Die Varikose mit ihren klinischen teils relevanten Auswirkungen ist vor allem in den Industrienationen weit verbreitet. Neben der Anamnese und der klinischen Untersuchung stellt die Duplexsonografie die Bildgebung der Wahl bei der Beurteilung der Varikose der unteren Extremitäten dar. Neben ihrer diagnostischen Zuverlässigkeit ist sie, im Vergleich zu anderen Formen, der Bildgebung kostengünstig, nicht invasiv, nebenwirkungsfrei [1] und ermöglicht nicht zuletzt die Mitbeurteilung der perivaskulären Umgebung. Die Duplexsonografie erlaubt eine systematische und in der Regel abschließende Beurteilung der relevanten anatomischen und funktionellen Aspekte des Venenleidens und ist wegweisend bei der Entscheidung bezüglich des Therapieplans. In den letzten Jahren wurden Anstrengungen unternommen, Untersuchung und Interpretation in der Abklärung der Varikose zu standardisieren. Hier sind insbesondere die Konsensusempfehlungen der Union Internationale de Phlébologie (UIP) bezüglich der Nomenklatur [2] und der duplexsonografischen Methodik [3] zu erwähnen.

Basic knowledge of the physiology, pathophysiology, classification, and epidemiology of chronic venous disease

OBJECTIVES To compare the diagnostic performance between a vascular specialist and a rheumatologist not familiar with vascular ultrasound when applying the compression sign for the diagnosis of temporal arteritis. METHODS Sixty consecutive patients with suspicion of giant cell arteritis were examined by both examiners. Compression of the temporal artery on both sides (stem and both branches) was performed to define whether signs of vasculitis, no vasculitis or an indefinite result were present. Each examiner was blinded to the result of the other. RESULTS In 59/60 patients, the examiners found an identical result. The interobserver agreement (Krippendorf alpha) was 0.92. CONCLUSIONS The new compression sign for the diagnosis of temporal arteritis is a simple and robust sonographic marker with an excellent interobserver agreement.

Background: Cardiac biomarkers or echocardiography for assessing right ventricular function are recommended to risk-stratify patients with acute non-massive pulmonary embolism (PE) but it remains unclear whether these tests affect the management and clinical outcomes in daily practice. Methods and results: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER) of whom 178 (30%) neither had a biomarker test nor an echocardiographic evaluation. Compared to the 409 (70%) patients with biomarkers or echocardiography of whom 210 (51%) had at least one positive test, patients without any testing were younger (61±18 vs. 67±16 years; p<0.001), more often outpatient at diagnosis (64% vs. 46%; p<0.001), had more often provoked PE (45% vs. 34%; p=0.010) and cancer (32% vs. 22%; p=0.015), and had less frequently main pulmonary artery embolism (26% vs. 37%, p=0.009) or an increased PE severity index (59% vs. 70%; p=0.012). The hospitalization rates were 80% without vs. 93% with testing (p<0.001); thrombolysis and/or embolectomy were performed in 2.8% vs. 4.9% (p=0.29), and the 30-day rates of mortality and PE recurrence were 7.4% vs. 3.2%, respectively (p=0.031). The predictive value of biomarker testing or echocardiography was lost (HR 0.62, 95%CI 0.27-1.39; p=0.24) when adjusted for other univariate predictors of mortality and recurrent PE, including cancer, chronic lung disease and bleeding complications. Conclusions: Although more than two thirds of the PE patients underwent risk assessment with a biomarker test or an echocardiogram, such testing had little impact on management and clinical outcomes.

Abstract Purpose: In patients with suspected giant cell arteritis (GCA), a search for the perivascular halo sign, a sophisticated color duplex ultrasound (CDU) finding, at experienced centers reliably identifies inflamed temporal arteries (TA). We tested whether TA compression in patients with GCA, a simple, largely operator-independent maneuver, elicits contrasting echogenicity between the diseased artery wall and the surrounding tissue (compression sign). Materials and Methods: 80 individuals with suspected GCA were prospectively enrolled in this single-center study. In all study participants, bilateral ultrasound examination of the TA established the presence/absence of the halo and compression sign. A positive compression sign was defined as visibility of the TA upon transducer-imposed compression of the artery. Based on ACR criteria, a team of specialized physicians independently grouped patients as GCA versus non-GCA. Results: 43/80 study participants were grouped as GCA. Both the halo sign and the compression sign were positive in 34/43 patients in the GCA group, and negative in all 37/37 of the non-GCA group, resulting in a sensitivity of 79 % and a specificity of 100 % for both the halo and the compression sign. Conclusion: In this cohort of individuals with suspected GCA, the halo sign and the compression sign were equal in their diagnostic performance. The simplicity of the compression sign suggests a level of reliability warranting further evaluation.

BACKGROUNDCardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice.DESIGN AND METHODSOverall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests.RESULTSAmong the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence.CONCLUSIONAlthough elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination.

PurposeTo validate a new sonographic criterion for the diagnosis or exclusion of vasculitic affection in the temporal arteries in patients suspected of having giant cell arteritis (GCA).Material & Methods45 consecutive patients referred for sonographic vascular evaluation were included. Temporal arteries (trunc, frontal and parietal branch) were examined on both sides using a Philips iU22, 5-17MHz linear scan head. Beside the known criteria consisting of the halo-sign, stenoses and occlusion, the compression-sign was tested. Slight pressure on the temporal artery was applied until the vessel collapsed. The compression-sign was positive, if temporal artery remained incompressible with an almost equal diameter. Final Diagnosis was made by independent physicians on the basis of the ACR-criteria.Results26/45 patients (58%) had GCA. Temporal artery was incompressible in 21/26 (81%), the halo-sign was positive in 20/26 (77%) patients. 14/26 patients had a typical histology. The sensitivity and specificity of the compression-sign compared to definite diagnosis was 81% and 100%, compared to biopsy 100% and 72%, respectively. The values for the halo-sign were comparable.ConclusionThe compression-sign is a robust sonographic criterion with high sensitivity and excellent specificity in the diagnosis of GCA. The diagnostic accuracy is equal to the halo-sign with the striking advantage being much easier to apply and therefore less operator dependent. PurposeTo validate a new sonographic criterion for the diagnosis or exclusion of vasculitic affection in the temporal arteries in patients suspected of having giant cell arteritis (GCA). To validate a new sonographic criterion for the diagnosis or exclusion of vasculitic affection in the temporal arteries in patients suspected of having giant cell arteritis (GCA). Material & Methods45 consecutive patients referred for sonographic vascular evaluation were included. Temporal arteries (trunc, frontal and parietal branch) were examined on both sides using a Philips iU22, 5-17MHz linear scan head. Beside the known criteria consisting of the halo-sign, stenoses and occlusion, the compression-sign was tested. Slight pressure on the temporal artery was applied until the vessel collapsed. The compression-sign was positive, if temporal artery remained incompressible with an almost equal diameter. Final Diagnosis was made by independent physicians on the basis of the ACR-criteria. 45 consecutive patients referred for sonographic vascular evaluation were included. Temporal arteries (trunc, frontal and parietal branch) were examined on both sides using a Philips iU22, 5-17MHz linear scan head. Beside the known criteria consisting of the halo-sign, stenoses and occlusion, the compression-sign was tested. Slight pressure on the temporal artery was applied until the vessel collapsed. The compression-sign was positive, if temporal artery remained incompressible with an almost equal diameter. Final Diagnosis was made by independent physicians on the basis of the ACR-criteria. Results26/45 patients (58%) had GCA. Temporal artery was incompressible in 21/26 (81%), the halo-sign was positive in 20/26 (77%) patients. 14/26 patients had a typical histology. The sensitivity and specificity of the compression-sign compared to definite diagnosis was 81% and 100%, compared to biopsy 100% and 72%, respectively. The values for the halo-sign were comparable. 26/45 patients (58%) had GCA. Temporal artery was incompressible in 21/26 (81%), the halo-sign was positive in 20/26 (77%) patients. 14/26 patients had a typical histology. The sensitivity and specificity of the compression-sign compared to definite diagnosis was 81% and 100%, compared to biopsy 100% and 72%, respectively. The values for the halo-sign were comparable. ConclusionThe compression-sign is a robust sonographic criterion with high sensitivity and excellent specificity in the diagnosis of GCA. The diagnostic accuracy is equal to the halo-sign with the striking advantage being much easier to apply and therefore less operator dependent. The compression-sign is a robust sonographic criterion with high sensitivity and excellent specificity in the diagnosis of GCA. The diagnostic accuracy is equal to the halo-sign with the striking advantage being much easier to apply and therefore less operator dependent.

We present a patient with an aortic aneurysm and the epidemiology, etiology, screening, symptoms and therapeutic options of abdominal aortic aneurysms are discussed. A widening of the abdominal aorta >3 cm is termed aortic aneurysm. As patients with aortic aneurysm are mostly oligosymptomatic until rupture occurs and an estimated 30,000 patients annually die from ruptured aortic aneurysm in the US a screening of the population at greatest risk (smokers, familial predisposition) is recommended. Screening is best done by ultrasound. Noninvasive therapy is limited to antiplatelet therapy and optimal adjustment of risk factors. For definitive treatment endovascular aortic repair (EVAR) is considered an established alternative to open surgery with lower 30 days mortality but higher reintervention rate.

Evidence-based check-up does not only include medical history and physical examination but consultation with regard to recommended vaccinations, screening for cancer and cardiovascular risk factors. Patients with PAD are at high risk for cardiovascular events but frequently claudication is not mentioned during anamnesis, thus specific attention to exercise-dependent leg discomfort is necessary. Recognition of PAD related symptoms is important because it may implicate secondary cardiovascular prevention and specific therapeutic options including walking exercise and endovascular revascularisation exist.

Travel-related venous thromboembolism (VTE) is probably less frequent than previously suspected and becomes relevant when a flight lasts eight hours or more. Usually, general measures such as avoiding constrictive clothing or dehydration and doing gymnastics and walking around in the cabin are sufficient for preventing VTE. Compression stockings can be recommended when risk factors for VTE are present. Low molecular weight heparins in prophylactic dosage should be considered after previous VTE.

Introduction: Percutaneous left ventricular assist devices are an important tool in the management of patients with severe cardiogenic shock. Limited experiences concerning vascular complications after long term implantation of these devices exist. We report on a large arteriovenous fistula after placement of a left ventricular assist device, which has not been described in the literature. The arteriovenous fistula was of clinical relevance because it represented a supplementary cardiac burden in a patient with impaired left ventricular function after a severe myocardial infarction.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Duplexsonographie der infrarenalen Aorta abdominalis Welche sind das? Erlauben diese Befunde eine Diagnose? Wenn ja, welche? Sind Differenzialdiagnosen möglich? Wenn ja, welche?

Background: Dilatation and enhanced distensibility are specific biophysical properties of varicose veins. Both can be assessed by ultrasonography. The aim of this study was to analyse correlations between the vein wall protein content and these two biophysical properties of varicose veins.Methods: Twenty-seven patients having surgery for varicose veins and six control patients with normal veins undergoing arterial bypass surgery were examined clinically and with ultrasonography the day before surgery. Fifty-two varicose and six control vein rings were harvested and analysed histopathologically and morphometrically; vascular tissue microarrays incorporated 116 vein wall sectors.Results: Elastin loss in the adventitia (P = 0.010) and reduction of type III collagen in the intima and media (P = 0.004) were observed in varicose veins. Elastin loss correlated negatively with vein diameter at rest (P = 0.005), whereas loss of type III collagen in the intima correlated negatively with the increase in vein diameter at the Valsalva manoeuvre (P < 0.001).Conclusion: Loss of elastin and type III collagen occurs in varicose veins and can be assessed with ultrasonography in vivo by measuring vein diameter and distensibility.