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PubMed2006

Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins.

BACKGROUND: Endovenous ablation of the great saphenous vein (GSV) may be performed simultaneously with stab phlebectomy of branch varicose veins or as a stand-alone procedure. A clinical approach of performing radiofrequency ablation (RFA) alone as initial treatment for varicose veins was reviewed. METHODS: Patients with duplex ultrasound-documented reflux in the GSV and CEAP clinical stage 2 to 6 were selected for RFA. Patients were examined within a week preoperatively with duplex ultrasound imaging. Patients were seen within a week postoperatively and again at 2 to 3 months to ascertain if further treatment was required. A retrospective review of the initial 184 procedures in a series from June 2002 through February 2005 was performed, allowing for a 9-month follow-up period. RESULTS: Three procedures were performed under general anesthesia and 181 with intravenous sedation and tumescent anesthesia. Postoperative duplex scans showed total occlusion or partial patency of <10 cm in 155 limbs. Seven (4.5%) had concomitant stab phlebectomy, seven subsequently had sclerotherapy, and 39 (25.2%) underwent subsequent stab phlebectomy of persistent symptomatic varicosities. In 101 limbs (65.1%), symptoms resolved and had no further therapy, and 24 limbs had a GSV that was patent for >10 cm on postoperative duplex imaging. Nine limbs had no further therapy (37.5%), eight (33.3%) had subsequent stab phlebectomy, and three had stripping of the GSV and stab phlebectomy. Four limbs had a redo RFA, four limbs had an aborted RFA procedure, and one limb was lost to follow-up. Failure of total GSV occlusion was more often associated with use of a 6F catheter. Complications were generally mild, and there was no postoperative deep vein thrombosis. CONCLUSION: Endovenous ablation of the GSV can be performed safely and effectively as the initial treatment for lower extremity varicose veins. Because most patients show clinical improvement after RFA, an algorithm of reassessment of the limb and branch varicose veins several months post-RFA allows most patients to defer stab phlebectomy.

Adult↗

PubMed1998

Treatment of central retinal vein occlusion by injection of tissue plasminogen activator into a retinal vein.

PURPOSE: To report the injection of tissue plasminogen activator into a retinal vein to treat central retinal vein occlusion. METHODS: An 81-year-old woman with visual loss of the right eye secondary to central retinal vein occlusion developed central retinal vein occlusion and visual loss in her left eye. Treatment of her left eye with topical ocular hypotensive medications, pentoxifylline, and laser chorioretinal anastomosis was without benefit. Thereafter, she underwent vitreoretinal surgery, including tissue plasminogen activator injection into a branch retinal vein of her left eye. RESULTS: The patient reported subjective improvement in the vision of her left eye. Ophthalmoscopic and fluorescein angiographic improvement were also noted. CONCLUSION: The feasibility of cannulating a retinal vein for treatment has been demonstrated.

Aged↗

PubMed1978

Saphenous vein bypass from the aorta to the anterior interventricular vein.

A patient is described who had myocardial revascularization with saphenous vein grafts. One of the grafts was inadvertently anastomosed to the anterior interventricular vein instead of the anterior descending coronary artery. He also underwent saphenous vein bypass to the right coronary artery and resection of a left ventricular aneurysm. The patient remained free of angina up to 3 1/2 years after operation, at which time he was seen with tachyarrhythmia and a continuous murmur. Coronary arteriography revealed patent bypass grafts to both the distal right coronary artery and the anterior interventricular vein. Whether the patient benefited from the graft to the anterior interventricular vein remains indeterminable because of the successful bypass to the right coronary artery and the left ventricular aneurysmectomy. He did experience clinical improvement for 3 1/2 years, and the symptom when he was seen at our institution was tachyarrhythmia, not chest pain. Additionally, his exercise tolerance had improved markedly. We believe the potential advantages of bypass from the aorta to the coronary veins is still unexplored.

Angina Pectoris↗

PubMed1995

Duplex Doppler endosonography in the diagnosis of splenic vein, portal vein, and portosystemic shunt thrombosis.

BACKGROUND/AIMS: Endoscopic ultrasonography is a promising procedure for imaging mesenteric vascular structures. METHODS: Duplex and color Doppler endosonography were used to prospectively evaluate 20 asymptomatic paid volunteers. Subsequently, 11 patients with nondiagnostic transabdominal ultrasound and suspected thrombosis of the splenic and/or portal veins or a portosystemic shunt were evaluated with duplex endosonography. The final diagnosis was based on CT, angiography, and/or surgery or autopsy findings in 9 of 11 patients. RESULTS: In normal volunteers, mesenteric vessel flow velocities and diameters were similar to previously described values. In 10 of the 11 patients with failed transabdominal ultrasound, duplex endosonography was able to provide the correct diagnosis (accuracy of ultrasound 0% versus EUS 91%, p < .001). Mean portal vein diameter was greater in the patient group than in the normal volunteers (18.5 mm versus 10.7 mm, p < .001) and all of the normal volunteers had a portal vein diameter less than 13 mm. No complications were experienced. CONCLUSION: Duplex endosonography allows visualization of the intra-abdominal vasculature and can be considered when transabdominal ultrasound is nondiagnostic in patients with suspected thrombosis of their splenic vein, portal vein, or portosystemic shunt. EUS is able to identify indirect findings of portal hypertension including portal vein enlargement and venous collaterals.

Adult↗

PubMed2003

Subfascial endoscopic perforating vein surgery as treatment for lateral perforating vein incompetence and venous ulceration.

INTRODUCTION: Endoscopic ligation of perforating veins (subfascial endoscopic perforating vein surgery [SEPS]) is valuable in treatment of venous ulcer on the medial aspect of the lower leg. Venous ulcerations on the lateral aspect of the lower leg are less common, but are of equal clinical importance. MATERIAL AND METHODS: Over 4 years we performed SEPS on the lateral aspect of the lower leg in 13 patients. Preoperative and postoperative duplex scanning of the perforating veins was performed in all patients. RESULTS: Mean follow-up was 53 months (range, 33-81 months). Complete healing of venous ulcer was achieved in six patients within 6 months. Ulceration persisted in six patients, and ulcer recurred in three patients after 17, 29, and 60 months, respectively. Postoperative duplex scans showed persistent insufficient perforating veins in about 25% of patients. CONCLUSION: There is a considerable difference between the results of SEPS on the medial side of the lower leg and the same procedure on the lateral side. SEPS on the lateral side of the lower leg, as performed in this small series, does not contribute to ulcer healing or recurrence. A considerable number of perforating veins are missed at surgery, resulting in persistent insufficient perforating veins postoperatively. The poor results of this study emphasize the need for adequate anatomic information to improve the surgical outcome.

Adult↗

PubMed2002

Hepatic vein-to-azygos vein connection in a patient with interrupted inferior vena cava.

Massive systemic-to-hepatic venous collaterals developed in a 8-year-old boy with left isomerism and azygos connection of the inferior vena cava who had undergone total cavopulmonary shunt leaving the hepatic vein connected to the common atrium 5 years previously. A hepatic vein-to-azygos vein connection via an autologous pericardial roll successfully ameliorated cyanosis and physical activity. Hepatic vein-to-azygos vein connection is technically easy and is favorable in providing balanced distribution of hepatic venous blood to both lungs. We recommend this technique as an effective alternative to hepatic vein-to-pulmonary artery connection in patients developing collateral vessels after total cavopulmonary shunt.

Azygos Vein↗

PubMed2002

Incidence and pattern of long saphenous vein duplication and its possible implications for recurrence after varicose vein surgery.

BACKGROUND: The incidence of long saphenous vein (LSV) duplication has not been clearly established. This anomaly could have implications for recurrence after varicose vein surgery. METHODS: Some 103 saphenograms obtained in 85 patients being considered for peripheral arterial bypass surgery were reviewed. Non-ionic contrast medium was injected directly into the vein or its tributaries at the ankle. Duplications of the LSV and their relation to thigh and calf perforator veins were assessed and recorded by two independent observers. RESULTS: There was evidence of duplication of the LSV in 50 (49 per cent) of the 103 saphenograms. Most duplications were present in the thigh (88 per cent) and the most common pattern was a closed loop (54 per cent). Perforator veins were connected to one branch of the duplication in 42 per cent of the legs (20 per cent of all 103 legs); in half the perforator vein was connected to the non-dominant branch of the duplication. Only ten of the 18 patients who had bilateral saphenograms had duplications in both legs, and only one patient had the same pattern of duplication on both sides. CONCLUSION: The incidence of LSV duplications is higher than previously reported.

Adult↗

PubMed2001

Extensive mesenteric vein and portal vein thrombosis successfully treated by thrombolysis and anticoagulation.

Mesenteric vein thrombosis is generally difficult to diagnose and can be fatal. A case of extensive thrombosis of the mesenteric and portal veins was diagnosed early and successfully treated in a 26-year-old man with Down syndrome who was admitted to hospital because of abdominal pain, severe nausea and high fever. Ultrasonography revealed moderate ascites, and there was minimal flow in the portal vein (PV) on the Doppler examination. Computed tomography (CT) showed remarkable thickening of the walls of the small intestine and extensive thrombosis of the mesenteric, portal and splenic veins. Because neither intestinal infarction nor peritonitis was seen, combined thrombolysis and anticoagulation therapy without surgical treatment was chosen. Urokinase was administered intravenously and later through a catheter in the superior mesenteric artery. Heparin and antibiotics were given concomitantly. The patient's symptoms and clinical data improved gradually. After 10 days, CT revealed that collateral veins had developed and the thrombi in the distal portions of the mesenteric veins had dissolved, although the main trunk of the PV had not recanalized. The only risk factor of thrombosis that was detected was decreased protein S activity.

Adult↗

PubMed1986

Influence of the profunda femoris vein on venous hemodynamics of the limb. Experience from thirty-one deep vein valve reconstructions.

Venous valve reconstruction in 31 limbs (28 patients) with chronic deep venous insufficiency is analyzed. The indications for operation were primary or secondary deep valvular incompetence with severe reflux and venous hypertension. Valvuloplasty was performed on a proximal valve of the superficial femoral vein (SFV) in 17 limbs and on a common femoral vein valve in two limbs; transplantation of a valve-bearing segment of the axillary vein was made to the common femoral vein in two limbs, to the SFV in seven limbs, and to the popliteal vein in three limbs. The results of valvuloplasty were satisfactory, with six failures observed during a follow-up period extending to 84 months (mean, 44 months). Eight of 12 valve transplant reconstructions failed within 2 years. Patency and competence of the reconstruction were obtained in 27 limbs at the 6-month postoperative control period. The effects on venous pressure were analyzed regarding the presence or absence of reflux into the profunda femoral vein (PFV) with preoperative retrograde phlebography. The results showed significant reduction of the ambulatory venous pressure (p less than 0.05) and increase in venous recovery time (p less than 0.01) in limbs with PFV competence. In limbs in which the PFV was incompetent the pressure values remained unchanged. These findings suggest that the functional state of the PFV is of great importance to the venous hemodynamics of the limb. This study also indicates that the principle of one-level repair in the SFV seems appropriate in limbs with a competent PFV.

Adult↗

PubMed2006

Correction of extrahepatic portal vein thrombosis by the mesenteric to left portal vein bypass.

OBJECTIVE: The goal of this study was to determine the effectiveness of mesenteric vein to left portal vein bypass operation (MLPVB) in correcting extrahepatic portal vein thrombosis (EHPVT) in children. The treatment of idiopathic EHPVT has been primarily palliative, whereas MLPVB restores hepatic portal flow in patients with EHPVT. METHODS: Thirty-four children with symptomatic EHPVT underwent surgery with intent to perform MLPVB and were followed for up to 7 years. MLPVB was successful in 31 patients (91%), all of whom maintain patent vein grafts and have symptomatic relief of EHPVT in follow-up. All patients had complete relief from gastrointestinal bleeding. Patients with hypersplenism had significant increases in platelet and leukocyte counts and reduction in spleen size. Superior mesenteric vein flow increased from 119 +/- 66 mL/min before bypass to 447 +/- 225 mL/min (P < 0.0001) after surgery. Postoperative blood flow in the bypass graft expressed as a fraction of calculated ideal portal flow for size correlated inversely with age (P < 0.001). Left-portal vein diameter increased from 2.6 +/- 1.6 mm to 7.3 +/- 2.4 mm 2 years after surgery (P < 0.002). Liver volume increased from 703 +/- 349 cm3 to 799 +/- 351 cm3 1 week after surgery (P < 0.001). Prothrombin time improved to normal in all patients 1 year after surgery. CONCLUSIONS: MLPVB provides excellent relief of symptoms in children with idiopathic EHPVT and results in liver growth and normalization of coagulation parameters. This surgery is corrective and should be done at as early an age as possible.

Blood Pressure↗

PubMed1998

Duplicated superficial femoral veins: a source of error in the sonographic investigation of deep vein thrombosis.

PURPOSE: To determine whether the number of false-negative ultrasound (US) findings of thrombosis is larger when a duplicated femoropopliteal venous system is present. MATERIALS AND METHODS: A retrospective review was performed of 381 venograms obtained after initial US findings were considered negative for thigh or popliteal thrombosis in patients in whom deep vein thrombosis was suspected Venograms were evaluated for the presence of thrombosis and the presence and configuration of duplicated superficial femoral veins. RESULTS: Multiple superficial femoral veins were present on 177 (46%) of the 381 venograms; 149 (84%) were duplex systems. False-negative US findings occurred in four (2%) of 204 patients with single femoral veins and in 10 (6%) of 177 patients with duplicated femoral veins (P = .056, not statistically significant). CONCLUSION: The frequency of missed proximal thrombosis at sonography appears to be increased when duplicated superficial femoral veins are present. Data from clinical and imaging studies are insufficient to support the adoption of a totally noninvasive imaging strategy.

Congenital Abnormalities↗

PubMed1985

Spiral saphenous vein graft for replacement of internal jugular vein: a series of case reports.

Bilateral radical neck dissection with internal jugular vein extirpation, be it simultaneous or staged, results in severe cephalic venous hypertension. Symptoms remit with time, however, acutely contribute to the morbidity of the procedure. Internal jugular vein replacement using autogenous saphenous vein that is fashioned into a spiral conduit has been used in three patients undergoing bilateral or second side radical neck dissection. The technique entails construction of a large vein conduit by wrapping saphenous vein around a chest tube in a spiral fashion. Patients treated had objective relief of the acute venous hypertension based on cephalic venous pressure measurements. The three patients undergoing the spiral vein grafting were notable for the lack of any expected symptoms derived from venous hypertension, and postoperative venograms demonstrate graft patency at one to two weeks.

Adult↗

PubMed1998

[Catheterization of the subclavian vein through the cannulation of the external jugular vein. Our experience].

UNLABELLED: The cannulation technique of the subclavian vein by the external jugular vein is described. OBJECTIVE: To point out this simple and safe method without complications deriving from the direct needle-prick of the subclavian vein. METHODS: Experimental plan. The comparative study includes 30 patients in the resuscitation department during the second half-year in 1996. Place. Resuscitation Department of the University Polyclinic in Palermo. Patients. 30% of these patients were male and 70% were female; coagulative serious disorders were present in some patients, in others the coagulative picture was unknown. Interventions and observations. The modified Seldinger technique has ben used, introducing a J wire through the needle cannula put in the external jugular vein, taking care not to exceed the length of the latter with the J wire. Less rigid and small catheters have been used which can fluctuate in the running blood and be carried in the superior vein cava. Once the subclavian vein has been cannulated, a Rx graph control of the thorax was made, showing the excellent position of the catheter. RESULTS: Only one failure, but this technique has not showed complications. CONCLUSIONS: This technique finds applications in all situations of extreme emergency, in which on the one hand it needs a central blood vessel, on the other there are hemorrhagic problems or there isn't any possibility to do a coagulative screening in short time.

Aged↗

PubMedDate not supplied

Anomaly of the portal vein with an anomalous hepatic vein--the first case report.

An anomaly of the portal vein associated with an anomalous hepatic vein is described as the first reported case. A 44-year-old woman was incidentally found to have a huge hemangioma by ultrasonography. Computed tomography revealed an anomalous portal system with a normally located gallbladder and round ligament. Arterial portography revealed anomalous branching of the portal vein, with absence of the left umbilical portion, the curved right portal branch mimicked the right-sided umbilical portion. Hepatic venography demonstrated patent umbilical veins communicating with the left hepatic vein. Intraoperatively the hepatic vein branch was found on the surface of the right hepatic lobe and the common bile duct was dorsal to the hepatic artery. A limited excision of the involved liver was performed safely with the help of the preoperative definition of the abnormal liver anatomy.

Adult↗

PubMed1976

Hormonal studies in pregnancy. I. Total unconjugated estrogens in maternal peripheral vein, cord vein, and cord artery serum at delivery.

The concentration of unconjugated total estrogens (primarily estrone, estradiol-17beta, and estriol) were measured by rapid radioimmunoassay method in serum samples from maternal peripheral vein, cord vein, and cord artery in normal pregnancies at delivery. The serum concentration of total free estrogens found in cord vein was four to five times higher than in maternal peripheral vein and cord artery. Levels obtained in maternal peripheral vein, cord vein, and cord artery were 47.8+/-1.8, 140.1+/-8.57, 31.8+/-2.15 ng. per millilitre (+/-standard error of the mean), respectively. These values are compared with those reported by others.

Collateral Circulation↗

PubMed2002

[Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency].

OBJECTIVE: To screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency. METHODS: Using mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins. RESULTS: Altogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene). CONCLUSION: C(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.

Base Sequence↗

PubMed2003

[Short saphenous vein incompetence as a cause of recurrent varicose veins].

UNLABELLED: The aim of the study was the retrospective ultrasound Doppler evaluation the patients with recurrent varicose veins after surgery of the short saphenous vein incompetence. This study was performed in 35 patients (42 limbs). Mean interval between the time of operation and ultrasound Doppler evaluation was 4.9 years. The causes of the recurrence were divided due to F. Vin and F. Chleir classification. Recurrences were classified in five categories. The main causes of recurrence were: the remains of the short saphenous vein in primary operation (52.3%) and junctional stump with incontinent collaterals (26.1%). CONCLUSIONS: The recurrence of varicose veins is mostly associated with incompetence of short saphenous vein. The colour-coded duplex sonography is a modern tool in preoperative diagnostics of anatomical variety of short saphenous vein and in establishing the cause of the recurrence. USG evaluation could make precise operation easier and in a case of recurrence helps to eliminate the origin of reflux.

Adult↗

PubMed1995

Renal-portal vein shunt for renal failure after left renal vein ligation in children: a review.

PURPOSE: Interruption of the inferior vena cava and left renal vein in the patient with a solitary left kidney without permanent renal damage has been reported in the past. We assess the risks of similar venous interruption in children and establish guidelines for the management of those cases when collateral drainage of the kidney is uncertain. MATERIALS AND METHODS: We compared our case with a review of all previous reports in the literature concerning ligation of the vena cava and left renal vein in patients with a solitary left kidney. RESULTS: Ligation of the left renal vein in an isolated left kidney in children has been shown to carry the risk of significant renal damage. Renal-portal vein shunt provided adequate drainage of the left kidney after inferior vena caval ligation in our case. CONCLUSIONS: While there have been reported cases of successful inferior vena cava or left renal vein ligation in the isolated left kidney with good renal function, adequate renal drainage should be established in cases where collateral drainage is uncertain, especially in children. Renal-portal vein shunt is a viable therapeutic option to establish left renal drainage in select circumstances.

Anastomosis, Surgical↗