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PubMedDate not supplied

Femoropopliteal bypass using autogenous vein and modified human umbilical vein. A comparative study.

This study is based on 223 consecutive femoro-popliteal and femorotibial bypass grafts performed between January 1978 and June 1985 at the Western General Hospital. Autogenous vein grafts demonstrated better 5 year patency rates (54%) than modified human umbilical vein (32%). The superiority of autogenous vein was even more marked when anastomoses were to below knee vessels: 56% compared with 26% at 5 years. Grafts anastomosed to the superficial femoral artery had similar long term patency to those anastomosed to the common femoral artery. When grafts were required for severe ischaemia, similar 5 year patency rates were achieved with autogenous vein (35%) and modified human umbilical vein (30%). The 5 year limb salvage rate in severe ischaemia was 72% for autogenous vein and 63% for modified human umbilical vein. The findings confirm that modified human umbilical vein is a satisfactory alternative when autogenous vein is not available.

Aged↗
PubMed1996

The site of residual abnormalities in the leg veins in long-term follow-up after deep vein thrombosis and their relationship to the development of the post-thrombotic syndrome.

Two major sequelae of deep vein thrombosis (DVT), obstruction to outflow due to the presence of residual thrombus and reflux due to valvular damage, may contribute to the development of the post-thrombotic syndrome (PTS). We studied the nature and site of residual abnormality, non-invasively with duplex ultrasound, in the veins of 69 limbs in 66 patients, 1 to 6 years after primary acute DVT. There were clinical features of the PTS in 27 limbs and 42 legs were asymptomatic. The pattern of duplex abnormalities was complex and varied for both the PTS and asymptomatic groups. The proportion of abnormal common and external iliac veins and abnormal common, deep and superficial femoral veins was similar for limbs with the PTS and asymptomatic limbs. Twenty-six per cent of legs with the PTS had reflux at the saphenofemoral junction compared with 19% asymptomatic legs (difference not significant). The PTS was associated with proportionally more abnormal popliteal veins (81% vs 55%) and posterior tibial veins (PTV), PTV#1 (41% vs 21%) and PTV#2 (41% vs 14%) when compared with asymptomatic limbs. The odds ratio for a popliteal vein abnormality being associated with the PTS was 3.63 (95% CI 1.16 to 11.43). The odds ratios for PTV#1 and PTV#2 abnormalities in association with the PTS compared to asymptomatic limbs were 2.52 (95% CI 0.87 to 7.31) and 4.13 (95% CI 1.30 to 13.11). In conclusion, residual venous abnormalities after DVT are common and when present in the popliteal and tibial veins are associated with an increased likelihood of PTS expression.

Case-Control Studies↗
PubMed1991

Deep venous drainage in great cerebral vein (vein of Galen) absence and malformations.

We report two types of venous patterns associated with great cerebral vein (vein of Galen) absence or unavailability. Developmental venous anomalies or vein of Galen arteriovenous malformations (VGAM) serve as an illustrative material. A diencephalic pattern that collects the thalamo-striate veins into the tentorial sinus is recognized in most VGAM. A telencephalic arrangement connecting the striate veins with the rostral afferents to the basal vein is less frequent. Both patterns reproduce embryonic stages preceding the development of the great cerebral vein, thus confirming Raybaud's hypothesis that in VGAM the pouch is not the vein of Galen but the medial vein of the prosencephalon. The prognostic value of each pattern can then be appreciated and the therapeutic strategies rationalized; some unexplained complications of the venous approach for non selected VGAM can thus be avoided.

Arteriovenous Fistula↗
PubMed1999

Intra-arterial vein bypass using a vein-loaded stent system to occlude wide-necked aneurysms: an experimental study in dogs.

We treated 13 experimental wide-necked aneurysms of lateral type produced in dog carotid arteries with a vein-loaded stent system consisting of an autologous vein graft, a vein-carrier stent, and two other self-expanding Z-shaped stents. The vein-loaded stent, made by connecting the autologous vein graft to the vein-carrier stent, was implanted in the common carotid artery to seal the aneurysm's orifice, after which two booster stents were deployed. The distal stent was placed to fix the distal end of the vein graft, and the proximal stent was placed at the proximal venous portion of the vein-loaded stent to reinforce its proximal end. In this manner an intra-arterial bypass was established across the aneurysm. Of 13 aneurysms seven were completely occluded, preserving the parent artery. The remaining six procedures resulted in parent artery occlusion because of failures in stent deployment. Angiograms performed in within 1 week six successfully treated dogs revealed the parent artery to be patent in four but thrombosed in two. Histological study of successful cases showed as smooth intima with slight endothelial hypertrophy and partially organised thrombus. The intraluminal features were also observed with a vascular endoscope at the time of treatment in four dogs and at the time of follow-up angiography in two. The appearances corresponded well to the macroscopic findings in the specimens. Our vein-loaded stent system offers complete closure of the orifice, which does not occur with conventional stent placement. The method is believed to show clinical promise for treating wide-necked aneurysms not curable by embolisation of the sac.

Aneurysm↗
PubMed2006

Flow direction of ascending lumbar veins on magnetic resonance angiography and venography: would "descending lumbar veins" be a more precise name physiologically?

BACKGROUND: Physiological flow direction of ascending lumbar vein (ALV) is not well recognized. METHODS: Two-dimensional time-of-flight magnetic resonance angiography (MRA) examinations of the lower extremities in 44 patients and venography (MRV) in 59 patients were retrospectively reviewed. chi2 analysis was used to compare the frequency of ALV detection between the MRA and MRV groups and between cases with filling defects above the ALV confluence and other cases in the MRV group. RESULTS: Frequency of ALV detection was significantly higher in the MRA group (60 of 88 veins, 68.2%) than in the MRV group (9 of 118 veins, 7.6%, P < 0.0001) and in cases with filling defects above the ALV confluence (8 of 23 veins, 34.8%; 6 were compression of the left common iliac vein by the right common iliac artery, 2 were thrombus of the proximal bilateral common iliac veins) than in other cases (1 of 95 veins, 1.1%) in the MRV group (P < 0.0001). CONCLUSIONS: Without compression or occlusion above the ALV confluence, the general flow direction of the ALVs is not ascending but descending, suggesting that "descending lumbar veins" is a more physiologically precise name for these veins than ALVs.

Adult↗
PubMed1975

Localization of hyperfunctioning parathyroid tissue. Radioimmunoassay of parathyroid hormone on samples from the large veins of the neck and thorax and selectively catheterized thyroid veins.

Radioimmunoassay of parathyroid hormone on samples obtained from the large veins of the neck and thorax was utilized for localization in twenty-one patients with hyperparathyroidism. In seventeen of these patients, as many of the thyroid and mediastinal veins as possible were also sampled. This study reveals that sampling of the large veins of the neck and thorax is an insensitive means of adenoma from hyperplasia. Anatomic variations in the drainage of the inferior thyroid veins and dilution of the parathyroid venous effluent by the large veins of the neck and thorax seem to explain this insensitivity and the occasionally misleading results of large vein sampling. Sampling of the small thyroid veins, however, is a sensitive and specific means of localization and permitted preoperative differentiation of adenoma from hyperplasia in fourteen of our seventeen patients. Communications between the inferior thyroid and thymic veins and the fact that mediastinal adenomas frequently bring their blood supply down from the cerevical area suggest that sampling of the small thyroid veins may be of only limited value in identifying a mediastinal adenoma.

Adenoma↗
PubMed1987

Autogenous reversed vein bypass for lower extremity ischemia in patients with absent or inadequate greater saphenous vein.

This report has presented the results of 329 reversed vein bypasses performed for lower extremity ischemia over a 6 3/4 year period. One hundred eighty-nine bypasses were formed from intact ipsilateral greater saphenous veins of adequate size and length. One hundred forty bypasses were formed in patients in whom the ipsilateral greater saphenous vein was absent or of inadequate size or length to complete the bypass. The grafts in these patients were accomplished using a variety of techniques including distal graft origin, use of arm veins and lesser saphenous veins, and use of vein splicing. The patency rates of these grafts were equivalent to those achieved using adequate intact ipsilateral greater saphenous vein. In view of these results, we conclude that the absence of a greater saphenous vein does not preclude successful autogenous lower extremity vein bypass and that prosthetic bypass is rarely justified.

Femoral Artery↗
PubMed1991

Extrahepatic portal vein aneurysm associated with a tortuous portal vein.

Portal vein aneurysm is rare and its etiology is controversial. A case of extrahepatic portal vein aneurysm associated with an unusually tortuous portal vein is described. Real-time ultrasonography showed anechoic masslike lesions at the porta hepatis communicating with the superior mesenteric vein and intrahepatic portal branches. This suggested the presence of two saccular portal vein aneurysms, 27 x 21 mm and 21 x 13 mm in size. Magnetic resonance imaging and portal venography confirmed the portal vein aneurysms and an unusually tortuous portal vein curving caudally between them. The liver was histologically normal and there was no evidence of portal hypertension. It is speculated that these portal vein aneurysms may have been congenital and that the associated tortuous portal vein might have been secondary to hemodynamic changes in the portal venous system.

Adult↗
PubMed2005

Reduced neointima in vein grafts following a blockage of cell recruitment from the vein and the surrounding tissue.

OBJECTIVE: Accumulation of intimal smooth muscle cells (SMC) is an important event in vein graft-stenosis. Different SMC sources have been reported, but their interrelations have been poorly studied. In a mouse vein graft model we investigated whether recipient-derived intimal SMCs are recruited from the surrounding tissue and whether blockage of SMC recruitment from the surrounding tissue and/or the donor vein will reduce neointimal formation. METHODS: To detect recipient-derived cells, wild-type veins were implanted into ROSA26 transgenic mice. To block cell recruitment from the surrounding tissue, implanted veins were isolated with a tube-shaped plastic film. To exclude vein-derived cells in the neointimal formation, acellular veins were implanted. RESULTS: In vein grafts isolated from the surrounding tissue the recipient contribution became minimal, but the total number of SMCs was not decreased. Acellular grafts contained an equal number of intimal SMCs as cellular controls after 4 weeks. Isolation of acellular grafts from the surrounding tissue decreased the number of intimal SMCs by 90%. CONCLUSIONS: Recipient-derived SMCs are mainly recruited from the surrounding tissue. Cell recruitment from either the vein or the surrounding tissue is enough to form a neointima. Therefore, a simultaneous inhibition of both these sources is needed to reduce accumulation of intimal SMCs.

Actins↗
PubMed1999

Open versus endoscopic saphenous vein harvesting: wound complications and vein quality.

BACKGROUND: The saphenous vein is an important conduit for coronary artery bypass grafting. Wound complications from traditional open vein harvesting occur often. Minimally invasive endoscopic saphenous vein harvesting may decrease wound complications. Vein quality may be an issue with endoscopic harvesting. METHODS: We reviewed 568 patients who had bypass grafting and saphenous vein harvesting either endoscopic (group A, n = 180) versus open (group B, n = 388). Both groups were demographically similar and management identical. Wound complication was defined by the need for intervention and included lymphocele, hematoma, cellulitis, edema, eschar, and infection. Multiple vein segments were obtained from 8 patients, 4 from each group, and examined histologically. RESULTS: Wound complications were significantly less in group A (9/180, 5%) versus group B (55/388, 14.2%), p value equal to or less than 0.001. Open harvesting (p< or =0.001), diabetes (p< or =0.001), and obesity (p< or =0.02) were risk factors for wound complication by univariate analysis. By multiple logistic analysis, open harvesting (p< or = 0.0007) and diabetes (p< or =0.0001) were independent risk factors for wound infection. Histologic evaluation of vein samples showed that there was no difference between the groups and vascular structural integrity was maintained. CONCLUSIONS: Endoscopic saphenous vein harvesting was associated with fewer wound complications and infections. Vein quality was not adversely effected because of endoscopic harvesting.

Aged↗
PubMed2001

VCAM-1 expression precedes macrophage infiltration into subendothelium of vein grafts interposed into carotid arteries in hypercholesterolemic rabbits--a potential role in vein graft atherosclerosis.

Intimal hyperplasia and atherosclerosis are major causes of late vein graft failure after coronary artery bypass surgery. Hypercholesterolemia appears to be a key risk factor for atherosclerosis in vein grafts as well as in native arteries. We used a rabbit model of interposition jugular vein graft to the carotid artery and compared intimal thickening, macrophage accumulation, and VCAM-1 expression between hypercholesterolemic (H group) and normocholesterolemic (N group) rabbits. Fifty-nine rabbits were divided into H and N groups. Intimal thickening in vein grafts was approximately three times more prominent in the H group than in the N group. Macrophage accumulation progressively increased with time in H group vein grafts, although it was negligible in the N group. In the H group, moreover, macrophages were initially more abundant in deep intima, and subsequently accumulated in subendothelium of the grafted vein. VCAM-1 expression in luminal endothelial cells of the grafted veins was time-dependently increased after the vein graft surgery in both the H and N groups, and was more prominent in the H group. Comparison of the time-courses between macrophage accumulation and VCAM-1 expression revealed that VCAM-1 expression in luminal endothelium preceded subendothelial accumulation of macrophages. VCAM-1 expression and macrophage accumulation may be key factors which regulate progression of vein graft atherosclerosis.

Animals↗
PubMed1999

Clinical efficacy of portal vein stent placement in patients with hepatocellular carcinoma invading the main portal vein.

BACKGROUND/AIMS: Hepatocellular carcinoma frequently invades the portal veins, and when it invades the main portal vein, the patient's prognosis is extremely poor. This study was undertaken to evaluate the clinical efficacy of stent placement into the portal vein in these patients. METHODS: Twenty-one patients with hepatocellular carcinoma invading the main portal vein were studied. Stents were placed in the portal veins to compress tumor thrombi after percutaneous transhepatic portography. RESULTS: Stents were successfully placed in the portal veins in all patients. Portal venous pressure significantly decreased from 25.3 +/- 7.4 mmHg to 22.4 +/- 6.6 mmHg (p < 0.0001) immediately after stent placement, leading to improvement in gastroesophageal varices, melena and ascites. Although a pseudoaneurysm of the hepatic artery related to portal vein puncture developed in one patient, there were no major complications in the other 20 patients. Blood flow through the stent was maintained during the survival period in 15 patients. The mean stent patency period was 12.4 months. Fifteen patients underwent transcatheter arterial chemoembolization without major complications after stent placement. The survival rate was 64.2% at 6 months and 29.2% at 1 and 2 years, respectively. The mean survival period was 13.7 months. CONCLUSION: Stent placement into the portal vein is a relatively safe and feasible procedure. It improves portal hypertension, expands treatment options, and helps to prolong the survival period in patients with hepatocellular carcinoma invading the main portal vein.

Aged↗
PubMed1996

Composite polytetrafluroethylene/vein bypass grafts: conventional distal vein segment or vein cuff?

OBJECTIVES: To determine the current status of PTFE vein composite grafts, we reviewed our experience with 205 composite reconstructions and compared the results of conventional distal vein segment to that of distal vein cuff. DESIGN: Retrospective review. SETTING: Department of Surgery, University Hospital. PATIENTS AND METHODS: The series included 85 women and 102 men with a median age of 70. The indications for surgery were claudication in 30, rest pain in 71 and ulcer/gangrene in 103. The site of the distal anastomosis was the popliteal artery in 111 and crural artery in 94. The graft consisted of a proximal PTFE graft anastomosed to a distal segment of reversed saphenous vein in 169 or to a modified distal Miller cuff in 36 operations after 1992. RESULTS: Cumulative life table primary patency rates for the whole series at 12, 24 and 36 months were 39%, 32% and 25% respectively. Limbs with good run-off demonstrated significantly better patency rates compared to limbs with poor run-off (55% and 17% at 12 months, 35% and 11% at 36 months, p = 0.04). The patency rate of femorocrural grafts with poor run-off was only 4% at 12 months. The overall limb salvage rates at 12 and 36 months were 63% and 55%, respectively. Similar results were obtained in limbs with distal reversed vein segment and distal vein cuff. CONCLUSION: The results of this study suggest that for infrainguinal bypass grafting where the saphenous vein is unavailable, a composite PTFE-vein graft might be an acceptable alternative in limbs with good run-off. Although not a randomised study, the results using a distal reversed vein segment of a cuff were similar.

Adult↗
PubMed1987

Reversed vein bypass to infrapopliteal arteries. Modern results are superior to or equivalent to in-situ bypass for patency and for vein utilization.

In recent years many reports have attributed improved patency and improved vein utilization with lower extremity arterial bypass to infrapopliteal arteries to the use of the in-situ vein graft technique (ISVB). This report describes 110 reversed vein bypasses (RVB) to infrapopliteal arteries performed from 1980-1986. Thirty-three per cent of these patients did not have an intact ipsilateral greater saphenous vein. One hundred per cent of patients had autogenous RVB performed using a variety of techniques, including vein splicing, use of arm veins, lesser saphenous veins, branch veins, and use of graft origins distal to the common femoral artery. The life table patency figures for these grafts are 90%, 85%, and 85% at 1 year, 3 years, and 5 years, respectively. The life table limb salvage at 5 years is 93%. These figures for patency, vein utilization, and limb salvage for modern RVB to infrapopliteal arteries are clearly equal to or superior to any reported figures for ISVB. Results for RVB are greatly improved when compared with historic controls, as are results for ISVB. There is no evidence to date demonstrating superiority of one technique versus another.

Adult↗
PubMed2003

Increased reactivity of murine mesenteric veins to adrenergic agonists: functional evidence supporting increased alpha1-adrenoceptor reserve in veins compared with arteries.

These studies examined adrenergic reactivity of mesenteric arteries and veins from deoxycorticosterone acetate-salt (DOCA-salt) hypertensive and sham control mice. We measured constrictions in unpressurized arteries and veins by monitoring vessel diameter using computer-assisted video micros-copy in vitro. Veins were more sensitive than arteries to the constricting effects of norepinephrine (NE) and phenylephrine (PE), but the alpha2-agonists clonidine and UK 14,304 [5-bromo-6-(2-imidazolin-2-yl-amino)-quinoxaline] did not constrict arteries or veins. Reactivity was not altered in arteries or veins from DOCA-salt mice. We next investigated the mechanism of increased venous reactivity to NE and PE by studying desensitization to maximum concentrations of NE and PE. Sham arteries desensitized to NE and PE more than DOCA-salt arteries, whereas DOCA-salt and sham veins maintained 80% of the initial NE and PE constriction. To determine whether the increased reactivity and resistance to desensitization in veins was due to a greater alpha-adrenoceptor reserve, vessels were incubated with the alkylating agent phenoxybenzamine (PBZ; 0.3, 3, 10, and 30 nM). The NE-elicited initial constriction was reduced by PBZ (3, 10, and 30 nM) in sham but only by PBZ (30 nM) in DOCA-salt veins. All doses of PBZ blocked NE responses in sham and DOCA-salt arteries. These data suggest that mesenteric veins express more alpha1-adrenoceptors than arteries, accounting for greater reactivity and resistance to desensitization compared with arteries.

Adrenergic Agonists↗
PubMed1999

Partial pressure of oxygen is lower in the left upper pulmonary vein than in the right in adults with atrial septal defect: difference in P(O2) between the right and left pulmonary veins.

BACKGROUND: The right-to-left shunt at the atrial level is responsible for arterial hypoxemia in patients with atrial septal defect. OBJECTIVES: This study investigated the mechanism of arterial hypoxemia in patients with atrial septal defect by measuring the P(O2) in both the right and left upper pulmonary veins. SUBJECTS AND METHOD: We prospectively measured the P(O2) in the femoral artery and the right and left upper pulmonary veins during cardiac catheterization in 13 adults (median age, 53 years) and 7 children (median age, 7 years) with secundum atrial septal defect. The adults and children were studied consecutively. Contrast echocardiography was performed to evaluate right-to-left shunt in all adults. RESULTS: Among the children, there were no patients showing arterial hypoxemia, and there was no difference in the P(O2) (+/-SD) between the right and left upper pulmonary veins (right, 100+/-3.8 mm Hg vs left, 100+/-7.8 mm Hg; p = 0.92). However, arterial hypoxemia was present in 11 of the 13 adult patients, although contrast echocardiography showed more than a moderate degree of right-to-left shunt in only four adults. The P(O2) was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in all adult patients (right, 91.6+/-13.8 mm Hg vs left, 73.0+/-11.5 mm Hg; p < 0.0001). CONCLUSION: The P(O2) was lower in the left upper pulmonary vein than it was in the right upper pulmonary vein in adults with atrial septal defect. Care must be taken in measuring pulmonary blood flow if the P(O2) in the left upper pulmonary vein is low enough to influence oxygen content. The decreased P(O2) in the left upper pulmonary vein may contribute to arterial hypoxemia in addition to right-to-left shunt at the atrial level in adults with atrial septal defect.

Adult↗
PubMed1992

Occlusion of the pig superior sagittal sinus, bridging and cortical veins: multistep evolution of sinus-vein thrombosis.

Cerebral sinus-vein thrombosis may lead to severe hemodynamic changes, elevated intracranial pressure (ICP), and brain edema. It is supposed that progression of the thrombus from the sinus into bridging and cortical veins plays a key role in the development of these pathophysiological changes, but this hypothesis lacks experimental proof. The aim of this study, using a novel animal model of sinus-vein thrombosis, was to evaluate the effects of a standardized occlusion of the superior sagittal sinus and its bridging and cortical veins on hemodynamic alterations, on brain water content, and on ICP in domestic pigs. In 10 animals, the middle third of the superior sagittal sinus was occluded with a catheter-guided balloon. Five of these pigs received an additional injection of 1 ml fibrin glue into the superior sagittal sinus anterior to the inflated balloon, leading to an obstruction of bridging and cortical veins. In five control animals the balloon was inserted but not inflated. Five pigs underwent cerebral angiography. Four hours after occlusion, the brains were frozen in liquid nitrogen, and coronal slices were examined for Evans blue dye extravasation, regional water content, and histological changes. Occlusion of the superior sagittal sinus alone did not affect ICP or cerebral perfusion pressure (CPP). The additional injection of fibrin glue caused an obstruction of cortical and bridging veins as well as severe increases in mean (+/- standard deviation) ICP to 49.4 +/- 14.3 mm Hg, compared with 8.3 +/- 4.5 mm Hg in sham-treated controls and 7.1 +/- 3.9 mm Hg in animals with occlusion of the superior sagittal sinus alone. There was also a steep fall in the mean CPP to 34.2 +/- 19.6 mm Hg compared with 96.4 +/- 13.8 mm Hg in the control group. White-matter water content anterior to the occlusion site was elevated to 81.9 +/- 3.7 gm/100 gm frozen weight in the fibrin group as compared to 70.7 +/- 2.2 gm/100 gm in controls. Posterior to the occlusion site, water content did not differ among the three groups. Angiography demonstrated collateral flow via cortical and bridging veins in animals with occlusion of the superior sagittal sinus alone. Additional fibrin glue obstructed these collateral vessels. The data suggest a multistep process of pathophysiological alterations in patients with sinus-vein thrombosis and may explain why these patients present with a wide variety of symptoms: minor neurological deficits or headache might indicate thrombosis of the superior sagittal sinus and/or its bridging veins.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

[Angiographic aspects of the hepatic veins in portal hypertension in schistosomiasis. The importance in assessing the hepatic vein pressure].

The authors comment upon the importance of the hepatic wedged venous pressure for the appraisal of the circulatory conditions of the portal system, mainly in cirrhotic patients. Wondering about the irregular results obtained in the study of schistosomotic portal hypertensive patients by occlusive catheterization and with the use of an occlusive balloon catheter, noted the scarcity of angiographic studies on the subject in this pathology. Present the angiographic aspects that were obtained from patients with schistosomotic portal hypertension complicated by digestive bleeding, by means of injecting the contrast material into a hepatic vein of the right hepatic lobe via a loosely introduced catheter. Those radiological aspects were distributed in two categories: 1) type I-presenting variable sinusoidal filling. Presence of anastomotic intraparenquimatous communications with or without calibrous anastomotic veins between the hepatic veins, 2) type II-presenting no sinusoidal filling. Presence of multiple anastomotic communications of varied calibers between the hepatic veins. Commenting the difficulty of assessing the wedged pressure in patients with schistosomotic portal hypertension because of the easy communication between the hepatic veins, the authors point out that the measured pressure, in all the cases, will be that of the opposite hepatic vein. That pressure, in this pathology, might represent the sinusoidal resistance (when present) between hepatic veins, instead of relating to the portal vein. Suggestion is made that the measure of the wedged hepatic pressure, in patients with schistosomotic portal hypertension, be appraised considering the angiographic aspects of the hepatic veins.

Angiography↗