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PubMed1992

The lesser saphenous vein: an underappreciated source of autogenous vein.

Use of the ipsilateral greater saphenous vein for arterial bypass procedures is frequently limited by previous stripping, bypass operations, or anatomic unsuitability. In such cases the contralateral greater saphenous vein or arm veins are often used. However, over the past 5 years we have used the lesser saphenous vein as a preferred alternative autogenous vein. Duplex scanning has been used in 311 cases for preoperative mapping and assessment with excellent correlation with actual anatomy found at operation. Harvest of the lesser saphenous vein has been facilitated by the use of a medial subfascial approach not requiring special positioning of the leg. A total of 91 lesser saphenous veins have been used for arterial bypass procedures; 66 of these were repeat cases. Vein use was 90.2%. In 40 of these cases the lesser saphenous vein was used as the entire conduit, including 10 in situ, 20 reversed vein (including 18 for coronary artery bypass), and 10 orthograde vein bypasses. In the remaining 33 cases the lesser saphenous vein was spliced to another vein to complete a bypass procedure. In the entire group, patency was 77% at 2 years. These data suggest that the lesser saphenous vein should be a principal alternative to ipsilateral greater saphenous vein for arterial bypass because of its ready availability, high use rate, ease of harvesting and preparation, and ideal handling characteristics.

Adult↗
PubMed1999

Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein.

OBJECTIVE: To determine the frequency of central venous catheter-induced thrombosis of the axillary vein. DESIGN: Prospective, controlled study. SETTING: Tertiary care university center. PATIENTS: Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein. INTERVENTIONS: Single-lumen, silicone elastomer or polyurethane catheters were inserted for a mean duration of 14.7+/-7.4 days (range, 4-33 days). On catheter removal, bilateral upper-extremity phlebographic examination was performed in each patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms. MEASUREMENTS AND MAIN RESULTS: Of the 60 patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, but no patient had clinical sign of pulmonary embolism. There were 35 patients (58.3%) who developed positive phlebographic examinations homolateral to the catheter. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis: nonobstructive clots adherent to the vessel wall and/or the catheter. Two patients (3.3%) had phlebographic signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting < or =6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of > or =15 days (p < .01). In the seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10+/-2.5 min) was not different from that of patients with no axillary vein thrombosis (14+/-9 min). CONCLUSIONS: Based on the data from the present study, we conclude that axillary vein catheterization is associated with a 11.6% frequency of upper-extremity deep vein thrombosis. This rate of vein thrombosis is similar to that observed after internal jugular or subclavian vein cannulation. Given the acceptable rate of this clinically important complication, axillary vein cannulation offers an attractive alternative site for catheter insertion to the internal jugular or subclavian vein in the critically ill. Because thrombosis is rare or absent in catheterizations lasting <15 days, it seems wise to withdraw axillary catheters after a maximum of 2 wks.

Arm↗
PubMed1984

Aminergic innervation of cerebral veins. Histochemical comparison with extracranial veins.

The density and distribution pattern of aminergic nerve fibers in intracranial and extracranial veins were compared by means of catecholamine histofluorescence studies. Extracranial veins (internal jugular, inferior caval, portal, renal, internal iliac, and femoral veins) showed quite a uniform distribution pattern. Large veins (jugular, caval, renal, and iliac veins) revealed a spiral pattern, and small veins presented as a meshwork (femoral vein) or in a longitudinal pattern (a branch of the femoral vein). In contrast, intracranial veins displayed more complex patterns: the dural sinus showed a longitudinal pattern and the internal cerebral vein and the superficial vein of Labbé revealed a meshwork of nerve fibers. The aminergic fibers were denser in cerebral veins (dural sinus and internal cerebral vein) than in extracranial veins. The complex distribution and the density of aminergic fibers in cerebral veins suggest that the aminergic innervation of the circulatory system may be more important in the brain than in the extracranial organs.

Amines↗
PubMed1990

Saphenous vein rupture pressure, rupture stress, and carotid endarterectomy vein patch reconstruction.

Early postoperative patch rupture is a catastrophic complication of carotid endarterectomy reconstruction with greater saphenous vein. Mechanical determinants of saphenous vein rupture were identified by structural measurements and the results applied to carotid endarterectomy patch geometry. Diameter and rupture pressure was measured in fresh saphenous vein segments from the ankle, knee, or thigh in 157 patients undergoing bypass operations. Circumferential hoop rupture stress was calculated and the results were applied to 157 carotid endarterectomy reconstructions. All vein ruptures were in the cylindric axis. The mean vein diameter was 4.58 mm. The mean vein rupture pressure was 2873 mm Hg (3.78 atm). Vein diameter was larger in the thigh than in the ankle or knee (p less than 0.01), but there was no significant difference in rupture pressure between veins from the three locations. Women had a smaller vein diameter than had men at all locations (p less than 0.01). There was a positive linear correlation between vein diameter and rupture pressure. The mean maximum diameter of curvature of 157 carotid endarterectomy reconstructions with a vein patch was 13.3 mm. Multiple random applications of the 157 veins to 157 carotid diameters predicted a mean patch rupture pressure of 1087 mm Hg (1.43 atm), 1163 mm Hg (1.53 atm) for men, and 866 mm Hg (1.14 atm) for women. Predicted vein patch rupture pressures less than 300 mm Hg were found in 5.7% of cases (8.8% women and 1.2% men). Only 0.6% of patients (1.8% women and 0% men) had a predicted rupture pressure less than 200 mm Hg. No veins with a diameter greater than or equal to 4.0 mm had a predicted patch rupture pressure less than 300 mm Hg. These results suggest that small-diameter saphenous veins have a higher risk of rupture when used as a carotid patch.

Blood Pressure↗
PubMed1987

[EC-IC bypass surgery using a long vein graft--reconstructive procedures for the occluded long vein grafts].

EC-IC bypass using a long vein graft has an advantage creating a large amount of blood flow immediately after the anastomosis, but on the other hand, disadvantage of relatively frequent incidence of the vein graft occlusion. In this report, we present three kinds of reconstructive operative procedures for the stenotic or occluded long vein grafts. Type A: A long vein graft bypass between external carotid and posterior cerebral artery was found occluded intraoperatively by the thrombosis occurred where the vein graft was injured during harvesting. Reconstruction was made simply by resecting the occluded segment of the graft and end-to-end suturing. Type B: A long vein graft used in subclavian artery-middle cerebral artery bypass was occluded three days postoperatively at the supraclavicular fossa by bleeding from the anastomosis site. The vein graft was found compressed and thrombosed. We reconstructed the occluded bypass by resecting the occluded supraclavicular segment and interposing a short vein graft with end-to-end anastomosis. Then, thrombectomy of the remaining vein graft was followed. Type C: A long vein graft used in external carotid-middle cerebral artery bypass stenosed at the anastomosis site with the external carotid artery a day after the operation. The stenotic bypass was successfully reconstructed by bridging a new short vein graft from another portion of the external carotid artery on the long vein graft distal to the stenotic site. All the long vein grafts we have done reconstructive surgery have been working well one to four years follow-up periods. So, we conclude that whenever a long vein graft occludes it should be reconstructed promptly before the vein graft becomes necrotic.

Adult↗
PubMed1989

Viscoelastic properties and collagen content of the long saphenous vein in normal and varicose veins.

Veins taken from patients undergoing surgery for varicose veins were compared with those obtained from patients undergoing other surgical procedures ('normals'). Varicose veins had a lower breaking strength and breaking energy than normal veins. Elastic stiffness was less in normals (tan theta = 41 (24] than in varicose veins (tan theta = 55 (18); P less than 0.01). There was no difference in viscoelastic behaviour between samples taken above, at, or below the valve leaflet insertion. In normals, perivalvular vein wall exhibited a 50 per cent lower breaking strength and elastic stiffness than vein from other sites. Collagen content was significantly higher in normal vein specimens in all sites examined (mean collagen content = 70 (21) micrograms/mg, versus 51 (20) micrograms/mg for varicose veins; P less than 0.001). We conclude that significant structural changes are seen in varicose veins. In normal veins, the perivalvular vein wall has distinct viscoelastic features when compared with vein wall from other sites. This difference was not found in veins which became varicose.

Collagen↗
PubMed2005

Experience with recipient's superficial femoral vein as conduit for middle hepatic vein reconstruction in a right-lobe living donor liver transplant procedure.

Middle hepatic vein reconstruction during the right-lobe living donor liver transplant procedure has been recognized to be a significant factor. We initially reconstructed only a single middle hepatic vein orifice draining into segment 8. In cases where the right-lobe liver graft has several major middle hepatic vein tributaries, including veins draining segment 5 that are remote from the right hepatic vein orifice, a long and thick interposition conduit is necessary for reconstruction. Among 11 consecutive adult patients who received a right-lobe liver graft without a middle hepatic vein at our institution, 8 underwent reconstruction of all major middle hepatic vein tributaries using a vein graft from the recipient's superficial femoral vein. The remaining 3 patients had no major middle hepatic vein tributaries. Posttransplant-computed tomography imagings showed increased liver mass with a patent superficial femoral vein graft in 8 patients. In the absence of a venous system from a deceased donor, a recipient superficial femoral vein offers an excellent size match to maintain the venous outflow of middle hepatic vein tributaries. Reconstruction with recipient superficial femoral vein plays an important role in maximizing liver function and minimizing morbidity in the early posttransplant period.

Adult↗
PubMed2003

Planning endovascular vein valve implantation: significance of vein size variability.

OBJECTIVE: Endovascular placement of prosthetic valves is currently in clinical trials as treatment for lower extremity venous hypertension caused by valvular insufficiency. Femoropopliteal vein sizing is a critical factor in treatment planning. A wide diameter range could influence selection of an endoprosthesis. Quantitative data describing intrasubject vein diameter variation are scant. We measured vein diameters with ultrasound imaging to assess minimum-maximum diameter range under forced conditions of venoconstriction and venodilatation. METHODS: Diameter of the common femoral vein (CFV), proximal femoral vein (PFV), mid-femoral vein (MFV), and distal femoral vein (DFV) in the thigh and the popliteal vein (PV) was measured in the morning under conditions of minimal venodilation and in the afternoon under conditions of stressed venodilatation that included activities of daily living and a 5-minute treadmill walk. Measurements were obtained twice on two different days in both extremities in 20 subjects with CEAP clinical classification C(0) (n = 10), C(3) (n = 7), C(4) (n = 1), or C(5) (n = 2). RESULTS: Average vein diameter increased, from 11.2 +/- 2.5 (SD) mm to 14.5 +/- 2.3 mm at the CFV, from 6.9 +/- 1.8 mm to 9.4 +/- 1.9 mm at the PFV, from 6.9 +/- 1.6 mm to 9.0 +/- 1.8 mm at the MFV, from 7.3 +/- 1.7 mm to 9.1 +/- 1.5 mm at the DFV, and from 8.4 +/- 1.4 mm to 9.7 +/- 1.8 mm at the PV (P <.001 for all differences). Maximum diameter change was 8.2 mm at the CFV, 7.0 mm at the PFV, 6.6 mm at the MFV, 6.0 mm at the DFV, and 5.1 mm at the PV. Dilatation of 4 mm or greater occurred in 43% of CFV, 15% of PFV, 11% of MFV, 3% of DFV, and 1% of PV. Minimum vein diameter was found at PFV in 41%, MFV in 34%, and DFV in 23% of morning measurements and at PFV in 21%, MFV in 38%, DFV in 28%, and PV in 16% of afternoon measurements. CONCLUSIONS: Femoropopliteal veins demonstrated a wide range of diameters, and significant diameter changes were detected in all vein segments. Variations in vein diameter must be evaluated in candidates for endovascular venous valve prostheses. Such devices must adapt to a wide range in vein diameter.

Adult↗
PubMed2004

Types of outlet of the major saphenous vein tributaries in patients with chronic vein insufficiency of the lower limbs.

Chronic vein insufficiency (CVI) is a disease which, when it develops, leads to varicose veins of the lower limbs. As approximately 25% to 50% of people suffer from it, it should be recognised as a public disease. The treatment of chronic vein insufficiency is based on a surgical approach. The aim of the operation is to remove (strip) the insufficient major saphenous vein (MSV), the main cause of the disease. The major saphenous vein drains into the femoral vein and forms the sapheno-femoral junction, which is located in the hiatus saphenous within the femoral triangle. We conducted 94 varicose vein operations by the Babcock method on patients suffering from chronic vein insufficiency. This surgical treatment was performed in "Therapy", a private clinic for peripheral vessel disease. We operated on 52 left lower limbs and 42 right lower limbs. The patients were qualified for the operation procedure after physical examination and Doppler ultrasonography imaging. We identified 5 types of major saphenous vein tributary drainage. The most common was Type I, in which there were 3 tributaries draining directly into the major saphenous vein. This type consisted of 45 cases (47.87%). We distinguished here 3 modifications. In Type II, however, there were 4 direct tributaries that drained into the major saphenous vein in 23 cases (24.46%). In this group of patients also 3 modifications were distinguished. Type III occurred in 14 cases (14.89%). We identified here 2 direct tributaries that drained into the saphenous vein and divided this type into 2 modifications. Type IV occurred in 8 cases (8.51%). Here we found 5 or 6 direct tributaries depending on the number of the external pudendal veins. Type V turned out to be very rare, occurring in only 4 cases (4.25%). Among all the types mentioned a thin tributary 1-2 mm wide was found in 10 cases (10.63%). This ran from under the fascia cribrosa into the saphenofemoral junction in the hiatus saphenous. This may be one of the causes of the recurrences of chronic vein insufficiency. There is also the possibility that a tributary will be overlooked or ignored during the operation, particularly when Type IV appears with 5 or 6 direct collaterals.

Humans↗
PubMed1996

Carotid endarterectomy saphenous vein patch rupture revisited: selective use on the basis of vein diameter.

PURPOSE: The single major disadvantage of carotid endarterectomy (CEA) patch reconstruction with greater saphenous vein (GSV) is central patch rupture, which has a reported incidence of 0.5% to 4%. This is a prospective evaluation of the selective use of GSV for a CEA patch based on previously established vein diameter criteria. METHODS: Between 1988 and mid-1995, 534 of 671 CEAs (80%) were reconstructed with GSVs that had a distended diameter > or = 3.5 mm. Thigh veins were used in all 252 women who underwent CEA. Of the 282 men who underwent CEA, 265 GSVs (94%) were harvested from below the knee and 17 from the thigh. During this period four thigh and 13 below-knee veins (3.2%) were rejected because the diameter was < 3.5 mm, and a synthetic patch was used instead. In 408 of the CEAs with GSV (76%) the vein rupture pressures and diameters were measured, the CEA geometry was measured, and the predicted CEA vein patch rupture pressures were calculated. RESULTS: No GSV patches ruptured in this series. This compares favorably with three patch ruptures in 239 previous CEAs when no vein diameter criteria was used (p = 0.03). This also compares favorably with a multicenter series of 13 GSV patch ruptures (0.73%) in 1773 CEAs (p = 0.03) and with a single-center series of eight ruptures (0.47%) in 1699 CEAs (p = 0.05). GSV diameters were 4.9 +/- 0.9 mm (mean +/- 1 SD); vein rupture pressures, 3.9 +/- 1.5 atmospheres; carotid bulb major axis diameters, 12.5 +/- 1.6 mm; carotid bulb maximum diameters of curvature, 14.2 +/- 2.2 mm; and CEA patch rupture pressures, 1.3 +/- 0.6 atmospheres (range, 280 mm Hg to 4 atmospheres). CEA vein patch rupture pressure correlates positively with vein diameter (p < 0.001, slope), but there is wide variability (correlation coefficient = 0.39). The 14 CEAs (3.4%) with predicted rupture pressures < 400 mm Hg were performed with veins 3.5 to 5.5 mm in diameter (mean, 4.2 mm), and all had carotid bulb major axis diameters > 12 mm (mean, 15.3 mm). Eight of these CEAs were reconstructed with thigh veins. CONCLUSIONS: Use of GSVs with a distended diameter > or = 3.5 mm for CEA patch reconstruction significantly reduces the probability of central patch rupture; however, a few CEAs reconstructed with veins > 3.5 mm in diameter and large carotid bulbs have predicted patch rupture pressures < 400 mm Hg. Because at times some veins will have rupture pressures lower than desirable, CEA reconstruction should be tailored to keep the carotid bulb major axis diameter < 13 mm.

Aged↗
PubMedDate not supplied

Intrahepatic portal vein branches after extrahepatic portal vein occlusion. Experimental study.

BACKGROUND/AIMS: Prehepatic portal hypertension caused by extrahepatic portal vein occlusion is a situation in which hepatocytes are not damaged by disease despite the fact that portal blood is unable to reach them due to portal vein occlusion. We explored the patency of intrahepatic portal vein branches after extrahepatic portal vein occlusion for the possibility of revascularization by splenoportal shunt. METHODOLOGY: Prehepatic portal hypertension was induced in 8 mini-pigs by external compression of the portal vein with a device consisting of an inflatable silicone balloon mounted on a silicone cuff and attached to a subcutaneous chamber. Another device consisting of cannula and a subcutaneous chamber was placed into the splenic vein for portal pressure monitoring and portal venograms. Both devices were placed during laparotomy with their chambers positioned subcutaneously. Portal vein compression was initiated one week later and was accomplished in two steps. Extrahepatic portal vein occlusion and the patency of intrahepatic portal vein branches were confirmed by direct portal venography. Alteration of the intrahepatic portal bed was examined at necropsy after 4 weeks, checking for the presence of occlusion or thrombosis. RESULTS: Portal vein occlusion was achieved in 5 animals, while severe stenosis was demonstrated in the remaining three. Portal venograms demonstrated patency of the lobar portal vein branches filled by hepatopetal collaterals around the occluded portal vein. All intrahepatic branches were free of thrombus at gross examination. CONCLUSIONS: In the absence of the hepatic parenchymal disease, lobar intrahepatic portal vein branches remain patent despite truncal portal vein occlusion and are supplied by rapidly developed hepatopetal collaterals.

Animals↗
PubMed2004

Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts.

BACKGROUND AND AIMS: Segmental resection of major hepatic veins or the portal vein is sometimes required if one is to secure adequate surgical margins from hepatic or pancreatic malignancies. An external iliac vein is widely sacrificed as a vein graft to replace the defect, but this is associated with postoperative edema of the lower leg. We developed a new method for constructing the great saphenous vein to interpose the hepatic or portal veins. PATIENTS AND METHODS: The great saphenous vein was divided transversely into three sections, which were aligned side-to-side. The three pieces were anastomosed to make a sheet 3 x 2 cm, which was rolled up into a cylindrical form of approximately 1 cm in diameter and 2 cm in length. We applied the finished vein grafts to interpose the major hepatic veins in three patients with metastatic liver tumors and the portal vein in two patients with pancreatic malignancies in cylindrical form and to reconstruct the portal vein in one patient with a pancreas cancer, using a three-row sheet as a patch graft. RESULTS: No patient developed venous thrombosis of the graft or edema of the lower leg. CONCLUSIONS: The newly customized vein graft was safe and useful for the reconstruction of the major hepatic or portal veins.

Aged↗
PubMed1995

Wrapped autologous greater saphenous vein bypass for severe limb ischemia in patients with varicose veins. Preliminary report.

The greater saphenous veins in patients with varicose veins has been overlooked as a conduit for arterial bypass. Greater saphenous veins is often normal and when only parts of the greater saphenous veins are of normal size, a veno-venous or a graft composite bypass may be performed. The goal of this preliminary study was to asses if wrapped autologous greater saphenous veins could be suitable conduits for arterial bypass in patients presenting with critical ischemia. In three patients the greater saphenous veins had one to four dilatations which were wrapped with short segments of Polytetrafluoroethylene graft. In three other patients, the dilated area being longer, the greater saphenous veins were totally wrapped in a hand-made mesh of Dacron. No complications were due to the wrapping procedure and the unwrapped segments did not dilate during a mean three year follow-up. We conclude that wrapped autologous greater saphenous veins may help save limbs of patients with critical ischemia. As an underestimated proportion of patients presenting with varicose tributaries have normal or quite normal greater saphenous veins, the caliber of the greater saphenous veins should be carefully measured before treating the varicose veins. All greater saphenous veins suitable for an arterial bypass should be preserved remembering that one or several dilatations may be wrapped if the greater saphenous veins is used as an arterial substitute. Patients should be informed of the reasons for this choice.

Femoral Artery↗
PubMedDate not supplied

Hepatic vein reconstruction at inferior vena cava confluence using left renal vein graft.

BACKGROUND/AIMS: To preserve remnant liver function, extended left hepatectomy combined with middle hepatic vein reconstruction using a left renal vein graft was performed in resection of liver metastasis from sigmoid colon cancer, involving the confluence of the middle and left hepatic veins. METHODOLOGY: The tumor, 5 cm in size, occupied the superior part of segment 4, and involved the confluence of the middle and the left hepatic veins. An extended left hepatectomy, including the left lobe, left caudate lobe and part of segment 8, together with the middle hepatic vein trunk, was performed. The left renal vein was resected as a graft from the confluence of the inferior vena cava just distal to the branches of the gonadal vein, renal-azygos, splenorenal communications and vertebral veins. The middle hepatic vein was reconstructed using the left renal vein 3 cm in length. RESULTS: Impaired values of liver function tests were normalized by the third postoperative day. Renal function was good throughout the postoperative period. The patient was discharged two weeks after the surgery. The reconstructed middle hepatic vein was patent, which was evaluated by a color Doppler ultrasonography, computed tomography and magnetic resonance imaging 60 days after the surgery. The patient remained well in the eight months thereafter. CONCLUSIONS: Hepatic vein reconstruction using a left renal vein graft is a new and preferable addition for the selection of an optimal graft.

Female↗
PubMed2004

Improvement in deep vein haemodynamics following surgery for varicose veins.

OBJECTIVE: o analyse the effect of superficial and perforating veins surgery on deep vein incompetence. METHODS: During a six-month period between 2000 and 2001 24 patients (32 limbs) with chronic venous insufficiency (CVI) were treated. They were selected because they had varicose veins and proximal deep vein incompetence with photoplethysmography (PPG) venous refilling time (VRT) <15 s with a below knee tourniquet, and a femoral or popliteal vein reflux time (RT) >1.5 s on duplex ultrasound. The group was divided according to aetiology into 21 legs with primary (Ep) and 11 with secondary CVI (Es). All patients underwent removal of varices with stripping of the saphenous veins, if appropriate. In 21 cases subfascial endoscopic perforating vein surgery (SEPS) was performed to ligate incompetent perforating veins. RESULTS: The average VRT for the entire group increased from 9.8 s before to 15 s after operation (p<0.001, paired t test). In the Ep group the average VRT increased from 11 to 18 s (p<0.001, paired t test), in Es group from 7.5 to 10 s (p>0.001, paired t test). Duplex ultrasonography before surgery showed femoral vein incompetence in 28 and the popliteal incompetence in 26 cases. The average femoral vein RT was 1.9 s before and 1.4 s after surgery (p<0.001, paired t test). The femoral RT in the Ep group decreased from 1.9 to 1.3 s (p<0.001, paired t test) and in the Es group from 1.9 to 1.6 s (N.S.). In the popliteal vein, RT was 1.8 s before, and 1.3 s after surgery (p<0.001, paired t test). The RT in the Ep group shortened from 1.8 to 1.1 s (p<0.001 paired t test) and in the Es group from 1.9 to 1.5 s (N.S.). CONCLUSION: Surgical treatment of varicose veins and of calf perforators results in reduced deep vein reflux. The improvement is most marked in cases of primary venous insufficiency.

Endoscopy↗
PubMed2003

Surgical anatomy for subfascial endoscopic perforating vein surgery of laterally located perforating veins.

OBJECTIVES: Endoscopic ligation of perforating veins is useful in treatment of perforating vein incompetence. Over the last few years the topic of interest has been the medial side of the lower leg; however, laterally located venous ulcers (10% of all) are of equal importance. Our poor results with lateral subfascial endoscopic perforating vein surgery (SEPS) procedures led us to study the anatomy of the perforating veins in the lateral leg. The presence of persistent insufficient perforating veins in our patients suggests that our procedure failed because of misinterpreted perforator anatomy. METHODS AND RESULTS: Anatomic dissection was performed in 16 cadavers in two stages, subcutaneously and subfascially. Perforating veins were classified relative to the short saphenous vein and intermuscular septa, with coordinates. Three hundred fifty-one perforating veins were found, for an average of 21.9 perforating veins per leg. The results showed that there is alignment of the perforating veins according to the septa between the anterior and peroneal compartment and between the peroneal compartment and the superficial dorsal compartment. Most of the perforating veins did not correlate with the short saphenous vein. CONCLUSION: Poor clinical results of lateral SEPS procedures might be improved after adjustment of the procedure for new anatomic information, which shows alignment of perforating veins along the intermuscular septa, obligating full septa dissection on the lateral side.

Dissection↗
PubMed2001

Embryological consideration of drainage of the left testicular vein into the ipsilateral renal vein: analysis of cases of a double inferior vena cava.

The right gonadal vein (GV=testicular vein in men, ovarian vein in women) usually drains into the inferior vena cava (IVC) while the left gonadal vein drains into the left renal vein (RV). This anatomical difference induces relatively weak haemodynamics in the left testicular vein (TV) and is considered to be a cause of a left varicocele. In textbooks on embryology, it has been documented that bilateral supracardinal veins (=origin of right and left IVC) and the subcardinal sinus (=origin of RVs and GVs) symmetrically develop during early embryogenesis. However, persistence and regression of the right and left supracardinal veins, respectively, results in drainage of the left GV into the ipsilateral RV. A double IVC (DIVC) commonly originates from a failure of disappearance of the left supracardinal vein. Although there have been a considerable number of case reports on DIVC, little attention has been paid to the anatomy of the left GV in such cases. We report here an autopsy case, a 72-year-old Japanese man, with a DIVC. This case belongs to type BC of McClure and Butler's classification. In this case, it was observed that the right TV drained into the confluence of the right IVC with the ipsilateral RV, while the left TV drained into the left RV in spite of the presence of the left IVC. This case indicates that the embryonic anastomosis point between the subcardinal sinus and the supracardinal vein on the left side is different from that on the right side. Statistical analysis of many case reports of DIVC also suggests that the bilateral supracardinal veins tend to asymmetrically anastomose with the subcardinal sinus during embryogenesis. These data imply that drainage of the left GV into the ipsilateral RV leads to regression of the left supracardinal vein but also to asymmetrical anastomosis between the supracardinal veins and the subcardinal sinus.

Aged↗
PubMed2002

Early results of a prospective randomized trial of spliced vein versus polytetrafluoroethylene graft with a distal vein cuff for limb-threatening ischemia.

OBJECTIVE: Single-piece vein remains the conduit of choice in patients who need bypass grafting for limb salvage. When this option is not available, two of the remaining options are prosthetic bypass graft or several segments of vein spliced together. In this study, we compare spliced vein bypass grafting versus polytetrafluoroethylene grafting with a distal vein cuff in patients with limb-threatening ischemia. METHODS: Between 1996 and 2000, 39 bypass grafting procedures in 36 patients were performed for limb-threatening ischemia. These procedures were prospectively randomized to either spliced vein bypass grafting (spliced group, 19 bypass grafts) or polytetrafluoroethylene grafting with a distal vein cuff (cuff group, 20 bypass grafts). All the patients in the cuff group underwent anticoagulation therapy with warfarin sodium after surgery. The inclusion criteria included: no single-piece vein option for bypass grafting, adequate vein for splice, no composite sequential option, and limb-threatening ischemia. The demographics were similar between the two groups. RESULTS: The primary patency rate at 2 years was 44% and 49% for the spliced and cuff groups, respectively. In the spliced group, seven of 19 bypass grafts underwent revision in the follow-up period, and two of 20 cuffed bypass grafts were successfully revised. The secondary patency rate was 87% and 59% (P <.05), with limb salvage rates of 94% and 85% for spliced and cuff groups, respectively. Four patients in the spliced vein group needed reoperation for wound complications related to vein harvest. One polytetrafluoroethylene graft needed removal for infection. Two early mortalities occurred in the spliced group, one from myocardial infarction and one from stroke. The overall survival rate at 2 years between the two groups was 67% and 100% for the spliced and cuff groups, respectively (P <.05). CONCLUSION: Although this is a preliminary report, it appears that both spliced vein bypass grafting and polytetrafluoroethylene bypass grafting with a distal vein cuff produce acceptable limb salvage rates. The secondary patency rate for spliced vein is better, but these bypass grafts more often need revision or reoperation for wound complications.

Aged↗