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At least 289 records · Page 16Linked to original sources
PubMed1993

[Autologous vein vs. human umbilical vein for femoropopliteal bypass].

Below knee femoropopliteal bypass was performed with reversed saphenous vein in 81 cases and with modified human umbilical vein in 74. The two groups were comparable as regards indications, coexisting disease and distal run-off. The cumulated patency rates were almost identical in the two groups, but early mortality and wound complications were higher in the saphenous vein group. Aneurysm formation in the umbilical veins was not a problem in this series. It is concluded that human umbilical vein is a very satisfactory bypass alternative when the saphenous vein is not available. In selected cases it may also be justifiable to use it in order to keep operation time and trauma at a minimum.

Adult↗
PubMed1977

Direct transhepatic measurement of portal vein pressure using a thin needle. Comparison with wedged hepatic vein pressure.

A technique for the direct measurement of portal vein pressure in fully conscious patients is described. This uses a percutaneous transhepatic approach with a thin Chiba needle and is shown to be simple and safe. The technique has been applied to 123 patients with a variety of liver disorders and the pressure measurements have been compared with those obtained by the indirect technique of wedge hepatic vein catheterization. Close agreement was found between portal vein pressure and wedged hepatic vein pressure in quiescent alcoholic liver disease and alcoholic hepatitis. In chronic active hepatitis, portal vein pressure tended to be higher than wedged hepatic vein pressure, indicating a presinusoidal component to the portal hypertension. This technique is shown to be useful in assessing idiopathic protal hypertension and in demonstrating hepatofugal flow.

Alcoholism↗
PubMed1997

Perfused human saphenous veins for the study of the origin of varicose veins: role of the endothelium and of hypoxia.

If venous stasis due to blood stagnation has been recognized to be involved in the development of varicose veins, the mechanism linking this situation to the modifications of the venous wall observed in varicoses is still unclear. In order to study this mechanism, human saphenous veins were incubated in normoxic or hypoxic conditions and the interactions between the endothelium and neutrophils were investigated. We observed that many neutrophils adhered to the endothelium of veins incubated in hypoxic conditions rather than in normoxia and that these adherent neutrophils were activated: they released high amounts of superoxide anion and of leukotriene B4. Studies in scanning electron microscopy confirmed the increased neutrophil adherence to the endothelium as well as their activation. These results were then related to the histological observation of varicose veins. These veins show a thickening of the media with extracellular matrix deposit as well as an alteration of the elastic lamina with the presence of smooth muscle cells in the intima. These results are in agreement with in vitro studies on isolated endothelial cells. They all show that hypoxia is able to activate endothelial cells: they release inflammatory mediators and become adhesive for neutrophils which are then activated. These activated leukocytes release free radicals and proteases which are able to degrade the extracellular matrix. In addition, hypoxia-activated endothelial cells secrete growth factors which will trigger smooth muscle cell proliferation and the synthesis of extracellular matrix components. Altogether and because they are frequently repeated, these processes could eventually lead to alterations of the venous wall similar to those observed in varicose veins.

Cell Adhesion↗
PubMed1998

[Echo Doppler classification of postoperative recurrence of varicose veins in the region of the internal saphenous vein].

OBJECTIVES: Surgical treatment of varicose veins of the lower limbs is frequently complicated by recurrence. Although recurrence was long thought to result from technical errors, certain patients have progressive disease. METHODS: We used duplex-Doppler to assess 102 patients (160 limbs) with recurrence after resection of the saphene-femoral junction with stripping of the internal saphenous vein and the varicose network on the medial aspect of the leg. A vein map was established to classify recurrences. RESULTS: Type I, junctional stump with incontinent collateral, was observed in 22.5% of the cases. Type II, sapheno-femoral junction in an anatomic position, was found in 18.1%. Type III, backward flow from a perforating vein or a collateral of the common femoral was found in 13.1% and type IV, cavemomous aspect, in 7.5%. In 45% of the cases, the patient had a progressive condition with backward flow from collateral branches in the perineal or inguinal area unconnected to the common femoral. DISCUSSION: The cause of recurrent varicose veins is a question of debate: inadequate or incomplete treatment versus disease progression. Due to the chronic and evolutive nature of varicose veins, duplex Doppler exploration is essential for the preoperative work-up. Follow-up examinations should also be performed every year when the clinical examination suggests recurrence.

Adult↗
PubMedDate not supplied

Brachial artery to brachial vein preserved vein allograft fistulas for hemodialysis.

Vein allografts were obtained from varicose vein patients in whom stripping and ligation was indicated. Proximal 30 cms of the long saphenous vein was removed and stored at -30 degrees C. A-V fistulas were constructed in the upper arm between brachial artery and the brachial or cephalic vein in dialysis patients. All these allograft vein recipients had major blood groups identical to the donors. Clinical experience over a two year period revealed a 100% long term patency. Complications including early graft thrombosis, superficial wound infection, hematoma formation and local edema were few and easily managed. Allograft rejection was not a problem in this series of patients. The large diameter grafts in upper arm position function well. They are convenient for the patient and preferred by dialysis personnel as a direct site for venepuncture. An initial experience suggests that preserved vein allografts may become the preferred material for arteriovenous fistulas.

Arteriovenous Shunt, Surgical↗
PubMed2000

Lengthening the greater saphenous vein with the use of the lateral femoral cutaneous vein.

Besides quality, the length of the greater saphenous vein dictates the feasibility of vein bypass grafts in femorodistal popliteal or tibial revascularization. A simple and effective technique of lengthening the greater saphenous vein is described that allows the use of the laterofemoral cutaneous vein in continuity. This technique can be applied when the distal segment of the greater saphenous vein is inadequate or unavailable.

Aged↗
PubMed2006

Subclavian vein obstruction with collateral flow through the umbilical and hepatic veins.

Upper venous return to the heart can be obstructed by any number of pathologies and often leads to formation of collateral pathways around the obstruction. This case report describes a thrombotic obstruction of the left subclavian and brachiocephalic veins and a collateral pathway involving recanalization of the umbilical vein. Even more rare and unique is the anastomosis of the recanalized umbilical vein to the middle and left hepatic vein rather than the portal vein. The anatomy of the expected collateral pathways and the anastomotic vascular anomaly is described in detail, including a discussion of the embryological development of the system.

Brachiocephalic Veins↗
PubMed1980

Below-knee bypass for limb salvage. Comparison of autogenous saphenous vein, polytetrafluoroethylene, and composite dacron-autogenous vein grafts.

Autogenous saphenous vein was used preferentially for 92 below-knee bypass procedures (44 femoral-distal popliteal and 48 femoral-distal tibial or peroneal) performed for limb salvage in 87 adult male patients during a 30-month period of study. When a saphenous vein was unavailable or of unsuitable length or diameter, we randomly used expanded polytetrafluoroethylene (PTFE) and composite Dacron-autogenous vein (DV) grafts. With good run-off, all grafts have remained patent. However, with poor run-off, cumulative patency by the life table method decreased to 54% for autogenous saphenous vein and 45% for PTFE, which was not significantly different. All composite DV grafts used with poor run-off became occluded within the first ten months of the study. We continue to recommend use of autogenous saphenous vein for revascularization of the ischemic lower extremity. When a suitable saphenous vein is unavailable, PTFE is a satisfactory alternative graft that is superior to composite DV grafts.

Aged↗
PubMed1991

Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf.

The mechanisms by which graduated compression stockings prevent deep vein thrombosis are not completely understood. Recent work has suggested that venous distension plays a role in initiating the process. Our previous work has shown that the deep veins of the lower limb distend in patients undergoing surgical procedures. We have investigated 40 patients receiving surgical treatment on the abdomen or neck. A medial gastrocnemius vein was studied using ultrasound imaging during the operations. In half the patients a graduated compression anti-embolism stocking was applied to the limb under study at the start of the operation, immediately after initial measurements of vein diameter. The median vein diameter in both groups was the same at the start of the operative procedures (control, 2.6 mm, interquartile range 2.1-3.3 mm; stocking, 2.6 mm, interquartile range 2.1-3.7 mm). After application of a stocking the median diameter in this group fell to 1.6 mm (interquartile range 1.3-2.8 mm) and then decreased slightly at the end of the operation. In the control group the vein diameter increased to 2.9 mm (interquartile range 2.3-4.0 mm) during the operative procedure.

Abdomen↗
PubMed2004

Incidence of deep vein thrombosis after varicose vein surgery.

BACKGROUND: Varicose vein surgery is generally considered to have little risk of postoperative deep vein thrombosis (DVT). This prospective study examined the incidence of DVT in patients undergoing varicose vein surgery. METHODS: Lower leg veins were assessed before operation by duplex ultrasonography in 377 patients, and reassessed 2-4 weeks after surgery, and again at 6 and 12 months. Patients were instructed to contact a physician if symptoms consistent with DVT occurred before the scheduled follow-up appointment. Preoperative prophylaxis (a single dose of subcutaneous heparin) was left to the discretion of the vascular surgeon. RESULTS: DVT was detected in 20 (5.3 per cent) of the 377 patients. Of these, only eight were symptomatic and no patient developed symptoms consistent with pulmonary embolus. Eighteen of the 20 DVTs were confined to the calf veins. Subcutaneous heparin did not alter the outcome. No propagation of thrombus was observed and half of the DVTs had resolved without deep venous reflux at 1 year. CONCLUSION: The incidence of DVT following varicose vein surgery was higher than previously thought, but these DVTs had minimal short- or long-term clinical significance.

Adolescent↗
PubMed2003

Comparison of functional results of nerve graft, vein graft, and vein filled with muscle graft in end-to-side neurorrhaphy.

End-to-side neurorrhaphy is an alternative method in the situation where the proximal part of the nerve cannot be found. When the intact nerve is not close enough to perform end-to-side neurorrhaphy, it will be necessary to use a graft for transporting the regenerating axons. In this study, we tried to find out whether it is possible to use a graft in an end-to-side neurorrhaphy, and compared the nerve graft with possible alternative grafts, i.e., vein and muscle-filled vein grafts. Thirty male Sprague Dawley rats were used, with an average weight of 293 g (range, 250-350 g). All experiments were done on the right side. A 2-cm nerve graft, beginning 1 cm distal to the branching level, was sectioned from the peroneal nerve. A 1-mm epineural window was opened in the tibial nerve. In the first group, the proximal side of this graft was sutured to the tibial nerve side in an end-to-side fashion, and the distal side was sutured to the distal peroneal nerve stump in an end-to-end fashion. In the second group, the right 2-cm jugular vein was harvested, and was used to bridge the defect instead of the nerve graft used in the first group. In the third group, a 2-cm jugular vein filled with fresh skeletal muscle was used to bridge the defect. At 2, 4, 8, 12, 20, and 28 weeks, functional assessment of nerve regeneration was performed, using walking-track analysis. The numbers of myelinated fibers and fiber diameters were measured, and an electron microscopic evaluation was carried out. Based on walking-track analysis and fiber diameters, the differences of all three groups were statistically significant (P < 0.05). While the differences of myelinated fibers between the first and second groups were not significant, the differences between the rest (group 1-group 3 and group 2-group 3) were significant (P < 0.05). Our study showed that, in end-to-side neurorrhaphy, the use of a nerve graft is possible, and a vein graft is also a good alternative, but a muscle-filled vein graft is not.

Anastomosis, Surgical↗
PubMed1988

Umbilical vein variations: review of the literature and a case report of a persistent right umbilical vein.

A case of a ligamentum teres formed from an obliterated right umbilical vein is described. It passed to the right branch of the portal vein. The quadrate and left lobes of the liver were not separated by the usual fissure. Very few cases of anomalous umbilical veins or persistent right umbilical veins have been recorded. Of these, several have been recorded only in the umbilical cord, while in others the persistent right umbilical vein has been found intra-abdominally, in an extrahepatic position, and passing directly to the right atrium or to the inferior vena cava. Its presence is generally associated with severe congenital abnormalities, in contrast with the present case. In view of the high incidence of congenital defects associated with aberrant or accessory umbilical veins, when these are detected either in the umbilical cord or in the abdomen by umbilical phlebography, it is suggested that the patient should be carefully investigated for other congenital abnormalities.

Adolescent↗
PubMed2002

Long-term results of vein sparing varicose vein surgery.

The aim of this study was to assess the long-term functional outcome of vein sparing varicose vein surgery using handheld Doppler ultrasound (HHD). The series consisted of 171 consecutive day-case surgery patients operated on for uncomplicated lower limb varicose veins. Venous segments considered competent were spared based on clinical examination and HHD, which was performed preoperatively only when deemed necessary by the surgeon. After a mean follow-up of 8 years all patients were examined, a systematic HHD evaluation was performed, and the findings were classified according to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification, and disability scoring was performed. During the follow-up period 17% of the legs were reoperated or scheduled for reoperation. At follow-up 79% of all patients were asymptomatic without reoperation. In 24%, recurrent varicosities were present and venous reflux was demonstrated by HHD. Recurrence was two times more common when the saphenofemoral junction had originally been left intact. Of all recurrent cases, reflux was demonstrated in the long saphenous vein (LSV) above the knee in 62%, in the LSV below the knee in 7%, in the short saphenous vein (SSV) in 16%, in the posterior arch vein in 38%, and in a thigh perforator in 8%. Of the legs reoperated during the follow-up period 41% presented with venous reflux at the follow-up visit. We conclude that HHD efficiently reveals sites of reflux that have been missed during previous surgery and that a thorough preoperative HHD examination and marking of reflux routes is required.

Adult↗
PubMed1998

Should vein be saved for future operations? A 15-year review of infrainguinal bypasses and the subsequent need for autogenous vein.

The decision to use prosthetic or autogenous vein as the initial conduit for first-time vascular bypass of the lower extremity depends in part on the likelihood of subsequent need for autogenous conduit for another leg or heart bypass. The true frequency of these later events is not known. To answer this question, we analyzed a database of infrainguinal and coronary artery bypasses (CABG) performed at one institution between January 1980 and July 1995, to determine how many patients required subsequent infrainguinal bypass or CABG after their initial leg bypass. Five hundred and seventy-two infrainguinal bypasses were performed on 440 patients (mean age 63.9); average follow-up was 5.6 years. The clinical philosophy favored autogenous vein for first bypass, which was used in 84% of first operations performed during the study period while prosthetic material was used in 16%. For patients in which vein was used for the first operation, and who went on to have a second operation, the use of prosthetic conduit rose from 16% of operations to 27% (p < 0.05). The rate of subsequent CABG after leg bypass was very low, 2% at 5 years, 3% at 10 years. The cumulative probability of requiring a subsequent infrainguinal bypass was 27% at 5 years, 32% at 10 years. Of these, 46% were ipsilateral and 54% were contralateral. Considering only subsequent tibial bypasses (where vein might be considered obligatory), the cumulative 5-year rate of subsequent leg bypass was only 13%. Another bypass was most likely to occur within the first 3 years, rarely thereafter. In summary, after primary infrainguinal bypass, additional procedures using vein may arise in 1/4 to 1/3 of patients, mostly in the first 3 years. However, only 13% will definitely need vein for tibial bypass in 5 years, and subsequent CABG is uncommon.

Aged↗
PubMed1999

Early morphology of accelerated vein graft atheroma in experimental vein grafts.

Vein grafts fail because of the development of intimal hyperplasia and atheroma. Recent experimental evidence suggests that the presence of hypercholesterolemia induces a three-fold increase in intimal hyperplasia with early atheroma development within 4 weeks of implantation. We have previously demonstrated endothelial cell preservation and a short-lived (3-day) polymorphonuclear leukocyte infiltrate in vein grafts. The aim of this study is to define the early morphology and ultrastructure of vein grafts implanted into a hyperlipidemic environment to provide a pathological foundation on which to examine the cellular and molecular events that determine this accelerated response. Twenty-one male New Zealand White rabbits underwent a right carotid interposition bypass graft using the ipsilateral external jugular vein; all animals received a 1% cholesterol diet for 4 weeks prior to surgery and continuing postoperatively until harvest. Animals (n = 3 per time point) were sacrificed at 60 min, 1 day, 3 days, 5 days, 7 days, 14 days, and 28 days postoperatively for scanning and transmission electron microscopy of the vein grafts. No concurrent controls were employed. The results of this study suggest that in the presence of hypercholesterolemia, the pathophysiological processes involved in the vein graft are similar to those reported for noncholesterol-fed animals. There is a sustained subendothelial response with the prolonged presence of macrophages and cellular debris and the accumulation of foam cells.

Animals↗
PubMed1990

Indirect carotid-cavernous sinus fistula: transvenous embolization from the external jugular vein using a superior ophthalmic vein approach. A case report.

A case of indirect carotid-cavernous sinus fistula treated by combined transarterial and transvenous embolization is described. A 49-year-old woman with a right indirect carotid-cavernous sinus fistula draining solely to the right superior ophthalmic vein was treated first by transarterial embolization with polyvinyl alcohol particles. Then, by approaching through the superior ophthalmic vein from the right external jugular vein, the cavernous sinus was embolized with platinum wire using a tracker microcatheter, which resulted in marked clinical improvement. Transvenous embolization by approaching from the external jugular vein through the superior ophthalmic vein represents a promising alternative when shunted blood drains anteriorly to the superior ophthalmic vein.

Arteriovenous Fistula↗
PubMed1995

Surgical management of subclavian vein obstruction, including six cases of subclavian vein bypass.

BACKGROUND: The indications are still being developed for the various procedures available to treat thrombotic and nonthrombotic subclavian vein obstruction. This article explores our experience with the surgical options, primarily with chronic venous occlusion, but also with acute thrombosis. METHODS: Twelve patients presented with acute or chronic venous thrombosis or nonthrombotic venous obstruction. Treatment included thrombolysis, vein patch angioplasty, thrombectomy, first rib resection, venolysis, and/or subclavian vein bypass by either jugular vein transposition or prosthetic axillojugular bypass. RESULTS: Six patients experienced relief of all symptoms; the other six have had relief from pain but continue to have occasional swelling. CONCLUSIONS: On the basis of our anecdotal experiences and those of others, the following protocol has been developed. After acute thrombosis, lytic therapy is recommended. If successful, first rib resection and venolysis should be considered; if unsuccessful and the patient has significant symptoms, immediate thrombectomy is indicated. If patency is established, rib resection and venolysis should follow. Persistent stenosis is treated by angioplasty, either with a vein patch or percutaneously. Complete occlusion is managed by jugular vein transposition or axillojugular bypass. Temporary arteriovenous fistulas accompany all open venous repairs.

Adolescent↗
PubMed2003

Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study.

The objective of this study was to determine the inter-relationships between a range of lifestyle factors and risk of varicose veins to identify which factors may be implicated in the etiology. An age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 years was selected from 12 general practices throughout Edinburgh. A detailed self-administered questionnaire was completed, and a comprehensive physical examination determined the presence and severity of varicose veins. The slightly higher age-adjusted prevalence of varicose veins in men than in women (39.7% versus 32.2%) was not explained by adjustment for an extensive range of lifestyle risk factors (male odds ratio [OR] 2.11, 95% confidence interval [CI] 1.51-2.96). In both sexes, increasing height showed a significant relationship with varicose veins (male OR 1.50, 95% CI 1.18-1.93 and female OR 1.26, 95% CI 1.01-1.58). Among women, body mass index was associated with an increased risk of varicose veins (OR 1.26, 95% CI 1.02-1.54). The current study casts doubt as to whether varicose veins occur predominantly in women. In addition, no consistent relationship with any lifestyle factor was shown. Self-reported evidence suggested a familial susceptibility, thereby warranting future genetic studies.

Adolescent↗