Journal of Vascular Surgery
Volume 51, Issue 1 , Pages 104-107 , January 2010

High prevalence of right-to-left shunt in patients with symptomatic great saphenous incompetence and varicose veins

Presented to the Twenty-first Annual Meeting of the American Venous Forum, Phoenix, Ariz, Feb 11-14, 2009.

  • David D. Wright, MB, FRCS

      Affiliations

    • BTG International Ltd in London, London, United Kingdom
    • Corresponding Author InformationCorrespondence: Dr David Wright, BTG International, 5 Fleet Pl, London EC4M 7RD, UK
    • ,
  • Kathleen D. Gibson, MD

      Affiliations

    • Overlake Hospital, Bellevue, Wash
    • ,
  • Jean Barclay, BS

      Affiliations

    • Conshohocken, Lake Washington Vascular, Conshohocken, Pa
    • ,
  • Alexander Razumovsky, PhD

      Affiliations

    • Sentient NeuroCare Services Inc, Cockeysville, Md
    • ,
  • Janet Rush, MD

      Affiliations

    • Conshohocken, Lake Washington Vascular, Conshohocken, Pa
    • ,
  • Charles N. McCollum, MD, FRCS

      Affiliations

    • Vascular Studies Unit, Academic Surgery Unit, University of Manchester, Manchester, United Kingdom

Received 16 April 2009 ,Accepted 4 August 2009.

References 

  1. Homma S, Sacco RL. Patent foramen ovale and stroke. Circulation. 2005;112:1063–1072
  2. Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age (A study using transesophageal echocardiography). Stroke. 1993;24:1865–1873
  3. Hagen PT, Scoltz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17–20
  4. de Belder MA, Tourikis L, Leach G, Camm AJ. Risk of patent foramen ovale for thromboembolic events in all age groups. Am J Cardiol. 1992;69:1316–1320
  5. Wilmshurst P, Nightingale S. Relationship between migraine and cardiac and pulmonary right-to-left shunts. Clin Sci. 2001;100:215–220
  6. Schwedt TJ, Demaerschalk BM, Dodick DW. Patent foramen ovale and migraine: a quantitative systematic review. Cephalalgia. 2008;28:531–540
  7. Purandare N, Oude Voshaar RC, McCollum C, Jackson A, Burns A. Paradoxical embolisation and cerebral white matter lesions in dementia. Br J Radiol. 2008;81:30–34
  8. Knauth M, Ries S, Pohimann S, Kerby T, Forsting M, Daffertshofer M, et al. Cohort study of multiple brain lesions in sport divers: role of patent foramen ovale. BMJ. 1997;314:701–705
  9. Koch AE, Kampen J, Tetzlaff K, Reuter M, McCormack P, Schnoor PW, et al. Incidence of abnormal cerebral findings in the MRI of clinically healthy divers: role of a patent foramen ovale. Undersea Hyperb Med. 2004;31:261–268
  10. Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R. Association of interatrial shunts and migraine headaches: impact of transcatheter closure. J Am Coll Cardiol. 2005;45:489–492
  11. Tobis J. Management of patients with refractory migraine and PFO: is MIST I relevant?. Catheter Cardiovasc Interv. 2008;72:60–64
  12. Cabrera J, Cabrera J, Garcia-Olmedo MA. Treatment of varicose greater saphenous vein with sclerosant in microfoam foam: long-term outcomes. Phlebology. 2000;15:19–23
  13. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27:58–60
  14. Weiss R, Weiss M, Wright D. Safety of intravenous foam for the treatment of varicose veins (Detection and effects of circulating bubbles following microfoam). Presented at: 18th American College of Phlebology Congress 2004;
  15. Wright D, McCollum C, Rush JE. A single-centre pilot study of polidocanol endovenous microfoam (PEM) treatment to evaluate presence and durability of gas emboli using echocardiography. Presented at: 22nd American College of Phlebology Congress Nov 2008;
  16. Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg. 2006;43:162–164
  17. Bush RG, Derrick M, Manjoney D. Major neurological events following foam sclerotherapy. Phlebology. 2008;23:189–192
  18. Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial doppler sonography (Consensus conference report). Cerebrovasc Dis. 2000;10:490–496
  19. Spencer MP, Moehring MA, Jesurum J, Gray WA, Olsen JV, Reisman M. Power M-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging. 2004;14:342–349
  20. Belvís R, Leta RG, Martí-Fàbregas J, Cocho D, Carreras F, Pons-Lladó G, et al. Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts. J Neuroimaging. 2006;16:133–138
  21. Chimowitz MI, Nemec JJ, Marwick TH, Lorig RJ, Furlan AJ, Salcedo EE. Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts. Neurology. 1991;41:1902–1904
  22. Horner S, Ni XS, Weihs W, Harb S, Augustin M, Duft M, et al. Simultaneous bilateral contrast transcranial Doppler monitoring in patients with intracardiac and intrapulmonary shunts. J Neurol Sci. 1997;150:49–57
  23. Di Tullio M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Homma S. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke. 1993;24:1020–1024
  24. Hamann GF, Schätzer-Klotz D, Frohlig G, Strittmatter M, Jost V, Berg G, et al. Femoral injection of echo contrast medium may increase the sensitivity of testing for a patent foramen ovale. Neurology. 1998;50:1423–1428
  25. Neuhardt D, Morrison N, Rogers C, Salles-Cunha S. Emboli detection in the middle cerebral artery concurrent with treatment of lower extremity superficial venous insufficeincy with foam sclerotherapy. Presented at: 22nd American College of Phlebology Congress Nov 2008;

 The study was sponsored by BTG International Limited UK.

 Competition of interest: D. W., J. B., and J. R. are full-time employees of BTG International. K.G. is a consultant to BTG International.

 The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

PII: S0741-5214(09)01621-8

doi: 10.1016/j.jvs.2009.08.008

Journal of Vascular Surgery
Volume 51, Issue 1 , Pages 104-107 , January 2010

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