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A subcutaneous vein remover has been developed to facilitate harvesting of the greater saphenous vein. The technique described is applicable only to the segment of saphenous vein above the knee. This technique was used in 19 selected patients without complication; however, intraoperative and postoperative precautions are necessary to prevent bleeding and injury to the vein.
This study was undertaken in order to clarify the influence of acute portal vein occlusion (PVO) and the following restoration of portal vein flow (R-PVF) in adult mongrel dogs. Acute abnormality was observed on systemic circulation and oxygen metabolism quickly after PVO, causing the shock to dogs. The hypovolemia causing by splanchnic sequestration was the leading cause at the early stage. As the occlusion time was extended, the cardiac function was lowered and the oxygen metabolism was destroyed. Using Anthron bypass catheter between portal and femoral veins during the PVO, the intestinal blood congestion was prevented and the influence on the oxygen metabolism was slight. After R-PVF, the cardiac functional deterioration and deficient compensation of oxygen metabolism were observed, which were more worsened as the occlusion time was longer. The simultaneous occlusion of the portal vein and superior mesenteric artery failed to improve the deterioration of systemic circulation and oxygen metabolism. No improvement of prognosis of dogs was found either. On the contrary, the systemic circulation was improved through the administration of dobutamine during PVO and after R-PVF, the improvement of systemic circulation and oxygen metabolism was also improved and the prognosis of dogs was improved.
In 227 patients 252 extremities were operated on with femoropopliteal bypass using the in situ vein technique. The valves were extirpated through incisions in the vein. At discharge 14 grafts were thrombosed, mainly because of inadequate size of the vein graft. Ten years after surgery more than 50% of the patients had died, and only 25% of the implanted grafts were patent. The dominating cause of death was coronary infarction. Thirty one limbs were amputated. At the end of follow-up 51 grafts were patent 10 to 17 years after surgery, mean 10.84 ears. With regard to mortality and long term patency the most important factors were: Preoperative history of myocardial disease, smoking, size of the vein graft and peripheral "run-off".
The effect of lumbar epidural analgesia and of general anaesthesia on the peroperative velocity of flow in the femoral vein was measured with Doppler ultrasound technique in 38 patients undergoing retropubic prostatectomy. The patients were randomly allocated to the epidural or the general procedure. The 125I-fibrinogen test was used to detect deep vein thrombosis (DVT). Epidural analgesia was associated with a significant (ca. 120%) increase in the femoral venous flow velocity. The peak flow showed a moderate (47%) increase, whereas the minimum flow was greatly increased (188%). The increase was significant already 2 min after induction of the analgesia and the rate continued to rise for about 11 min. General anaesthesia significantly reduced the flow velocity in the femoral vein. Immediately after induction of the anaesthesia the velocity approached zero, but gradually rose, and after about 8 min was stabilized at level 40% below the preoperative velocity. The peak flow velocity in all patients of this group fell by 24 to 40%. Only 2 of 17 patients with epidural analgesia, but 11 of 21 with general anaesthesia had postoperative DVT. In the 11 patients with DVT the mean minimum velocity of flow was decreased (by 85%), but in the 10 without DVT it was increased (by 175%). The difference was not statistically significant. Increased velocity of flow in the femoral vein, especially of minimum flow, seems to counteract development of DVT.
Portal veins can be recognized in SEM by the presence of an accompanying element such as the bile ductule. Endothelial cells within these vessels possess small marginal microvilli. Portal veins show few sinusoidal inlets (direct connections to sinusoids) and no attached "wandering" cells. Sinusoids in periportal areas are narrower and more tortuous than the wider and straighter central ones. Periportal endothelial fenestrae have a larger diameter (111 nm) than central ones (105 nm), but their number per square micron, and therefore the porosity (% open area), is higher in centrolobular sinusoids (7.94 vs 5.96%). Central veins have smoother endothelial cells and show numerous sinusoidal outlets (direct sinusoidal connections). Cells are seen attached to the wall and are probably migrating out of the liver. In the orifices of some sinusoidal outlets, traversing bars can be observed, which obstruct the flow of blood from the sinusoids into the central vein. From our observations and measurements the following conclusions can be drawn: a. In the narrower periportal sinusoids, moving blood cells will be forced against the wall, causing a massage of the space of Disse. This will influence the exchange of fluids and particles through the endothelial fenestrae, and it will cause stirring of the fluid in the space of Disse. b. Centrolobular sinusoids have a larger perimeter and an endothelial lining with a higher degree of porosity. These structural factors will favour transport and uptake processes in the centrolobular parenchyma. c. Sinusoidal blood flow might be expected to be slower in central areas, since the number of sinusoids appear to equal that of the portal region, but their lumen is wider.
It has been shown that dual trunk central retinal vein (CRV) occurs in 20.3 per cent of a normal population. Confirmatory evidence has been produced by the results of anatomical, histological and micro-dissection studies. Occlusion of the single trunk of such a vein in its retrolaminar, or intraneural part, would result in a venous occlusion affecting one-half of the retina similar to that of branch retinal vein occlusion (BRVO). Yet this should be regarded as a variation of CRVO. Visual prognosis seems to be better in hemi-central retinal venous occlusion than in total CRVO. The site of development of collateral gives a clue to the site of the occlusion. Therefore, it is suggested that hemi-CRVO is a distinct entity and should not be confused with so-called hemi-spherical vein occlusion which is a variation of BRVO.
OBJECTIVE: To evaluate the changes in the Doppler waveform of the hepatic veins in patients with cirrhosis. DESIGN: We analyzed prospectively with Doppler ultrasound the flow of the hepatic veins and we compared the different Doppler waveform patterns with the degree of liver failure according to the Child-Pugh score. PATIENTS: Forty three patients with cirrhosis and 60 normal individuals with similar age and sex. RESULTS: Abnormal hepatic vein waveforms were found in 40 of 43 patients with cirrhosis and in none of the 50 controls subjects. No statistically significant differences were detected between the different Doppler waveform patterns and the Child-Pugh score (p = 0.063). CONCLUSIONS: Our findings indicate that an alteration of the Doppler waveform pattern of hepatic veins suggest the presence of cirrhosis and that there is no association between the degree of the liver failure and the waveform patterns.
The levels of unconjugated estriol in maternal vein serum during labor, cord artery serum, and cord vein serum were measured in normal pregnancy and in pregnancy complicated by intrauterine growth retardation. The mean level of unconjugated estriol in maternal vein serum was significantly lower in the intrauterine growth-retarded group than in the normals (p less than 0.001). The mean estriol level in cord vein was lower only in the most severely growth-retarded subgroup as compared to the normal. There was no difference seen in the cord artery values among the groups.
In order to determine the hepatic portions by cystic vein, we carried out abdominal angiography in 153 patients. The cystic vein was recognized in eleven patients, but only in nine cystic venous flow could be measured. In this group of patients, in which the cystic venous flow was detected, hepatic angiography was performed through the right hepatic artery (RHA) in six patients, the anterior branch of RHA in one patient, and the cystic artery in two patients. Simultaneously, angiographical CT was performed in five patients. As the results, it is presumed that the cystic venous flow perfused segment 4 portal branch (P4) + segment 5 (S5) in four patients, P4 in two patients, segment 6 portal branch (P6), S5 + right portal vein (RPV) + right hepatic vein (RHV), and S5 + RHV in one patient, respectively, and we concluded that in 70% of cases cystic venous flow perfused either P4 or S5.
From April 1981 to April 1985, 128 limbs in 120 patients who had primary femoropopliteal bypasses were entered in a randomized comparative study. Grafts used were 56 randomized and five obligatory reversed saphenous veins (RSVs), 41 randomized and 24 obligatory superficial femoral-popliteal veins (SF-PVs), and two obligatory prosthetic grafts. The primary patency rates of randomized SF-PVs (64% at 3 years) and RSVs (60% at 3 years) were not significantly different. Similarly, there was no statistically significant difference in the secondary patency rates of 68% for SF-PVs and 63% for RSVs at 3 years. Combinations of obesity, hypertension, and poor medical condition mandated obligatory RSV use. Obligatory SF-PV use was necessitated by absence (eight cases) or inadequacy (16 cases) of the saphenous vein. Indications for bypass were critical ischemia (RSVs, 93% and SF-PVs, 92%) and claudication (RSVs, 7% and SF-PVs, 8%). Diabetes was present in 69% of patients with SF-PV bypass and 49% of those with RSV bypass. Limb retention, operative mortality, and patient survival rates were not significantly different with each graft. Continuation of the study as originally structured, with nonselective SF-PV use, became ethically untenable when it was appreciated that results in black patients and patients with excessively large grafts were markedly inferior and that construction of 3 cm moderately tapered anastomoses significantly reduced the incidence of distal anastomotic hyperplasia. These results, obtained during a period when important lessons about SF-PV use were being learned, indicate that during the first three years of observation after primary femoropopliteal bypass, the differences in cumulative primary and secondary patency rates of SF-PVs and RSVs were not statistically significant. Results in the most recent 76 SF-PV grafts, with primary and secondary patency rates of 82% and 89% at 3 years, provide a more realistic picture of the effectiveness of SF-PVs as primary femoropopliteal bypass grafts.
On the basis of observations made on three infants, a description is given of a late complication of umbilical vein catheterization not hitherto reported. The children showed the symptoms of thrombosis of the splenic vein with secondary splenomegaly and marked gastric and/or esophageal varices, while the portal vein showed no abnormality. The diagnosis was preoperatively established by means of selective angiography of the superior mesenteric artery and the splenic artery. Treatment in these three cases consisted of splenectomy, with good clinical and radiological results.
OBJECTIVES: Current management of extrahepatic portal vein thrombosis (EPVT) comprises endoscopic eradication therapy of esophageal varices and conventional shunt surgery. The authors have used the novel technique of mesenterico-left portal bypass (Rex shunt) in seven children with symptomatic EPVT, and report their results here. METHODS: Median age of the children was 12 years (range, 2-16 years). All children had portal hypertension with hypersplenism and recurrent bleeding from esophageal varices. Furthermore, one patient suffered from a severe hepatopulmonary syndrome. Preoperative evaluation included liver function tests, liver biopsy, hepatic duplex ultrasonography, and radiologic evaluation of the intrahepatic and extrahepatic vascular anatomy. The internal jugular vein was used as vein graft in all patients. RESULTS: Median follow-up period was 15 months (range, 3-28 months). Ultrasound scans revealed sufficient perfusion in all shunts (median, 35 cm/s; range, 28-60 cm/s). The intrahepatic portal perfusion in segment 4 improved from a median of 6 cm/s before surgery to 18 cm/s postoperatively. The platelet count increased within 3 months from a mean of 50,625/microL to 137,750/microL. The clinical signs of hypoxemia in the child with hepatopulmonary syndrome disappeared within 6 months. CONCLUSIONS: In accordance with the limited experience published by others, the authors' data confirmed the mesenterico-portal Rex shunt as the therapy of choice for children with EPVT. Furthermore, this report is the first to show that a hepatopulmonary syndrome can be abolished by mesenterico-portal Rex shunt.
In many patients with varicose veins the combination of surgery and sclerotherapy gives good results and reduces the operating time for each patient considerably. Especially in all patients with recurrent and side branch varicose veins this method seems to be advantageous. During the last ten years we treated 3328 patients with varicose veins. The combined method was used in 64% (2130 patients).
Extravasal compression of the external iliac vein was found in 110 out of 604 investigated patients with lower-limb varicosis. A method of external iliac vein decompression is proposed that eliminates partial occlusion of deep veins and restores disrupted hemodynamics.
The Branch Vein Occlusion Study is a multicenter, randomized, controlled clinical trial designed to answer several questions regarding the management of complications of branch vein occlusion. This report addresses the questions, "Can peripheral scatter argon laser photocoagulation prevent the development of neovascularization?" and "Can peripheral scatter argon laser photocoagulation prevent vitreous hemorrhage?" To answer the first question, 319 eyes were assigned randomly to either a treated or an untreated control group. Comparing treated patients with control patients (average follow-up time, 3.7 years), the development of neovascularization was significantly less in treated eyes (P = .009, log rank test). To answer the second question, 82 eyes were assigned randomly to either a treated or untreated control group. Comparing treated patients with control patients (average follow-up time, 2.8 years), the development of vitreous hemorrhage was significantly less in treated eyes (P = .005, log rank test). Although the Branch Vein Occlusion Study was not designed to determine whether peripheral scatter treatment should be applied before rather than after the development of neovascularization, data accumulated in this study suggest that peripheral scatter treatment should be applied after the development of neovascularization rather than before the development of neovascularization. Because the occurrence of vitreous hemorrhage was lessened by peripheral scatter argon laser photocoagulation, we recommend laser photocoagulation for patients with branch vein occlusion who have developed neovascularization and who meet the eligibility criteria of this study.
A 71-year-old woman had edema and venous dilatation of her upper right limb that caused painful functional disability following a shoulder injury. Arteriograms demonstrated an arteriovenous fistula between the subclavian artery and vein associated with thrombosis of the vein at the same level. The arteriovenous fistula was found to have multiple arteriovenous communications. Because of associated distal venous thrombosis, venous drainage was retrograde through the brachial vein. The inflow arteries of the fistula were embolized and then the subclavian vein thrombosis was recanalized, dilated, and an endoluminal stent inserted. Clinical signs completely resolved.
An 8-month old girl was presented with superior caval vein syndrome early after cardiac surgery. Angiography showed severe stenosis of the superior caval vein with 50 mmHg pressure gradient. Following balloon angioplasty, the pressure gradient was reduced to 7 mmHg with some residual stenosis of the superior caval vein. When the patient was reevaluated 5 months after the procedure, angiography revealed a normal diameter of the superior caval vein without a pressure gradient.
An acutely swollen, painful calf is usually caused by deep vein thrombosis or pseudo deep vein thrombosis; however, the differential diagnosis and management of these 2 entities can prove difficult and even hazardous unless a careful, systematic approach is used. This article describes the use of 2 invasive techniques (ascending venography and arthrography) and several noninvasive methods (magnetic resonance imaging, computerized axial tomography, and non-Doppler ultrasound) to differentiate between deep vein thrombosis and pseudo deep vein thrombosis. The author discusses a practical, cost-effective approach to diagnosing and managing the acutely swollen, painful calf.