Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

Foam sclerotherapy is effective in abolition of superficial venous reflux and may contribute to similar ulcer healing and long-term recurrence rates to superficial venous surgery. Foam sclerotherapy is an attractive alternative to surgery in this group of patients.

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Over one-third of superficial veins treated with foam sclerotherapy recanalised at one year and just under a quarter of superficial veins recanalised at two years. Despite this, ulcer recurrence rates were low, and recanalisation failed to predict recurrence.

Background: Factors contributing to recurrence of varicose veins after thermal ablation are not well known. The goal of this prospective, non-randomized, multi-center trial was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF) and laser ablation.Methods: Seven centers enrolled patients into the study during a twelve-month period, from January 1st, to December 31st, 2010. All patients underwent previous thermal ablation of the great saphenous vein (GSV), small saphenous vein (SSV) or anterior accessory great saphenous vein (AAGSV). Patients with high ligation of the GSV and/or stripping were excluded from the study. From a specific designed study tool, recurrence was identified as to site, etiology, and primary mode of treatment (RF, laser).Results: 2,380 patients were evaluated during this time frame. A total of 164 patients, (7%), 3 with bilateral limb involvement, had varicose vein recurrence at a mean of 3 years after treatment (range, 9 months to 8 years) This group of 164 patients with varicose vein recurrence were the subjects of this study. 33% were between the age of 51 and 60, median age range was 51-60, and 83% were women. A history of deep venous thrombosis (DVT) was present in 2% of the patients and deep venous insufficiency was present in 17%. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 131, 52 of these patients had either SSV or AAGSV ablation concurrently. Total or partial GSV recanalization occurred in 47 patients (29%). Of these 47 patients, 27 had RF ablation, and 20 had laser thermal ablation. New AAGSV reflux occurred in 40 patients (24%), and new SSV reflux occurred in 24 patients (12%) Primary or associated perforator pathology was present in 64% of patients.Conclusions: Recurrence of varicose veins at 3 years after thermal ablation was 7%. The three most important factors associated with varicose vein recurrence included new or recurrent perforating veins; recanalized GSV and new AAGSV reflux, in decreasing frequency. In this study, patients who underwent RF treatment had a higher rate of GSV recanalization than those who were treated with laser.