment of Professional Practice (APP).This guide of good practice is the result of the collective work of a group of vascular physicians experienced in phlebology, mostly members of the "Foam Club" of the Rhone-Alpes region which is thus its promoter. This consensus document has been formulated in accordance with the criteria used by the "HAS".The different chapters deal with the training, the equipment, the manufacture of the foam, the indications/contra-indications, the echo-Doppler investigations, the injections, the follow-up, the safety precautions, the reports and the legal aspects, particularly concerning information and patient consent.

Longtemps, la chirurgie a ete le pilier du traitement des varices saphenes mais l’essor des traitements endovasculaires avec notamment l’utilisation de mousses fibrosantes a profondement change la donne en phlebologie. Face a ce bouleversement des pratiques, il nous est apparu indispensable d’elaborer un referentiel, definissant un cadre scientifique et medico-legal opposable a l'HAS, L'AFSSPS, la CNAM, l'ONM, aux associations de malades, assureurs, etc. Il fournira, pour les confreres desireux de se former a la methode, un document de reference issu de l’experience cumulee des auteurs et des donnees scientifiques actualisees. Enfin, il permettra d’etablir des referentiels d’evaluation des pratiques professionnelles (EPP). Ce guide de bonnes pratiques est le fruit du travail collectif d’un groupe de medecins vasculaires pratiquant la phlebologie, issus majoritairement du club mousse de la region Rhone-Alpes qui en est donc le promoteur. Ce consensus a ete concu sur le mode formalise selon les criteres de l’HAS. Les chapitres traitent de la formation, du materiel, de la confection de la mousse, des indications/contre-indications, des examens echo-Doppler, des injections, des controles apres traitement, de la securite, des comptes-rendus et aspects reglementaires notamment de l'information et du consentement du patient.

RésuméLongtemps, la chirurgie a été le pilier du traitement des varices saphènes mais l’essor des traitements endovasculaires avec notamment l’utilisation de mousses fibrosantes a profondément changé la donne en phlébologie. Face à ce bouleversement des pratiques, il nous est apparu indispensable d’élaborer un référentiel, définissant un cadre scientifique et médico-légal opposable à l’HAS, L’AFSSPS, la CNAM, l’ONM, aux associations de malades, assureurs, etc. Il fournira, pour les confrères désireux de se former à la méthode, un document de référence issu de l’expérience cumulée des auteurs et des données scientifiques actualisées. Enfin, il permettra d’établir des référentiels d’évaluation des pratiques professionnelles (EPP).Ce guide de bonnes pratiques est le fruit du travail collectif d’un groupe de médecins vasculaires pratiquant la phlébologie, issus majoritairement du club mousse de la région Rhône-Alpes qui en est donc le promoteur. Ce consensus a été conçu sur le mode formalisé selon les critères de l’HAS.Les chapitres traitent de la formation, du matériel, de la confection de la mousse, des indications/contre-indications, des examens écho-Döppler, des injections, des contrôles après traitement, de la sécurité, des comptes-rendus et aspects réglementaires notamment de l’information et du consentement du patient.

Some interfaces in semiconductors or insulators structurally cause a valence mismatch, which leads to a two-dimensional space charge that must be balanced by localised or mobile charge carriers. Screening by mobile electrons presents a lot of theoretical as well as practical interests. However it is extremely rare, so that we are aware of only one case, on which we focus here: the (0 0 1) interface between LaAlO3 and TiO2-terminated SrTiO3. Theoretically, this interface between two insulators is positively charged. Electron conductivity is observed in this system, but whether it is associated with the interface screening or an extrinsic unintended doping is not yet settled. Here, we use the literature and our own numerical and practical experiments to discuss the physics of this system.

La sclerose des varices connait un grand essor grâce a l'utilisation de mousses qui en decuplent les possibilites mais il n'existe pas actuellement de schema strategique de traitement. L'auteur a developpe une strategie de traitement a la mousse sans schema preconcu mais qui s'adapte a la cartographie variqueuse : le SOV concept. Apres un examen echo-Doppler minutieux, on ne traite dans un premier temps, a la mousse et sous echographie, que les varices « anatomiques » (reflux majeurs dans des veines dilatees et deformees). A distance, un nouvel examen confirme la sclerose effective de ces varices anatomiques et eventuellement la suppression des reflux dans des varices « fonctionnelles » (reflux dans des veines d'aspect normal). En effet, ces reflux fonctionnels sont susceptibles de disparaitre lorsque l'on supprime un siphon en amont ou une surpression en aval. La non-suppression des reflux dans ces varices fonctionnelles signifie leur traitement secondaire. Il est donc possible de ne pas eradiquer la totalite des varices mais la totalite des reflux, preservant ainsi le capital veineux. La conservation des voies de drainage naturel ralentit probablement l'evolution de la maladie variqueuse. Le SOV concept n'est pas un nouveau traitement mais une nouvelle strategie de traitement a la mousse des varices.

Dans cette etude prospective sur 2 ans, les auteurs ont voulu apprecier la tolerance et l'efficacite de la sclerose saphenienne echo-guidee chez des patients sous anticoagulants. Soixante-quatre saphenes (50 grandes et 14 petites) de 47 patients d'âge moyen 65 ans (32-92) decoagules pour une raison d'ordre cardiaque (32), vasculaire (12) ou mixte (3) ont beneficie au plus de 3 seances de sclerose. Aucun incident ou accident n'a ete constate au cours de l'etude et le traitement anticoagulant ne semble pas modifier les resultats de la sclerotherapie.

L'interet de l'utilisation de mousse de sclerosant est maintenant bien avere. L'auteur propose une nouvelle methode simple, economique, n'utilisant pas de materiel a resteriliser, pour fabriquer de la mousse de sclerosant dans des seringues en plastique et avec des aiguilles de 0,5 mm de diametre. Le principe reside dans l'aspiration d'un melange air/sclerosant en positionnant la pointe de l'aiguille (orifice tourne vers le cote) a la surface du liquide. Cette methode simple devrait permettre la generalisation de l'utilisation de mousse de sclerosant dans le but d'eradiquer tous les types de varices.