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PubMedDate not supplied

[The ostial valve of the junction of the internal saphenous vein and the wall of the femoral vein].

Anatomical, pathological and Doppler-ultrasonographic study has enabled analysis of the various mechanisms participating in normal valve function as well as during insufficiency of the deep and superficial venous systems. This leads to definition of normal morphology and of that of its various pathological changes, analysis of the various mechanisms via study of vein wall and valve behaviour and, finally, to determination that the absolute integrity of the vein wall and its valves is essential if a good hemodynamic result is to be obtained and that these two factors must work together since the inadequacy of one or other would result in valvular insufficiency. The following abnormalities of the ostial valve have been identified: a) loss of insertion into the vein wall of a valve segment, this being the most common; b) valve retraction; c) total destruction of the valve with persistence of fragments. Doppler-ultrasonography has shown that the only visible part of the valve system is the vein wall and the free edge of each valve, enabling determination in a context of valvular insufficiency of the existence of: Vein wall distension. Abnormal valve movements: a) valve prolapse; b) paradoxal movements; c) valve rigidity; d) trans-valve reflux. This same investigation also enabled us to confirm certain differences concerning relative valvular insufficiency, i.e. major vein wall distension accompanied by absence of contact, at the mid-line, with the free edge of each valve. It was possible in the group of patients with insufficiency of the deep venous system to closely evaluate the action of the reflux hypertensive wave on the ostial valve, in the case of total valve absence and in cases showing insufficiency of the first vein wall valve.

Adult↗
PubMed1990

[The main principles of transmission of vertical reflux of blood from the deep to superficial femoral veins in patients with varicose veins].

Under study were ways of spread of retrograde blood flow in different variants of disorders of work of the femoral vein valves in 106 patients with varicose disease. Incompetence of valves of the common femoral vein causes leakage of blood from deep veins through sapheno-femoral anastomosis or superficial veins. Injury of valves of deep and superficial veins is responsible for the involvement of communicatory veins connected with them in the pathological process. Grounds for different kinds of operations on veins for varicose disease are given.

Adult↗
PubMed2005

Arabidopsis thickvein mutation affects vein thickness and organ vascularization, and resides in a provascular cell-specific spermine synthase involved in vein definition and in polar auxin transport.

Polar auxin transport has been implicated in the induction of vascular tissue and in the definition of vein positions. Leaves treated with chemical inhibitors of polar auxin transport exhibited vascular phenotypes that include increased vein thickness and vascularization. We describe a recessive mutant, thickvein (tkv), which develops thicker veins in leaves and in inflorescence stems. The increased vein thickness is attributable to an increased number of vascular cells. Mutant plants have smaller leaves and shorter inflorescence stems, and this reduction in organ size and height is accompanied by an increase in organ vascularization, which appears to be attributable to an increase in the recruitment of cells into veins. Furthermore, although floral development is normal, auxin transport in the inflorescence stem is significantly reduced in the mutant, suggesting that the defect in auxin transport is responsible for the vascular phenotypes. In the primary root, the veins appear morphologically normal, but root growth in the tkv mutant is hypersensitive to exogenous cytokinin. The tkv mutation was found to reside in the ACL5 gene, which encodes a spermine synthase and whose expression is specific to provascular cells. We propose that ACL5/TKV is involved in vein definition (defining the boundaries between veins and nonvein regions) and in polar auxin transport, and that polyamines are involved in this process.

Amino Acid Sequence↗
PubMed1995

Portal vein reconstruction using an internal jugular vein as a graft: report of a case.

We report the case of a 41-year-old man with pancreatic carcinoma invading the portal vein who was successfully treated by portal vein resection combined with pancreatoduodenectomy and reconstruction using an autointernal jugular vein. The internal jugular vein is an ideal graft for portal vein replacement because it has sufficient length, a well-matched diameter, and there is no venous insufficiency after unilateral resection. Nevertheless, this is the first report of portal vein reconstruction using the internal jugular vein as a graft.

Adenocarcinoma↗
PubMed1992

High ligation of the greater saphenous vein for treatment of lower extremity varicosities: the fate of the vein and therapeutic results.

This study was carried out to determine the subsequent fate of the greater saphenous vein and the efficacy of its high ligation along with surgical excision or sclerotherapy of varicosities. From 1988 to 1990, 22 patients underwent high ligation and sclerotherapy, 22 underwent high ligation and varicose vein excision, and four underwent high ligation alone. There were 36 women and 12 men patients. The average patient age was 48. Sixty limbs were scanned by duplex ultrasound pre- and postoperatively to determine the status of the greater saphenous vein. Average follow-up time was 10 months. Patients and surgeons rated the results of therapy for ablation of varicosities and alleviation of symptoms. Surgical complications were evaluated. At postoperative scan, 47 greater saphenous veins (78%) were found to be completely patent, nine (15%) were thrombosed for a short segment (less than 10 cm) and four (7%) were more significantly thrombosed. Those limbs in which high ligation and sclerotherapy were performed had the highest complete patency rate (96%). Patient and surgeon satisfaction was good to excellent in every case. The only complications were three symptomatic greater saphenous vein thromboses. Although follow-up is relatively brief, complete patency of the ligated greater saphenous vein was found in most cases. High ligation allows preservation of a patent greater saphenous vein, which can be used as an arterial conduit at a later date and gives therapeutic results comparable to stripping without the additional morbidity.

Combined Modality Therapy↗
PubMed1998

Does umbilical vein catheterization to exchange transfusion lead to portal vein thrombosis?

UNLABELLED: The aetiopathology of extrahepatic portal vein obstruction is unknown. In retrospective studies, umbilical vein cannulation and sepsis have been alleged to cause portal thrombosis. This prospective study was undertaken to detect whether thrombosis and consequent obstruction of the splenoportal venous system develops after umbilical vein catheterization for exchange transfusion in newborns using Doppler ultrasound. Forty children (M = 24; F = 16) who had undergone exchange transfusion for hyperbilirubinaemia were studied at school age. Maximal duration of the venous umbilical cannulation was 120 min and sepsis did not occur. Clinical, biological and sonographic examinations were normal, except in 3 children. In 2 the left branch of portal vein could not be identified (normal variant). CONCLUSION: Our results show that, in these children, umbilical vein catheterization did not lead to development of portal vein thrombosis. However, when other risk factors such as umbilical infection, traumatic catheterization are associated, children should be screened for obstruction of the portal vein.

Child↗
PubMed2004

Portal and mesenteric vein thrombosis after portal vein embolization in a patient with protein S deficiency.

Portal vein embolization can be performed safely, and so far no major complications have been reported. We report an extremely rare complication of portal vein embolization, a case of portal and mesenteric thrombosis in a 65-year-old patient with protein S deficiency. Right portal vein embolization was carried out prior to extended right hepatectomy for advanced gallbladder carcinoma involving the hepatic hilus. Computed tomography 14 days after embolization revealed massive thrombosis of the portal and the superior mesenteric veins. A protein S deficiency was found by means of an extensive workup for hypercoagulable state. Portal vein embolization may have triggered a cascade of events that was expressed as portal and mesenteric vein thrombosis resulting from deficiency of protein S. It may be better to determine the concentrations of such coagulation regulators prior to portal vein embolization.

Aged↗
PubMed1998

Risk factors for hemiretinal vein occlusion: comparison with risk factors for central and branch retinal vein occlusion: the eye disease case-control study.

OBJECTIVE: Possible risk factors for hemiretinal vein occlusion were identified and compared with risk factor profiles for central and branch retinal vein occlusion. DESIGN: The design was a multicenter case-control study. METHODS: The authors identified 79 patients with hemiretinal vein occlusion (HRVO), 258 patients with central retinal vein occlusion (CRVO), 270 patients with branch retinal vein occlusion (BRVO), and 1142 control subjects at 5 clinical centers. Risk factor data were obtained through interviews, clinical examinations, and laboratory analyses of blood specimens. RESULTS: Systemic hypertension and history of diabetes mellitus were associated with increased risk of HRVO. Risk of CRVO increased with history of diabetes, systemic hypertension, and higher erythrocyte sedimentation rate (females only); risk of CRVO decreased with increasing amounts of physical activity and increasing amounts of alcohol consumption. Systemic hypertension, higher body mass index, and higher alpha2-globulin levels were associated with increased risk of BRVO, whereas higher high-density lipoprotein levels and increasing levels of alcohol consumption were associated with decreased risk of BRVO. Glaucoma history was associated with all three types of retinal vein occlusion. CONCLUSION: Patients presenting with retinal vein occlusion should be evaluated for cardiovascular disease, diabetes, and glaucoma.

Adult↗
PubMed2007

Posterolateral cervical vein as a recipient vein in reconstructive microvascular surgery of the head and neck.

Free flaps are becoming the preferred method of choice for head and neck reconstruction. However, many patients who have undergone radiotherapy and radical neck dissection or who require treatment for recurrent tumor, often present difficulty in choosing recipient vessels. The authors have noted a potential recipient vein coursing vertically along the anterior ridge of the trapezius muscle. They used this vein as the recipient vein in two patients; the two free flaps were transferred successfully without complications. This vein, which they provisionally named the posterolateral cervical vein (PLCV), is considered an important option as a recipient vein in head and neck reconstruction when more commonly used recipient cervical veins are unavailable.

Aged↗
PubMed1992

Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen.

The sonographic parameters in portal hypertension (PHT) were examined in a consecutive population of 118 patients who had PHT diagnosed using specific endoscopic, sonographic and Doppler signs. A patent or enlarged paraumbilical vein was found in 85.6% of patients overall and 82.5% of patients with varices indicating a relatively high sensitivity. A portal vein diameter greater than or equal to 13mm was found in only 41.1% and greater than or equal to 15mm in only 20% of patients. A thrombosed portal vein and reversed portal vein flow were present in 3.4% and 5.3% of patients respectively. These signs have only been reported in the context of PHT and are felt to be specific for PHT, but both have a very low sensitivity. Portal vein velocities were highly variable suggesting that this is not a useful predictor of PHT. Splenomegaly was found in only 53.5% of patients demonstrating its poor sensitivity as a sign of PHT. Varices were found in 73.3% of patients overall, and in 100% of patients with a patent or enlarged paraumbilical vein combined with ascites. No other statistically significant correlation between varices and sonographic findings was demonstrated. We conclude that the presence of a patent or enlarged paraumbilical vein is a practical, useful and sensitive ultrasound sign to look for in the diagnosis of PHT.

Esophageal and Gastric Varices↗
PubMed1992

Cardiac catheterization through the internal jugular vein in pediatric patients. An alternative to the usual femoral vein access.

The percutaneous femoral vein approach is used routinely for cardiac catheterization in the pediatric age but in some children, it may be impossible as in the case of iliac vein or inferior vena cava thrombosis due to previous cardiac catheterization, or inconvenient as for right ventricular endomyocardial biopsies. In the period between 1982 and 1990, 160 cardiac catheterizations or right ventricular endomyocardial biopsies were performed in 102 children. Patients ranged in age between 2 months and 17 years (mean, 3.8 years) and in weight from 3.2 to 57.3 kg (mean, 14.4 kg). Indications for the internal jugular vein approach were as follows: (1) thrombosis of the inferior vena cava due to previous cardiac catheterization in 42 patients (41 percent); (2) right ventricular endomyocardial biopsy after cardiac transplant in 19 patients (19 percent); (3) control catheterization of the pulmonary arteries following classic or bidirectional cavopulmonary anastomosis in 16 patients (16 percent); (4) superior vena cava obstruction following Mustard's procedure in 14 patients (14 percent); (5) failed percutaneous femoral venous approach in six patients (6 percent); and (6) absence of the hepatic segment of the inferior vena cava in four patients (4 percent). The right or left internal jugular vein could be entered in all but three procedures (98 percent). Seventeen patients had more than one procedure through the same internal jugular vein and the vein was found patent in all. A complete right heart cardiac catheterization was performed using this route. Right ventricular endomyocardial biopsy and interventional procedure were performed through this route. Two major complications occurred. A patient developed a central transient ischemic attack and another patient developed a persistent Horner syndrome. Accidental carotid puncture occurred in five patients without consequences. Our data indicate that cardiac catheterization in infants and children can be performed safely through the internal jugular vein, with a high success rate and a low incidence of major complications.

Adolescent↗
PubMed2002

Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency: a case report.

Hypercoagulability is one of the causes of portal vein and superior mesentery vein thrombosis. We report a case of Bacteroides fragilis bacteremia associated with portal vein and superior mesentery vein thrombosis secondary to antithrombin III and protein C deficiency. The patient presented with high fever for more than 3 weeks. Abdominal sonography revealed a liver cyst of 1.7 cm in diameter over segment 4 and a renal stone of 0.7 cm in size over the lower portion of the right kidney but no evidence of hydronephrosis. Elevation of liver enzymes was also noted. Intermittent fever was noted despite treatment with ceftriaxone and doxycycline. On Day 15 of hospitalization, blood culture revealed B. fragilis, which prompted further investigation of the source of intraabdominal and pelvic infection. Abdominal computed tomography revealed portal vein and superior mesentery vein thrombosis. Endoscopic studies of the gastrointestinal tract showed no tumor or diverticulum. Study of coagulation factors disclosed deficiency of antithrombin III and protein C. Clinicians should remain aware of the need to promptly search for a portal or mesentery vein thrombosis in cases of Bacteroides bacteremia of unknown origin.

Adult↗
PubMed2003

[A case of unification anomalies of the superior vena cava and absence of the left brachiocephalic vein with dilated azygos and hemiazygos veins].

We report a case of dilated azygos vein simulating a tumor in the posterior mediastinum. The patient was a 47-year-old male who was found to have anomalies of unification of the superior vena cava and absence of the left brachiocephalic vein. He was admitted to our hospital because chest radiographs and computed tomography (CT) scans showed a well-circumscribed oval mass 2.5 cm in diameter, behind the bifurcation of the trachea. This lesion, which was markedly enhanced in chest CT, magnetic resonance imaging (MRI) and MR angiography (MRA) was diagnosed as a dilated azygos vein. An enlarged hemiazygos vein and collaterals were also recognized. Upon digital subtraction venography of both upper extremities, the right atrium and the left brachiocephalic vein could not been distinguished from the superior vena cava and the infraclavicular vein, respectively. Collaterals entering the azygos and hemiazygos veins were, however, recognized. It was considered that MRA and disital subtraction venography were very useful for confirmation of the diagnosis in this case.

Abnormalities, Multiple↗
PubMedDate not supplied

[Histochemical comparison of the enzyme profiles of healthy veins and varicose veins].

In the context of studies bearing on the enzymatic activity in healthy veins and varicose veins, sample sections of veins were excised in eight patients with primary varices of the long saphenous vein. The veins were subjected to histochemical methods for identifying enzymes. The histochemical dosage related to lactate-dehydrogenase, alkaline phosphatase, adenosine triphosphoric acid enzymes, as well as lysosomal beta-glucuronidase, non-specific esterase and phosphatase acid enzymes. The authors deal with the specific problems involved in the different enzymatic methods, and their relevance to prognosis. In conformity with the results of our histochemical studies, the comparison between the enzymatic profiles of healthy and varicose veins showed an increase in lysosmal enzyme activity in the vein walls leading to varicose degeneration. The increase in activity was more pronounced in the media than in the intima. A reverse pattern was observed in the behaviour of enzymes involved in energetic metabolism. The enzymatic activity in the venous wall leading to varicose degeneration proved to have decreased. This reduction in the enzymatic activity was more marked in the intima than in the media and was particularly pronounced in the case of the histochemical identification of adenosine triphosphoric acid Ca++.

Acid Phosphatase↗
PubMedDate not supplied

[Results of vascular repairs in trauma of the femoral veins, iliac veins and the inferior vena cava].

We examined the records of 12 patients operated for lesions of the inferior vena cava, the iliac vein, or the common femoral vein were examined. The results of venous grafts, treatment of the lesions of the posterior inferior vena cava or the supra hepatic vena cava and the permeability after repair of these large vessels was studied. Treatment included simple suture (n = 9), venous patch (lateral iliac vein, n = 1), and venous autografts (common femoral veins, n = 2). For 3 lesions of the posterior or supra-hepatic inferior vena cava, haemostasis was obtain by double clamping (n = 2) or four-way clamping (n = 1) with right hepatectomy. In 9 cases, the patients were followed-up for a mean of 59 months. Morphologic exploration with phlebography (n = 1) or echo-Doppler examination (n = 7) was performed during the follow-up period. There were no post-operative deaths. There were no functional sequellae affecting the lower limbs. In one case, the echo-Doppler examination revealed repermeabilization of a thrombosed lateral iliac vein after simple suture. Lesion repair of large diameter veins with autografts using the internal jugular or internal saphenous vein gave good results. Haemostais of posterior or supra-hepatic lesions to the inferior vena cava was obtained with clamping. In cases with associated hepatic involvement, haemostasis was controlled with a four-way clamp and trans-hepatic access or digitoclasty. Long-term permeability of venous repair was good.

Abdominal Injuries↗
PubMed1996

[Partial or total stripping of the great saphenous vein. 5-year recurrence frequency and 3-year frequency of neural complications after partial and total stripping of the great saphenous vein].

One hundred and sixty-three patients with primary long saphenous vein varices were randomized to either classical (total) stripping of the long saphenous vein (n = 84) or partial stripping, i.e. only of the femoral part of the vein (n = 79). Permanent nerve lesions were evaluated clinically three years and recurrence of varicosities evaluated five years postoperatively. It was found that 24 patients (29%) who had total stripping performed had permanent lesions of the saphenous nerve, whereas only four of the patients (5%) who had partial stripping of the vein had lasting nerve lesions (p < 0.01). Ten percent of patients in both groups had recurrence of varicosities. The present - one and only - long-term, randomized study of different stripping procedures shows that stripping the long saphenous vein below the knee increases the permanent nervedamage six-fold without reducing long-term recurrency. Total stripping of the long saphenous vein should be abandoned as a routine in varicose vein surgery.

Follow-Up Studies↗
PubMed1998

The middle colic vein: an alternative source of portal inflow in orthotopic liver transplantation complicated by portal vein thrombosis.

BACKGROUND: Portal vein thrombosis (PVT) was previously considered a contraindication to orthotopic liver transplantation (OLT) since adequate portal blood supply is mandatory for graft function and patient survival. Improvements in surgical technique, however, have meant that this problem now can be circumvented in most instances. Nevertheless portal vein thrombosis remains an obstacle in OLT and is associated with increased incidence of primary non-function and long-term liver failure. METHODS: A 55-yr-old patient underwent OLT for secondary biliary cirrhosis associated with hepatitis C infection and complicated by long standing PVT. Involvement of the portal, mesenteric, and splenic veins prevented standard portal venous reconstruction. Portal inflow was accomplished by a side-to-end anastomosis between the middle colic vein and the donor portal vein. RESULTS: Hepatic reperfusion and subsequent liver function were excellent. Portal blood flow, as measured by color-enhanced Doppler ultrasound, was normal following surgery until discharge. The post-operative course was complicated by abdominal wound dehiscence and recurrent cytomegalovirus (CMV) infection. The patient was discharged in good clinical condition, with excellent liver function and patent portal vein 89 d after OLT. CONCLUSIONS: The middle colic vein is a novel, not previously described, source of portal venous inflow for OLT complicated by extensive splanchnic venous inflow thrombosis.

Anastomosis, Surgical↗
PubMed2003

Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis.

Noninvasive diagnosis of deep vein thrombosis (DVT) is based on ultrasound examination of the leg veins, usually restricted to only compression of the proximal veins (CUS). Patients with negative CUS findings require a second examination or a combination with other tests, which impairs clinical efficiency. In this prospective outcome study, 1646 consecutive patients with clinically suspected DVT were examined once by a standardized protocol of complete compression ultrasound comprising all proximal and distal veins (CCUS) as the only diagnostic test. The examination was equivocal in 15 patients (1% technical failure rate). Another 366 patients (22%) were tested positive for proximal DVT, distal DVT, muscle vein thrombosis, or phlebitis. Of 1265 patients in whom CCUS findings were negative, 242 met exclusion criteria for follow-up (age <18, life expectancy <3 months, other reasons for anticoagulation, postthrombotic lesions of the leg veins, or lack of informed consent). During the 3 months of follow-up, three of 1023 patients with negative CCUS findings experienced a symptomatic venous thromboembolic event (0.3% [95% CI 0.1%-0.8%]). We conclude that the CCUS protocol has a low technical failure rate and is safe with respect to excluding DVT, thereby reducing the diagnostic workup of patients with suspected DVT to a single ultrasound examination.

Adult↗