Reentry Point Research Articles

Hydrodynamic boost: a novel re-entry technique in subintimal angioplasty of below-the-knee vessels.

To describe the hydrodynamic boost (HB) technique and report our preliminary results with this technique in the subintimal angioplasty of below-the-knee vessels. HB was used in 23 cases (14 males, mean age 73 ± 12years) of critical limb ischemia, with long chronic total occlusion of tibial arteries extended to the ankle level. The operator performs a manual injection of diluted contrast dye through a 4F catheter into the subintimal space, close to the patent true distal lumen, in order to achieve a tear in the intimal flap and a connection with the true lumen. In 19/23 (83%) cases, the HB was effective in creating a connection between the subintimal space and the true distal lumen and it was possible to advance a wire and to conclude the procedure. In 4/23 (17%) lesions, the HB failed and the procedure was successfully completed by retrograde approach. No major complications occurred. Mean length between catheter tip and re-entry point was 8 ± 5mm. HB seems to be a feasible, safe and effective re-entry technique in distal below-the-knee vessels. This method represents an easy option for re-entry that extends the possibility of antegrade approach to obtain a successful revascularization. • In subintimal angioplasty of below-the-knee vessel re-entry can represent a challenge. • Inability to re-enter may determine the failure of the revascularization procedure. • HB is a novel re-entry technique feasible in distal below-the-knee vessels. • HB may increase the success rate of antegrade approach. • In case of failure, retrograde approach remains feasible.

Mathematical modeling reveals the mechanisms of feedforward regulation in cell fate decisions in budding yeast

The determination of cell fate is one of the key questions of developmental biology. Recent experiments showed that feedforward regulation is a novel feature of regulatory networks that controls reversible cellular transitions. However, the underlying mechanism of feedforward regulation‐mediated cell fate decision is still unclear. Therefore, using experimental data, we develop a full mathematical model of the molecular network responsible for cell fate selection in budding yeast. To validate our theoretical model, we first investigate the dynamical behaviors of key proteins at the Start transition point and the G1/S transition point; a crucial three‐node motif consisting of cyclin (Cln1/2), Substrate/Subunit Inhibitor of cyclin‐dependent protein kinase (Sic1) and cyclin B (Clb5/6) is considered at these points. The rapid switches of these important components between high and low levels at two transition check points are demonstrated reasonably by our model. Many experimental observations about cell fate decision and cell size control are also theoretically reproduced. Interestingly, the feedforward regulation provides a reliable separation between different cell fates. Next, our model reveals that the threshold for the amount of WHIskey (Whi5) removed from the nucleus is higher at the Reentry point in pheromone‐arrested cells compared with that at the Start point in cycling cells. Furthermore, we analyze the hysteresis in the cell cycle kinetics in response to changes in pheromone concentration, showing that Cln3 is the primary driver of reentry and Cln1/2 is the secondary driver of reentry. In particular, we demonstrate that the inhibition of Cln1/2 due to the accumulation of Factor ARrest (Far1) directly reinforces arrest. Finally, theoretical work verifies that the three‐node coherent feedforward motif created by cell FUSion (Fus3), Far1 and STErile (Ste12) ensures the rapid arrest and reversibility of a cellular state. The combination of our theoretical model and the previous experimental data contributes to the understanding of the molecular mechanisms of the cell fate decision at the G1 phase in budding yeast and will stimulate further biological experiments in future.

Targeted True Lumen Re-Entry With the Outback Catheter

Purpose: To report a single-center experience with the Outback re-entry device for targeted distal true lumen re-entry during subintimal recanalization of chronic total occlusions (CTOs) and compare the results with a systematic review of the literature. Methods: Between February 2011 and July 2013, 104 Outback devices were employed in 91 patients (mean age 64±9 years; 57 men) for subintimal recanalization of 100 vessels with CTOs after initial failure of spontaneous reentry. Fifty-two cases involved a retrograde approach to aortoiliac occlusions and 48 were re-entry attempts in infrainguinal CTOs. Outcome measures included complications and technical success, defined as successful targeted re-entry at the preplanned site of the distal true lumen. To evaluate device accuracy, the re-entry distance (between the point of true vessel reconstitution and the eventual re-entry point) was measured. Results: Outback success was 93% (93/100); only 7 cases failed owing to heavy calcification (5/52 aortoiliac vs 2/48 infrainguinal, p=0.44). Re-entry was highly accurate, with a re-entry distance of ~1 cm in both subgroups (1.2±0.1 cm in aortoiliac vs 1.3±0.1 cm in infrainguinal, p=0.40). There were no major and 17 minor complications (9/52 aortoiliac vs 8/48 infrainguinal, p=0.93). Results are in line with the systematic review that identified 11 studies (only 1 randomized trial) involving mostly the femoropopliteal segment (119 aortoiliac and 464 infrainguinal segments). The pooled Outback success rate was 90% (95% confidence interval 85% to 94%) and the pooled complication rate was 4.3% (95% confidence interval 1.6% to 8.3%). Conclusion: The Outback device is safe and has a very high rate of achieving targeted true lumen re-entry, which minimizes the sacrifice of healthy vessel in the aortoiliac and infrainguinal arteries.

Atmospheric Interface Reentry Point Targeting Using Aerodynamic Drag Control

The ability to control the location of a spacecraft atmospheric interface reentry has been traditionally accomplished using propulsion. A novel technique is presented here where a predefined point of atmospheric interface reentry is achieved by adjusting the aerodynamic drag of a spacecraft in a circular orbit. If this method is employed at a sufficiently high starting altitude, any ground-track point accessible by the orbit can be targeted. This method can be broken up into two different parts. The first consists of finding the decay profile that achieves the desired reentry location. The second consists of keeping the spacecraft within this nominal decay trajectory, given the atmospheric uncertainty and other perturbations. The two parts of this method are presented here in detail. Finally, a case study is provided to demonstrate how this method could work in a realistic scenario and to evaluate its performance. The case study shows that a reentry point can be targeted with a error of less than 200 km, using a typical Global Positioning System for navigation. Finally, a discussion of potential applications is provided.

Duplex Ultrasound investigation of perforating veins

ZusammenfassungPerforansvenen verbinden die oberflächli-chen Beinvenen mit den tiefen Beinvenen. Im Ultraschall sind sie meist nur dann sichtbar, wenn sie pathologisch gedehnt sind. Die Untersuchung der Perforansvenen und ihrer Flusskurven ist eine der größeren Herausforderungen in der Duplexsonographie der Beinvenen. In diesem Beitrag soll schema-tisch und in Bildern gezeigt werden, wie die Flusskurven am häufigsten aussehen. Die meisten an einer Varikose beteiligten Perforansvenen stellen den Wiedereintrittspunkt des Blutes in das tiefe Venensystem dar und sind primär nicht pathologisch gedehnt. Selten ist eine Perforansvene selbst der oberste Insuffizienzpunkt, in der Regel liegen diese Venen dann am Oberschenkel. Auch der Fluss in Perforansvenen bei Insuffizienz des tiefen Venensystems und nach Traumata wird beleuchtet.

Successful bypass restenting across the struts of an occluded subintimal stent in chronic total occlusion using a retrograde approach

Recently, subintimal angioplasty has been introduced as a bailout strategy to improve the success rate of PCI for vessels with CTO. However, the long-term outcome of subintimal angioplasty has not been determined, and a limitation of subintimal angioplasty is the uncertainty in making the re-entry point. We report two cases, where occlusive in-stent restenosis occurred in a stent implanted in the subintimal space of the RCA that had CTO. These two cases were successfully treated with bypass restenting across the struts of an occluded subintimal stent using a retrograde approach. A retrograde wire crossed the occluded segment through the lumen along the outside of the stent and reentered the inside of the stent across the stent struts. The reverse CART technique followed by multiple restenting across the stent struts restored antegrade flow. Follow-up angiography demonstrated the patency of the RCA.

The (Dubious?) Benefits of Second Chances in Batterer Intervention Programs

In batterer intervention programs, there are conflicting recommendations about best practices for responding to client dropout. Risk management philosophies emphasize the importance of swift and sure sanctions for failure to comply with program attendance requirements. In contrast, change theory emphasizes the importance of providing clients with multiple opportunities to engage in treatment. To clarify the implications of each of these philosophies, the current study examined rates of program dropout, reinstatement, and completion in a consecutive sample of 294 probation-mandated clients referred to a large batterer intervention program. Just over half (53.7%) of men completed intervention on their first attempt. Over the 2-year follow-up study period, 73 clients were reinstated once by the intervention program, 23 clients were reinstated twice, and 5 clients reinstated three (or more) times. Reinstated clients were, in general, more similar to men who failed to complete than those who completed on their first attempt. Although rates of dropout at each reentry point were quite high (56% to 80%), 32 of the 73 (43.7%) reinstated clients eventually completed. There were significant costs associated with providing clients with additional chances to complete the program, with successful reinstatement requiring an average of 7.55 phone calls to clients, 3.82 phone calls to referral agents, one letter, and 0.73 in-person meetings. Results are discussed in terms of practice and policy implications of risk management and change theory approaches to dropout.

Successful Extra-Anatomical Recanalization of Occluded Superficial Femoral Arteries Using the Outback Device—A Report of 2 Cases

We report 2 cases where the Outback catheter facilitated extra-anatomical bypass after vessel perforation during attempted subintimal vessel dissection. Attempted subintimal angioplasty of the superficial femoral artery (SFA) resulted in vessel perforation in 2 patients with chronic SFA occlusion and limb ischemia. Due to the lack of other endovascular or surgical options, the Outback catheter was used to reenter the patent lumen distal to the perforation. A stent graft was then deployed from proximal to the perforation to beyond the reentry point with successful outcomes. Although the reentry devices are typically used to enter the lumen from the subintimal plane, this novel technique involves using the Outback catheter to enter from the extravascular compartment and facilitate bypass of the SFA occlusion via an extra-anatomical route. This novel technique can be used to restore in-line blood flow when attempted endovascular revascularization failed due to vessel perforation.

Hg concentrations and accumulations in fungal fruiting bodies, as influenced by forest soil substrates and moss carpets

Abstract This article summarizes trends in total Hg concentrations (THg) in fungal fruiting bodies (basidiomata) and their underlying soil substrates in the absence and presence of surrounding moss layers. Three forest locations across south-western New Brunswick spanning from a central mainland location to Grand Manan Island in the Bay of Fundy were chosen for the study. Geographic location had an effect on THg in the soil layers and in the basidiomata (THg on island > THg along the mainland coast > THg mainland) but this effect was weak and probably obscured by the large THg variations within the basidiomata and their soil and moss substrates at each location. Within the soil, THg increased with increasing total organic S (TS) and C (TC) concentrations, and depended on type of moss cover if present. Within the mosses, THg varied by species, by moss-internal TS, and by THg and TS within the underlying soil. Basidiomatal THg also varied strongly by species, and was further affected by: (i) developmental stage, from emergence to senescence, (ii) cap versus stalk, (iii) basidiomatal TS, and (iv) soil THg, TS and TC. These variations and their interdependencies were explored and quantified by way of multiple regression analyses. Basidiomatal bioconcentration of soil THg (F layer) varied strongly by species as well. Basidiomatal Hg extraction from the soil was estimated to be small in terms of reducing the accumulated Hg loads within the soil, but represents a re-entry point of Hg into the local food chain.

Dynamic Modeling and Control of a Current New Horizontal Type Cross-Lapper Machine

A non-woven cross-lapper machine uses the pulley block structure to pull the pulley bracket, which folds out the required web thickness and width of the non-woven products by the reciprocating motion of the pulleys. The system needs to move back and forth at a stable constant speed, and be able to stop at the precise position of the re-entry point when reciprocating. This paper deals with the modeling and control of the current new horizontal type cross-lapper machine. The Lagrange’s equation is applied to derive the non-linear dynamic equation of the system. In the controller design, this study first obtains the transfer function of the high-order linearization system. Then, the approximation criterion is used to obtain the corresponding low-order system transfer function, so that the analysis and design effort is reduced. Both the realizable proportional and integral control, and pole-placement design through state feedback, are applied for the control system design. The performances of the designed controllers are verified through computer simulation.

Intravascular ultrasound‐guided retrograde wiring for chronic total occlusion

This report describes a retrograde wiring technique, using intravascular ultrasound, for a blunt chronic total occlusion with a side branch at the site of occlusion of which the operator has difficulty of awareness of the proper re-entry point with the retrograde wire angiographically.

Aorto-Pericardial Filling Without Tamponade: An Unusual Late Bentall Complication

Aorto-Pericardial Filling Without Tamponade: An Unusual Late Bentall Complication

The outlook in business and related fields

AbstractA bachelor's degree is required for many high‐wage jobs, but the community college has an important role to play as an entry and reentry point for a growing number of occupations.

Endovascular Management of Thoracic Dissections

The first surgical management of aortic dissection was reported in 1935 by Gurin et al,1 who created a distal reentry point in the iliac artery to decompress the false lumen. In 1949, Abbott2 reported the repair of a chronic dissection by wrapping cellophane around the descending aorta to reinforce it. Despite the efforts of these early pioneers and other investigators, it was not until 1955 that a major therapeutic advance was made; this was the year that DeBakey, Cooley, and Creech introduced a revolutionary surgical treatment that involved excision of the intimal tear, obliteration of the false lumen, and either direct reanastomosis or insertion of a prosthetic graft.3 The next great milestone in therapy was introduced by Wheat et al4 in 1965, when they described medical therapy directed toward lowering blood pressure and dP/dt. Since then, investigators have made significant advances in the detection, characterization, and treatment of aortic dissection; however, the morbidity and mortality of this debilitating disease remain alarmingly high, with an overall in-hospital mortality of 27.4% reported by the International Registry of Aortic Dissection (IRAD).5 The latest additions to the armamentarium to treat dissection have been based on percutaneous interventional techniques. The minimally invasive nature of these techniques makes them an attractive alternative to open surgical intervention; however, the exact role and long-term durability of these procedures remain to be proven. The earliest endovascular therapies were directed toward the complications of aortic dissections and included angioplasty of an obstructed aorta, stenting of obstructed branch vessels, and fenestration of the dissection flap to relieve mesenteric ischemia.6–8 More recently, the advent of the stent graft has led to a novel endovascular approach aimed at treating the inciting lesion of aortic dissection by obliterating the primary intimal tear.9,10 Since the first reports in …

Gray-scale median of the atherosclerotic plaque can predict success of lumen re-entry during subintimal femoral-popliteal angioplasty

This study assessed whether the duplex ultrasound (DUS)-derived gray-scale median (GSM) of the most six distal portion of the occluded femoral-popliteal arterial segment can predict success of lumen re-entry for subintimal angioplasty. During the last 3 years, 108 patients (62% men) with a mean age of 73 +/- 10 years underwent 116 primary attempted DUS-guided subintimal angioplasties of the femoral-popliteal segment. Preprocedural B-mode DUS images of the plaque at the most distal occlusion segment were digitalized and normalized using Photoshop (Adobe, San Jose, Calif) software and standard criteria (gray level, 0 to 5 for lumen blood and 185 to 190 for the adventitia on a linear scale of 0 to 255). Overall GSM of the plaque segment about 2 cm long, immediately before the planned re-entry point to the true arterial lumen, was used for retrospective correlation with procedure success and other clinical indicators. Mean plaque GSM for all cases was 22.5 +/- 12.6 (range, 3 to 60). The overall success rate of subintimal angioplasty procedures was 85%. Mean plaque GSM for 99 successful cases (18.4 +/- 7.8) was significantly lower than for 17 cases (46.4 +/- 8.1) where we failed (P < .0001). We failed in 90% of 19 cases with GSM >35, in 71% of 24 cases with GSM >20, and in 50% of 34 cases with GSM >25. There was no statistically significant difference (P = .45) between plaque GSM in 64 patients with diabetes (23.3 +/- 13.5) compared with 52 nondiabetic patients (21.5 +/- 11.4). Similarly, plaque GSM was not statistically different (P = .9) in 52 patients with renal insufficiency (22.7 +/- 13.2) compared with 64 patients with normal creatinine levels (22.4 +/- 12.2). At the 6-month follow-up, no statistically significant difference was found between mean GSM (17.8 +/- 7.8) in 47 stenosis-free cases compared with mean GSM (18 +/- 6.8) in 22 cases where severe restenosis (>70%) or reocclusion was identified by DUS scan (P = .4). Plaque echogenicity represented by DUS-derived GSM can be used to predict the success of primary subintimal femoral-popliteal angioplasties.

The Pre-X atmospheric re-entry experimental lifting body: Program status and system synthesis

Atmospheric glided re-entry is one of the main key technologies for future space vehicle applications. In this frame Pre-X is the CNES proposal to perform in-flight experimentation mainly on reusable thermal protections, aero-thermo-dynamics and guidance to secure the second generation of re-entry X vehicles. This paper describes the programme status and the synthesis of the system activities performed up to now together with the main technical issues. A preliminary in-flight experimentation and measurement plan has been assessed defining the main objectives. The current Pre-X procurement specification states that the vehicle recovery without damage of the TPS is mandatory for the mission success. The functional and experimental measurements are transmitted from the vehicle to ground during flight, except for some innovative measurement. The vehicle is recovered in the Pacific Ocean assuring sufficient duration of buoyancy. Flight is foreseen for year 2010. During the year 2005 the phase A of the Pre-X program has been achieved with the main objective to verify the compliance of the proposed vehicle solution with the procurement specification. Phase B is currently running. The VEGA and DNEPR launch vehicles have been assumed as main candidates for launching Pre-X and VEGA is the baseline. A complete system loop has been performed including the operations, ground system assessment, and visibility analysis. The vehicle re-entry point is at 120 km and the mission objectives are fulfilled between Mach 25 and 5. Then the vehicle has to pass to subsonic speeds, the parachute opens and it is finally recovered in the sea.

&lt;span xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:m="http://www.w3.org/1998/Math/MathML" style="font-style:italic;"&gt;Six Modernist Moments in Poetry&lt;/span&gt; (review)

Six Modernist Moments Poetry. David Young. Iowa City: University of Iowa Press, 2006. xiv + 175 pp. $29.95 (cloth). These are six rooms, David Young tells us by way of introduction, in my gallery of modernist (ix). Young's latest book, Six Modernist Moments Poetry, offers readers a stimulating tour of his gallery, featuring of six modernist poets: Rainer Maria Rilke's Bowl of Roses, William Butler Yeats's Among School Children, Wallace Stevens's Sunday Morning, William Carlos Williams's January Morning, Marianne Moore's An Octopus, and Eugenio Montale's Mediterranean. Young's experience and skills as a poet, translator, and teacher result an engaging and accessible reading experience for general readers, as well as a thought-provoking analysis for scholars. Young provides a personal rationale for why he selected these six poets and why these six poems. The book, he states, is outcome of an encounter with modern poetry that began for him as a freshman at college when he pulled Stevens's The Auroras of Autumn off a library book shelf. Consequently, book is culmination, what Young describes as composite portrait, of many years of studying, teaching, translating, composing, and loving poetry. His conclusion is this: the modernist narrative is really many narratives at once and that modernist poetic practice as I understand and value it can best be demonstrated through close attention to six exemplary poems (ix). He presents each poem its entirety at opening of a chapter devoted to its exploration. The inclusion of these should be a valued introduction for some readers and a welcomed reentry point for others. Following poem, Young offers his readers a thorough, clearly written close reading. For chapters devoted to Rilke and Montale's poems, he provides his own lucid translations which, given his extensive experience translating their works, further aid ensuing explications. In his introduction, Young states, It's my hope that grouping them together and examining them company of someone who has spent a lot of time with them will prove a helpful experience for (x). By reading this book, one undoubtedly will be helped to see interpretive nuances of each poem. It is as though a master poetic guide leads you through textual ambiguity helping you to both see and understand modernist aesthetic. A case point is his presentation of final section of Yeats's Among School Children. He patiently guides readers to conclusion that contains most inconclusive images and its slipperiest (38). He convincingly points out: The reader can, for example, decide that final lines introduce a resounding unity or that they open up a gulf that reveals a crisis of meaning and signification. However, articulation of such resolutions and chasms is a choice that a reader makes, not a conclusion so firmly built into poem that no one can argue it or mistake its meaning. (42) Such a comment reminds me of best teachers I had as a student. In Young's case, he aims to open up interpretive possibilities for his readers, while not foregoing an appreciation and understanding of language and structure created by poet. It is not about reducing poem to a single interpretation, rather it is about illustrating to his readers how poem plays with language and offers us possibility to engage it imaginatively. Of six modernists Young's book, three of them-Williams, Moore, and Stevens-are Americans who stayed at home to write rather than travel to Europe. Their selection indicates part of Young's purpose for this study. [l]f modernist art was to be truly valid, applicable to every place and every culture, he argues, then it could and should be naturalized and practiced on American soil (xii). Young admits his introduction that his appreciation for Williams came later, for it took him longer to hear music. …

Factors Affecting Patency of Subintimal Infrainguinal Angioplasty in Patients with Critical Lower Limb Ischemia

Because subintimal angioplasty (SA) is a technique that can achieve recanalization of long arterial occlusions, it is considered an alternative to lower limb bypass operations. The aim of this prospective study was to identify the risk factors that affect patency of SA in patients suffering from critical limb ischemia (CLI). 51 consecutive infrainguinal SA were done in 46 patients suffered from CLI. The patients were followed-up with regular duplex scans up to 12 months post-intervention. Sex, atherosclerosis risk factors, and some technical details of the procedure (number of patent run-off vessels after the procedure, length and re-entry point of angioplasty) were examined as potential risk factors of patency, using survival analysis statistical techniques. The overall patency rate at 12 months post-intervention was 50%. According to Cox-regression analysis, the factors that affect patency were the number of run-off vessels and the length of occlusion. Patients with two or three run-off vessels had a hazard of occlusion of 0.30 (P = .027) compared to those who had one run-off vessel. The 12-months patency in patients with more than one run-off vessels was 81% vs. 25% in patients with one run-off vessel. Regarding the length of angioplasty, the hazard of reocclusion was 1.02 for every centimeter of occlusion (P = .049). The number of patent run-off crural vessels after the angioplasty and the length of occlusion are significant risk factors for reocclusion of infrainguinal SA in patients with CLI. Trying to recanalize more than one run-off vessels could raise the SA patency.

Haemodynamic Strategy for Treatment of Diastolic Anterograde Giacomini Varicose Veins

ObjectivesTo assess the diagnosis and outcome of a haemodynamic strategy for the treatment of primary varicose veins associated with anterograde diastolic flow (ADF) in the Giacomini vein (GV). MethodsADF in the GV, with the escape point located at the saphenopopliteal junction, was demonstrated in 15 patients (15 limbs) by duplex ultrasound. No other escape points were seen in this group. ADF was defined as the flow present in the relaxing phase after isometric contraction of the lower limb, measured in the standing position. Duplex and clinical follow-up was performed prospectively at 1 week, at 1, 3, 6, and 12 months and once per year thereafter, between 1998 and 2001. Surgery consisted of flush division of the GV from the small saphenous vein (SSV) and division of the incompetent collateral veins from the GV. ResultsGV diameter showed an average reduction from 6 to 4mm 33 months after surgery. Fourteen patients (93%) showed no symptoms or varicose veins. GV reconnection and recurrent ADF was demonstrated in two patients (13%). ConclusionsADF is a rare condition associated with primary varicose veins. ADF occurs when there is a closed venovenous shunt with recirculation in the muscular diastole. This implies that, although a part of the circuit is ascendant, the re-entry point must be located downstream to the scape point. Accurate duplex assessment is required to distinguish this atypical haemodynamic condition from an abnormal systolic circuit bypassing a deep vein obstruction. Interruption of the GV above its junction with the SSV abolished ADF with an acceptable rate of recurrences.

Durability of reflux-elimination by a minimal invasive CHIVA procedure on patients with varicose veins. A 3-year prospective case study

Objectives: to assess the outcome of a conservative and haemodynamic method for insufficient veins on an ambulatory basis (French acronym, “CHIVA”) with preservation of the greater saphenous vein (GSV) for treatment of primary varicose veins. Methods: duplex incompetence of the sapheno-femoral junction (SFJ) and the GSV trunk, with the re-entry perforating point located on a GSV tributary was demonstrated in 58 patients with varices (58 limbs). The re-entry point was defined as the perforator, whose compression of the superficial vein above its opening eliminates reflux in the GSV. Duplex scanning was performed preoperatively and at 7 days, and patients were followed prospectively at 1, 3, 6, 12, 24, and 36 months after CHIVA. Operation consisted in flush ligation and division from the GSV of the tributary containing the re-entry perforating vein (no additional high ligation is included). If reflux returned, SFJ interruption was performed in a second surgical procedure. Results: the GSV diameter showed an average reduction from 6.6 to 3.9 mm 36 months after surgery. Reflux in the GSV system was demonstrated in all but five (8%) patients. Of the 53 patients with recurrent reflux, 46 underwent SFJ interruption. Conclusions: elimination of reflux in the GSV after the interruption of insufficient collaterals is only temporary.Eur J Vasc Endovasc Surg 25, 159–163 (2003)