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The authors mention the technique of Koichi Ishigami, relative to 15 cases. This involves the anastomosis of the spermatic vein with the long saphenous vein. The authors use phlebography to show the permeability of this venovenostomy, and emphasize the quality of their results.
While annual attrition and high break-down rate of saphenous vein graft (SVG) used for CABG has widely noted in Western countries, no sizable studies have yet available in Japan. We studied 142 SVGs of 77 pts, which we divided into two groups; 80 SVGs of 44 pts in mid-term period (5 to 8 years after surgery) and 62 SVGs of 33 pts in long-term period (9 to 17 years after surgery). The patency rate of SVGs was 69% in mid-term and 77% in long-term. Whereas these patency rates at each periods were superior to those reported from USA and European countries, a quarter of SVGs in mid-term period and a half in long-term period had significant stenotic changes (over 50%). Of patent SVGs, diseased SVGs reached 36% in mid-term period and 73% in long-term period. In conclusion, although the patency rate of SVGs in Japanese patients was higher than that of the Western countries, vein graft disease apparently occurred in a large proportion of patent SVGs.
In the material of 29 human fetuses, of both sexes, without developmental anomalies, we investigated by corrosion technique outflow of blood from the thyroid gland. On the basis of this study, we noticed in one case the rare variation of immediately of the orifice of the middle thyroid vein to the vertebral vein. This observation may be applicable of evaluation of phlebograms of thyroid gland and surgery of this organ.
Venous thrombosis is a well-known complication of permanent cardiac pacemaker implantation, particularly, chronic occlusion of the subclavian vein is reported to occur in 20-33% of the cases where the percutaneous approach is performed. We examined 135 asymptomatic patients with digital venography to asses the frequency of venous thromboses causing stenosis and occlusion of the subclavian or anonymous arteries in pacemaker carriers. We considered both one- (44) and two-chamber (91) pacemakers and investigated a possible statistically significant difference between them: we found 21 venous thromboses (15%), seven of them in one-chamber pacemakers (15.9%) and 14 two-chambers pacemakers (15.3%). None of our 94 male and 41 female patients was on anticoagulants or had any evidence of coagulation disorders. Venography was performed 39.3 months (mean) after pacemaker implantation (range: 3-120 months). We conclude that digital venography is a simple and relatively noninvasive method permitting better depiction of subclavian, anonymous and caval veins than Doppler US and also showing some vascular abnormalities which may complicate pacemaker implantation.
We herein describe a patient with a giant mixed hepatocellular carcinoma and cholangiocarcinoma (MHC) surrounding the inferior vena cava (IVC). The patient was treated by extended left hepatic lobectomy with resection of the main right, left and middle hepatic veins and preservation of the inferior right hepatic vein (IRHV) after hepatic arterial infusion (HAI) chemotherapy. The patient died of distant metastases 4 years after initial HAI chemotherapy. As there is no hope of cure with HAI alone in the patients with MHC, this operative procedure even after HAI is recommended for patients with reduced liver function, tumor involving the RHV and surrounding the IVC.
A patient with a complete agenesis of the inferior vena cava is presented. In this rare anomaly the blood of the pelvic veins is drained through the dilated venae lumbales, vena azygos and vena hemiazygos into the superior vena cava. The malformation was detected within the scope diagnostics of deep vein thrombosis. The diagnosis was made by sonography, computed tomography and magnetic resonance angiography.
BACKGROUND: Despite the success of arterial angioplasty as well as arterial stent placement, restenosis remains a significant problem in prolonging blood vessel patency. This animal model was used to test the theory that a stent lined (VLS) or covered (VCS) with autologous vein would be more biologically compatible with the arterial intima. If successful, this technique would prevent angioplasty failure due to intimal hyperplasia (IH) by supplying a healthy endothelial surface and help to eliminate elastic recoil mechanism (ERM) by the use of a stent rendered less thrombogenic in both stenosed and restenosed arteries. There might in addition, be other applications for these modified stents. METHODS: Nine 50 kg -young pigs had Gianturco-Roubin VLS and VCS mounted on a balloon angioplasty catheter implanted via a transverse arteriotomy. VLS were implanted in 3 left iliac and 6 left carotid arteries and VCS were placed in the matching contralateral arteries. The change from iliac to carotid arteries was due to the initial perception that the iliac artery was the right size for this device. It proved to be too large and the carotid artery, which was initially felt to be too small proved to be the right size. Operative angiography was performed to ensure proper placement. Duplex imaging of the carotid artery placements were performed at 10-14 days. All animals were sacrificed at 30-33 days and specimens examined grossly and microscopically. Three 16.5% of the devices were found to be patent, two VILS and one VCS. The remaining 14 (78%) were occluded by distortion or thrombus or both. RESULTS: Five devices migrated distally, 2 of which remained patent albeit of smaller diameter. One device migrated to the brain, was not recovered and was presumed occluded. All arteries and veins, with two exceptions, demonstrated varying degrees of IH. We believe failure was due to the inability of the stents to resist ERM in these healthy pig arteries. The IH observed, we believe, is due to the forced dilatation required to seat the devices. CONCLUSIONS: Based on the observations of the patent devices we suggest that arteries can be relined and supported with modifications of this technique, using a more ERM resistant stent that may be placed without forceful dilatation. This will require further study.
Recent advances in venous reconstruction allow the surgeon to bypass obstructive lesion of the venous system successfully. Because of low pressure and low velocity flow in the venous system, and adjunct temporary arteriovenous fistula appears to be essential for patency of the venous bypass. The existing data has shown that autogenous vein is superior to prosthetic material for bypassing venous obstruction. We are presenting a 44-year-old patient who has failed medical treatment and successfully been treated by this method.
A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months postoperatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.
The aim of this study was to assess early hemodynamic improvement after a stripping operation or saphenofemoral ligation by means of air plethysmography. This prospective study assessed 109 limbs of 71 patients treated between May 2000 and December 2001 for primary varicose veins due to greater saphenous insufficiency. Eighty-nine limbs were treated by stripping surgery (stripping group), and 20 limbs were treated with saphenofemoral ligation (saphenofemoral ligation group). To evaluate venous hemodynamic changes, air plethysmography was performed before surgery and 7-14 days after surgery. A significant decrease and normalization of the venous filling index and residual volume function was observed in the two groups. A decrease in venous volume was observed in the ligation group, but the change was not statistically significant. In contrast, a significant decrease in venous volume was observed in the stripping group. The ejection fraction was not improved in either of the groups. From these results we conclude that hydrostatic forces can be controlled by means of a stripping operation as well as by saphenofemoral ligation in the early postoperative period.
Pulmonary arteriovenous fistulae after a cavopulmonary anastomosis have been reported to resolve after hepatic venous return is included in the pulmonary circulation. We report a case in which the hepatic veins were redirected to the pulmonary circulation by connecting them directly to the azygous continuation of the inferior vena cava that had previously been connected to the right pulmonary artery. The patient's arterial saturation of 71% increased to 92% after 6 months.
Iliofemoral vein obstruction that causes venous hypertension in an extremity may produce symptoms that severely limit a patient's activities. A saphenofemoral venous crossover graft may relieve those symptoms. The procedure also is indicated for the repair of the venous system following severe, limb-threatening vascular trauma. For chronic obstruction, the procedure should be delayed for six months to allow for the possible development of adequate collateral circulation.
Thrombosis or stenosis of the subclavian vein is frequently caused by cannulation for dialysis or nutritional access. In a patient with an ipsilateral arteriovenous fistula, the resulting edema and venous congestion can interfere greatly with dialysis and can lead to limb threatening significant disability to the point of phlegmasia cerulea dolens. The author describes four patients who underwent a recently described procedure to decompress the venous system in the setting of subclavian obstruction. A description of the technique is included.
A 17-month-old female patient was operated on for ventricular septal defect and pulmonary stenosis. During the operation several cardiac anomalies were observed; these were dextrocardia, ventricular septal defect, persistent left superior vena cava, drainage of the great cardiac vein into the left internal thoracic vein and a pericardial pouch. These anomalies have not previously been reported together.
A case of 'absent' left pulmonary vein with ventricular septal defect was diagnosed based on echocardiography, magnetic resonance imaging and cardiac catheterization at newborn stage. Pulmonary arterial banding was performed at the age of 1 month to ameliorate the pulmonary flow. At a cardiac catheterization 1 year later, the left pulmonary veins were visualized with moderate stenosis at their entrance into the left atrium. The patient has been stable after surgical repair of the ventricular septal defect and dilation of the pulmonary venous stenosis.
Residual venous obstruction (RVO) in patients with previous deep vein thrombosis (DVT) of the lower limbs has been suggested as an independent risk factor for recurrent venous thromboembolism (VTE). RVO could be a marker of a persistent prothrombotic state. We have compared the rate of RVO in patients with DVT and a personal history of at least one previous episode of VTE to the rate of RVO among patients with a first episode of DVT. All patients underwent compression ultrasonography (CUS) of the lower limbs 1 year after index DVT. RVO was arbitrarily defined as a thrombus occupying, at maximal compressibility, more than 20% of the vein area in the absence of compression. 50 consecutive patients with recurrent DVT and 50 age and sex-matched patients with a single episode of DVT were enrolled. The index event was idiopathic in 62% of patients with recurrent DVT and in 60% of patients with a single episode. In 74% of patients with recurrent DVT the index event occurred in either the contralateral leg or in a different segment of the ipsilateral leg. RVO was detected in 50% of patients with a single episode of DVT and in 88% of patients with recurrent DVT (p<0.00001). The prevalence of RVO is significantly higher in patients with recurrent DVT than in patients with a single episode. This finding supports the importance of RVO as a potential marker of a persistent prothrombotic state.
OBJECTIVE: To compare blood glucose (BG) concentrations measured with a portable blood glucose meter in blood samples obtained with a marginal ear vein (MEV) nick technique, from a peripheral venous catheter, and by direct venipuncture in healthy cats and cats with diabetes mellitus. DESIGN: Prospective study. ANIMALS: 1 0 healthy cats and 11 cats with diabetes mellitus. Procedure-On day 1, blood samples were collected every hour for 10 hours by the MEV nick technique and from a peripheral venous catheter. On day 2, blood samples were collected every hour for 10 hours by the MEV nick technique and by direct venipuncture of the medial saphenous vein. RESULTS: For all cats, mean BG concentration for samples collected by the MEV nick technique was not significantly different from mean concentration for samples obtained from the peripheral venous catheter. For healthy cats, mean BG concentration for samples collected by the MEV nick technique was not significantly different from mean concentration for samples obtained by direct venipuncture. For cats with diabetes mellitus, mean BG concentration for samples collected by the MEV nick technique was significantly different from mean concentration for samples obtained by direct venipuncture; however, for the range of concentrations examined, this difference was not clinically important. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that for the range of concentrations examined, the MEV nick technique is a reasonable alternative to venous blood collection for serial measurement of BG concentrations in cats.
The requirement for a safe diagnostic strategy should be based on an overall posttest incidence of venous thromboembolism of less than 1% during 3 month follow-up. Compression ultrasonography (CUS) has a negative predictive value (NPV) of 97% to 98% indicating the need of repeated CUS testing. Serial CUS testing is safe but you have to repeat 100 CUS to find 1 or 2 CUS positive for deep vein thrombosis (DVT), which is not cost-effective indicating the need to improve the diagnostic work-up of DVT by the use of clinical score assessment and D-dimer testing. The combination of a less sensitive D-dimer test (SimpliRed) and low clinical score does not, whereas the combination of a sensitive D-dimer test (ELISA VIDAS or Tinaquant) and low clinical score does safely exclude DVT without the need of CUS. The combination of a first negative CUS and a negative less sensitive D-dimer test (SimpliRed) or a sensitive ELISA D-dimer at a higher cut off level of 1,000 ng/ml safely excludes DVT with a NPV of > 99% without the need to repeated CUS in about 60%. The sequential use of a sensitive D-dimer and clinical score assessment will safely reduce the need for CUS testing by 40% to 60%. Large prospective outcome studies demonstrate that one negative examination with complete duplex color ultrasonography (CCUS) of the proximal and distal veins of the affected leg with suspected DVT is safe to withhold anticoagulant treatment with a NPV of 99.5%. This indicates that CCUS is equal or superior to serial CUS or the combined use of clinical score, D-dimer testing and CUS. Pulmonary angiography is the gold standard for segmental pulmonary embolism (PE) but not for subsegmental PE. A normal perfusion lung scan and a normal rapid ELISA VIDAS D-dimer test safely exclude PE. Helical spiral CT detects all clinically relevant PE and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic ventilation perfusion scan (VP-scan) or a high probability VP-scan. Single-slice helical CT as the primary diagnostic test in patients with suspected PE in 5 retrospective studies and in 3 prospective management studies indicate that the NPV of a normal helical spiral CT, a negative CUS of the legs together with a low or intermediate pretest clinical probability is 99%. Helical spiral CT can replace both the VP-scan and pulmonary angiography to safely rule in and out PE. The combination of clinical assessment, a rapid ELISA VIDAS D-dimer followed by CUS will reduce the need for helical spiral CT by 40% to 50%.