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LYMPHOLOGY
PHLEBO
N37
Advisory board
PRESIDENT
J. A. JIMNEZ COSSO, MD
Head, Dept of Angiology and Vascular Surgery
La Paz Hospital - 28043 Madrid, Spain
MEMBERS
C. ALLEGRA, MD
Head, Dept of Angiology
Hospital S. Giovanni Via S. Giovanni Laterano, 155 - 00184, Rome, Italy
P. COLERIDGE SMITH, MD
Senior Lecturer and Consultant Surgeon University College London Medical School
The Middlesex Hospital Mortimer Street - London W1N 8AA, UK
M. COSPITE, MD
Head, Dept of Angiology
University Clinic, Palermo, Italy
G. JANTET, MD
Consultant Vascular Surgeon
Past President of the Union Internationale de Phlbologie
14, rue Duroc, 75007 Paris, France
P. S. MORTIMER, MD
Consultant Skin Physician & Senior Lecturer in Medicine (Dermatology)
St Georges Hospital - Black Shaw Road, London SW17 OQT, UK
A. N. NICOLAIDES, MD
Institute of Neurology and Genetics
6, International Airport Avenue - Ayios Dhom Ctios
P. O. Box 3462 CY 1683 Nicosia - Cyprus
H. PARTSCH, MD
President of the Union Internationale de Phlbologie
Baumeistergasse 85
A 1160 Vienna, Austria
M. PERRIN, MD
Chirurgie Vasculaire
Past President of the Socit de Chirurgie Vasculaire de Langue Franaise
Past President of the Socit Franaise de Phlbologie
Past President of the European Venous Forum
26, Chemin de Dcines - 69680 Chassieu, France
L. THIERY, MD
Angiologist & Surgeon
Consultant, University Hospital Gent - Korte Meer 12, 900 Gent, Belgium
CITED/ABSTRACTED
IN EMBASE/Excerpta Medica
2002 Les Laboratoires Servier All rights reserved throughout the world
and in all languages.
V. WIENERT, MD
Head, Dept of Phlebology
University Clinic - Pauwelstrasse, 51000 Aachen, Germany
EDITORIAL
T
PHLEBOLYMPHOLOGY 2002
Peter Gloviczki, MD
Congress Chair and President
International Union of Angiology
S1
PREFACE
PHLEBOLYMPHOLOGY 2002
A.N. Nicolaides
Chairman and Medical Director, The Cyprus Institute
of Neurology and Genetics
Emeritus Professor of Vascular Surgery, Imperial College
of Science, Technology and Medicine, London
Past President of the International Union of Angiology
S3
Andrew NICOLAIDES
Chairman of the MRA
Institute of Neurology and Genetics
6, International Airport Avenue
Ayios Dhom Ctios
P.O. Box 23462 CY 1683
Nicosia, Cyprus
Iris BAUMGARTNER
Inselspital Bern Abteilung
Angiologie Freiburgerstrasse 4
3010 Bern, Switzerland
Yves BLOMME
Volkskliniek
Tichelrei
B-9000 Gent, Belgium
Andrzej GABRUSIEWICZ
Daniele RIGHI
Viale Mamiani, n. 24
50137 Firenze, Italy
Vassilios PAPAVASSILIOU
11, Gedeon Street
11525 Athens, Greece
Bernhard PARTSCH
Krankenhaus Lainz
Dermatologische Abteilung
Wolkersbergenstr.1
1130 Wien, Austria
S4
Patricia SENET
Hpital Charles Foix
Pavillon de lOrbe
7, avenue de la Rpublique
94205 Ivry-sur-Seine, France
Elena IBORRA
Ciutat Sanitaria i Universitaria
de Bellvitge
Servicio de Angiologa y Cirurga Vascular
C/ Fcixa Llarga, s/n
08907 LHospitalet de Llobregat, Spain
PHLEBOLYMPHOLOGY 2002
CONTENTS
Part 1
ADVANCES IN VASCULAR MEDICINE ---- S11
Straub-Rotarex-assisted recanalization
of in-stent occlusions of femoropopliteal arteries:
long-term results - U. Frank
Part 2
AORTIC ANEURYSMS ----------------------------------- S21
AORTIC ANEURYSMS I
ETIOLOGY, GENETICS, TREATMENT
AORTIC ANEURYSMS II
Keynote lecture: The natural history of thoracoabdominal aortic aneurysms and the effectiveness
of surgical treatment - H. Safi
Straub-Rotarex-assisted recanalization
of thrombotic/embolic arterial occlusions:
long-term results - U. Frank
PHLEBOLYMPHOLOGY 2002
S5
Part 3
ATHEROSCLEROSIS --------------------------------------- S31
RISK FACTORS OF ATHEROSCLEROSIS
Keynote Lecture: Global cardiovascular risk in
patients with peripheral arterial diseases - S. Novo
What techniques have been effective
at the Mayo clinic to stop smoking? - R. Hurt
Optimizing adherence to smoke cessation
in vascular disease patients: is this possible?
The Canadian perspective - J. Irvine
Part 5
Part 4
CEREBROVASCULAR DISEASES --------------- S33
CEREBROVASCULAR DISEASE I
S6
PHLEBOLYMPHOLOGY 2002
Part 6
TASC
CoCaLIs
Part 7
IUA PRIZE ---------------------------------------------------------- S57
ABSTRACTS PRESENTED BELOW ARE
THOSE BY THE THREE FINALISTS
OF THE IUA FELLOWSHIP
Duplex imaging analysis of greater
saphenous vein reflux: basis for strategy
of endovenous obliteration treatment - O. Pichot
Potential use of D-dimer measurement
in patients treated with oral anticoagultants
for a venous thromboembolic episode
E. Ombandza-Moussa
Duplex ultrasound criteria for defining
the severity of carotid stenosis - K. A. Fillis
Part 8
LYMPHOLOGY-------------------------------------------------- S61
LYMPHEDEMA AND CHYLOUS DISORDERS
Microcirculation and lymphedema - G. Thibaut
Nonoperative treatment of chronic
lymphedema - T. Rooke
PHLEBOLYMPHOLOGY 2002
S7
Part 9
PERIPHERAL ARTERIAL DISEASE----------- S65
DIABETES, CRITICAL LIMB ISCHEMIA,
AMPUTATION
Carotid artery atherosclerosis according
to the ACE I/D polymorphism in subjects
with diabetes mellitus - E. Andreadis
PATIENTS WITH PERIPHERAL ARTERIAL DISEASE
AND CHANGES IN THE UPPER-LIMB VESSELS
Intimal thickening of the radial artery - J. Woodcock
PERIPHERAL ARTERIAL DISEASE: EPIDEMIOLOGY,
QUALITY OF LIFE, MEDICAL TREATMENT
Legs for Life: a screening and educational
program for vascular disease - P. Beatty
Disease-specific quality of life (QOL) analysis:
is it necessary in patients with claudication?
P. A. Coughlin
PHARMACOTHERAPY FOR PERIPHERAL
ARTERIAL DISEASE
The 3rd transatlantic vascular medicine
symposium
VASCULAR BIOLOGY
The prevalence and natural history of PAD:
A rationale and primer for PAD
pharmacotherapy - J. Dormandy
Pathophysiology of claudication - W. Hiatt
Measuring clinical outcomes: claudication
(Report of the transatlantic Guidelines)
K. H. Labs
Measuring clinical outcomes: CLI (Report
of the transatlantic Guidelines) - F. Moneta
ESTABLISHED THERAPIES FOR CLAUDICATION
Role of lifestyle and exercise interventions
A.Hirsh
Part 10
S8
PHLEBOLYMPHOLOGY 2002
Part 11
VASCULAR SURGERY --------------------------------- S101
VASCULAR ACCESS
PHLEBOLYMPHOLOGY 2002
S9
Part 12
S10
PHLEBOLYMPHOLOGY 2002
Part 1
ADVANCES IN
VASCULAR MEDICINE
S12
PHLEBOLYMPHOLOGY 2002
In his presentation W. Baker reviewed current practices in his institution in terms of carotid artery surgery.
He also presented the different morphological aspects
of carotid plaques and the importance that this could
have in selecting patients for surgery. The main ideas
generated in the talk were:
The majority of this surgery is done on the basis of
preoperative ultrasound.
PHLEBOLYMPHOLOGY 2002
venous thromboembolism and major bleeding outcomes. But there is still some resistance to sending
patients home for treatment.
The possibility for treating these patients with longterm LMWH instead of oral anticoagulants was also
pointed out, with recent data showing fewer side
effects and better patient tolerance in terms of quality
of life. There is also evidence that patients treated with
long-term LMWH for DVT had less incidence of
posthrombotic syndrome. The possible rebound
phenomenon of an increased incidence of new DVT
after cessation of long-term therapy with LMWH
remains an important issue.
S13
S14
PHLEBOLYMPHOLOGY 2002
risk of amputation. The first therapeutic option is surgical revascularization. Sometimes, because of poor
runoff, increased prevalence of aged patients, or
increased comorbidity, bypass surgery presents a high
risk of failure, and only intensive medical care can be
performed. In CLI, most studies report pharmological
treatments carried out only once during 3 or 4 weeks,
without any data about long-term follow up to
6 months. Intensive medical care of CLI includes:
unfractionated heparin administration, PGE1 or
7.4%
Amputations
Maintenance
therapy
14.8%
Surgical revascularization
29.6%
Persistent CLI
14.8%
2nd Cycle of PGE1
7.4%
Amputations
3.7%
Deaths
3.7%
Stable PAD
Stable PAD
PHLEBOLYMPHOLOGY 2002
S15
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PHLEBOLYMPHOLOGY 2002
Tissue
PHLEBOLYMPHOLOGY 2002
S17
R ecurrence of varicose veins even after optimal surgical therapy is a well-known problem, with a frequency of between 10% and 50% on long-term follow-up. Ultrasound-guided sclerotherapy has been
one of the alternatives to conventional surgery. In
recent years microfoam sclerosants have appeared, and
the first short-term results of this therapy were
reported by the author. One advantage of microfoam
in comparison to liquid sclerosants is a displacement of
blood by the foam, thereby effectively transporting the
S18
PHLEBOLYMPHOLOGY 2002
In
Radiofrequency
Success rate in %/(n of pt)
Laser
Success rate in %/(n of pt)
100 (45)
95 (43)
93 (46)
91 (46)
3-5 months
100 (41)
91 (44)
6-9 months
90 (30)
61 (31)
10-12 months
80 (10)
80 (10)
1 week
4-8 weeks
Straub-Rotarex-assisted recanalization
of thrombotic/embolic arterial occlusions: long-term results
U. FRANK, T. ZELLER, K. BRGELIN, P. FLGEL, B. HORN, U. SCHWARZWLDER, F-J. NEUMANN (Germany)
Rotarex is a new device for embolectomy, catheterguided, which rotates and at the same time aspirates
thrombus and neointima.
The authors used such a device for treating 67 patients,
in 36% of the cases for acute thromboembolic occlusion of a native artery, and in 11% for acute bypass
occlusion, mean occlusion length was 21 cm, and 6%
of the patients were in Fontaine stage II a, 62% in stage
II b, 23% in stage III, and 9% in stage IV.
PHLEBOLYMPHOLOGY 2002
S19
S20
PHLEBOLYMPHOLOGY 2002
Part 2
AORTIC ANEURYSMS
AORTIC ANEURYSMS I
ETIOLOGY, GENETICS, TREATMENT
Moderators: P. GLOVICZKI (USA), P. BALAS (Greece)
With the participation of : D. Tilson (USA), W. Pearce (USA), F. Lederle (USA),
K. Wayne Johnston (Canada), P. Kalman (Canada), C. Zarins (USA)
S22
PHLEBOLYMPHOLOGY 2002
AORTIC ANEURYSMS II
Moderators: A. OLDENBURG (USA), P. KALMAN (Canada)
Vascular imaging has dramatically changed , primarily driven by endovascular aneurysm repair.
In general, imaging criteria are not as demanding for
open surgical repair of AAAs. Sophisticated new imaging techniques are nonetheless helpful in generating
more useful information for operative planning with
less invasive preoperative studies.
CT angiography and 3-dimensional reconstructions are
superior to the traditional pairing of conventional CT
and angiography in cases of open repair, even in complex thoracoabdominal aortic aneurysms. Preoperative
imaging for endovascular aneurysm repair (EVAR) is
even more demanding, computer-aided measurement,
planning and simulation software (CAMPS) in combi-
PHLEBOLYMPHOLOGY 2002
S23
S24
PHLEBOLYMPHOLOGY 2002
The
S25
S26
he talent LPS Stent-graft is a modular, self-expanding graft that can be inserted in the suprarenal position
and is available in large sizes with ease of use. The
1-year results of the trial comparing 237 EAVR with
PHLEBOLYMPHOLOGY 2002
S27
During his talk R. White described the Endologix unibody bifurcated endograft which requires surgical exposure of only one vessel and has the unique advantages of percutaneous delivery of the contralateral limb.
He also recommend the use of intravascular ultrasound (IVUS) which provides data that is otherwise not
S28
PHLEBOLYMPHOLOGY 2002
The analyses showed that the presence of devicerelated endoleaks correlated with a higher risk of
aneurysmal rupture and conversion compared to
patients without type I and type III endoleaks. Type II
endoleak was not associated more often with these
events. Consequently intervention in type II endoleaks
should only be performed in case of increase of
aneurysm size.
The main points of K. Ouriels talk referred to the failure modes of aortic endoprostheses which depend on:
the characteristics of arterial anatomy;
PHLEBOLYMPHOLOGY 2002
S29
Part 3
ATHEROSCLEROSIS
he concept of arteriosclerosis of the lower extremities as a marker of risk for total cardiovascular morbidity and mortality is well established. Numerous
studies like the Whitehall study, the San Diego study,
and others, have shown that if one follows prospectively a group of patients with peripheral arterial
disease (PAD) and compares them with healthy
controls, morbidity and mortality is increased in the
PAD group by a factor of 2. S.W. Cheng et al analyzed
the survival of 655 patients with PAD in a follow-up of
ailoring the techniques of counseling and pharmacotherapy to the needs of the individual patient using
serum concentrations of cotinine (a major metabolite
of nicotine) can increase smoking cessation rates, as
was pointed out by R. Hurt. He presented the experience at the Mayo Nicotine Dependence Center in USA.
This group uses the serum levels of cotinine to adjust
the dosage for nicotine patches on an individual basis
in order to control the abstinence syndrome. In heavy
smokers, more intensive treatment is obtained on the
basis of inpatient-hospitalized programs with a
reported long-term abstinence rate of 50%.
S32
PHLEBOLYMPHOLOGY 2002
Part 4
CEREBROVASCULAR
DISEASES
CEREBROVASCULAR DISEASE I
Chairman: K. CHERRY (USA), G.DERIU (Italy)
Even though carotid endarterectomy is a safe, effective, and durable procedure, the number of carotid
operations performed is smaller than required. In order
to improve this situation, the authors suggest increasing the number of centers undertaking carotid
endarterectomy, and improving patient awareness
(improved carotid registry). They performed 4 pilot
studies in:
Asymptomatic
persons
Symptomatic
with TIAs
Symptomatic
with stroke
3%
25%
36%
In asymptomatic patients with carotid bruit they observed a greater percentage of persons with moderate carotid
stenosis than in asymptomatic persons.
S34
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S35
Bovine
Revision
3.8%
Late mortality
4.2%
1.9%
1.4%
7%
2.5%
2%
S36
PHLEBOLYMPHOLOGY 2002
According to the authors, the eversion endarterectomy technique allows for complete removal of atheromatous plaque and examination of distal and proximal
arteries, to decrease the restenosis and occlusion rate.
The authors performed carotid operations by means of
S everal
PHLEBOLYMPHOLOGY 2002
S37
S38
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
References
1. Wholey M.H, Wholey M, Mathias K et al. Catheter Cardiovasc Interv.
2000;50:160-167.
2. Roubin GS, New G, Iyer SS, et al. Circulation. 2001;103:532-537.
S39
Part 5
Class II stockings improve venous pumping. Belowknee stockings are preferable as they are usually
tolerated, as skin changes never occurred above the
knee. The indications for class II stockings are maintenance therapy in CVI.
Class III and IV stockings are more active on the deep
venous system than class II stockings, and reduce leg
volume more in CVI swelling and lymphedema. One
recent study showed that narrowing the femoral vein
seems to be more effective with adhesive bandages
than with class III stockings. Adhesive bandages reduce
edema by 54% and reflux by 65% versus 30% and
43% for class III stockings.
Concerning prevention of postthrombotic syndrome,
controversial results have been published.1-3 More
trials are needed to confirm or not whether compression therapy can prevent postthrombotic syndrome.
Class I
Class II
Class III
Class IV
C0-C1, S
++
++
C3
++
++
(+)
C4
++
++
C5
(+)
C6
(+)
S42
PHLEBOLYMPHOLOGY 2002
local treatment of venous ulcers. Products combine living cells with extracellular support components.
Apligraf is a bilayered skin construct, made of neonatal foreskin cells (fibroblasts and keratinocytes) in a collagen bovine matrix. It handles like human skin and is
easy graftable. Apligraf was approved by the FDA in
Venous ulcer
Poor healing
Apligraf, 1 application
Maintenance
of conventional treatment
Good healing
Bad healing
Re-application of Apligraf
(no more than 3 times)
Bad healing
Further reading
Falanga V. Arch Dermatol. 1998;134:293-300.
PHLEBOLYMPHOLOGY 2002
Flap
Venous surgery
Ulcer excision
S43
S ince the 1990s, less invasive surgery has been performed to treat superficial venous incompetence such
as proximal stripping-stab avulsion of the greater saphenous
vein. This technique avoids saphenous nerve injury and
allows a partial preservation of the saphenous vein for
further bypass surgery if necessary. Recurrence rate
with this technique fluctuates between 2% and 10%
after 3 years follow-up.
Endoluminal ablation of the saphenous vein is now
currently performed, either by laser (Diomed,
Endolaser 810 nm) or by radiofrequency thermal
injury (VNUS Closure System). Thermal injury by
VNUS Closure system has its advantages (local anesthesia, excellent immediate cosmetic results) and disadvantages (very expensive, complicated logistically,
predisposal to late groin recurrence in the absence of
S44
results are expected in 70% of cases (5 years of followup) after deep venous reflux surgery, mainly valvuloplasty. The recommended technique is valvuloplasty
reconstruction.
In cases of secondary deep venous reflux, SEPS is
recommended as an associated procedure. The procedures of choice in cases of secondary venous reflux are:
transposition > transplantation > cryopreserve transplants. Good clinical results are expected in 50% of the
cases, without any correlation between clinical and
hemodynamic results.
PHLEBOLYMPHOLOGY 2002
Open
C0
9.5%
C1
59.1%
C2
14.2%
C3
13.4%
C4
2.9%
C5
0.7%
C6
0.1%
PHLEBOLYMPHOLOGY 2002
S45
Saphenofemoral
junction
Saphenopopliteal
junction
Perforator
incompetence
Deep vein
incompetence
Primary
62.3%
10.3%
47.1%
19.4%
Recurrence
43.5%
18.8%
63.8%
29.0%
Secondary
42.9%
21.4%
35.7%
50.0%
S46
There are reports in the literature of a Koebner phenomenon (lesions developing in areas of unspecific
trauma) in morphea.
All the lesions so far have been resistant to different
forms of therapy including local steroids, general
antibiotics, and puva therapy which have been shown
to be effective in many of these cases.
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S47
VASCULAR MALFORMATIONS
AND CHRONIC VENOUS DISEASE
Moderators: B. B. LEE (Korea), K. BURNAND (UK)
The
S48
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
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PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S51
S52
under local anesthesia, then use elastic wraps and analgesia for 3 days, followed by compression stockings.
The first results will be published in a short time, but
up to now the author has not observed deep vein
thrombosis or other important complications.
PHLEBOLYMPHOLOGY 2002
Part 6
CONSENSUS MEETINGS
TASC
Symptom management:
S54
PHLEBOLYMPHOLOGY 2002
CoCaLIs
Finally D. Clement presented a summary in management of the CoCaLIs patient, and two proposed
recommendations in PAOD coronary management in
which -blockade could be applied when an intermediate or high cardiac risk was detected, or in all types
of patients. Here we show option 2, which was the
most accepted by the audience (Figure 2).
Aortography
indicated
yes
Noninvasive treatment,
6-montly follow-up
no
yes
in Ccr
or kidney length
Angioplasty stent
yes
-Blockade
Intermediate/high
Low
DSE (Thallium)
Negative
Positive
Coronary angiography
Vascular surgery
PHLEBOLYMPHOLOGY 2002
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Part 7
IUA PRIZE
Purpose
To characterize greater saphenous vein (GSV) reflux in
order to better define indications for appropriate
endovascular obliteration treatment. Materials and
methods: Color-flow duplex imaging was used to
categorize 132 lower limbs in 102 consecutive outpatients, presenting with chronic superficial vein disease
associated with GSV incompetence characterized by a
>2-second reflux duration. The following parameters
were assessed; saphenofemoral junction (SFJ) morphology and hemodynamics, reflux origin, and GSV
main trunk reflux extent. Results: GSV reflux was
related to partial or complete terminal valve incompetence in respectively 33 (24.8%) and 37 (27.8%) limbs,
to subterminal valve incompetence in 37 (27.8%)
limbs, and to segmental incompetence of the GSV
trunk in 26 (19.6%) limbs. Reflux originated from the
common femoral vein (CFV) into the incompetent SFJ
in 70 (52.6%) or into a thigh perforater in 7 (5.3%)
limbs. GSV reflux arose from SFJ tributary drainage
associated with CFV reflux in 32 (24%) limbs. Circumflex and superficial epigastric veins were involved
in 65.2% and 50.7% of the SFJ tributaries, with a mean
S58
Conclusions
The preliminary analysis of our study suggests that in
two thirds of cases, endovenous obliteration treatment
limited to the above-knee segment of the GSV could
be suitable. Furthermore, in order to preserve GSV
competent valves and collateral vein drainage, treatment should start just below the main SFJ tributary
when the subterminal valve is incompetent, and just
below the main branch connection when only the GSV
trunk is incompetent.
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
using the Vidas (bioMrieux, France) analyzer. A significantly lower level of D-dimers was observed in
patients on oral anticoagulants compared with patients
without this treatment, 197 + 134 mg/L versus 399
+ 239 mg/L, respectively (P<0.001). A level over the
normal value (500 mg/L) was found in only 3 patients
out of 81 receiving an oral anticoagulant treatment as
compared with 21 of the 68 patients without treatment. This decrease in D-dimer in patients receiving
oral anticoagulants was the same in the different age
populations. There was no correlation between INR
and D-dimer levels in this study. The clinician should
be informed of the decrease in D-dimer in patients
treated with anticoagulants. The decrease in D-dimer
plasma level during oral anticoagulant treatment
suggests that D-dimer concentration in plasma is an
indirect marker of reduced clotting activity in vivo.
S59
Purpose
Duplex ultrasound scan (DUS) criteria for grading
>50% carotid artery pathology is typically divided into
broad disease groups such as intermediate, severe, and
occlusive lesions. The purpose of this study was to validate DUS criteria for stratifying 50% to 100% carotid
stenosis in 10% intervals, as compared with digital subtraction cerebral angiography (DSCA). Furthermore,
the new velocity criteria were utilized to determine the
clinical management of these patients compared with
angiography.
Methods
Threshold velocity criteria for determining the degree
of carotid stenosis was defined in 7 categories: <50%,
50% to 60%, 60% to 70%, 70% to 80%, 80% to 90%,
90% to 99%, and occlusion. These criteria were compared with DSCA. In cases where duplex velocity criteria did not correlate with angiography, we reviewed
how the angiographic findings altered the surgeons
attitude toward surgical or conservative management.
S60
Results
The sensitivity, specificity, positive predictive value
(PPV), and negative predictive value (NPV) for each
velocity criteria category as compared to angiography
were determined. The results are as follows: a)<50%
stenosis; 98%, 95%, 94%, 98%, b) 50%-60% stenosis: 82%, 99%, 85%, 83%, c) 60%-70% stenosis: 91%,
95%, 77%, 96%, d) 70%-80% stenosis: 80%, 99%,
94%, 97%, e) 80%-90% stenosis: 84%, 99%, 91%,
99%, f) 90%-99% stenosis: 95%, 99%, 95%, 99%, g)
occlusion: 100% for all values. There was a high correlation (R=0.96) between duplex scan and angiography in 93% (302/326) of the cases. Clinical management was altered in 3% (10/326) of the cases based on
the results of DSCA.
Conclusions
The DUS velocity criteria to grade the severity of
carotid disease in 10 percent intervals is reliable and
accurate. Clinical management of patients with carotid
stenosis can be based solely on carotid DUS in 97% of
patients considered for treatment of carotid artery
disease.
PHLEBOLYMPHOLOGY 2002
Part 8
LYMPHOLOGY
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PHLEBOLYMPHOLOGY 2002
S63
Part 9
PERIPHERAL ARTERIAL
DISEASE
Depending
ACE
PEG
PEL
II
41%
44%
13%
ID
47.7%
34.9%
17.4%
DD
27.5%
37.7%
34.8%
The authors concluded that the patients with DD genotype are more exposed to cardiovascular diseases due to
more echolucent plaques.
S66
PHLEBOLYMPHOLOGY 2002
increased radial artery wall thickness can be demonstrated in vivo in patients with coronary atherosclerosis;
PHLEBOLYMPHOLOGY 2002
S67
98 000
588 000
E-mails:
5 200
3099
Cardiologists:
286
Vascular surgeons:
1661
Podiatrists:
291
Radiology nurses:
1876
Vascular nurses:
3161
1998 2001
Technologists:
3267
Medical students:
Other:
Program impact
S68
402
4864
18 907
PHLEBOLYMPHOLOGY 2002
53%
79%
40.8%
Numbness in legs:
29.9%
Cold feet:
30%
Statistics:
Learned more about:
PVD:
69%
Leg pain:
61%
Diabetes:
67%
Heart disease:
38%
48.2%
Overweight:
44.8%
41.4%
Diabetes:
39.8%
60%
Weight:
55%
Smoking:
48%
Diet:
46%
Program components:
Site recruitment, training, and technical assistance
Public education and awareness
Professional education and awareness
Program evaluation
Program oversight and management
PHLEBOLYMPHOLOGY 2002
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PHLEBOLYMPHOLOGY 2002
Pathophysiology of claudication
W. HIATT (USA)
easurable hemodynamics such as the anklebrachial index (ABI) at rest do not ultimately predict
function. There is a well-noted lack of correlation
between ABI and treadmill testing. In addition bypass
surgery/angioplasty do improve ABI but do not always
normalize function, as exercise training does not
improve ABI but may improve function.
A factor underrecognized in the past is changes in
skeletal muscle metabolism based on microcirculatory
PHLEBOLYMPHOLOGY 2002
S71
lassical end points in clinical trials concerning intermittent claudication are treadmill testing and quality
of life assessment. Based on some well conducted studies, absolute claudication distance (ACD) serves best as
a primary end point, whereas initial claudication
distance (ICD) and quality of life assessment should be
restricted to serve as secondary end points. With regard
to the treadmill protocol, data show that graded as well
S72
Surgery and definitions of success by itself are problematic, because of the very strict criteria defined to
reflect ideal result and that rarely can be fulfilled (alive,
without complications, primary bypass patency, limb
salvage, wound healing, no recurrence of ischemia,
and no need for reoperation). By having these criteria,
only a small percentage of patients have an ideal result.
Definitions, however, should be adapted to patients
with considerable comorbidities to reflect what can be
expected (assisted patency, limb salvage, alive).
PHLEBOLYMPHOLOGY 2002
he author stressed the point that so far no pharmacologic therapy for the treatment of intermittent claudication has been as effective as the reduction of risk
factors by changing the lifestyle and consequent exercise programs.
Exercise programs are known to be effective in improving walking ability and physical functioning. They are
safe, without any record of morbidity or mortality.
The best results are achieved with supervised exercise
at least three times per week, but patients have to be
motivated and compliant. In order to be effective this
has to be continued for 3 to 6 months. The author cited
PHLEBOLYMPHOLOGY 2002
S73
Part 10
THROMBOTIC
DISORDERS
Leg compression and ambulation are better than bed rest for the
treatment of symptoms of acute proximal deep vein thrombosis
H. PARTSCH (Austria)
Stockings/walking
(n=18)
Inelastic bandages/walking
(n=18)
All patients were treated with dalteparin 200 IU/kg/24 h sc once daily.
S76
PHLEBOLYMPHOLOGY 2002
There were 2 prospective series on deep vein thrombosis (DVT) and personal experiences with outpatient
treatment presented by the author. The low-molecular-weight heparin (LMWH) dalteparin (200 U/kg
body weight once daily) and phenprocoumon were
used as anticoagulants. The selection process was monitored in 156 consecutive patients, and the practicability and quality of outpatient treatment in 202 consecutive cases followed over 4 years. All distal DVTs were
treated as outpatients. Of proximal DVTs 11% were
admitted to hospital (9% for thrombectomy or thrombolysis and 2% for conservative treatment). One hundred percent of the dalteparin injections were done as
PHLEBOLYMPHOLOGY 2002
S77
Patients without
cancer
Patients with
cancer
P value
25
(CI 95% 17-30)
26
(CI 95% 21-31)
<0.01
34%
38%
< 0.01
50.5%
38.7%
< 0.01
Deterioration
5.8%
9.9%
< 0.01
Recurrent VTE
3.0%
10.2%
< 0.01
LMWH
39/1481
UFH*
41/1471
LMWH
46/306
UFH
71/323
OR 0.61 (0.40-0.93)
in favor of LMWH compared with UFH
Table II. Mortality at 3-month follow-up and DVT treatment. Meta-analysis (9 studies, 1992-97).
In a large observational study by Haas and coworkers it was also shown that prophylaxis of VTE is less efficient
in cancer patients (Table III).
Patients without
cancer
Patients with
cancer
(n=16.954)
(n=6.124
Death
0.7%
3.1%
0.0001
0.09%
0.31%
0.0001
8%
14%
0.0001
In-hospital mortality
P value
S78
PHLEBOLYMPHOLOGY 2002
Prophylaxis
PHLEBOLYMPHOLOGY 2002
shown more recently to significantly reduce phlebographically verified DVT (7.9% vs 22.5%, P<0.001)
and symptomatic VTE (1.4% vs 4.2%, P<0.001).
References
1. Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Br J Surg.
2001;88:913-0193.
2. Mismetti P, Laporte-Simitsidis S, Tardy B, et al. Thromb Haemost. 2000;
81:14-19.
3. Hull RD, Pineo GF, Stein PD, et al. Ann Int Med. 2001;135:858-869.
4. Lensing AW, Prins MH, Davidson BL, Hirsh S. Arch Inter Med. 1995;
601-607.
5. Breddin HK, Hach-Wunderle V, Nakov R, Kakkar VV. N Engl J Med. 2001;
344:626-631.
S79
Fibrin
Thrombin
TAFI
TAFIa
Thrombomodulin complex
Anti FXa
Heparinomimetics
Anti FVIIa
Antithrombin
New developments
Viscosity modulator
Antiplatelet drugs
Serpins
Anti-TF
S80
PHLEBOLYMPHOLOGY 2002
Sepsis
Percutaneous interventions
Excessive bleeding
Limited experiences
Adjunctive administration
Trials in development
Factor Xa (FXa) has a central position in the coagulation system, with a naturally extremely low catalytic
activity. There is a strong amplification of its activity
after assembly with the prothrombinase complex. An
effective indirect inhibition of FXa is achieved by pentasaccharides and synthetic, structurally modified
analogs. Despite the demonstrated effectiveness of FXa
inhibitors (pentasaccharid, Arixtra) for the prophyInhibition of the tissue
factor pathway of coagulation
FIIa
FXa
inhibitors
Platelet function
inhibitors
TFPI
Clopidogrel, GPIIb/IIIa
receptor blocker
S81
The
S82
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S83
S84
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
Two ADP receptor antagonists, ticlopidine and clopidogrel have been shown to be effective in different trials. The combination therapy of clopidogrel and ASA
has been shown to be even more effective leading to
an average risk reduction of 23% in stroke and
myocardial infarction.
According to the author the evidence of the efficacy of
GP IIb/IIIa ihibitors is so far not conclusive.
S85
Anticoagulant and bleeding effects of low-molecularweight heparins at surgical and interventional dosages
can be effectively neutralized by heparinase
O. IQBAL, D. A. HOPPENSTEADT, P. PICCOLO, Q. MA, A. DAUD, H. L. MESSMORE, J. M. WALENGA, D. FAREED (USA)
S86
PHLEBOLYMPHOLOGY 2002
hrombolysis creates recanalization channels, leaving large parts of the clot nondissolved, which poses a
potential source of rethrombosis. In the in vitro study
the authors determined how thrombolysis depended
on penetration of plasma containing thrombolytic
agents rt-PA and streptokinase (SK) under conditions
of turbulent or laminar tangential flow. They performed 20 serial spinecho MRI in 40 minutes to measure the transport of plasma labelled by Gd-DTPA into
clots and to measure the remaining clot size on transverse cross-section.
PHLEBOLYMPHOLOGY 2002
They stated that when SK at 250 IU/mL was used, turbulent flow reduced the cross-section of clots after 40
minutes to 34+/-18% whereas the laminar flow left the
clots unaffected. After 40 minutes of exposure to rapid
flow of plasma containing 2 mg/mL rt-PA, the crosssection of clots was completely dissolved in contrast to
laminar flow where is 86+/-5% of the cross-section of
clots left.
The concluded that the rapid turbulent flow of plasma
allows faster lysis of clot especially by fibrin- specific rt-PA.
S87
Adjudicated
Pentasaccharide
n/N (%)
Enoxaparin
n/N (%)
Pentasaccharide/
enoxaparin
Exact
95%C
Hip fracture
52/626 (8.3)
119/624 (19.1)
-61.6
-73.4;-45
85/1695 (5.0)
151/1716 (8.8)
-45.4
-59.0;-27.6
45/361 (12.5)
101/363 (27.8)
-63.1
-75.5;-44.8
All types
182/2682 (6.8)
371/2703 (13.7)
-55.3
-63.2;-45.8
Type of surgery
Table V. Results of a meta-analysis comparing pentasaccharide with enoxaparin on incidence of adjudicated VTE.
S88
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
3. Thrombocytopenia.
4. Premature coronary artery disease.
5. Premature cerebrovascular disease (TIAs, small
stroke syndrome,
stroke).
cerebrovascular
thrombotic
S89
2. Factor Leiden
F V Leiden is responsible for an acquired resistance to
activated protein C and is due to a mutation in position 506 (arg -> glu). It is found in an average of 5%
of the caucasian population with a single founder effect
(21 to 34 000 years ago), but in 20% of patients with
VTE (1).
S90
PHLEBOLYMPHOLOGY 2002
F V Leiden
F II G20210A
AT deficiency
25%
8%
Prot S deficiency
19%
2%
Prot C deficiency
38%
10%
Healthy controls
3%
1-2%
Table VI. Frequency of combined genetic risk factors in patients with DVT and healthy controls.
Low-risk patients
(no long-term
anticoagulation required)
Heterozygous for F II
Heterozygous for FV Leiden
Heterozygous for Prot C or S deficiency
3-5
5-10
5-10
Intermediate risk
(not enough data available,
every case considered
individually)
AT deficiency heterozygous
F V Leiden combined with another abnormality
10-40
10-40
High risk
(long-term anticoagulation
required)
F V Leiden homozygous
Prot C or S deficiency homozygous
AT deficiency homozygous
50-80
>100
lethal
Reference
1. Emmerich J et al. Thromb Haemost. 2001;86:809-816.
PHLEBOLYMPHOLOGY 2002
S91
follow-up of nontreated patients. Clinical VTE assessment has become highly standardized and expressed
as a score which has to be included in strategy algorithms.1 Low clinical score is 0 and was associated with
3% DVT; intermediate score is between 1 and 2 and
was associated with 17% DVT, high score is 3 and was
associated with 75% DVT.
The speakers team have published strategies for DVT
or PE diagnosis, which have been validated in prospective management studies (Figures 4 and 5). The helical
CT scan may further replace V/Q scan or pulmonary
angiography, only in combination with ultrasonography and clinical assessments.
Low or intermediate
High
ELISA D Dimer
No DVT
Venography
No DVT
DVT
No DVT
DVT
Venous
lower limb US
No DVT
DVT
S92
PHLEBOLYMPHOLOGY 2002
Low
Intermediate
ELISA D Dimer
ELISA D Dimer
Proximal compression
US
Proximal compression
US
No
DVT
DVT
No
DVT
No
DVT
V/Q Scan
Treatment
V/Q Scan
No
treatment
Positive
Negative
Non
diagnostive
Non
diagnostive
Negative
Positive
Treatment
No
treatment
No
treatment
Pulmonary
angiography
No
treatment
Treatment
PHLEBOLYMPHOLOGY 2002
S93
High
Proximal compression US
duplex
Positive
Negative
V/Q Scan
Negative
Positive
Figure 5 (continued).
No
diagnostique
Pulmonary
angiography
No
treatment
Treatment
DVT
Venography
Lower-limb venous US
Serial compression US
Plasma D Dimers by ELISA
Plasma D Dimers by whole blood agglutination
PE
Pulmonary angiography
D Dimers by ELISA
D Dimers by whole blood agglutination
Lower-limb venous US
V/Q lung scan
normal
non diagnostic
high probability
Helical CT pulmonary scan (single slice)
Sensitivity
Specificity
97
97
99
99
86
98
98
98
40
65
97
99
85
30-50
99
70
98
40
65
98
90
90
S94
PHLEBOLYMPHOLOGY 2002
Low-molecular-weight heparin (LMWH) is an efficient treatment of TVE and may be safer in terms of
bleeding than unfractionated heparin (UFH). LMWH
is given at curative dosage, once or twice a day, without any biological monitoring except for platelet count.
LMWH is maintained for at least 5 days, and warfarin
is started on the first day. Many studies have compared
the different therapeutic strategies:
3. Treatment of massive PE
In one small study, massive PE was treated either with
heparin alone or heparin + streptokinase. The study
was rapidly stopped because of 4/4 deaths in the
heparin group versus 0/4 in the thrombolytic treatment group. Pulmonary embolism with shock is a
definitive indication of thrombolytic therapy. The benefit of thrombolysis in clinically stable patients with
hypokinesis or right ventricular dilatation on echocardiography has to be evaluated in clinical trials.
Clinical data
Scoring
Cancer
+2
Heart failure
+1
Previous VTE
+1
SBP <100 mm Hg
+2
Pa O2 <8 kPA
+1
Associated DVT
+1
Low risk (0-2): event rate = 2.2% - High risk (3): event rate = 27.3%.
PHLEBOLYMPHOLOGY 2002
S95
any studies from 1972 to 2001 focused on the duration of anticoagulant treatment after DVT. Recurrence
rates after 12 months of follow-up varied between 7%
and 14% for 3 to 6 weeks of treatment after DVT versus 4% to 15% for 3 to 6 months of treatment, 8 to
27% for 3 months and 9% to 16% for 6 to 12 months
of treatment. Results are difficult to compare because
of differences in methodology. Six months of treatment
appears to be better than 6 weeks, but 3 months may
be valuable. In secondary prevention of VTE, recurrence rates during the first year after interuption of
prolonged treatment is around 10%, whatever the
duration of the initial treatment (6, 12, or 27 months).
A recent meta-analysis1 demonstrated that long duration (6 months) of treatment is better than short duration, without an increased risk of bleeding (relative risk
of bleeding of 1.43). In the Cochrane review, only 4 trials were selected. The risk of recurrence was reduced
with prolonged treatment, without any rebound
phenomon after anticoagulant withdrawal, but an
increased risk of bleeding was observed. Mortality did
not correlate with duration of the treatment (6 weeks,
versus 6 months), in a 10-year follow-up.
Longer treatment may not be better for all, as Pinede
demonstrated that 6 weeks of treatment were enough
Reference
1. Pinede L. J Int Med. 2000;247:553-562.
S96
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S97
sis which was distal to the popliteal vein. DVT diagnosis was assessed by compression ultrasonography (US),
and PE by V/Q scan or spiral CT. Mean patient age was
69 years old, 43% of them were male, 26% outpatients, 33% patients from surgery departments, 22%
with a known cancer. Data from US, V/Q scan, and
spiral CT are in Table X.
Nb of patients
Proximal unilateral
862 (45%)
397 (46 %)
Distal unilateral
783 (41%)
230 (29%)
Proximal bilateral
156 (8%)
83 (53%)
Distal bilateral
112 (6%)
50 (45%)
Clinical symptoms, cancer prevalence and in/outpatient ratio were not statistically different between bilateral calf DVT group and other DVT.
S98
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S99
The purpose of this study was to compare low-molecular-weight heparin (LMWH) and unfractionated
heparin (UFH ) in the treatment of acute deep venous
thrombosis. Phlebography had been performed and a
Marder score had been determined at baseline and
after 21 days of treatment.
Marder Score
Iliac vein
C Fem V
S Fem V
10
PO V
LLV
16
S100
PHLEBOLYMPHOLOGY 2002
Part 11
VASCULAR SURGERY
VASCULAR ACCESS
Moderators: S. STERIOFF (USA), E. ASCHER (USA)
An all-autogenous policy renders fewer complications and reintervention rates when compared with AV
grafts.
A large percentage of hospitalizations for renal dialysis are due to AVG access failure.
S102
In this retrospective study patency data for 1385 vascular accesses (clipped or sutured) was extracted from
17 different hospitals and dialysis centers. Five hundred and eighteen arteriovenous fistulae (242 clip, 276
suture) and 827 arteriovenous grafts (443 clip, 384
suture) qualified for patency comparisons.Access
patencies (primary, secondary,overall and intention to
treat) were significantly improved in anastomoses con-
PVAG graft by either surgical intervention or percutaneous intervention.The PVAG graft allows for early
access without compromising long- term performance.
Both PVAG and ePTFE grafts have similar long- term
outcomes, despite early access with the PVAG vascular access grafts. The PVAG graftpewrforms well with
percutaneous interventions and appears to allow for
greater secondary patency rates beyond 600 days.
PHLEBOLYMPHOLOGY 2002
S103
In the following multicenter, randomized, prospective, controlled study the authors compared the performance of a multilayered self-sealing PVAG vascular
access graft and expanded ePTFE vascular access graft
survival, complications, time to early cannulation,
hemostasis times after decannulation, and performance of PVAG graft by either surgical intervention or
S104
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
S105
fter explaining the concept of anastomotic engineering the author presented the early results of the
North American Prospective Randomized Multicenter
Trial comparing Distaflo ePTFE graft with a standard
ePTFE graft with vein cuff for infragenicular revascularization in patients with critical limb ischemia. A total
Distaflo
PTFE+vein cuff
87% (39/45)
91% (40/44)
96% (43/45)
100% (44/44)
FU 10 months (1-24)
57% (25/44)
59% (26/44)
S106
PHLEBOLYMPHOLOGY 2002
he practice of Duplex arteriography is cheap, noninvasive, mobile, studies the wall morphology, is
hemodynamic and is sensitive to low flows. There are
problems when the runoff is very poor, or there has
been previous surgery, severe calcification, or obesity.
Based on these principles the author presented his
experience in 450 patients, 70 of whom had to be
studied by arteriography due to poor visualization. He
carried out an analysis from aorta to pedal arteries
PHLEBOLYMPHOLOGY 2002
S107
AORTIC SURGERY:
CHALLENGES AND INFECTIOUS COMPLICATIONS
Moderators: E. A. BASTOUNIS (Greece) and P. FIORANI (Italy)
he management of an AAA and coexisting abdominal diseases has been a long-standing controversy. It is
not as clear to whether a single or two-stage approach
is the appropriate treatment option and which lesion
should be treated first. The author has presented his
experience in concomitant operation performed in
47 patients. As a second operation he differentiates
minor operations (cholecystectomy, inguinal hernia
repair, or small-bowel resection) and major operations
(colon, gastric, renal, or hepatic resection). The
S108
combination with major operation resulted in a considerable prolongation of operative time and blood
loss. At any rate he stated that combination of aneurysmectomy with other abdominal operations can be
achieved with low morbidity and mortality rates
depending on the high standards of care. In the future,
the application of endovascular options in vascular
surgery and laparoscopic approach in general surgery
may bring new light to the controversy.
PHLEBOLYMPHOLOGY 2002
aneurysm-related death included adjacent organ infection, female gender, Staphilococcus aureus infection,
aneurysm rupture, and location other the infrarenal
aorta. However, late outcome is favorable with no
aneurysm-related death and low graft-related complication rate similar to standard repair. In situ aortic
grafting is a safe and durable option in most patients.
PHLEBOLYMPHOLOGY 2002
S109
S110
PHLEBOLYMPHOLOGY 2002
Part 12
VASCULAR DISEASES
RENOVASCULAR HYPERTENSION
Moderators: R. CAMBRIA (USA) and M. McKUSICK (USA)
S112
PHLEBOLYMPHOLOGY 2002
PHLEBOLYMPHOLOGY 2002
indicate that clinical progression requiring intervention occurs in less than 10% to 15% over 4 to 5 years.
Medical therapy (angiotensin-converting enzyme
inhibitors ACEI, and angiotensin receptor blockersARBs) is a primary element of the treatment of the
renal artery stenosis, and can produce a successful
blood pressure control in a considerable number of
cases.
It is very important to know that there are recognizable syndromes which herald failure of medical therapy,
and the need to consider renal revascularization such
as intractable hypertension, progressive renal failure
during medical therapy, and flash pulmonary edema
out of proportion to cardiac dysfunction. Only in those
cases where there is evident failure of medical therapy
is revascularization justified.
S113
Digital necrosis of the upper limb (DNUL) is less frequent than gangrene in the lower limbs (ratio 1/4).
The causes are much more various, and atheroma is
rarely involved. A retrospective study including 278
cases of DNUL observed in the medical centers of Lille
and Rouen was reported. Evaluation of the patients
included clinical examination, evaluation of vascular
risks, biological tests, nailfold capillary examination,
and duplex ultrasonography.
Etiologic diagnosis was found in 96% of patients and
remained unknown in 4%.
An overview was given of the different etiology:
Connective tissue disease (>> systemic slerosis, >>
women): 32.6%
S114
PHLEBOLYMPHOLOGY 2002
VASCULAR MALFORMATIONS
Moderator: R. SHEPHERD (USA)
Truncular form
Extratruncular form
Aplasia or obstructive
Dilatation
Infiltrating
Limited
Aplasia or obstrutive
Dilatation
Infiltrating
Limited
Aplasia or obstructive
Dilatation
Infiltrating
Limited
Superficial
Infiltrating
Limited
Infiltrating
Limit
S115
INDEX
A
Agnell G
Aguiar E
Aleksandrovics V
Ambrozy E
Andreadis E
Andreozzi G
Andrews K
Angelides N
Arko F
Ascher E
S88
S24 S51
S47
S47
S66
S15 S68
S66
S34
S58 S60
S102 S10
B
Baker W
Bakhos M
Balas P
Bastounis E
Bauer K
Baumeister R
Baumeister R
Beatty P
Beebe H
Belcaro G
Belch J
Bender C
Bergan J
Berridge D
Beyessier L
Biasi G
Bick R
Bjarnason H
Blttler W
Blinc A
Bhler K
Bosson J
Bower T
Breddin H
Brokelmann J
Buller H
Bullo C
Brgelin K
Burnand K
Buth J
Byrne D
Byrne P
S13 S36
S86
S22
S36 S108
S88
S62
S63
S68
S26
S12 S100
S54 S71
S63
S16 S44
S70
S99
S38
S89 S98
S19
S77
S87
S47
S98 S99
S35 - S107 S109
S85 S99 - S100
S49
S88
S38
S19 S20
S43 S62
S29
S109
S20
C
Cailleux N
Calligaro K
Callini E
Cambria R
Campisi C
Carpentier P
Carra G
Cherry K
Chetter I
Clement D
Coleridge Smith P
Colonna M
Conrad J
Cormier F
Cormier J
Cornelli U
Corson
Coughlin P
Courtois H
Criado F
S114
S105
S25
S112 S113
S62 S63
S90 S96 S98
S38
S34 - S35 - S109
S70
S12 S55 S73 S88
S18
S98
S59
S35 S115
S35 S115
S86 S97
S18
S20 S70
S114
S27
D
D'Angelo F
Daud A
De Castro Silva M
Delcey V
S118
S25
S86
S50 S51
S114
Deriu G
Deschamps C
Devulder B
Diamantopoulos M
Dickson C
Dion Y
Dormandy J
Durand A
S34
S63
S114
S66
S103
S24
S71
S62
J
Jacobson J
Jaff M
S73
Jiang P
S46
Jckel K
Johansen K
Johnson B
S16
S45
S109
S58 S60
K
E
Ehringer H
Eklof B
Elalamy I
Emmerich J
Enrici E
Eriksson B
S47
S100
S59
S90
S50
S88
F
Fareed J
Farjallat M
Feldo M
Fernandes E
Fernandes J
Fett M
Fichelle J
Fillinger M
Fillis K
Fiorani P
Fletcher J
Flgel P
Frank U
Gaggl U
S47
Gale S
S110
Gerdsen R
S46
Gerlach H
S77
Giannakopoulos N
S66
Glasz T
S16
Glickman M
S103 S104
Gloviczki P
S12 S14 S15 S22 S26
S35 S45 S54 S63 S109
Goldhaber S
S80 S83
Goldstone J
S109
Greenberg R
S26
Groegler F
S105
Gschwandtner M
S47
Guidicelli H
S103
H
Haas S
Hachulla E
Hallet J
Harris E
Hatron P
Heinz G
Hiatt W
Hingorani A
Hirsch A
Hirsh A
Hitos K
Hobson R
Hofer J
Hollier L
Hoppensteadt D
Horellou M
Horn B
Housely E
Hull R
Hussein E
Iqbal O
Irvine J
S86 S100
S32
Kadar A
Kaiser B
Kakkar V
Kakou M
Kalman
Kalra M
Kamionek I
Kapfer X
Kaul S
Kent P
Kesik J
Kester R
Kirsch W
Klokocovnik T
Konkin T
Kovalovs S
Krievins D
Kucharzewski M
Kuentz F
S16
S81
S78 S89 S100 S112
S66
S22 S23
S35
S48
S105
S89
S20 S70
S20
S20 S70
S103
S24
S103
S47
S47
S48
S103
L
Labarere J
Labs K
Lacis A
Le Chatelier A
Lederle F
Lederman A
Lee B
Leroux P
Levesque H
Lietuvietis E
Lindberg J
Liu R
Lorber M
Lusiani L
S99
S72
S47
S59
S20
S24 S51
S49 S115
S99
S114
S47
S103 S104
S97
S103 S104
S38
M
Ma Q
Maghlaoua M
Magne J
Mahler F
Maric S
Matsunaga P
Mattasi R
Maurizi-Balzan J
McCollum C
Medn G
Meichelboeck W
Meissner M
Messmore H
Meyer G
Michalak J
Michiels J
Michon Pasturel U
Mickay A
Miller A
Misra S
Misselwitz F
Mohamed S
Mohanty D
Moneta F
Moneta G
Money S
S86
S103
S103
S110
S47
S24
S25
S103
S18
S47
S105
S12
S86
S95
S20
S76
S114
S109
S103
S102
S100
S97
S89
S72
S43 S47
S103 S104
PHLEBOLYMPHOLOGY 2002
Moore W
Morasch M
Morrison N
Mousa S
S27 S 38
S109
S19
S97
N
Nakov R
Neumann F
Nicolaides A
Noel A
Nogales L
Norgren L
Novo S
S100
S19 S20
S1 S12 S36 S66
S35 S63 S109
S84
S54 S71
S15 S32 S37 S88
R
Raake W
Rabe E
Ramussen T
Rassmusen P
Richardson P
Rieger H
Riles T
Rogers P
Rooke R
Ross J
Rowland C
Rutherford R
S
O
Oderich G
Olcott C
Oldenburg A
Ombandza-Moussa E
Ouriel K
S109
S58 S60
S23 S36
S59
S29
P
Pagnan A
S38
Palacin P
S103
Panneton J
S35 S104 S106 S109
Pannier-Fischer F
S45 S46
Papasteriades C
S66
Parodi J
S28 S39
Partsch H
S42 S76 S100
Pastore A
S25
Pavkov M
S49
Pearce W
S22
Pecher M
S103
Penillon S
S103
Perrin M
S42 S44 S92
Pesavnto R
S38
Petersen F
S103
Piccolo P
S86
Pichot O
S1 S58 S103
Pipinos I
S58 S60
Ponca C
S46
Poncar C
S45
Q
Quin R
PHLEBOLYMPHOLOGY 2002
S98
S45 S46
S35
S97
S67
S32 S68 S76
S39
N109
S32 S47 S62
S103 S104
S109
S54
S109
Safi H
Samama M
Sasahara A
Schanzer H
Schattenkirchner S
Schneider B
Schonath M
Schreen G
Schulman S
Schultz C
Schuman E
Schwarzwlder U
Scott D
Seinturier C
Selzle K
Sersa I
Sessa C
Sevestre M
Shah D
Shapira A
Sheehan M
Shenov S
Shepherd J
Shepherd R
Shigematsu H
Shimoura J
Simari R
Simkin R
Simonian S
Slezak A
S25 S109
S59
S80
S44 S50
S48
S47
S48
S51
S96
S86
S103 S104
S19 S20
S70
S98
S48
S87
S103
S99
S37
S50
S110
S103
S17
S104
S84
S17
S50 S51
S45
S48
Smith H
Spinelli F
Stanson A
Sterioff S
Sternbergh W
Stokes G
Strukelj M
Sulkowski L
Sullivan T
S109
S106
S63
S102
S103 S104
S103 - S104
S87
S48
S27
T
Tarassi K
Textor S
Thibaut G
Thor S
Tilson D
Tonello
S66
S113
S62
S47
S22
S38
U
Ulloa J
S50 S51
V
Vaghi M
Vallence P
Vanhoutte P
Vassilopoulos C
Veith F
Visona A
S25
S67
S17
S66
S25 S28 S32
S38
W
Walenga J
Wayne Johnston K
Weston M
White R
Willfort A
Wittenhorst M
Woodcock J
Wright D
Wronski J
S84 S86
S22
S20
S28
S47
S45 S46
S67
S18
S20
Z
Zarins C
Zdkiola Z
Zeller T
Zorzoli C
Zubilewicz T
S119
SERVIER RESEARCH
FELLOWSHIP 2003-2005
awarded by the
RESEARCH FUND OF THE
UNION INTERNATIONALE
DE PHLBOLOGIE
S120
PHLEBOLYMPHOLOGY 2002
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