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At least 217 records · Page 12Linked to original sources
PubMed2003

Prophylactic gamma radiation of unaffected vein grafts failed to prevent vein graft disease in a chronic hypercholesterolemic porcine model.

OBJECTIVE: The value of prophylactic brachytherapy on vein graft disease is unknown. METHODS AND RESULTS: Vein bypass grafts in 23 hypercholesterolemic pigs after ex vivo gamma irradiation of the vein grafts (10, 20, and 40Gy) and 16 control veins were analyzed regarding: (1) expression of platelet-derived growth factor (PDGF-AA and -BB, ELISA); (2) smooth muscle cell (SMC) proliferation/cell death (double-immunohistochemistry Mib-1/TUNEL/SMC alpha-actin); and (3) vessel wall dimensions. Planimetric data on vessel wall dimensions revealed no positive effect of gamma radiation on neointima formation and inner lumen diameter. On the contrary, vein grafts subjected to 40Gy were significantly more likely to be occluded and to have reduced inner lumen and increased neointima formation. Radiation therapy had no effect on PDGF expression and SMC proliferation/cell death. The mean inner lumen diameter decreased as PDGF-AA expression increased. CONCLUSIONS: Prophylactic gamma radiation of unaffected vein grafts failed to prevent vein graft disease in a hypercholesterolemic porcine model. High-dose radiation (40Gy) resulted in more frequent graft occlusion and vein sclerosis.

Anastomosis, Surgical↗
PubMed1997

Vein quality influences neointimal hyperplasia in an organ culture model of human saphenous vein.

OBJECTIVES: The severity of pre-existing pathological changes in human saphenous vein (HSV) correlates with the development of vein graft stenosis and graft patency. The aim of this study was to investigate the influence of pre-existing intimal hyperplasia on development of the neointima in vitro, using an organ culture model. MATERIALS AND METHODS: Segments of HSV were harvested during coronary artery bypass surgery. Histology was performed on part of the vein; the remainder was maintained in culture. Pre-existing intimal thickness (PIT) in HSV from day 0 and neointimal thickness (NIT) in cultured HSV were measured using computerised image analysis on histological sections. Day 0 and 14 veins were compared with respect to intimal hyperplasia. RESULTS: Twelve pairs of veins were examined. A mean tissue ATP of 297 nmoles/g wet weight for cultured. HSV confirmed cell viability. Mean PIT was 180 microns (CI: 86-274) and mean NIT was 60 microns (CI: 48-72), with a significant correlation between them using the Spearman Rank test (Rs = 0.72; p = 0.008). CONCLUSIONS: Pre-existing vein quality as measured by PIT correlates with the development of neointimal hyperplasia in culture, adding further support to clinical evidence that poor vein quality predisposes to vein graft stenosis due to an inherent susceptibility to intimal hyperplasia.

Graft Occlusion, Vascular↗
PubMed2002

Bypass in the absence of ipsilateral greater saphenous vein: safety and superiority of the contralateral greater saphenous vein.

PURPOSE: The purposes of this study were to evaluate the long-term results of different autogenous conduits used for infrainguinal bypass when ipsilateral greater saphenous vein (IGSV) is absent or inadequate and to determine the impact on the contralateral lower extremity. METHODS: The study was performed as a retrospective evaluation of a prospective vascular registry together with review of patient records and telephone follow-up. RESULTS: From January 1990 to June 2000, 226 autogenous infrainguinal reconstructions were performed in 203 patients without adequate IGSV. The patients consisted of 128 men and 98 women, with a mean age of 69 years. Prevalent risk factors included diabetes (51%) and prior coronary bypass (46%). Limb salvage was the predominant indication (93%), and 59% of the procedures were secondary reconstructions. All bypasses were completed with autogenous vein, which included contralateral greater saphenous vein (CGSV; 31%), single-segment lesser saphenous vein (5%), single-segment arm vein (19%), and autogenous composite vein (45%). Bypasses were performed to the tibial and pedal arteries in 84% of the cases. The 30-day mortality and graft occlusion rates were 1% and 9%, respectively. The overall postoperative morbidity rate was 24%, with a 7% rate of major complications. Follow-up was complete in 95% of patients over a mean period of 24 months (range, 0.1 to 106 months). The 5-year primary patency rates were significantly better for CGSV compared with autogenous composite vein grafts (61% +/- 7% versus 39% +/- 6%; P <.009). The 5-year secondary patency (60% to 73%) and limb salvage (78% to 81%) rates did not differ significantly between the three groups. Follow-up of the contralateral lower limb revealed that nine of 226 limbs (4%) were amputated at a mean of 36 months after the ipsilateral bypass. The overall 5-year contralateral limb preservation rate was 90% +/- 3%. Contralateral vein harvest and the presence of diabetes did not affect the need for bypass or amputation of the contralateral limb. CONCLUSION: For most patients with inadequate IGSV, the CGSV is the alternative conduit of choice because of its length, superior performance, ease of harvest, and minimal risk to the donor limb.

Aged↗
PubMed2002

Improved technique of portal vein reconstruction in pediatric liver transplant recipients with portal vein hypoplasia.

BACKGROUND: Children with small or hypoplastic portal veins represent a challenge for liver transplantation. Graft loss of up to 70% has been reported in these patients in the past. A variety of techniques has been used in both cadaveric and living related transplants in an effort to overcome this problem. Variability arises as to whether to use a vascular graft and where on the portal system to attach the graft. METHOD: We present our usage of a simple and straightforward interposition iliac vein allograft fashioned in a manner to achieve large anastomotic cross-sectional area on the confluence of the superior mesenteric/splenic veins. The procedure also overcomes problems of graft vein/portal vein size mismatch in the cases where liver and vein grafts are procured from much larger donors. RESULTS: A total of 14 children presented with hypoplastic portal vein (diameter<5 mm), of a total of 30 consecutive patients requiring cadaveric liver transplants, and benefited from this technique. Median recipient age was 10.5 months. Revascularization times ranged from 22 to 43 min with a mean of 33 min. All patients are alive and well at a mean follow-up of 329 days (10 months). All liver grafts are well and functioning. No portal vein problem was detected. CONCLUSION: Results from this technique are clearly encouraging. Because portal vein hypoplasia is a common problem in pediatric transplant candidates, we believe this alternative technique is of interest and should be added to the transplant surgeon's armamentarium.

Body Weight↗
PubMed2006

Transjugular portosystemic shunt in chronic portal vein occlusion: importance of segmental portal hypertension in cavernous transformation of the portal vein.

The authors describe a patient with bleeding varices due to chronic portal vein occlusion. A transjugular intrahepatic portosystemic shunt (TIPS) attempt failed because of cannulation of a low-pressure network of portal veins, which communicated only with the chronically thrombosed native portal vein. A second TIPS attempt was successful after transhepatic catheterization of a high-pressure portal system that was continuous with periportal collateral veins and mesenteric veins. After 8 months and one TIPS revision for hepatic vein stenosis, the patient has improved liver function, collapsed varices, and a patent TIPS on ultrasonogram. This case illustrates that cavernous transformation of the portal vein may result in variable intrahepatic portal perfusion and pressures and that TIPS in such cases requires careful selection of an intrahepatic portal vein to achieve adequate portal decompression.

Aged↗
PubMed2005

Varicose veins arising from the pelvis due to ovarian vein incompetence.

Vulval varices and perivulval veins are common though often unrecognised, and pelvic pain is a common complaint, sometimes without an obvious cause, hence treatment is not always successful. An association between these two problems has long been established, and some cases of pelvic pain are clearly associated with venous pathology. Often, these patients present to the vein clinic with recurrent varicose veins, because the standard procedures have failed and the pelvic origin was not recognised. The understanding of the pathology has evolved and will be reviewed. To establish diagnosis, the communication from the atypical varicose veins in the legs to the ovarian veins must be shown and incompetence of one or both ovarian veins must be demonstrated. Treatment requires elimination of the retrograde flow in the ovarian veins. This can be by either surgical ligation and removal or obliteration with coils and sclerosant. Having removed the cause and relieved the pelvic symptoms, the leg veins can then be successfully treated.

Female↗
PubMed1998

The retinopial vein: a vein passing directly from the retina to the pia mater at the optic nerve head.

BACKGROUND/AIMS: All blood drainage from the retina is thought to occur through the central retinal vein with rare, if any, exceptions. A chance observation of a specimen in which this pattern did not apply suggested that the subject required review. METHODS: An optic nerve head, identified from an earlier study as possessing an unconventional venous drainage arrangement, was examined histologically using interrupted serial resin sections. 200 fundus photographs were examined to compare with the results from the sectioned optic nerve head. RESULTS: A retinopial vein passing from the temporal retina and entering the pia mater without first joining the central retinal vein was observed. Two of the fundus photographs and possibly four others displayed a venous pattern consistent with this arrangement. CONCLUSIONS: The retinopial vein complements the central retinal vein in blood drainage from the retina. Uncertainty in identifying the vein ophthalmoscopically prevents a reliable estimate of its incidence but it appears to be uncommon. Retinal dysfunction may be limited in cases of central retinal vein occlusion in the presence of a retinopial vein.

Female↗
PubMed1997

Expression and function of decapentaplegic and thick veins during the differentiation of the veins in the Drosophila wing.

The differentiation of the veins in the Drosophila wing involves the coordinate activities of several signal transduction pathways, including those mediated by the transmembrane receptors Torpedo and Notch. In this report, the role of the signalling molecule Decapentaplegic during vein differentiation has been analysed. It is shown that decapentaplegic is expressed in the pupal veins under the control of genes that establish vein territories in the imaginal disc. Decapentaplegic, acting through its receptor Thick veins, activates vein differentiation and restricts expression of both veinlet and the Notch-ligand Delta to the developing veins. Genetic combinations between mutations that increase or reduce Notch, veinlet and decapentaplegic activities suggest that the maintenance of the vein differentiation state during pupal development involves cross-regulatory interactions between these pathways.

Alleles↗
PubMed1993

Double left renal veins and multiple right renal veins found in Japanese adults.

A case of circumaortic renal venous collar, the first such collar to be observed in a Japanese female cadaver, is presented, and its anatomical organization is compared with that in another case in which four right renal veins accompanied four right and three left renal arteries in a Japanese male cadaver. Double left renal veins are formed by persistence of a more central retroaortic venous anastomosis, in contrast to multiple right renal veins, which are formed by persistence of some embryonic renal veins arranged in ladder-like patterns. In our case, the dorsal limb of the renal collar communicated with the azygos system veins and lumbar veins. The azygos system veins were considered to have atrophied as a result of some persisting retroaortic venous anastomoses located in the thorax. Therefore, we believe that the renal collar was related to the atrophy of the azygos system veins. To determine whether there are racial differences in incidence of renal collar, further studies in Asians are required.

Aged↗
PubMed2001

[The formation and involution of the optociliary vein during the course of central retinal vein occlusion].

BACKGROUND: Formation of collateral pathways by veins on the optic nerve head is sometimes observed during the resolution of a central retinal vein occlusion (CRVO). However, no cases have been reported which documented the formation and involution of these collateral pathways during the resolution of a CRVO. CASE: A 56-year-old man with a non-ischemic CRVO was followed over a 10-year period by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (IA). Initial examination revealed only mild arteriosclerosis and absence of the optociliary vein (OCV) in the right eye. Approximately 9 years later, the patient returned with non-ishemic CRVO, and FA demonstrated a prolongation of the retinal circulation time to 12.1 seconds (normal < 11.0 seconds). Monitoring of this patient during treatment disclosed development of an OCV on the optic nerve head and gradual decrease in the retinal hemorrhage. In FA, the retinal circulation time was shortened and returned to normal. IA verified an outflow through the OCV into choroidal veins. Later, ophthalmoscopy showed a narrowing of the diameter of the OCV. CONCLUSION: We suggest that the OCV developed to drain blood from retinal veins to the vortex veins through choroidal veins to compensate for the slowing of retinal blood outflow. The reperfusion of the central retinal vein was accompanied by the narrowing of the OCV.

Collateral Circulation↗
PubMed2000

[Compensation of external jugular vein to the reflux of cerebral blood after bilateral ligation of the internal jugular vein].

OBJECTIVE: To investigate the effects of conserving external jugular veins for compensating the back flow of intracranial veins. METHODS: The rhesus monkey was underwent bilateral radical neck dissection to simulate that performed in the human. In operation, the changes of intracranial pressure (ICP) after ligating these jugular veins was observed. RESULTS: The results indicate that ligation of the external and internal jugular veins will increase the ICP obviously, but conserving external jugular veins will reduce the increase of ICP and shorten the recovery time from increased ICP. CONCLUSIONS: The conservation of the external jugular veins will compensate the back flow of intracranial veins after RND. The experiment provides a simple and effective method for the prevention of intracranial complications and preservation of the flow of facial veins.

Animals↗
PubMed2002

Endoscopic vein harvest: early results of a prospective trial with open vein harvest.

BACKGROUND: Conventional open long saphenous vein harvest (OVH) is often associated with significant wound pain and serious morbidity in some patients with a resultant extended treatment period. Endoscopic vein harvest (EVH) in theory should alleviate wound pain, be less predisposed towards leg wound infection and lead to greater patient satisfaction. This study aims to compare the two techniques on this basis and determine whether EVH is a viable technique within normal operative time. METHODS: During September and December 2000, 60 saphenous vein harvests were prospectively randomised to EVH (n=30) and OVH (n=30); all performed by one surgeon with the Clearglide(r) endoscopic vein harvest system (Ethicon Inc). End points were impaired wound healing (ASEPSIS score) and postoperative pain (Visual analogue scale) and operative variables. Statistical analysis done using Fisher s exact test and Mann-Whitney U test as appropriate. RESULTS: The groups were well matched demographically. Patients in the EVH group had significantly lower ASEPSIS scores (p<0.001) and postoperative pain (p<0.001). The vein was harvested at 0.96cm/min (0.43-1.5+/-0.33) in the OVH group compared to 0.81cm/min (0.41-1.13+/-0.19) in the EVH group (p=0.09). The new procedure did not prolong the overall operative time (p=0.53). Two patients needed to be converted to open technique. There was no difference found in the vein quality by histological analysis. CONCLUSIONS: These data clearly demonstrate that endoscopic vein harvest results in significantly reduced post-operative pain, better impaired wound healing, allows earlier ambulation and does not prolong the operative time significantly with no compromise in vein quality.

Aged↗
PubMed1992

Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries.

The influence of coronary artery stenoses on patient survival and event-free survival is known, but no studies have reported the long-term outcome of patients with stenoses in saphenous vein bypass grafts. We retrospectively studied 723 patients who underwent a postoperative angiographic study that documented a stenosis of 20% to 99% in at least one saphenous vein graft and who did not undergo reoperation or percutaneous transluminal coronary angioplasty within 1 year after that catheterization. The mean follow-up interval was 83 months (range 1 to 237 months). For comparison, a group of 573 patients who underwent a postoperative catheterization that did not show any vein graft stenosis were also followed up. Cox regression analyses were used to identify predictors of late survival, reoperation-free survival, and event-free survival. For the entire group of patients with stenotic vein grafts, moderate or severe impairment of left ventricular function (p less than 0.001), interval between operation and catheterization (p less than 0.001), older age (p = 0.001), triple-vessel or left main coronary artery disease (p = 0.004), and stenosis of the vein graft to the left anterior descending coronary artery (p = 0.09) were associated with decreased late survival. Patients with an operation-to-catheterization interval greater than or equal to 5 years were at particularly high risk, and multivariate analyses of that subgroup confirmed that a stenotic graft to the left anterior descending artery was a strong predictor of decreased survival (p less than 0.001), decreased reoperation-free survival (p less than 0.001), and decreased event-free survival (p less than 0.001). Patients greater than or equal to 5 years postoperatively with greater than or equal to 50% stenosis of vein grafts to the left anterior descending artery had survival of 70% and 50% at 2 and 5 years after catheterization, compared with 97% and 80% for those with greater than or equal to 50% stenosis of the native left anterior descending artery (p = 0.002). Late vein graft stenoses are more dangerous than native coronary stenoses. Late stenoses in saphenous vein grafts to the left anterior descending coronary artery predict a high rate of death and cardiac events and are an indication for reoperation.

Cardiac Catheterization↗
PubMed1980

The significance of vein wall thickness and diameter in relation to the patency of femoropopliteal saphenous vein bypass grafts.

Two hundred and twenty-five reversed saphenous vein femoropopliteal bypass graft procedures were performed on 186 patients with occlusive vascular disease. These grafts were followed for a mean of 19 months, with the longest period being 64 months. Numerous factors ascertained before, during, and after operation were analyzed using a life-table technique to see how these factors correlated with graft patency. The internal diameter and wall thickness of the vein grafts appeared to significantly influence graft patency. The best results were obtained using veins with a large internal diameter and a thin wall. In contrast, none of the other factors studied (which included age, sex, blood pressure, height, weight, indication for surgery, diabetic state, serum lipids, angiographic data, the site of the upper and lower anastomoses, the use of spliced vein segments, the type of vein preparation and the consumption of cigarettes before operation) were useful predictors of graft patency. It is suggested that vein diameter and vein wall thickness should be taken into consideration when analyzing the results of saphenous vein femoropopliteal bypass graft procedures, and also that the assessment of these factors may influence the choice of graft material for a femoropopliteal bypass graft.

Adult↗
PubMed1982

Management of traumatic peripheral vein injuries. Primary repair or vein ligation.

The management and outcome of 83 patients who had 86 venous injuries were retrospectively reviewed to identify optimal management techniques in patients with peripheral vein injuries. Venous injuries of the arms were associated with no long-term sequelae, and management with vein ligation appears safe. In patients with venous injuries of the legs, primary repair by lateral suture or primary end-to-end reanastomosis is recommended when technically easy. In patients who are unstable or in whom primary repair cannot be performed, vein ligation is recommended. Autogenous vein interposition grafting appears indicated only in the popliteal area when vein reconstitution should be aggressively sought. Vein ligation in peripheral vein injuries should be followed with aggressive postoperative management to prevent the development of distal edema. Limb elevation is effective in minimizing the development of adverse sequelae.

Adolescent↗
PubMed1998

Reconstruction of the hepatic and portal veins using a patch graft from the right ovarian vein.

We describe a patch-graft technique using the right ovarian vein for reconstruction of the right hepatic and portal veins after resection in hepatectomy and pancreatoduodenectomy in female patients. After partial resection of the right hepatic vein or portal vein for removing either hepatic or pancreatic tumors, the defects were covered by a patch graft from the right ovarian vein. The proximal part of the vein, 5 cm in length, was harvested, divided longitudinally, and then divided into two equal parts, which were sutured together to give a patch measuring 2.5 x 2.0 cm. This technique can be applied for reconstruction after partial resection of the hepatic or portal vein in hepatectomy and pancreatoduodenectomy.

Colonic Neoplasms↗
PubMedDate not supplied

Investigation of blood flow velocity by color Doppler imaging in nonischemic central retinal vein occlusion with collateral veins.

PURPOSE: To study the blood flow velocity in the central retinal vein after the resolution of non-ischemic central retinal vein occlusion (CRVO) with optociliary vein (OCV). METHODS: Eleven patients and 22 healthy volunteers were studied. Indocyanine green (ICG) angiography was used to investigate the choroidal veins in the affected eyes. Color Doppler imaging was used to measure the blood velocity in the central retinal artery and vein in the 11 affected and 22 healthy eyes. RESULTS: Indocyanine green angiography verified the formation of retinochoroidal collaterals in all the affected eyes. The velocity in the central retinal vein was significantly lower in the affected eyes. CONCLUSIONS: The results indicate that the collaterals are important routes of extraretinal outflow of retinal venous blood. It is recommended in the investigation of CRVO by color Doppler imaging to perform ICG angiography to determine if retinochoroidal collateral veins have been formed.

Aged↗
PubMed1990

The use of internal jugular vein as interposition graft for femoral vein reconstruction following traumatic venous injury: a useful approach in selected cases.

Complex venous injuries remain a controversial and interesting challenge to the vascular and trauma surgeon. Data from the Vietnam Vascular Registry, combined with experience from recent civilian series, seem to indicate that the best results are obtained when venous repair is undertaken. This is especially true of combined arterial and venous injury where compromised venous outflow may lead to limb loss in spite of patent arterial reconstruction. The larger size of veins, however, has required the construction of complex and time-consuming panel and spiral-vein grafts. This makes them far from ideal in the trauma treatment setting, where minimization of blood loss and operating room time are high priorities. We present a case of combined injury to both femoral artery and vein, where the femoral vein injury was repaired using autologous internal jugular vein as interposition graft while the arterial injury was repaired with autologous saphenous vein from the opposite limb. The avoidance of prosthetics, ease of harvest, size match, and little associated morbidity all make a strong case for use of the internal jugular vein where speedy reconstruction of large venous conduits is indicated.

Adolescent↗