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Congenital Hepatic Vascular Malformations  

Microsoft Academic Search

\\u000a Congenital hepatic vascular malformations are rare entities that result in abnormal shunting of blood through the liver. Three\\u000a different types of shunting can occur: arteriovenous (hepatic artery to hepatic vein), arterioportal (hepatic artery to portal\\u000a vein) and portovenous (portal vein to hepatic vein). Malformations result from alterations in the formation of blood vessels\\u000a during fetal development and can occur as

Guadalupe Garcia-Tsao


Vein of Galen malformation  

Microsoft Academic Search

Since 1984, 43 patients with true vein of Galen ancurysmal malformations have been referred to us and managed according to our patient selection, technique, and follow-up guidelines. Thirty-four were embolized transarterially with bucrilate (isobutyl cyanoacrylate) or enbucrilate (N-butyl cyanoacrylate) embolization. No cutdown or hypotension during or after the embolization was used and no balloon catheter was employed. Forty-seven percent of

P. Lasjaunias; R. Garcia-Monaco; G. Rodesch; K. Ter Brugge; M. Zerah; M. Tardieu; D. Victor



Vascular malformations in childhood.  


Vascular malformations are inborn errors of vascular embryogenesis present at birth that should be diagnosed in childhood and, when necessary, treated to prevent later complications. The current trend is to classify these lesions according to flow characteristics and the predominant type of vascular channel affected. Given the complexity, and in many cases, the rarity, of vascular malformations, they should be managed by multidisciplinary teams at vascular anomalies centers. Furthermore, because the association between vascular malformations and certain syndromes is becoming increasingly recognized, a better understanding of these lesions will help to improve overall patient management in this setting. PMID:22483320

Del Pozo, J; Gómez-Tellado, M; López-Gutiérrez, J C



Cervico-Facial Vascular Malformations  

Microsoft Academic Search

\\u000a Craniofacial vascular lesions are best categorized into hemangiomas (i.e., showing proliferation and potential involution) and vascular malformations (i.e., not showing such behavior) [1]. While hemangiomas and PHACE syndrome will briefly be dealt with at the end of this chapter, vascular malformations are\\u000a the main focus of this paper.

Jeyaledchumy Mahadevan; Hortensia Alvarez; Pierre Lasjaunias


Vein of Galen malformations: epidemiology, clinical presentations, management.  


The vein of Galen aneurysmal malformation is a congenital vascular malformation that comprises 30% of the pediatric vascular and 1% of all pediatric congenital anomalies. Treatment is dependent on the timing of presentation and clinical manifestations. With the development of endovascular techniques, treatment paradigms have changed and clinical outcomes have significantly improved. In this article, the developmental embryology, clinical features and pathophysiology, diagnostic workup, and management strategies are reviewed. PMID:22107867

Recinos, Pablo F; Rahmathulla, Gazanfar; Pearl, Monica; Recinos, Violette Renard; Jallo, George I; Gailloud, Philippe; Ahn, Edward S



Compartmentalization of massive vascular malformations.  


A total of 18 patients with massive vascular malformations of the head and neck region were treated with compartmentalization using nonabsorbable sutures followed by injection of a sclerosant agent into each compartment. The indication for compartmentalization was either to stop potentially uncontrollable, life-threatening hemorrhage during the dissection of the lesion or to reduce its vascularity to allow a less dangerous subsequent resection. Compartmentalization was used in both high-flow and low-flow vascular malformations. In this technique, large nonabsorbable sutures are placed deeply in multiple areas within the lesion. The aim is to divide the malformation into multiple compartments by changing the direction of the suturing; in this way the sclerosing agent is provided with a more effective environment. The sclerosant used was either sodium tetradecyl sulfate 3%, absolute alcohol, or both. The total amount of infiltrate varied from 3 to 35 cc, according to the size of malformation. After compartmentalization, swelling was the most noticeable complication. With this technique, it was possible to treat what were considered untreatable malformations using standard techniques and to control the inevitable serious bleeding. PMID:15622226

Jackson, Ian T; Keskin, Mustafa; Yavuzer, Reha; Kelly, Christopher P



Cerebral venous development in relation to developmental venous anomalies and Vein of Galen aneurysmal malformations.  


Cerebrovascular venous development and intracranial vascular malformations are extensive topics for which volumes of text may be devoted. However, a basic knowledge of the embryology of cerebral venous system and venous architecture is essential for understanding of cerebral vascular malformations. The aim of this work is to provide the reader with a brief overview of the development of the cranial venous anatomy. We will highlight the superficial and deep venous systems with special attention to developmental venous anomalies and vein of Galen aneurysmal malformations. PMID:21596280

Pearl, Monica; Gregg, Lydia; Gandhi, Dheeraj



Vascular malformations and arteriovenous fistulas of the kidney.  


Vascular malformations of the kidney are disease processes that involve renal veins and arteries and include congenital arteriovenous malformations (AVMs) and arteriovenous fistulas. AVMs are congenital communications between arteries and veins with a vascular nidus that bypass the capillary bed. Congenital AVMs are rare and subclassified in cirsoid, angiomatous, and aneurysmal types. Congenital AVMs are different from iatrogenic or traumatic arteriovenous fistulas (AVF), which are characterized by a single direct communication between an artery and a vein without an intervening vascular nidus. These lesions may present with a wide range of signs and symptoms that vary from hypertension to renal masses. Imaging is valuable in the detection and characterization of AVM and AVF. The presence of arteriovenous shunting characterizes AVM and AVF. These lesions represent an important group of entities for diagnostic consideration, and understanding the vascular anatomy helps in guiding for proper treatment. This article describes the imaging features of each lesion that help to differentiate it from the others and the endovascular therapies to treat these vascular processes and their possible complications. PMID:20092371

Cura, Marco; Elmerhi, Fadi; Suri, Rajeev; Bugnone, Alejandro; Dalsaso, Timothy



Interventional occlusion of congenital vascular malformations  

Microsoft Academic Search

Background  New materials and devices have been used in the management of cardiac malformations. In this paper, we present our experience\\u000a with interventional occlusion of congenital vascular malformations.\\u000a \\u000a \\u000a \\u000a Methods  Between January 1997 and December 2005, 139 patients with congenital vascular malformations who had undergone interventional\\u000a occlusion in the Children’s Hospital, Zhejiang University School of Medicine were studied. The clinical data of the

Chun-Hong Xie; Cheng-Sen Xia; Fang-Qi Gong; Yin-Bao Zhou; Wei-Hua Zhu



Pathologie neurovasculaire malformative de l'enfant : malformations anévrismales de la veine de Galien (MAVG), malformations artérioveineuses piales (MAVP), malformations des sinus duraux (MSD)  

Microsoft Academic Search

The purpose of this article is to give an overview of the cerebral and spinal cord pediatric malformations; we particularly describe three of them: Vein of Galen arteriovenous Malformation, Pial Arteriovenous Malformation, and Dural Sinus Malformation. We report the experience of Bicêtre since 1981 to 2003, with 317 VGAM, 302 Pial AVM and 30 DSM. We describe natural history, clinical

A. Ozanne; H. Alvarez; T. Krings; P. Lasjaunias



Massive localised lymphoedema: a rare vascular malformation.  


Lymphatic malformations are a subset of congenital vascular malformations, and are caused by a defect in lymphatic development during embryogenesis. When lymphatic mesoderm development is prematurely arrested, it retains it proliferative potential. Stimulus in the future can cause the lesion to proliferate locally without coordination or regulation, resulting in the rare condition known as massive localised lymphoedema (MLL). We present a case report of MLL, a rare and ill-defined soft tissue mass reported in the morbidly obese, with reference to the existing literature. PMID:23761611

Williams, K J; Al-Sakkal, M N; Alsafi, A; Davies, A H



Hemangiomas and Vascular Malformations: Current Theory and Management  

PubMed Central

Vascular anomalies are a heterogeneous group of congenital blood vessel disorders more typically referred to as birthmarks. Subcategorized into vascular tumors and malformations, each anomaly is characterized by specific morphology, pathophysiology, clinical behavior, and management approach. Hemangiomas are the most common vascular tumor. Lymphatic, capillary, venous, and arteriovenous malformations make up the majority of vascular malformations. This paper reviews current theory and practice in the etiology, diagnosis, and treatment of these more common vascular anomalies.

Richter, Gresham T.; Friedman, Adva B.



Percutaneous Treatment of Peripheral Vascular Malformations  

Microsoft Academic Search

Vascular malformations arise from errors in the morphological processes that shape the embryonic\\u000avascular system during fetal development. These developmental errors result in abnormal clusters of\\u000ablood vessels. Although these lesions are present at birth, they might not become visible until weeks or\\u000aeven years after birth. Typically, the lesions grow in proportion to the growth of the child. A

Linden van der E



The challenge of large vascular malformations  

Microsoft Academic Search

Vascular malformations are of the low- or high-flow variety, the latter variety also having shunting characteristics. In this\\u000a manuscript, significant and challenging conditions will be presented. The high-flow lesions can cause excessive growth in\\u000a the local area, and severe bleeding is always a possibility, either spontaneous or during surgery. Clinical examination, angiography,\\u000a and Doppler studies confirm the diagnosis. In treatment

Ian T. Jackson



GI-Associated Hemangiomas and Vascular Malformations  

PubMed Central

Hemangiomas and vascular malformations of the gastrointestinal tract, rare clinical entities, present as overt or occult bleeding. They can be distributed throughout the intestinal digestive system, or present as a singular cavernous hemangioma or malformation, which is often located in the rectosigmoid region. Misdiagnosis is common despite characteristic radiographic features such as radiolucent phleboliths on plain film imaging and a purplish nodule on endoscopy. Adjunctive imaging such as computed tomography and magnetic resonance imaging are suggested as there is potential for local invasion. Endorectal ultrasound with Doppler has also been found to be useful in some instances. Surgical resection is the mainstay of treatment, with an emphasis on sphincter preservation. Nonsurgical endoscopic treatment with banding and sclerotherapy has been reported with success, especially in instances where an extensive resection is not feasible.

Yoo, Stephen



Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management  

Microsoft Academic Search

Objective: To investigate the presence and outcome of uterine vascular malformations in women with abnormal premenopausal bleeding. Study design: In this observational study 265 consecutive patients with abnormal premenopausal bleeding were examined by the same ultrasonographer with transvaginal gray-scale ultrasonography and color Doppler imaging. A final diagnosis of uterine vascular malformation was based on ultrasonographic findings, hysteroscopy or histological findings.

Dirk Timmerman; Thierry Van den Bosch; Karen Peeraer; Ellen Debrouwere; Dominique Van Schoubroeck; Luc Stockx; Bernard Spitz



Syndromes associated with vascular tumors and malformations: a pictorial review.  


Use of the International Society for the Study of Vascular Anomalies (ISSVA) classification system has been strongly recommended in recent years because of the need for separate therapeutic measures for patients with vascular tumors and malformations. In the ISSVA classification system, vascular tumors, which are neoplastic, are distinguished from vascular malformations, which are caused by vascular structural anomalies and are not neoplastic, on the basis of the presence or absence of neoplastic proliferation of vascular endothelial cells. It is important that radiologists be familiar with the development, diagnosis, and treatment of vascular tumors and malformations, especially the imaging features of low- and high-flow vascular malformations. Some vascular tumors and malformations develop in isolation, whereas others develop within the phenotype of a syndrome. Syndromes that are associated with vascular tumors include PHACE syndrome. Syndromes that are associated with vascular malformations include Sturge-Weber, Klippel-Trénaunay, Proteus, blue rubber bleb nevus, Maffucci, and Gorham-Stout syndromes, all of which demonstrate low flow, and Rendu-Osler-Weber, Cobb, Wyburn-Mason, and Parkes Weber syndromes, all of which demonstrate high flow. Because imaging findings may help identify such syndromes as systemic, it is important that radiologists familiarize themselves with these conditions. PMID:23322836

Nozaki, Taiki; Nosaka, Shunsuke; Miyazaki, Osamu; Makidono, Akari; Yamamoto, Asako; Niwa, Tetsu; Tsutsumi, Yoshiyuki; Aida, Noriko; Masaki, Hidekazu; Saida, Yukihisa


MRI characteristics and classification of peripheral vascular malformations and tumors  

Microsoft Academic Search

Vascular malformations and tumors comprise a broad spectrum of lesions that can cause significant morbidity and even mortality\\u000a in children and adults. Classification of vascular malformations into high flow and low flow has significant impact on management\\u000a since the main treatment of the former is transarterial embolization and the later percutaneous sclerotherapy. Magnetic resonance\\u000a imaging (MRI) is a noninvasive effective

Hicham Moukaddam; Jeffrey Pollak; Andrew H. Haims



Neurosurgical vascular malformations in children under 1 year of age  

Microsoft Academic Search

Purpose  This study aims to analyze the clinical and radiological findings, timing and type of treatment, and outcome in children under\\u000a 1 year of age that presented with neurosurgical vascular malformations.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective review of 23 children under 1 year of age with neurosurgical vascular malformations was performed at a single\\u000a institution between 1999 and 2009.\\u000a \\u000a \\u000a \\u000a \\u000a Results  The lesions found in this age group

Graciela Zuccaro; Romina Argañaraz; Francisco Villasante; Alejandro Ceciliano



Parry-Romberg syndrome associated with intracranial vascular malformations.  


We describe a 23-year-old woman with iridocyclitis, enophthalmos, facial hemiatrophy, and transient numbness of her contralateral upper and lower extremities. The patient was found to have white matter densities in the right hemisphere in magnetic resonance T2-weighted images and vascular malformations involving right vertebral, right carotid, and right anterior cerebral arteries. Histopathologic evaluation of a biopsy specimen of anterior orbital fat and lacrimal gland revealed fibrosis and chronic inflammation. These findings were consistent with the diagnosis of progressive facial hemiatrophy (Parry-Romberg syndrome) in association with iridocyclitis and intracranial vascular malformations. PMID:9747688

Miedziak, A I; Stefanyszyn, M; Flanagan, J; Eagle, R C



Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage  

Microsoft Academic Search

Objective\\u000a   In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent\\u000a cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is\\u000a found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the\\u000a occurrence

M. R. Germans; F. A. Pennings; M. E. S. Sprengers; W. P. Vandertop



MRI of non-ischemic vascular disease: aneurysms and vascular malformations  

Microsoft Academic Search

.   Due to flow-void phenomena, MRI is of great value in the demonstration of cerebral aneurysms and vascular malformations as\\u000a well as of related parenchymal changes and hemorrhagic complications. Magnetic resonance angiography can produce vascular\\u000a images which are of importance in the diagnosis and follow-up of the lesions.

G. Wilms; P. Demaerel; H. Bosmans; G. Marchal



Spinal vascular malformations--typical and atypical findings.  


Vascular malformations of the spinal cord and its meninges are rare diseases which comprise true inborn cavernomas and arteriovenous malformations (AVM), including perimedullary fistulae, glomerular and juvenile AVMs, and presumably acquired dural arteriovenous fistulae. This article gives an overview of the imaging features on magnetic resonance imaging (MRI) and digital subtraction angiography of both typical and atypical findings to describe the wide variety of possible pathological entities encountered. Clinical differential diagnoses, the neurological symptomatology and potential therapeutic approaches of these diseases, which may vary depending on the underlying pathology, are given. Although MRI constitutes the first choice diagnostic modality for suspected spinal vascular malformations, we conclude that the definite diagnosis of the disease and thus the choice of the appropriate therapeutic approach rests on selective spinal angiography which should be performed at a specialized center. Treatment in symptomatic patients offers an improvement in prognosis. Microsurgical treatment is recommended for symptomatic spinal cord cavernomas. Dural arteriovenous shunts can either be treated by microsurgical or endovascular approaches, the former being a simple, quick and secure approach to obliterate the fistula while the latter is technically demanding. In spinal arteriovenous malformations of both the fistulous and the glomerular type, the endovascular approach is the method of first choice; in selected cases, surgery or a combined therapy may be necessary. PMID:17966075

Bostroem, A; Thron, A; Hans, F J; Krings, T



Diagnosis and management of extensive vascular malformations of the lower limb: part I. Clinical diagnosis.  


There is significant confusion in the literature when describing vascular anomalies, and vascular malformations are often misnamed or incorrectly classified. Part I of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limbs will discuss the dermatologist's role in the diagnosis of these lesions. At least nine types of vascular malformations with specific clinical and radiologic characteristics must be distinguished in the lower limbs: Klippel-Trénaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. This article highlights the differences in clinical appearance and discusses the differential diagnosis of extensive vascular malformations in an attempt to ensure earlier diagnosis and better outcomes for these patients. PMID:22000870

Redondo, Pedro; Aguado, Leyre; Martínez-Cuesta, Antonio



Photosclerosis of cutaneous vascular malformations with a pulsed 810-nm diode laser  

NASA Astrophysics Data System (ADS)

Various continuous wave lasers have been effectively used for sclerosis of cutaneous vascular lesions. The risk of scarring has been as high as 15% in some applications, however. Pulse dye lasers have virtually eliminated scarring as a complication, substituting high cost and cumbersome operation. Pre-clinical studies have demonstrated the ability of the 810 nm gallium-aluminum-arsenide diode laser in photosclerosis. In this study, a small group of patients (n equals 6) were treated with a pulsed 810 nm diode laser (Surgimedics, The Woodlands, TX). Pulse widths used were 5 - 15 msec with corresponding energy densities during the square wave pulse of 14 - 42 J/cm2. Pulse interval was 32 msec. Lesions treated include telangiectasias (n equals 5), spider veins, (n equals 4), capillary dermal malformation (n equals 1) and a cutaneous venous malformation (n equals 1). Lower extremity spider veins were the most resistent to treatment, rarely disappearing entirely. Telangiectasias were most responsive, usually disappearing after one treatment. No scarring was noted and textural changes were seen in only one patient. While these data are preliminary and parameters have not been optimized, pulsed diode laser exposure can be an effective treatment for cutaneous vascular lesions.

Bass, Lawrence S.



Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: Doppler sonographic screening in a large family  

Microsoft Academic Search

Background\\/Aims: The prevalence of hepatic vascular malformations in hereditary hemorrhagic telangiectasia has been estimated in the literature on clinical criteria, thus giving unreliable data. In our study the presence of hepatic vascular malformations in hereditary hemorrhagic telangiectasia was evaluated in a large Italian family by using Doppler sonography as screening technique. Doppler sonographic findings were compared to computed tomography and

Elisabetta Buscarini; Luigi Buscarini; Cesare Danesino; Mauro Piantanida; Giuseppe Civardi; Pietro Quaretti; Sandro Rossi; Michele Di Stasi; Matteo Silva



Quality of life in patients with vascular malformations of the lower extremity  

Microsoft Academic Search

With the exception of capillary malformations (port-wine stains), the adverse psychosocial effects of vascular malformations have not received much attention in the medical literature. We, therefore, studied health related quality of life of patients with vascular malformations located primarily on the lower extremity, who presented to us over a 10-year period. Patient's self-assessment of quality of life was measured by

Corstiaan C. Breugem; Maruschka P. Merkus; J. Henk Sillevis Smitt; Dink A. Legemate; Chantal M. A. M. van der Horst



Vascular Lesions: GLUT-1 expression as a diagnostic tool to discriminate tumors from malformations.  


Vascular lesions constitute a widely heterogeneous group of tumors and malformations. For head and neck vascular anomalies, most studies have not attempted to make the differential diagnosis between true hemangiomas and vascular malformations, because an accurate diagnosis remains a challenge for physicians. The successful treatment of vascular anomalies depends on a profound knowledge of their biologic behavior and correct classification. Recently, specific immunohistochemical markers such as erythrocyte-type glucose transporter protein 1 have been described to differentiate hemangiomas from vascular malformations. This report describes 2 cases of intramuscular vascular anomalies involving the masseter muscle histologically diagnosed primarily as cavernous hemangiomas and presents the imaging and pathologic findings. Ample surgical excision was performed through an intraoral approach. Immunohistochemistry showed no uptake of glucose transporter protein 1. The literature was reviewed and the designation intramasseteric vascular malformation for this entity is proposed. PMID:22330334

Patiño-Seijas, Beatriz; Lorenzo-Franco, Fernanda; Rey-Sanjurjo, José Luis; González-Cuesta, Margarita; López-Cedrún Cembranos, José Luis



Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations.  


Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zürich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision. PMID:1162593

Ya?argil, M G; DeLong, W B; Guarnaschelli, J J



Interventional management of high-flow vascular malformations.  


High-flow vascular malformations are among the most challenging lesions in the field of interventional radiology. For an optimal long-term result, the clinician must have a full understanding of the types of lesions, their natural history, appropriate diagnostic studies, indications for treatment, and all the treatment options, including surgery, embolization, laser, and pharmacotherapy. Surgery should, in general, be used primarily for lesions that are completely resectable or are so bulky that embolization would not provide a satisfactory result. Embolization techniques are directed at elimination of the nidus of the lesion, using a variety of penetrating embolic agents both by direct puncture and transcatheter approaches. This paper reviews the principles and techniques primarily involving embolization for lesions occurring in various parts of the body, emphasizing the lessons learned in treating more than 2000 patients over a 30-year period. PMID:23499129

Rosen, Robert J; Nassiri, Naiem; Drury, Jennifer E



Vaginal vascular malformation mimicking pelvic organ prolapse requiring serial embolizations.  


Vaginal vascular malformation (VVM) is rare. There are, in fact, less than ten cases reported to date. VVM often presents as a mass protruding from the vagina, mimicking pelvic organ prolapse (POP). It can coexist with POP, thereby usually exaggerating the severity of POP. We report a case of VVM in a premenopausal woman who presented as severe POP and urinary incontinence. The diagnosis was confirmed with computed tomography (CT) scan and angiography. The patient underwent conservative management with embolization. These procedures had to be repeated three times in 1.5 years due to lesion recurrence. In mitigation, conservative treatment eliminates the risks associated with surgery, e.g. massive hemorrhage and visceral injuries. It does, however, require a long course of treatment and follow-up. PMID:23430075

Pue, Leng Boi; Lo, Tsia-Shu; Wu, Pei-Ying



Cerebral Cavernous Malformations: Somatic Mutations in Vascular Endothelial Cells  

PubMed Central

OBJECTIVE Germline mutations in three genes have been found in familial cases of cerebral cavernous malformations (CCM). We previously discovered somatic and germline truncating mutations in the KRIT1 gene supporting the “two-hit” mechanism of CCM lesion formation in a single lesion. The purpose of this study was to screen for somatic, nonheritable, mutations in three more lesions from different patients and identify the cell type(s) in which somatic mutations occur. METHODS Somatic mutations were sought in DNA from three surgically excised, fresh-frozen CCM lesions by cloning and screening PCR products generated from KRIT1 or PDCD10 coding regions. Laser capture microdissection (LCM) was used to isolated endothelial and nonendothelial cells in order to determine if somatic mutations were found in endothelial cells. RESULTS A CCM lesion harbored somatic and germline KRIT1 mutations on different chromosomes and are therefore biallelic. Both mutations are predicted to truncate the protein. The KRIT1 somatic mutations (novel c.1800delG mutation and previously identified 34 nucleotide deletion) in CCMs from two different patients were only found in the vascular endothelial cells lining caverns. No obvious somatic mutations were identified in the two other lesions; however, the results were inconclusive possibly due to the technical limitations or the fact that these specimens had a small proportion of vascular endothelial cells lining pristine caverns. CONCLUSION The “two-hit” mechanism occurs in vascular endothelial cells lining CCM caverns from two patients with somatic and Hispanic-American KRIT1 germline mutations. Methods for somatic mutation detection should focus on vascular endothelial cells lining pristine caverns.

Gault, Judith; Awad, Issam A.; Recksiek, Peter; Shenkar, Robert; Breeze, Robert; Handler, Michael; Kleinschmidt-DeMasters, Bette Kay



Surgical treatment of spinal vascular malformations performed using intraoperative indocyanine green videoangiography.  


This study aims to evaluate the benefits of intraoperative indocyanine green (ICG) videoangiography and associated surgical outcomes of patients with spinal vascular malformations. ICG videoangiography was used during 24 surgical interventions to treat spinal vascular malformations at the Beijing Tiantan Hospital from August 2009 to May 2011. The vascular malformations were removed or the fistulae were occluded with the assistance of ICG videoangiography. The completeness of fistula clipping or nidus extirpation and each patient's neurological status were evaluated. Among these 24 patients, there were seven with spinal dural arteriovenous fistulae, five glomus arteriovenous malformations, one juvenile arteriovenous malformation, nine perimedullary arteriovenous fistulae, and two perimedullary arteriovenous fistulae in combination with perimedullary arteriovenous malformations. Intraoperative ICG videoangiography confirmed the definite clipping of the fistulous points and complete removal of intramedullary arteriovenous malformations in all but one patient. All patients had satisfactory preservation of spinal cord blood supply and venous return. No adverse effects or complications related to ICG videoangiography occurred. Three patients were lost to follow up; 21 patients were followed clinically with a mean follow up of 7.5 months. The neurological deficits completely resolved in six patients, improved significantly in 10, remained stable in two, and were aggravated in three patients. Our experience shows that intraoperative ICG videoangiography offers useful information on the pathological and physiological vascular anatomy encountered during surgery for spinal vascular malformations. PMID:23632289

Wang, Guihuai; Ma, Guangshuo; Ma, Jun; Hao, Shuyu; Li, Dezhi; Han, Lijiang; Wang, Tao; Su, Wei; Han, Bo; Yen, Chun-Po; Kwan, Aij-Lie



Prevalence of oral hemangioma, vascular malformation and varix in a Brazilian population.  


Hemangioma, vascular malformation and varix are benign vascular lesions, common in the head and neck regions. Studies about the prevalence of these lesions in the oral cavity are scarce. The aim of this study was to estimate the prevalence of and to obtain clinical data on oral hemangioma, vascular malformation and varix in a Brazilian population. Clinical data on those lesions were retrieved from the clinical forms from the files of the Oral Diagnosis Service, School of Dentistry, Federal University of Minas Gerais, Brazil, from 1992 to 2002. Descriptive analysis was performed. A total of 2,419 clinical forms in the 10-year period were evaluated, of which 154 (6.4%) cases were categorized as oral hemangioma, oral vascular malformation or oral varix. Oral varix was the most frequent lesion (65.6%). Females had more oral hemangioma and oral varix than males. Oral vascular malformation and oral varix were more prevalent in the 7th and 6th decades, respectively. Oral hemangioma and oral varix were more prevalent in the ventral surface of the tongue and oral vascular malformation, in the lips. Oral hemangioma was treated with sclerotherapy (54.5%), and vascular malformation was managed with sclerotherapy and surgery (19.4% each). The data of this study suggests that benign vascular lesions are unusual alterations on the oral mucosa and jaws. PMID:17384854

Corrêa, Priscila Henriques; Nunes, Lara Cristina Caldeira; Johann, Aline Cristina Batista Rodrigues; Aguiar, Maria Cássia Ferreira de; Gomez, Ricardo Santiago; Mesquita, Ricardo Alves


Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options  

Microsoft Academic Search

Vascular malformations can be classified into high-flow arteriovenous malformations (AVM) and low-flow venous or lymphatic\\u000a malformations (VM\\/LM). VMs and LMs have the ability to cross multiple tissue boundaries. Not only is subcutaneous tissue often\\u000a involved, but multiple muscle groups, tendons, bone cortex and bone marrow are also not uncommonly violated. Magnetic resonance\\u000a imaging (MRI) provides valuable information for the assessment

Laura Fayad; Tuncay Hazirolan; David Bluemke; Sally Mitchell



Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations  

Microsoft Academic Search

Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. Bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was

T. Muir; M. Kirsten; P. Fourie; N. Dippenaar; G. O. Ionescu



Pharmacological therapy of vascular malformations of the gastrointestinal tract  

PubMed Central

Vascular malformation (AVM) in the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and iron deficiency anemia, especially in an aging population. While endoscopic coagulative therapy is the method of choice for controlling bleeding, a substantial number of cases require additional therapy. Adjunctive or even primary phamacotherapy may be indicated in recurrent bleeding. However, there is little evidence-based proof of efficacy for any agent. The bulk of support is derived from anecdotal reports or case series. The present review compares the outcome of AVM after no intervention, coagulative therapy or focus on pharmacological agents. Most of the literature encompasses two common AVMs, angiodysplasia and hereditary hemorrhagic telangiectasia. Similarly, the bulk of information evaluates two therapies, hormones (estrogen and progesterone) and the somatostatin analogue octreotide. Of these, the former is the only therapy evaluated in randomized trials, and the results are conflicting without clear guidelines. The latter therapy has been reported only as case reports and case series without prospective trials. In addition, other anecdotally used medications are discussed.

Szilagyi, Andrew; Ghali, Maged P



Diagnosis and management of extensive vascular malformations of the lower limb: part II. Systemic repercussions [corrected], diagnosis, and treatment.  


At least nine types of vascular malformations with specific clinical and radiologic characteristics must be distinguished in the lower limbs: Klippel-Trénaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. Extensive vascular malformations are often more complex than they appear and require a multidisciplinary therapeutic approach. Vascular malformations may be associated with underlying disease or systemic anomalies. Part II of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limb highlights the systemic repercussions [corrected] (bone, articular, visceral, and hematologic involvement), diagnosis, and treatment of these lesions. PMID:22000871

Redondo, Pedro; Aguado, Leyre; Martínez-Cuesta, Antonio



Pediatric Vascular Malformations: Pathophysiology, Diagnosis, and the Role of Interventional Radiology  

Microsoft Academic Search

The Mulliken and Glowacki classification (1982) differentiated vascular anomalies into two groups based on their endothelial\\u000a characteristics: hemangiomas and vascular malformations. Vascular anomalies are localized defects of the vasculature that\\u000a affect a limited number of vessels in a restricted area of the body. These defects are secondary to errors in vascular morphogenesis.\\u000a Depending on the type of vessel involved, the

Anne Marie Cahill; Els Louisa Francine Nijs


Multispectral imaging of pigmented and vascular cutaneous malformations: the influence of laser treatment  

NASA Astrophysics Data System (ADS)

The paper investigates influence and efficacy of laser therapy on pigmented and vascular cutaneous malformations by multispectral imaging technique. Parameter mapping of skin pigmented and vascular lesions and monitoring of the laser therapy efficacy are performed by multispectral imaging in wavelength range 450-700nm by scanning step - 10nm. Parameter maps of the oxyhemoglobin deoxyhemoglobin and melanin derived from the images are presented. Possibility of laser therapy efficacy monitoring by comparison of the parameter maps before and after laser treatment has been demonstrated. As both cutaneous pigmented and vascular malformations are commonly found lesions, the parameter mapping would be a valuable method to use routinely.

Kuzmina, Ilona; Diebele, Ilze; Asare, Lasma; Kempele, Anna; Abelite, Anita; Jakovels, Dainis; Spigulis, Janis



[Vascular malformations: the need for a multidisciplinary treatment. Considerations on a clinical case].  


The case reported here is a paradigm of a complex vascular malformation with a therapeutic approach which involved both vascular radiology and surgery. The case came to our attention in 1999 and consisted in a tumefaction of the left gluteal region in a 14-year-old female. The lesion had previously been evaluated by ultrasonography and magnetic resonance imaging. The lesion was described as a dysplastic malformation with a high vascular factor. After angiography, we decided to embolize the mass. A second embolization also yielded no result, and therefore we decided to remove the dysplasia surgically. The dysplasia, however, was resolved only in 2001 after a third embolization. Because of the multiple types of symptoms, a multidisciplinary approach is required to obtain both a correct classification and treatment of the vascular malformations. PMID:15152524

Eleuteri, Edoardo; Coppola, Marcello; Midiri, Giuseppe; Amanti, Claudio; Papaspyropoulos, Vassilios; Scardella, Laura; Di Giovan Paolo, Marco; Angelini, Licinio


Functional and topographical considerations in the surgical management of cerebral vascular malformations  

PubMed Central

Cerebral vascular malformations with potential surgical consequences mainly consist of arteriovenous malformations (AVM) and cavernous malformations. The standard preoperative workup of these lesions includes basic neuroradiological investigation, such as computed tomography, magnetic resonance imaging (MRI), and magnetic resonance angiography, and conventional angiography, to assess the exact neurotopographical relationships of the nidus, arterial feeding pedicles, and venous drainage. In cases where lesions are located near or within eloquent areas, precise documentation of the anatomy can be obtained using various functional tests including functional MRI, activated positron emission tomoqraphy, and magnetoencephalography (MEG), which may then be integrated into a neuronavigational system allowing for selective, image-guided surgery, thus potentially reducing surgical morbidity. Preoperative embolization may in certain cases improve the surqical excision by reducinq blood flow throuqh the AVM. Cavernous malformations may also be removed with minimally invasive and highly selective techniques.

Mohr, Gerard; Tampieri, Donatella; Klein, Denise; Soualmi, Lahbib



Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations  

SciTech Connect

Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig.

Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.



RGB imaging system for monitoring of skin vascular malformation's laser therapy  

NASA Astrophysics Data System (ADS)

A prototype RGB imaging system for mapping of skin chromophores consists of a commercial RGB CMOS sensor, RGB LEDs ring-light illuminator and orthogonally orientated polarizers for reducing specular reflectance. The system was used for monitoring of vascular malformations (hemagiomas and telangiectasias) therapy.

Jakovels, Dainis; Kuzmina, Ilona; Berzina, Anna; Spigulis, Janis



ORIGINAL RESEARCH White Matter Reorganization After Surgical Resection of Brain Tumors and Vascular Malformations  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) and white matter tractography (WMT) are promising techniques for estimating the course, extent, and connectivity patterns of the white matter (WM) structures in the human brain. In this study, DTI and WMT were used to evaluate WM tract reorganization after the surgical resection of brain tumors and vascular malformations. METHODS: Pre- and postoperative

M. Lazar; A. L. Alexander; P. J. Thottakara; B. Badie; A. S. Field


The cerebral cavernous malformation signaling pathway promotes vascular integrity via Rho GTPases  

Microsoft Academic Search

Cerebral cavernous malformation (CCM) is a common vascular dysplasia that affects both systemic and central nervous system blood vessels. Loss of function mutations in the CCM2 gene cause CCM. Here we show that targeted disruption of Ccm2 in mice results in failed lumen formation and early embryonic death through an endothelial cell autonomous mechanism. We show that CCM2 regulates endothelial

Aubrey C Chan; Sutip Navankasattusas; Wonshill Koh; Nyall R London; Jing Ling; Anne H Mayo; Stavros G Drakos; Christopher A Jones; Weiquan Zhu; Douglas A Marchuk; George E Davis; Kevin J Whitehead; Dean Y Li



Focal congenital lipoatrophy and vascular malformation: a mild form of inverse Klippel-Trenaunay syndrome?  


A 2 year-and seven month-old male boy with vascular malformation and localized soft tissue hypotrophy is reported. Such presentation could represent the mildest end of the spectrum of 'inverse' Klippel-Trenaunay syndrome, a recently proposed disorder presenting with tissue hypotrophy as opposed to partial or complete limb overgrowth of classic Klippel-Trenaunay syndrome. PMID:23000147

Cappuccio, Gerarda; Brunetti-Pierri, Nicola



Chronic Iliac Vein Occlusion and Painful Nonhealing Ulcer Induced by High Venous Pressures from an Arteriovenous Malformation  

PubMed Central

Chronic femoral vein compression (May-Thurner Syndrome) is a known rare cause of deep venous thrombosis. Subsequent angiogenesis and the development of arteriovenous malformation (AVM) in the setting of chronic venous thrombosis is by itself a rare and poorly understood phenomenon. We report a case in which elevated venous pressures resulting from such compression appear to have resulted in the development of a pelvic arteriovenous malformation, which was further complicated by chronic, nonhealing painful lower extremity ulcers, and the development of extensive subcutaneous venous collaterals. Following successful embolization of the pelvic AVM and ablation of veins under the ulcers with laser and sclerotherapy, the patient's ulcers healed and she became pain-free.

Link, Daniel P.; Granchi, Phillip J.



Bilateral pectoral musculature malformations with concomitant vascular anomaly.  


We report on a unique combination of multiple variations concerning the pectoral muscles and the left external jugular vein. Specifically, a bilateral hypoplasia of the medial clavicular portion of the pectoralis major muscle was noticed along with the coexistence of total right pectoralis minor aplasia, substituted by loose connective and fatty tissue. Simultaneously, a supernumerary anterior-placed external jugular vein was found, which, after its supraclavicular course, pierced the interval between the left clavicular and the sternocostal head, and drained into the left jugular junction. The combination of the above anomalies constitutes an atypical pattern of Poland syndrome. We discuss the related embryological development and the relative literature. Attention was paid to the clinical importance for plastic surgeons, general surgeons, and radiologists, facilitating them with accurate interpretation of anterior thoracic wall findings. PMID:21154292

Paraskevas, G K; Raikos, A



Vein of Galen Aneurysmal Malformations: An Ultrasonographic Incidental Finding--A Case Report  

PubMed Central

Background. The Vein of Galen aneurysmal malformation (VGAM) is a rare congenital, cerebral, arteriovenous deformity. Good cross-discipline cooperation is in demand because of associated complications and high mortality. The recognition of the optimal therapeutic window is useful to allow proper management. Case Report. We report on the successful treatment of a 2-week-old, healthy girl with a VGAM, which came across in the context of the newborn ultrasonographic screening. After interdisciplinary discussion, 2 embolizations of the VGAM followed without complications—the first in the age of 6 months and the second at 12 months of life. Before and after the intervention, the patient had an age-appropriate development without neurological deficits. Conclusion. The endovascular transarterial embolization is described as the treatment of choice. Time and method of intervention depend on clinical signs of the patient. In our case the patient was asymptomatic. So the arteriovenous abnormality was an incidental finding by ultrasound. Because of the natural history of the disease, and the potential severe neurocognitive consequences at long-term followup if left untreated, it was decided to embolize the lesion. Thanks to embolization with glue, good therapeutical and clinical results could be obtained with normal neurological development.

Stephan, S.; Rodesch, G.; Elolf, E.; Wiemann, D.; Jorch, G.



Intraoperative localization of vascular malformation of small bowel by selective intra-arterial dye injection.  


Angiomatous malformation is the most common vascular abnormality, accounting for 30-40% cases of obscure GI bleeding from small bowel. Surgical resection is the treatment of choice in severe or recurrent hemorrhage requiring multiple blood transfusions. However, the diffuse nature of the lesions poses a challenge to localize them accurately preoperatively, for exact resection. We present a case in which we have used selective mesenteric angiography with selective cannulation and exact localization of the lesion by injecting dye such as methylene blue, indigo carmine, and fluorescein, to localize the angiomatous malformation before surgical resection and also to determine the exact resection to be done. PMID:20871200

Eshpuniyani, Priya B; Kantharia, Chetan V; Prabhu, Ramkrishna Y; Supe, Avinash N


Intra-vascular leiomyoma of the popliteal vein.  

PubMed Central

A large mass in the popliteal fossa was found to be a leiomyoma of the popliteal vein with portions of tumour both inside and outside the vein. This is only the second recorded case of a benign smooth muscle tumour of a peripheral vein. Images Figure 1

Grimer, R. J.; Armstrong, G. R.



Long-time octreotide in an adolescent with severe haemorrhagic gastrointestinal vascular malformation  

PubMed Central

Gastrointestinal vascular malformations are a rare cause of acute or chronic blood loss. Usually they are treated by endoscopic obliteration or surgical resection. When such a therapy is inapplicable, pharmacotherapy may be required. At the age of 15 years, our female patient suffered from transfusion dependent recurrent gastrointestinal haemorrhage due to multiple gastrointestinal vascular malformations. Gastroscopy, coloscopy and capsule endoscopy revealed numerous foci making both endoscopic obliteration and complete surgical resection impossible. Neither regular transfusions nor substitution with coagulation factors were helpful. However, subcutaneous octreotide resulted in immediate stop of bleeding. Initial treatment by daily subcutaneous injections was followed by monthly depot application. Over 3 years only 2 transfusions had to be given. The patient required thyroxin substitution, otherwise, no side effects occurred and the girl had a good quality of life. The authors conclude that octreotide is safe and effective in gastrointestinal angiodysplasias inaccessible to endoscopy or surgery.

Classen, Carl Friedrich; Haffner, Dieter; Hauenstein, Christina; Wolf, Ricarda; Kyank, Ulrike



Percutaneous Treatment of Peripheral Vascular Malformations in Children: Long-Term Clinical Outcome  

SciTech Connect

Purpose: This study was designed to assess the rate of complications and clinical failure at 3 and 12 months after percutaneous treatment of vascular malformations in children. Furthermore, we describe patient satisfaction of treatment results during 5 years of follow-up. Methods: In a retrospective cohort study, we evaluated 26 patients younger than aged 19 years who were treated for symptomatic vascular malformations. Data on treatment outcomes and patient satisfactions were obtained with a precoded structured questionnaire. Patient files and imaging data were retrieved to obtain information regarding the vascular malformations and treatment. Clinical success was defined as disappearance or partial improvement of the complaints. Patient satisfaction was declared whenever patients answered in the questionnaire that they were satisfied with the treatment results. Results: Of 26 eligible patients, we included 23 (88%). The mean follow-up was 36 (range, 15-127) months. Posttreatment, 87% (20/23; 95% confidence interval (CI), 66-97%) of patients reported clinical success at 3 months. At 1, 2, 3, 4, and 5 years of follow-up this percentage was 74%, 59%, 59%, 59%, and 59%, respectively. Eleven (48%, 95% CI 27-69%) patients had experienced complications and 22% (95% CI 7-44%) had major complications, of which 5 had required additional treatment. In all, 83% (19/23) of the patients reported satisfaction with the treatment. Conclusions: Percutaneous treatment of vascular malformations improved clinical symptoms in 87% of the patients at 3 months and were sustainable for half of all patients during a 5-year follow-up period. However, major complications were seen in 22%.

Linden, Edwin van der, E-mail: [Medical Center Haaglanden, Department of Radiology (Netherlands); Otoide-Vree, Marleen [Medical Center Haaglanden, Landsteiner Institute (Netherlands); Pattynama, Peter M. T. [Groene Hart Hospital, Erasmus Medical Center Rotterdam, Department of Radiology (Netherlands)



Contrast-enhanced sonography as a novel tool for assessment of vascular malformations  

Microsoft Academic Search

Background  Vascular malformations with arteriovenous shunt components can cause significant disability, chronic pain, and functional\\u000a impairment. Effective treatment may require serial procedures, yet an imaging modality optimized to control cost and reduce\\u000a radiation exposure in this predominantly pediatric population has not yet been identified.\\u000a \\u000a \\u000a \\u000a \\u000a Methods and Results  We describe the use of contrast-enhanced sonography as a novel tool to define vascular anatomy

Yukiko Oe; Lauren Orr; Sherelle Laifer-Narin; Eiichi Hyodo; Agnes Koczo; Shunichi Homma; Jessica Kandel; Philip Meyers



Central retinal vein occlusion and scleroderma: implications for sclerodermatous vascular disease.  

PubMed Central

A patient with scleroderma (progressive systemic sclerosis) who developed central retinal vein occlusion is described. The aetiology of this condition is discussed and the role of possible sclerodermatous vascular disease is highlighted. It is suggested that studies of fundal vasculature could be useful in the clinical assessment of sclerodermatous vascular disease. Images

Littlejohn, G O; Urowitz, M B; Pavlin, C J



[Application of cyanoacrylate glue and ethylene vinyl alcohol copolymer for the treatment of vascular malformations of the central nervous system].  


Arterio-venous malformations (AVMs) and dural arterio-venous fistulas (AVFs) are relatively rare developmental vascular system disorders and constitute the majority of vascular malformations of the nervous system. The malformations are characterized by a large variety of vascular architecture. Intracranial or intramedullary hemorrhage constitute the most serious complications of the malformations. The algorithm of management aiming at complete recovery or hemorrhage prevention has not been completely established yet due to considerable individual variability of malformations. The obliteration of malformations pathological vessels using cyanoacrylate glue or ethylene vinyl alcohol copolymer (EVOH)--so called endovascular embolization--has been the most dynamically developing treatment method recently. The procedure, unlike classical surgical resection of pathological vessels, is significantly less invasive and associated with shorter hospitalization period. The features and properties of embolization agents (cyanoacrylate and EVOH) as well as application of the agents for treatment of the vascular pathologies of the central nervous system are discussed in the paper. The procedure of endovascular introduction of embolization agents into the lumen of malformation vessels is also presented in the article. The analyzed literature and own experiences allow to claim that the application of cyanoacrylate and EVOH is a relatively safe therapeutic method that in part of the cases enables complete embolization of pathological vessels. The development of endovascular systems and the advances in embolization agents should trigger further intensive improvement of the technique. PMID:21387843

Guzi?ski, Maciej; Kurcz, Jacek; Bereza, S?awomir; Garcarek, Jerzy; Sasiadek, Marek



Stabiliztin of VEGFR2 Signaling by Cerebral Cavernous Malformation 3 is Critical for Vascular Development  

SciTech Connect

Cerebral cavernous malformations (CCMs) are human vascular malformations caused by mutations in three genes of unknown function: CCM1, CCM2, and CCM3. CCM3, also known as PDCD10 (programmed cell death 10), was initially identified as a messenger RNA whose abundance was induced by apoptotic stimuli in vitro. However, the in vivo function of CCM3 has not been determined. Here, we describe mice with a deletion of the CCM3 gene either ubiquitously or specifically in the vascular endothelium, smooth muscle cells, or neurons. Mice with global or endothelial cell-specific deletion of CCM3 exhibited defects in embryonic angiogenesis and died at an early embryonic stage. CCM3 deletion reduced vascular endothelial growth factor receptor 2 (VEGFR2) signaling in embryos and endothelial cells. In response to VEGF stimulation, CCM3 was recruited to and stabilized VEGFR2, and the carboxyl-terminal domain of CCM3 was required for the stabilization of VEGFR2. Indeed, the CCM3 mutants found in human patients lacking the carboxyl-terminal domain were labile and were unable to stabilize and activate VEGFR2. These results demonstrate that CCM3 promotes VEGFR2 signaling during vascular development.

Y He; H Zhang; L Yu; M Gunel; T Boggon; H Chen; W Min



Treatment of High-Flow Vascular Malformations by Venous Embolization Aided by Flow Occlusion Techniques  

SciTech Connect

Purpose: Transvenous embolization techniques may be helpful as alternatives to the arterial route when treating high-flow vascular malformations. We present our experience using these techniques in four patients. Methods: In one patient the venous portion of the arteriovenous malformation (AVM) was punctured directly; in the other three patients it was catheterized via a retrograde venous approach. Flow occlusion techniques were utilized in all patients during embolization, which was performed with absolute alcohol or N-butyl-2-cyanoacrylate.Results: Excellent clinical and angiographic results were obtained, with obliteration of arteriovenous shunting in all patients. There were no complications.Conclusion: The embolization of certain AVMs using a venous approach is a safe and effective treatment.

Jackson, James E. [Department of Diagnostic Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 OHS (United Kingdom); Mansfield, Averil O. [Department of Surgery, St. Mary's Hospital, Praed Street, London W2 (United Kingdom); Allison, David J. [Department of Diagnostic Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 OHS (United Kingdom)



Normalization of pulmonary vascular resistance long after successful primary sutureless repair for congenital pulmonary vein stenosis.  


A 3-month-old infant with perimembranous ventricular septal defect (VSD) and pulmonary hypertension presented at our center. Cardiac catheterization showed a systolic pulmonary-to-systemic arterial pressure ratio of 0.99 and a pulmonary vascular resistance of 9.32 ?m(2). Pulmonary angiography showed focal orifice stenosis in the right lower and left lower and upper pulmonary veins, whereas the right upper pulmonary vein was atretic. Sutureless pericardial marsupialization concomitant with VSD patch closure was used to repair the three stenotic veins. Administration of home oxygen therapy and sildenafil citrate was continued after surgical repair. Postoperative catheterization 1.5 years after surgery showed patency of the three repaired veins and normalization of pulmonary vascular resistance. PMID:21509494

Hoashi, Takaya; Kagisaki, Koji; Sakaguchi, Heima; Ichikawa, Hajime



Cerebral cavernous malformation gene CCM3 is critical for vascular development by regulating VEGFR2 signaling *  

PubMed Central

Cerebral cavernous malformations (CCMs) are human vascular malformations caused by mutations in three genes of unknown function: CCM1, CCM2, and CCM3. CCM3, also known as PDCD10 (programmed cell death 10), was initially identified by its mRNA induction by apoptotic stimuli in vitro. However, the in vivo function of CCM3 has not been determined. Here, we describe mice with a deletion of the CCM3 gene either ubiquitously or specifically in certain cell types, including the vascular endothelium, smooth muscle cells, and neurons. Mice with global or endothelial cell-specific deletion of CCM3 die at embryonic stage, exhibiting defects in embryonic angiogenesis. CCM3 deletion reduces VEGFR2 signaling in embryos and derived endothelial cells. CCM3 is recruited to and stabilizes VEGFR2 in response to stimulation by VEGF, and the C-terminal domain of CCM3 is required for the stabilization of VEGFR2. Indeed, the CCM3 mutants found in human patients with a deletion of the C-terminal domain were labile, and unable to stabilize and activate VEGFR2. These results demonstrate that CCM3 regulates vascular development by modulating VEGFR2 signaling.

He, Yun; Zhang, Haifeng; Yu, Luyang; Gunel, Murat; Boggon, Titus J.; Chen, Hong; Min, Wang



Microvascular proliferation in congenital vascular malformations of skin and soft tissue  

PubMed Central

Background Congenital vascular malformations (VMs) are mass?forming lesions that usually progress slowly, but may become symptomatic because of episodes of sudden growth and pain, particularly those with a substantial component of arteriovenous shunting. Aim To systematically investigate the features of microvascular proliferation in a large series of surgically treated VMs. Methods 107 resection specimens of clinically and histologically well?documented VMs were screened for the presence and extent of microvascular proliferation, based on morphological parameters, microvessel density (MVD), mast cell density (MCD) and proliferative activity (Ki?67 labelling index) of endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). The extent of microvascular proliferation was correlated with the histological type of VM and clinical characteristics of patients. Results Microvascular proliferation was observed in 32 (30%) of all VMs, of which 30 cases seemed to be arteriovenous malformations. MVD in areas of microvascular proliferation was 282 (186)/mm2 vs 13 (9)/mm2 in areas with mature vessels. Both ECs and VSMCs in these areas showed high Ki?67 labelling indexes (mean (SD) 15 (18) and 17 (24)/mm2, respectively). In all lesions, a positive correlation was found between MCD and MVD. Age, sex and location of VM had no predictive value for the occurrence of microvascular proliferation. However, if present, the involved tissue areas were larger and the proliferative activity of EC was higher in male patients than in female patients. Conclusions Recognition of microvascular proliferation as a not uncommon feature, congenital arteriovenous malformations provide new insight into the growth behaviour and vascular composition of these lesions.

Meijer-Jorna, Lorine B; van der Loos, Chris M; de Boer, Onno J; van der Horst, Chantal M A M



Histologically proven venous congestive myelopathy without concurrent vascular malformation: Case reports and review of the literature  

PubMed Central

Background: Venous congestive myelopathy is a progressive myelopathy that is generally caused by a spinal dural arteriovenous fistula. Case Description: We report a patient with histologically confirmed venous congestive myelopathy without concurrent vascular malformations in radiological and intraoperative findings. Conclusions: The definitive underlying etiology of this congestive myelopathy was unclear. However, this case report highlights the possibility of venous congestive myelopathy with etiology other than a dural arteriovenous fistula. Further, a systematic and elaborate examination should be undertaken to explore the underlying pathology whenever this type of spinal parenchymal lesion is detected.

Matsubara, Teppei; Akutsu, Hiroyoshi; Watanabe, Shinya; Nakai, Kei; Ayuzawa, Satoshi; Matsumura, Akira



Loss of cerebral cavernous malformation 3 (Ccm3) in neuroglia leads to CCM and vascular pathology.  


Communication between neural cells and the vasculature is integral to the proper development and later function of the central nervous system. A mechanistic understanding of the interactions between components of the neurovascular unit has implications for various disorders, including cerebral cavernous malformations (CCMs) in which focal vascular lesions form throughout the central nervous system. Loss of function mutations in three genes with proven endothelial cell autonomous roles, CCM1/krev1 interaction trapped gene 1, CCM2, and CCM3/programmed cell death 10, cause familial CCM. By using neural specific conditional mouse mutants, we show that Ccm3 has both neural cell autonomous and nonautonomous functions. Gfap- or Emx1-Cre-mediated Ccm3 neural deletion leads to increased proliferation, increased survival, and activation of astrocytes through cell autonomous mechanisms involving activated Akt signaling. In addition, loss of neural CCM3 results in a vascular phenotype characterized by diffusely dilated and simplified cerebral vasculature along with formation of multiple vascular lesions that closely resemble human cavernomas through cell nonautonomous mechanisms. RNA sequencing of the vascular lesions shows abundant expression of molecules involved in cytoskeletal remodeling, including protein kinase A and Rho-GTPase signaling. Our findings implicate neural cells in the pathogenesis of CCMs, showing the importance of this pathway in neural/vascular interactions within the neurovascular unit. PMID:21321212

Louvi, Angeliki; Chen, Leiling; Two, Aimee M; Zhang, Haifeng; Min, Wang; Günel, Murat



Loss of cerebral cavernous malformation 3 (Ccm3) in neuroglia leads to CCM and vascular pathology  

PubMed Central

Communication between neural cells and the vasculature is integral to the proper development and later function of the central nervous system. A mechanistic understanding of the interactions between components of the neurovascular unit has implications for various disorders, including cerebral cavernous malformations (CCMs) in which focal vascular lesions form throughout the central nervous system. Loss of function mutations in three genes with proven endothelial cell autonomous roles, CCM1/krev1 interaction trapped gene 1, CCM2, and CCM3/programmed cell death 10, cause familial CCM. By using neural specific conditional mouse mutants, we show that Ccm3 has both neural cell autonomous and nonautonomous functions. Gfap- or Emx1-Cre–mediated Ccm3 neural deletion leads to increased proliferation, increased survival, and activation of astrocytes through cell autonomous mechanisms involving activated Akt signaling. In addition, loss of neural CCM3 results in a vascular phenotype characterized by diffusely dilated and simplified cerebral vasculature along with formation of multiple vascular lesions that closely resemble human cavernomas through cell nonautonomous mechanisms. RNA sequencing of the vascular lesions shows abundant expression of molecules involved in cytoskeletal remodeling, including protein kinase A and Rho-GTPase signaling. Our findings implicate neural cells in the pathogenesis of CCMs, showing the importance of this pathway in neural/vascular interactions within the neurovascular unit.

Louvi, Angeliki; Chen, Leiling; Two, Aimee M.; Zhang, Haifeng; Min, Wang; Gunel, Murat



Stereotactic radiosurgery of angiographically occult vascular malformations: Indications and preliminary experience  

SciTech Connect

Stereotactic radiosurgery has been shown to treat successfully angiographically demonstrated arteriovenous malformations of the brain. Angiographic obliteration has represented cure and eliminated the risk of future hemorrhage. The role of radiosurgery in the treatment of angiographically occult vascular malformations (AOVMs) has been less well defined. In the initial 32 months of operation of the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 24 patients meeting strict criteria for high-risk AOVMs were treated. Radiosurgery was used conservatively; each patient had sustained two or more hemorrhages and had a magnetic resonance imaging-defined AOVM located in a region of the brain where microsurgical removal was judged to pose an excessive risk. Venous angiomas were excluded by performance of high-resolution subtraction angiography in each patient. Fifteen malformations were in the medulla, pons, and/or mesencephalon, and 5 were located in the thalamus or basal ganglia. Follow-up ranged from 4 to 24 months. Nineteen patients either improved or remained clinically stable and did not hemorrhage again during the follow-up interval. One patient suffered another hemorrhage 7 months after radiosurgery. Five patients experienced temporary worsening of pre-existing neurological deficits that suggested delayed radiation injury. Magnetic resonance imaging demonstrated signal changes and edema surrounding the radiosurgical target. Dose-volume guidelines for avoiding complications were constructed. Our initial experience indicates that stereotactic radiosurgery can be performed safely in patients with small, well-circumscribed AOVMs located in deep, critical, or relatively inaccessible cerebral locations.

Kondziolka, D.; Lunsford, L.D.; Coffey, R.J.; Bissonette, D.J.; Flickinger, J.C. (Univ. of Pittsburgh, PA (USA))



Arteriovenous malformations: ethanolamine oleate sclerotherapy.  


Peripheral vascular malformations are now described according to some accepted guidelines, and the principle of proper treatment (nodus ablation) is becoming clear. An appropriate classification schema for vascular anomalies and definite indications for treatment are important to successful treatment overall. Non-invasive imaging (US, CT, and MRI) in association with clinical findings is critical in establishing the diagnosis, evaluating the extent of the malformation, and planning appropriate treatment. Direct nidus phlebography is useful not only in making a correct diagnosis but also in treating the lesion by sclerotherapy. When a patient suffers clinical complications, the nidus sclerotherapy becomes mandatory. If the vascular malformation remains bloodstream to a drainage vein during nidus opacification, flow control is necessary to achieve complete nidus ablation. A multidisciplinary approach is needed in the treatment of a high-flow lesion. A dedicated team approach is necessary for appropriate management in most cases. PMID:17988037

Hyodoh, H; Hyodoh, K



Establishment of a Varicose Vein Center in a Tertiary Vascular Surgery Practice: Urban Versus Rural Differences  

Microsoft Academic Search

We examined changes in practice patterns after the establishment of a varicose vein center (VVC) within two tertiary university vascular surgery practices and compared differences between urban (U) and rural (R) sites. Practice patterns for the treatment of VVs were compared 3 years before (period 1) and 3 years after (period 2) the formation of a U-VVC and an R-VVC

Syed M. Hussain; Robert B. McLafferty; Marc A. Passman; Jeffrey B. Datillo; Don E. Ramsey; Raoul J. Guzman; Thomas C. Naslund; Kim J. Hodgson



Vein of Galen aneurysmal malformation: Prenatal diagnosis and early endovascular management  

Microsoft Academic Search

A prenatally diagnosed patient was referred to our hospital at 35 weeks of gestation. Antenatal ultrasonography demonstrated cardiomegaly and aneurysm of the vein of Galen. A 3,290 g male baby was delivered by elective cesarean section at 37 weeks of gestation. Physical examination was remarkable for tachypnea, hyperdynamic precordium with a continuous murmur, cranial bruit and bounding carotid pulses. Magnetic resonance

Leyla Karadeniz; Asuman Coban; Serra Sencer; Recep Has; Zeynep Ince; Gulay Can



Transhepatic Preoperative Portal Vein Embolization Using the Amplatzer Vascular Plug: Report of Four Cases  

SciTech Connect

The Amplatzer Vascular Plug (AVP) is a device originally intended for arterial and venous embolization in peripheral vessels. From December 2004 to March 2007 we implanted a total of 8 AVPs in the portal venous system in our institution for preoperative portal vein embolization in 4 patients (55-71 years) prior to right hemihepatectomy. AVP implantation was successful in all patients. Total occlusion of the embolized portal vein branches was achieved in all patients. There were no major complications associated with the embolization.

Ringe, Kristina I., E-mail:; Weidemann, Juergen; Rosenthal, Herbert; Keberle, Marc [Medizinische Hochschule Hannover, Abteilung Diagnostische Radiologie (Germany); Chavan, Ajay [Institut fuer Radiologie, Klinikum Oldenburg GmbH (Germany); Baus, Stefan; Galanski, Michael [Medizinische Hochschule Hannover, Abteilung Diagnostische Radiologie (Germany)



Intracranial vascular malformations: imaging of charged-particle radiosurgery. Part II. Complications  

SciTech Connect

Seven of 24 patients with intracranial vascular malformations who were treated with helium-ion Bragg-peak radiosurgery had complications of therapy. New symptoms and corresponding radiologic abnormalities developed 4-28 months after therapy. Five patients had similar patterns of white matter changes and mass effect on computed tomographic scans and magnetic resonance images. The abnormalities were centered in the radiation field. Gray matter changes and abnormal enhancement in the thalamus and hypothalamus outside the radiation field developed in one patient. This patient also had vasculopathic changes on angiograms. Rapidly progressive large vessel vasculopathy developed in another patient and caused occlusion of major vessels. Thus, different mechanisms may be involved in the complications of heavy-ion radiosurgery.

Marks, M.P.; Delapaz, R.L.; Fabrikant, J.I.; Frankel, K.A.; Phillips, M.H.; Levy, R.P.; Enzmann, D.R.



A Systematic Classification of the Congenital Bronchopulmonary Vascular Malformations: Dysmorphogeneses of the Primitive Foregut System and the Primitive Aortic Arch System  

PubMed Central

Purpose We reviewed the cases of 33 patients from our clinic and 142 patients from the literature with congenital bronchopulmonary vascular malformations (BPVM), systematically analyzed the bronchopulmonary airways, pulmonary arterial supplies, and pulmonary venous drainages, and classified these patients by pulmonary malinosculation (PM). Materials and Methods From January 1990 to January 2007, a total of 33 patients (17 men or boys and 16 women or girls), aged 1 day to 24 years (median, 2.5 months), with congenital BPVM were included in this study. Profiles of clinical manifestations, chest radiographs, echocardiographs, esophagographs, computer tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), cardiac catheterizations with angiography, contrast bronchographs, bronchoscopies, chromosomal studies, surgeries, and autopsies of these patients were analyzed to confirm the diagnosis of congenital BPVM. A total of 142 cases from the literature were also reviewed and classified similarly. Results The malformations of our 33 patients can be classified as type A isolated bronchial PM in 13 patients, type B isolated arterial PM in three, type C isolated venous PM in two, type D mixed bronchoarterial PM in five, type F mixed arteriovenous PM in one, and type G mixed bronchoarteriovenous PM in nine. Conclusion Dysmorphogeneses of the primitive foregut system and the primitive aortic arch system may lead to haphazard malinosculations of the airways, arteries, and veins of the lung. A systematic classification of patients with congenital BPVM is clinically feasible by assessing the three basic bronchovascular systems of the lung independently.

Lue, Hung-Chi; Chiu, Ing-Sh; Chiu, Han-Yao; Tsao, Lon-Yen; Cheng, Ching-Yuan; Yang, Albert D.



Enlarged Left Vitelline Vein Remnant as a Cause of Cyanosis after the Fontan Procedure: Resolution with an Amplatzer Vascular Plug  

Microsoft Academic Search

A 6-year-old girl with heterotaxy and a functional single ventricle had persistent cyanosis 4 years after a fenestrated Fontan\\u000a procedure. Cardiac catheterization revealed a large venous fistula from a left-sided hepatic vein to the coronary sinus, resulting\\u000a in desaturation. The anomalous vein was occluded with an Amplatzer vascular plug.

A. Rothman; R. J. Acherman; C. F. Luna; H. Restrepo



Bipolar radiofrequency-induced interstitial thermoablation for oral cavity vascular malformations: Preliminary results in a series of 5 children.  


We report our assessment of the effectiveness of bipolar radiofrequency-induced interstitial thermoablation (BRIT) for the treatment of certain oral cavity vascular malformations in 5 children. Two of these patients had lymphangiomatous macroglossia (LM), 1 had lymphangioma circumscriptum (LC), and 2 had a venous malformation (VM). Each patient underwent BRIT at least twice; treatment was delivered at 4- to 8-week intervals according to each patient's circumstances. The 2 patients with LM required three treatment sessions; although their tongue volume decreased after each session, both still required a partial glossectomy to achieve a satisfactory reduction in volume. The patient with LC underwent two BRIT treatments, which reduced the size of the lesion by half; the remainder was excised. The 2 patients with a VM (1 buccal and 1 lingual) responded well to BRIT, and their malformations almost completely disappeared. Our early results with BRIT suggest that it is an effective treatment for oral cavity vascular malformations-more so for patients with venous rather than lymphangiomatous lesions. PMID:23288796

Civelek, Senol; Say?n, Ibrahim; Ercan, Ibrahim; Cak?r, Burak Omür; Turgut, Suat



Uterine arteriovenous malformation.  


Uterine arteriovenous malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. Despite it being rare, it is a potentially life-threatening condition. This case report describes a 33-year-old woman who presented with secondary post-partum hemorrhage. Transabdominal ultrasound (US) of the pelvis showed increased vascularity with multidirectional flow of the uterus and a prominent vessel, located on the left lateral wall. She also had retained product of conception, which complicated the diagnosis. A uterine artery angiogram confirmed an AVM in the fundal region with an early draining vein. Embolisation of the AVM was performed successfully. PMID:23983582

Hashim, Hilwati; Nawawi, Ouzreiah



Uterine Arteriovenous Malformation  

PubMed Central

Uterine arteriovenous malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. Despite it being rare, it is a potentially life-threatening condition. This case report describes a 33-year-old woman who presented with secondary post-partum hemorrhage. Transabdominal ultrasound (US) of the pelvis showed increased vascularity with multidirectional flow of the uterus and a prominent vessel, located on the left lateral wall. She also had retained product of conception, which complicated the diagnosis. A uterine artery angiogram confirmed an AVM in the fundal region with an early draining vein. Embolisation of the AVM was performed successfully.

Hashim, Hilwati; Nawawi, Ouzreiah



Congenital absence of the portal vein in a patient with multiple vascular anomalies.  


A 15-year-old male patient accepted to emergency department with nausea, vomiting, sleepiness, and severe epigastric pain. The patient has a history of mild mental retardation since his childhood. Physical examination showed epigastric tenderness. Laboratory findings were consistent with mildly increased liver enzymes and hyperammonemia. Result of abdominal ultrasound was suboptimal due to lack of patient cooperation. Patient underwent abdominal and thoracic computed tomography (CT) examination to investigate the possible causes of hyperammonemia and liver disease. The CT scan showed the absence of portal vein with direct connection of portomesenteric system with systemic venous circulation. There were also various arterial and venous anomalies along with multiple hepatic masses. Whole anatomy of the thorax and abdomen was delineated with multiplanar reformatted images and maximum intensity projection technique. Imaging findings are consistent with Type Ib Abernethy malformation. The patient also underwent brain magnetic resonance imaging to investigate the presence of central nervous system changes due to hyperammonemia. PMID:23266872

Ogul, Hayri; Bayraktutan, Ummugulsum; Yalcin, Ahmet; Turan, Mehmet Ibrahim; Ozgokce, Mesut; Eren, Suat; Kantarci, Mecit



Arterial and venous coronary pressure-flow relations in anesthetized dogs. Evidence for a vascular waterfall in epicardial coronary veins.  


The coronary circulation of anesthetized dogs was tested for the presence of vascular waterfalls by manipulating coronary arterial and coronary venous pressures. The left main coronary artery and the coronary sinus were cannulated, and relationships between coronary artery pressure, coronary sinus pressure, and coronary flow were studied. Experiments were conducted during diastolic arrests, under steady state conditions, in the absence of autoregulation. Relations of coronary flow to coronary sinus pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the coronary sinus. When the great cardiac vein was cannulated, relations of great vein flow to great vein pressure at constant coronary artery pressure were consistent with the presence of a vascular waterfall in the great vein, indicating that waterfall behavior can occur in epicardial veins other than the coronary sinus. In dogs on right heart bypass, with the coronary sinus and great vein uncannulated, the relationship between right atrial pressure and coronary sinus pressure showed a waterfall pattern, indicating that the waterfall is not an artifact of venous cannulation. In the right heart bypass experiments, venous waterfall behavior was seen in beating hearts as well as during diastolic arrests. We conclude that a vascular waterfall is present in epicardial coronary veins which can significantly influence coronary blood flow. PMID:6611215

Uhlig, P N; Baer, R W; Vlahakes, G J; Hanley, F L; Messina, L M; Hoffman, J I



Trends in the Management of Intracranial Vascular Malformations in the USA from 2000 to 2007  

PubMed Central

Objective. To assess prevalence, clinical characteristics, trends in treatment pattern, and outcome in patients with intracranial vascular malformations (IVMs). Methods. Nationwide inpatient sample. Patients with the diagnosis of an IVM admitted to US hospitals from 2000 to 2007. Results. In 58,051 IVM-related admissions (detection rate 2.4/100,000 person-years; mean age 49 ± 17 years; 52% women) major diagnoses were intracranial hemorrhage (ICrH) in 15%, seizure 32%, ischemia 5%, and headache 9%. Procedures included surgery (13%), embolization (13%), radiation therapy (2%), aneurysm clipping (1%), and mechanical ventilation (6%). Ventilation and ICrH were associated with death (2%), whereas ventilation, ICrH, surgery, seizure, and ischemia were associated with unfavorable outcome (20%). IVM detection rate and hospital outcome remained stable over time, whereas mean age and comorbid diagnosis of cerebral ischemia increased (ICrH and seizure decreased). Conclusion. IVMs are infrequent and present in 1/6 patients with some form of ICrH. Overall, seizure is the dominant comorbid diagnosis (1/3 patients). IVMs are equally prevalent among race-ethnic groups and are increasingly detected later in life. The inpatient care of IVM patients results in death or discharge into specialized care in 1/5 patients.

Choi, Jae H.; Pile-Spellman, John; Brisman, Jonathan



Nevus vascularis mixtus (cutaneous vascular twin nevi) associated with intracranial vascular malformation of the Dyke-Davidoff-Masson type in two patients.  


The term twin spotting refers to phenotypes characterized by the spatial and temporal co-occurrence of two (or more) different nevi arranged in variable cutaneous patterns, and can be associated with extra-cutaneous anomalies. Several examples of twin spotting have been described in humans including nevus vascularis mixtus, cutis tricolor, lesions of overgrowth, and deficient growth in Proteus and Elattoproteus syndromes, epidermolytic hyperkeratosis of Brocq, and the so-called phacomatoses pigmentovascularis and pigmentokeratotica. We report on a 28-year-old man and a 15-year-old girl, who presented with a previously unrecognized association of paired cutaneous vascular nevi of the telangiectaticus and anemicus types (naevus vascularis mixtus) distributed in a mosaic pattern on the face (in both patients) and over the entire body (in the man) and a complex brain malformation (in both patients) consisting of cerebral hemiatrophy, hypoplasia of the cerebral vessels and homolateral hypertrophy of the skull and sinuses (known as Dyke-Davidoff-Masson malformation). Both patients had facial asymmetry and the young man had facial dysmorphism, seizures with EEG anomalies, hemiplegia, insulin-dependent diabetes mellitus (IDDM), autoimmune thyroiditis, a large hepatic cavernous vascular malformation, and left Legg-Calvé-Perthes disease (LCPD) [LCPD-like presentation]. Array-CGH analysis and mutation analysis of the RASA1 gene were normal in both patients. PMID:22991195

Ruggieri, Martino; Milone, Pietro; Pavone, Piero; Falsaperla, Raffaele; Polizzi, Agata; Caltabiano, Rosario; Fichera, Marco; Gabriele, Anna Lia; Distefano, Angela; De Pasquale, Rocco; Salpietro, Vincenzo; Micali, Giuseppe; Pavone, Lorenzo



Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease  

SciTech Connect

Purpose: To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases. Methods: Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue. Results: Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients. Conclusion: Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

Chu, Hee Ho; Kim, Hyo-Cheol, E-mail:; Jae, Hwan Jun [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University College of Medicine and Seoul National University Hospital, Department of Surgery (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of)



Natural History and Outcome of Hepatic Vascular Malformations in a Large Cohort of Patients with Hereditary Hemorrhagic Teleangiectasia  

Microsoft Academic Search

Background  Hereditary hemorrhagic telangiectasia is a genetic disease characterized by teleangiectasias involving virtually every organ.\\u000a There are limited data in the literature regarding the natural history of liver vascular malformations in hemorrhagic telangiectasia\\u000a and their associated morbidity and mortality.\\u000a \\u000a \\u000a \\u000a \\u000a Aim  This prospective cohort study sought to assess the outcome of liver involvement in hereditary hemorrhagic telangiectasia patients.\\u000a \\u000a \\u000a \\u000a Methods  We analyzed 16 years of surveillance

Elisabetta BuscariniGioacchino; Gioacchino Leandro; Dario Conte; Cesare Danesino; Erica Daina; Guido Manfredi; Guido Lupinacci; Gianfranco Brambilla; Fernanda Menozzi; Federico De Grazia; Pietro Gazzaniga; Giuseppe Inama; Roberto Bonardi; Pasquale Blotta; PierAngelo Forner; Carla Olivieri; Annalisa Perna; Maurizio Grosso; Giacomo Pongiglione; Edoardo Boccardi; Fabio Pagella; Giorgio Rossi; Alessandro Zambelli



Huge arteriovenous malformation in masseter muscle.  


Arteriovenous malformation is a tumor characterized by direct connection between an artery and vein without capillaries in-between, and it is commonly located intracranially. Intramuscular arteriovenous malformations are rare in the head and neck region. Less than 1% of the vascular tumors are localized in a muscle, 15% of them are in the head and neck muscles. Among the head and neck muscles, masseter muscle is the most common location, with the rate of 4.9%. The condition of a 36-year-old patient who applied to our clinic with the complaints of progressively increasing pain and progressively growing mass in the right cheek that appeared 1.5 years ago was diagnosed as arteriovenous malformation located in the masseter muscle. After preoperative embolization, the mass was successfully treated with total excision. In this case report, diagnostic and therapeutic tools addressing arteriovenous malformation located in the masseter muscle are discussed in the light of current literature. PMID:19625853

Karaman, Emin; Mercan, Hasan; Ozdilek, Alper; Alimoglu, Yalcin; Korkut, Nazim



Pigment epithelium-derived factor and vascular endothelial growth factor in branch retinal vein occlusion with macular edema  

Microsoft Academic Search

Background  We investigated whether pigment epithelium-derived factor (PEDF) or vascular endothelial growth factor (VEGF) influence macular\\u000a edema in patients with branch retinal vein occlusion (BRVO). This investigation aimed to clarify the influence of PEDF in\\u000a the vitreous fluid on retinal vascular permeability in patients with macular edema secondary to BRVO. The findings were expected\\u000a to be useful for the treatment of

Hidetaka Noma; Hideharu Funatsu; Tatsuya Mimura; Seiyo Harino; Shuichiro Eguchi; Sadao Hori



Venous Grafts Procured During the Learning Curve for Endoscopic Veins Harvesting Show Compromised Vascular Remodeling  

PubMed Central

BACKGROUND Endoscopic vein harvest (EVH) is the US standard of care for CABG but recent comparisons to open harvest suggest that conduit quality and outcomes may be compromised. To test the hypothesis that problems with EVH may relate to its learning curve and conduit quality, we analyzed the quality and early function of conduits procured by technicians with varying EVH experience. METHODS EVH was performed during CABG by “experienced” (>900 cases, n=55 patients) vs. “novice” (<100 cases, n=30 patients) technicians. Afterwards, conduits were and examined for vascular injury using optical coherence tomography (OCT), with segments identified as injured further examined for gene expression using a tissue injury array. Conduit diameter was measured intra- and postoperatively (day 5 and 6 months) using OCT and Computed-Tomography angiography. RESULTS EVH performed by novice harvesters resulted in increased number of discrete graft injuries and higher expression of tissue injury genes. Regression analysis revealed an association between shear stress and early dilation (positive remodeling) (R2 =0.48, p <0.01). Injured veins showed blunted positive remodeling at 5 days and a greater degree of late lumen loss at 6 months. CONCLUSION Under normal conditions, intraluminal shear stress leads vein grafts to develop positive remodeling over the first postoperative week. Injury to conduits, a frequent sequela of the learning curve for EVH, was a predictor of early graft failure, blunted positive remodeling and greater negative remodeling. Given the ongoing annual volume of EVH cases, rigorous monitoring of the learning curve represents an important and unrecognized public health issue.

Kiani, Soroosh; Desai, Pranjal H.; Thirumvalavan, Nannan; Kurian, Dinesh John; Flynn, Mary Margaret; Zhao, XiaoQing



Vascular assessment of the right internal jugular vein in low birth weight newborns.  


Abstract Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery. Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500?g; very low birth weight (VLBW) newborns, <1500?g; and extremely low birth weight (ELBW) newborns <1000?g. Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300?g, anteroposterior diameter of the RIJV 2.2?mm, and the distance from the skin-RIJV 3.6?mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7?mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p?

Montes-Tapia, Fernando; Rodríguez-Taméz, Antonio; Hernandez-Garduño, Adolfo; Barreto-Arroyo, Itzel; Rodríguez-Balderrama, Isaías; de la O-Cavazos, Manuel; Quero, José



Use of a new mixture for embolization of intracranial vascular malformations  

Microsoft Academic Search

The internal carotid artery system in swine has a special anatomic configuration similar to a brain “arterial-arterial malformation”. The internal carotid artery breaks up into a multitude of fine channels (rete mirabile) situated at the base of the skull on the side of the hypophysis. This anatomic arterial model was used to analyze acute and chronic angiographic and histological changes

P. Lylyk; F. Viñuela; H. V. Vinters; J. Dion; J. Bentson; G. Duckwiler; T. Lin



A case of ruptured renal cortical arteriovenous malformation of the right testicular vein in hemorrhagic fever with renal syndrome  

PubMed Central

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization.

Lee, Seung Min; Kim, Hong Dae; Lee, Young-Ki



Vascular Anatomy of the Spinal Cord and Classification of Spinal Arteriovenous Malformations  

PubMed Central

Summary The arterial and venous anatomy of the spinal cord was described in terms of extrinsic and intrinsic contribution to the cord substance. Based upon anatomical location of an arteriovenous shunt, spinal arteriovenous malformations (AVMs) were classified into intramedullary AVM, perimedullary arteriovenous fistula (AVF) and duralAVF. This simple classification seems practical from the standpoint of endovascular and surgical treatments since it reflects anatomical differences in the shunt location, which is the target in either approach.

Miyasaka, K.; Asano, T.; Ushikoshi, S.; Hida, K.; Koyanagi, I.



Pulmonary sequestration and related congenital bronchopulmonary-vascular malformations: nomenclature and classification based on anatomical and embryological considerations.  

PubMed Central

The pulmonary sequestration spectrum and related congenital lung anomalies present an extremely complex and varied group of bronchopulmonary-vascular malformations. Previous attempts at nomenclature and classification have proved inadequate. In this article we present a classification of the newly named pulmonary malinosculation spectrum, which includes all congenital lung anomalies where there is abnormal connection (that is, malinosculation) of one or more of the four major components of lung tissue--namely, tracheobronchial airway, lung parenchyma, arterial supply, and venous drainage, which in various combinations make up these lesions. We feel that this simple descriptive approach will improve our understanding and management of these complicated lesions and this is supported by the clinical experience we report in the next article.

Clements, B S; Warner, J O



Accuracy of Susceptibility-Weighted Imaging for the Detection of Arteriovenous Shunting in Vascular Malformations of the Brain  

PubMed Central

Background and Purpose To determine the accuracy of susceptibility-weighted magnetic resonance imaging (SWI) for the detection of arteriovenous shunting (AVS) in vascular malformations of the brain (BVM). Methods We retrospectively identified 60 patients who had been evaluated for known or suspected BVM by both SWI and digital subtraction angiography (DSA), without intervening treatment, during a 3-year period. SWI images were retrospectively assessed by two independent reviewers for the presence of AVS as determined by the presence of signal hyperintensity within a venous structure in the vicinity of the BVM. Discrepancies were resolved by consensus among a panel of three neuroradiologists. Accuracy parameters of SWI for the detection of AVS were calculated utilizing DSA as the reference standard. Results A total of 80 BVMs were identified in the 60 patients included in our study. Of the 29 BVMs with AVS on DSA, 14 were untreated AVMs, 10 were previously-treated AVMs, and 5 were untreated dural arteriovenous fistulas. Overall, SWI was 93% sensitive and 98% specific for the detection of AVS in BVMs, with excellent inter-observer agreement (kappa 0.94). In the 14 previously-treated AVMs, SWI was 100% sensitive and specific for the detection of AVS. In the 28 BVMs associated with intracerebral hemorrhage, SWI was 100% sensitive and 96% specific for the detection of AVS. Conclusions SWI is accurate for the detection of arteriovenous shunting in vascular malformations of the brain and, for some patients, SWI may offer a non-invasive alternative to angiography in screening for or follow-up of treated BVMs.

Jagadeesan, Bharathi D.; Delgado Almandoz, Josser E.; Moran, Christopher J.; Benzinger, Tammie L.S.



Aqueous soluble vascular endothelial growth factor receptor-2 in macular edema with branch retinal vein occlusion.  


Abstract Purpose/Aim: The aqueous humor level of soluble vascular endothelial growth factor receptor (sVEGFR)-2 may influence macular edema in patients with branch retinal vein occlusion (BRVO). The association of sVEGFR-2 with macular edema was investigated in this study. Materials and methods: A retrospective case-controlled study was performed in 22 patients with BRVO and macular edema, as well as 5 patients with non-ischemic ocular diseases as the control group. The severity of macular edema was examined by optical coherence tomography. Aqueous humor samples were obtained during intravitreous injection of anti-VEGF agents, triamcinolone acetonide, or combined vitrectomy and cataract surgery. sVEGFR-2 levels in aqueous humor were determined by enzyme-linked immunosorbent assay. Results: The aqueous humor level of sVEGFR-2 (median: 124.5?ng/ml) was significantly elevated in BRVO patients compared with the control group (78.1?pg/ml) (p?=?0.010). In addition, the sVEGFR-2 level was correlated with the severity of macular edema (p?=?0.033). Conclusions: sVEGFR-2 may be involved in the pathogenesis of macular edema associated with BRVO. Measurement of aqueous humor sVEGFR-2 levels may be helpful for understanding the disease status in BRVO patients with macular edema. PMID:23972086

Noma, Hidetaka; Mimura, Tatsuya



A case of ruptured renal cortical arteriovenous malformation of the right testicular vein in hemorrhagic fever with renal syndrome.  


Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage, and renal failure. Among the various hemorrhagic complications of HFRS, the spontaneous rupture of an arteriovenous malformation of the testicular vessels with a retroperitoneal hematoma is a rare finding. Here, we report a case of HFRS complicated by a massive retroperitoneal hematoma that was treated with transcatheter arterial embolization. PMID:23682233

Lee, Seung Min; Kim, Hong Dae; Lee, Young-Ki; Noh, Jung Woo



Changes in foveal thickness after vitrectomy for macular edema with branch retinal vein occlusion and intravitreal vascular endothelial growth factor  

Microsoft Academic Search

Purpose To examine the outcome of vitrectomy for macular edema associated with branch retinal vein occlusion (BRVO) and determine\\u000a the relationship between the severity of macular edema and the concentration of vascular endothelial growth factor (VEGF)\\u000a and interleukin-6 (IL-6) in the vitreous fluid. Design Prospective observational case series. Patients and Methods Thirty-four consecutive patients (34 eyes) with macular edema associated

Makiko Yamasaki; Hidetaka Noma; Hideharu Funatsu; Atsushi Minamoto; Tatsuya Mimura; Katsunori Shimada; Hidetoshi Yamashita; Yoshiaki Kiuchi



Capillary-venous malformation in the lower limb.  


Regional capillary malformation of a lower extremity is associated with the overgrowth of bone or soft tissue in several disorders, most commonly Klippel-Trenaunay syndrome and Parkes Weber syndrome. We have observed a subset of patients with a capillary malformation of the leg, minor growth disturbance, and prominent veins. The objective of the current study is to describe a series of patients with regional capillary malformation of the lower extremity in association with phlebectasia. This is a retrospective series of 17 patients diagnosed with capillary-venous malformation of the lower extremity. We excluded patients with clinical or radiographic evidence of lymphatic or arteriovenous malformation. Age, presentation, associated features, radiographic findings, and management were documented. In most patients the capillary malformation covered a large area without sharply demarcated borders. Four patients had one or more discrete, well-defined capillary stains involving less than 5% of the total surface area of the affected lower limb. Prominent veins were most common in the popliteal fossa and on the knee and dorsal foot. Approximately two-thirds of patients had a leg length discrepancy, with the affected leg being longer (n = 6) or shorter (n = 4); in many the affected leg was also slightly larger (n = 8) or smaller (n = 4) in girth. Radiographic imaging showed dilatation of superficial (n = 16), muscular (n = 9), and deep veins (n = 6). We characterize a subset of patients with regional capillary-venous malformation of the lower extremity with prominent veins and minor hypotrophy/hypertrophy that differs from Klippel-Trenaunay syndrome (capillary-lymphatic-venous malformation) but belongs at the minor end of the spectrum of vascular disorders with overgrowth. PMID:23829172

Uihlein, Lily C; Liang, Marilyn G; Fishman, Steven J; Alomari, Ahmad I; Mulliken, John B



Vascular corrosion casting: analyzing wall shear stress in the portal vein and vascular abnormalities in portal hypertensive and cirrhotic rodents  

Microsoft Academic Search

Vascular corrosion casting is an established method of anatomical preparation that has recently been revived and has proven to be an excellent tool for detailed three-dimensional (3D) morphological examination of normal and pathological microcirculation. In addition, the geometry provided by vascular casts can be further used to calculate wall shear stress (WSS) in a vascular bed using computational techniques. In

Christophe Van Steenkiste; Bram Trachet; Christophe Casteleyn; Denis van Loo; Luc Van Hoorebeke; Patrick Segers; Anja Geerts; Hans Van Vlierberghe; Isabelle Colle



Dynamic regulation of the cerebral cavernous malformation pathway controls vascular stability and growth  

PubMed Central

SUMMARY Cardiovascular growth must balance stabilizing signals required to maintain endothelial connections and network integrity with destabilizing signals that enable individual endothelial cells to migrate and proliferate. The cerebral cavernous malformation (CCM) signaling pathway utilizes the adaptor protein CCM2 to strengthen endothelial cell junctions and stabilize vessels. Here we identify a CCM2 paralogue, CCM2L, that is expressed selectively in endothelial cells during periods of active cardiovascular growth. CCM2L competitively blocks CCM2-mediated stabilizing signals biochemically, in cultured endothelial cells, and in developing mice. Loss of CCM2L reduces endocardial growth factor expression and impairs tumor growth and wound healing. Our studies identify CCM2L as a molecular mechanism by which endothelial cells coordinately regulate vessel stability and growth during cardiovascular development as well as postnatal vessel growth.

Zheng, Xiangjian; Xu, Chong; Smith, Annie O.; Stratman, Amber N.; Zou, Zhiying; Kleaveland, Benjamin; Yuan, Lijun; Didiku, Chuka; Sen, Aslihan; Liu, Xi; Skuli, Nicolas; Zaslavsky, Alexander; Chen, Mei; Cheng, Lan; Davis, George E.; Kahn, Mark L.



Cerebral cavernous malformation is a vascular disease associated with activated RhoA signaling.  


Cerebral cavernous malformation (CCM) involves the homozygous inactivating mutations of one of three genes, ccm1, -2, or -3 resulting in hyperpermeable blood vessels in the brain. The CCM1, -2, and -3 proteins form a complex to organize the signaling networks controlling endothelial cell physiology including actin dynamics, tube formation, and adherens junctions. The common biochemical defect with the loss of CCM1, -2, or -3 is increased RhoA activity leading to the activation of Rho-associated coiled coil-forming kinase (ROCK). Inhibition of the ROCK rescues CCM endothelial cell dysfunction, suggesting that the inhibition of RhoA-ROCK signaling may be a therapeutic strategy to prevent or arrest the progression of the CCM lesions. PMID:23096573

Richardson, Bryan T; Dibble, Christopher F; Borikova, Asya L; Johnson, Gary L



Diagnosis and management of extensive vascular malformations of the lower limb part ii. systemic repercusion, diagnosis and treatment  

Microsoft Academic Search

At least nine types of VMs with specific clinical and radiological characteristics must be distinguished in the lower limbs: Klippel- Trenaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes-Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. Extensive VMs are often more complex than they appear, and require a multidisciplinary therapeutic approach.

Pedro Redondo; Leyre Aguado; Antonio Martínez-Cuesta


Feasibility of minocycline and doxycycline use as potential vasculostatic therapy for brain vascular malformations: pilot study of adverse events and tolerance  

PubMed Central

Background Tetracyclines may be useful in preventing pathological vascular remodeling, thus decreasing the risk of spontaneous hemorrhage from brain vascular malformations. Methods Arteriovenous malformation (AVM) and intracranial aneurysm patients undergoing non-invasive management were treated with minocycline or doxycycline (200mg/day) up to 2 years in a prospective open-label safety pilot trial. The primary outcome was to compare dose limiting intolerance (DLI), defined as treatment-related dose-reduction and withdrawal between the agents. Results 26 patients with AVMs (n=12) or aneurysms (n=14) were recruited. Adverse event rates were similar to other reported trials of these agents; four of 13 (31%) minocyline and three of 13 (23%) doxycycline patients had DLI (hazard ratio=3.1, 95%CI=0.52–18.11, log rank p =0.70,). Conclusions It is feasible to propose a long-term trial to assess the potential benefit of tetracycline therapy to decrease hemorrhagic risk in brain vascular malformations.

Frenzel, Tim; Lee, Chanhung Z.; Kim, Helen; Quinnine, Nancy J.; Hashimoto, Tomoki; Lawton, Michael T.; Guglielmo, B. Joseph; McCulloch, Charles E.; Young, William L.



Vein Graft-Coated Vascular Stents: A Feasibility Study in a Canine Model  

Microsoft Academic Search

Purpose: To evaluate different vein grafts for luminal coating of endovascular stents in normal canine arteries.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Twenty-four tantalum Strecker stents were coated with either autologous (n= 10), denatured heterologous (n= 11), or denatured homologous vein grafts (n= 3). The carotid artery (n= 11) and the iliac artery (n= 13) were stented using a transfemoral approach. Angiograms were performed at

Frank Schellhammer; Jörg Haberstroh; Ajay K. Wakhloo; Eva Gottschalk; Martin Schumacher



Real-time ultrasonography as a monitoring technique for interstitial Nd:YAG laser treatment of voluminous hemangiomas and vascular malformations  

NASA Astrophysics Data System (ADS)

Voluminous vascular anomalies of the head and neck region are still treated with conventional surgery although Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser therapy is an effective treatment method. One hundred thirty give patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy, partly complemented by a non-contact mode Nd:YAG laser light application. The vascular tumors had a diameter of more than 3 cm in two or all three dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients showed a complete clinical regression of the vascular tumor, a third of the patients had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser and three of them subsequently underwent conventional surgery. Only 10 patients showed cosmetic and functional deficits. These results on the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrated the high effectiveness of this novel and innovative therapy modality.

Werner, Jochen A.; Gottschlich, Stefan; Lippert, Burkard M.; Folz, Benedikt J.



Immunomodulation of vascular endothelium. 1. Ultrastructural changes following ultraviolet B irradiation of peripheral veins  

SciTech Connect

Immunologic function of endothelial cells is especially important in consideration of vein allografting for arterial reconstruction and in organ allotransplantation. Ultraviolet B radiation (UVB) has previously been shown to modulate graft immunogenicity, and to alter cell surface receptor function. In this study, superficial epigastric veins were UVB irradiated with 10, 24, 40, 80, and 150 mJ/cm2 while control veins were not irradiated; all specimens were examined for endothelial ultrastructural changes. Veins were perfuse-fixed at 1, 3, 7, 14, and 28 days after irradiation, and were evaluated by transmission electron microscopy and scanning electron microscopy. Control veins had a normal appearing endothelial lining, composed of elongated, attenuated endothelial cells. Veins irradiated with more than 24 mJ/cm2 displayed injured endothelial cells characterized by altered microvilli, defects in the cell surface, and a change in cell shape. The degree of cell damage correlated closely with increasing UVB dose. At doses of 80 mJ/cm2 or greater there was moderate to severe endothelial cell separation from the underlying basement membrane and an increase in cellular lysosomes. The effects of UVB were maximal at 3 days with virtual recovery in resurfacing of all specimens with endothelium 28 days after irradiation. These data suggest that UVB has a dose-dependent effect on venous endothelium that is morphologically reversible with time. Cell membrane changes seen following exposure to UVB may contribute to altered cell surface receptor function.

Marin, M.L.; Gordon, R.E.; Hardy, M.A.; Reemtsma, K.; Benvenisty, A.I. (Columbia Univ. College of Physicians Surgeons, New York, NY (USA))



Versatility of Tissue Expander in Abdominal Wall Reconstruction After Removal of Vascular Malformations in Children.  


BACKGROUND: Children who had extensive abdominal wall vascular anomalies (VAs) face 3 common reconstructive options: either tolerating the complications of these lesions, exposure to repeated laser therapy session with its sequelae, or excision followed by a color-matched skin graft. The use of serial tissue expansion and excision of the affected skin offers a potentially better option under the right circumstances. Tissue expanders (TEs) have broad applicability but are not without complications. OBJECTIVE: To study the versatility of use of TEs in the management of children who had extensive VAs in their abdominal wall with special emphasis to the complications and children and parental satisfaction. MATERIALS AND METHODS: Retrospective data collection of 12 patients' charts, operative data of 84 operative procedures, and follow-up visits. Statistical analysis done using Student t test significance and P < 0.05 was considered statistically significant. RESULTS: Using 35 different sizes of TEs and 84 operative procedures in 9 boys and 3 girls aged from 2 to 12 years with different types of abdominal wall VAs revealed an overall complications rate of 20%. Child and parental satisfaction was found to be good overall. CONCLUSIONS: Tissue expander is a useful and feasible tool for reconstruction of the abdominal wall with extensive VAs in children; parents and children were satisfied and body image is acceptable. PMID:23728247

Fahmy, Mohamed A Baky



Vascular movement of beet necrotic yellow vein virus in Beta macrocarpa is probably dependent on an RNA 3 sequence domain rather than a gene product  

Microsoft Academic Search

RNAs 1 and 2 of beet necrotic yellow vein virus (BNYVV) carry the functions enabling viral RNA replication, cell-to-cell movement, virus assembly and vascular movement of the virus in the systemic host Spinacea oleracea .I nBeta macrocarpa ,o n the other hand, BNYVV RNA 3 is required for vascular movement. Replication-competent RNA 3 trans- cripts carrying various point mutations and

Emmanuelle Lauber; H. Guilley; T. Tamada; K. E. Richards; G. Jonard



Surgical treatment of major vascular malformations localized to the flexor digitorum superficialis muscle: report of 3 cases  

Microsoft Academic Search

Three cases of congenital arteriovenous malformations localized to the flexor digitorum superficialis presented to a single surgeon. In all three cases, the tumours were resectable with negligible morbidity to the upper extremity.

R. R. Reid; N. Zimmerman; G. A. Dumanian



Surgical Treatment of Major Vascular Malformations Localized to the Flexor Digitorum Superficialis Muscle: Report of 3 Cases  

Microsoft Academic Search

Three cases of congenital arteriovenous malformations localized to the flexor digitorum superficialis presented to a single surgeon. In all three cases, the tumours were resectable with negligible morbidity to the upper extremity.




Prevention of coronary in-stent restenosis and vein graft failure: does vascular gene therapy have a role?  


Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), including stent insertion, are established therapies in both acute coronary syndromes (ACS) and symptomatic chronic coronary artery disease refractory to pharmacological therapy. These continually advancing treatments remain limited by failure of conduit grafts in CABG and by restenosis or thrombosis of stented vessel segments in PCI caused by neointimal hyperplasia, impaired endothelialisation and accelerated atherosclerosis. While pharmacological and technological advancements have improved patient outcomes following both procedures, when grafts or stents fail these result in significant health burdens. In this review we discuss the pathophysiology of vein graft disease and in-stent restenosis, gene therapy vector development and design, and translation from pre-clinical animal models through human clinical trials. We identify the key issues that are currently preventing vascular gene therapy from interfacing with clinical use and introduce the areas of research attempting to overcome these. PMID:22796519

Robertson, Keith E; McDonald, Robert A; Oldroyd, Keith G; Nicklin, Stuart A; Baker, Andrew H



An odd application of artificial vascular graft in the kidney transplantation of a patient with severe deep vein thrombosis: a case report.  


Transplantation of a living-related donor kidney was performed for a 41-year-old man. The planned right donor nephrectomy from the patient's 64-year-old father was uneventful. However the recipient's bilateral iliac veins and inferior vena cava were occluded, requiring a connection of the donor renal vein to the recipient's right great saphenous vein using an artificial vascular graft. On postoperative day 9, the patient recovered normal renal function with a serum creatinine that gradually decreased to 1.399 mg/dL. Color Doppler and computed tomography angiography imaging showed patency of the artificial vascular graft with no evidence of thrombosis. In addition, warfarin was used to improve his protein S deficiency. PMID:24034057

Mo, M; Peng, L; Yu, S; Gao, C



Vascular anomalies and the growth of limbs: a review.  


Growth of the limb in a child can be impaired, with the coexistence of a vascular malformation. In these vascular bone syndromes, altered growth is manifest as overgrowth or hypotrophy. The vascular malformation is usually complex and gets progressively worse with time. The two types of vascular anomalies in limbs, fast-flow and slow-flow, can be associated with limb length discrepancies. The fast-flow vascular malformations together with arteriovenous fistulae are part of Parkes Weber syndrome, characterized by congenital red cutaneous staining, hypertrophy in girth and increasing of limb length, lymphedema, increasing skin alterations due to a distal vascular steal, and pain, all of which develop during childhood. Treatment is generally conservative. An affected lower extremity can be complicated by pelvic tilting and scoliosis because leg length discrepancy may reach 10 cm. To avoid such a course, stapling epiphysiodesis of the knee cartilages is often performed, but this orthopedic procedure may augment the worsening of the arterial venous malformation in the limb. Therefore, less aggressive orthopedic management is preferable. Slow-flow vascular anomalies associated with limb growth alteration include (1) a diffuse capillary malformation (port-wine stain) with congenital hypertrophy of the involved extremity which is non-progressive; (2) purely venous malformations invading skin, muscles and joints, with pain, functional impairment, a chronic localized intravascular coagulopathy requiring distinctive management, and usually a slight undergrowth of the affected extremity and progressing amyotrophy; (3) the triad of a port-wine stain, anomalous veins and overgrowth of the limb, often known as Klippel-Trenaunay syndrome, which requires orthopedic management to decide the optimal timing for epiphysiodesis (i.e. when leg length discrepancy is >2.5 cm). Varicose veins are sometimes surgically removed after ultrasonographic and Doppler evaluation has confirmed a normal deep venous system. Capillary malformations can be effectively treated with pulsed dye laser, but results are usually poor in distal extremities. PMID:15599224

Enjolras, Odile; Chapot, René; Merland, Jean Jacques



Tumeurs et malformations vasculaires, classification anatomopathologique et imagerie  

Microsoft Academic Search

The understanding of vascular anomalies (vascular tumours and vascular malformations) was obscured, for a long time, by confusion and uncertainties in nosology and terminology. The International Society for the Study of Vascular Anomalies (ISSVA) recently adopted a classification scheme, clearly separating vascular tumours (hemangiomas of different types) which result from active cell proliferation, from vascular malformations, which are inborn defects

M. Wassef; R. Vanwijck; P. Clapuyt; L. Boon; G. Magalon



Development of endothelium-denuded human umbilical veins as living scaffolds for tissue-engineered small-calibre vascular grafts.  


Tissue-engineered small-calibre vessel grafts may help to alleviate the lack of graft material for coronary and peripheral bypass grafting in an increasing number of patients. This study explored the use of endothelium-denuded human umbilical veins (HUVs) as scaffolds for vascular tissue engineering in a perfusion bioreactor. Vessel diameter (1.2?±?0.4?mm), wall thickness (0.38?±?0.09?mm), uniaxial ultimate failure stress (8029?±?1714 kPa) and burst pressure (48.4?±?20.2 kPa, range 28.4-83.9 kPa) were determined in native samples. The effects of endothelium removal from HUVs by enzymatic digestion, hypotonic lysis and dehydration were assessed. Dehydration did not significantly affect contractile function, tetrazolium dye reduction, mechanical strength and vessel structure, whereas the other methods failed in at least one of these parameters. Denudation by dehydration retained laminin, fibronectin, collagen and elastic fibres. Denuded HUVs were seeded in a perfusion bioreactor with either allogeneic HUVs endothelial cells or with saphenous vein endothelial cells harvested from patients with coronary artery disease. Seeding in a perfusion bioreactor resulted in a confluent monolayer of endothelial cells from both sources, as judged by histology and scanning electron microscopy. Seeded cells contained von Willebrand factor and CD31. In conclusion, denuded HUVs should be considered an alternative to decellularized blood vessels, as the process keeps the smooth muscle layer intact and functional, retains proteins relevant for biomechanic properties and for cell attachment and provides a suitable scaffold for seeding an autologous and flow-resistant endothelium. PMID:22689499

Hoenicka, Markus; Schrammel, Siegfried; Bursa, Jiri; Huber, Georgine; Bronger, Holger; Schmid, Christof; Birnbaum, Dietrich E



Endogenous prostaglandin D(2) synthesis decreases vascular cell adhesion molecule-1 expression in human umbilical vein endothelial cells.  


We examined the role of prostaglandin D(2) (PGD(2)) in the expression of vascular cell adhesion molecule-1 (VCAM)-1 following interleukin-1beta (IL-1) stimulation in human umbilical vein endothelial cells (HUVEC) transfected with lipocaline-type PGD(2) synthase (L-PGDS) genes. HUVEC were isolated from human umbilical vein and incubated with 20 U/ml IL-1 and various concentrations of authentic PGD(2). The isolated HUVEC were also transfected with L-PGDS genes by electroporation. The L-PGDS-transfected HUVEC were used to investigate the role of endogenous PGD(2) in IL-1-stimulated VCAM-1 biosynthesis. We also used an anti-PGD(2) antibody to examine whether an intracrine mechanism was involved in VCAM-1 production. PGD(2) and VCAM-1 levels were determined by radio- and cell surface enzyme-immunoassay, respectively. VCAM-1 mRNA was assessed by RT-PCR. IL-1-stimulated VCAM-1 expression by HUVEC was dose-dependently inhibited by authentic PGD(2). L-PGDS gene-transfected HUVEC produced more PGD(2) than HUVEC transfected with the reporter gene alone. IL-1 induced increases in VCAM-1 expression in HUVEC transfected with reporter genes alone. However, this effect was significantly attenuated in the case of IL-1 stimulation of HUVEC transfected with L-PGDS genes, and accompanied by an apparent suppression of VCAM-1 mRNA expression. Neutralization of extracellular PGD(2) by anti-PGD(2)-specific antibody influenced neither VCAM-1 mRNA expression nor VCAM-1 biosynthesis. In conclusion, HUVEC transfected with L-PGDS genes showed increased PGD(2) synthesis. This increase was associated with attenuation of both VCAM-1 expression and VCAM-1 mRNA expression. The results suggest that endogenous PGD(2) decreases VCAM-1 expression and VCAM-1 mRNA expression, probably through an intracrine mechanism. PMID:16154157

Negoro, Hideyuki; Shin, Wee Soo; Hakamada-Taguchi, Rie; Eguchi, Naomi; Urade, Yoshihiro; Goto, Atsuo; Toyo-Oka, Teruhiko; Fujita, Toshiro; Omata, Masao; Uehara, Yoshio



Occlusion of Arteriovenous Fistulas of In-Situ Saphenous Vein Bypass Grafts Using the Amplatzer Vascular Plug 4: Initial Experience  

SciTech Connect

We examined the safety and efficacy of vessel occlusion of the Amplatzer Vascular Plug 4 (AVP-4) in patients with arteriovenous fistulas after in-situ saphenous vein bypass grafts. We treated 18 fistulas of seven patients (four women, mean {+-} standard deviation age 76 {+-} 7 years, range 63-88 years). All fistulas were detected within 14 days after surgery. Initial diagnosis and follow-up was established by sonography. We measured the diameter of the feeding vessel and the time of vessel occlusion after plug deployment. Additionally, we recorded procedure time and the dose area product. Additional interventional procedures were necessary in three patients. We successfully used 19 AVP-4 for occlusion of all fistulas without thromboembolic complications. There was no need for recapturing the device, and we did not observe dislocation. Mean occlusion time was 9.6 min (range 5-22 min). Mean diameter of the feeding vessels was 3.5 mm (range 2.6-5.1 mm). Plug sizes ranged from 4-8 mm (mean 5.5 mm) resulting in an oversizing of 33-88%. Mean procedure time for patients with and without additional intervention was 91 {+-} 38 min and 35 {+-} 18 min, respectively. Mean dose area product was 11,790 cGy/cm{sup 2} (range 1,850-23,500 cGy/cm{sup 2}). Permanent occlusion of the fistulas was confirmed by ultrasound after a mean follow-up of 4 months (1-6 months). Occlusion of arteriovenous fistulas with an AVP-4 seems to be effective and safe in patients with in-situ saphenous vein bypass grafts. The AVP-4 is well suited for this purpose because of the appropriate diameter of the feeding vessels.

Libicher, Martin, E-mail: [Klinikum der Universitaet zu Koeln, Institut und Poliklinik fuer Radiologische Diagnostik (Germany); Reichert, V. [Klinikum der Universitaet zu Koeln, Klinik und Poliklinik fuer Gefaesschirurgie (Germany); Schwabe, H. [Klinikum der Universitaet zu Koeln, Institut und Poliklinik fuer Radiologische Diagnostik (Germany); Matoussevitch, V.; Gawenda, M. [Klinikum der Universitaet zu Koeln, Klinik und Poliklinik fuer Gefaesschirurgie (Germany)



Ocular vascular thrombotic events: central retinal vein and central retinal artery occlusions.  


We prospectively assessed associations of thrombophilia- hypofibrinolysis with central retinal vein occlusion (CRVO) (40 patients) and central retinal artery occlusion (CRAO) (9 patients). We used polymerase chain reaction measures for thrombophilia (factor V Leiden, prothrombin, C677T MTHFR, platelet glycoprotein PlA1/A2) and hypofibrinolysis (plasminogen activator inhibitor-1 4G4G). Serologic thrombophilia measures included protein C, protein S (total and free) and antithrombin III, homocysteine, lupus anticoagulant, anticardiolipin antibodies IgG-IgM, and factors VIII and XI. Serologic hypofibrinolysis measures included Lp(a) and plasminogen activator inhibitor activity. For comparison with 40 CRVO and 9 CRAO patients, 80 and 45 race-gender matched controls were studied. The factor V mutation was more common in CRVO (3/40, 8%) than controls (0/79, 0%), P = .036, as was high (>150%) factor VIII (12/40, 30%) versus (4/77, 5%), P = .0002. Low antithrombin III (<80%) was more common in CRVO (5/39, 13%) than in controls (2/73, 3%), P = .049. Homocysteine was high (> or =13.5 micromol/L) in 5/39 (13%) CRVO patients versus 2/78 controls (3%), P = .04. Three of 9 CRAO patients (33%) had low (<73%) protein C versus 2/37 controls (5%), P = .044. Two of 9 CRAO patients (22%) had high (> or =13.5 micromol/L) homocysteine versus 0/42 controls (0%), P =. 028. Four of 9 CRAO patients had the lupus anticoagulant (44%) versus 4/33 (12%) controls (P = .050). CRVO is associated with familial thrombophilia (factor V Leiden, factor VIII, low antithrombin III, homocysteinemia), and CRAO is associated with familial and acquired thrombophilia (low protein C, homocysteinemia, lupus anticoagulant), providing avenues for thromboprophylaxis, and triggering family screening. PMID:18160589

Glueck, Charles J; Ping Wang; Hutchins, Robert; Petersen, Michael R; Golnik, Karl



Acquired vascular malformation in ruptured caesarean section scar: a rare cause of life-threatening vaginal bleeding.  


Uterine arteriovenous malformations (AVM) are rare and potentially life-threatening lesions. Patients present with severe vaginal bleeding which usually does not respond to conservative management and on most of occasions requires radiological or surgical intervention. We report a case of acquired AVM in a ruptured caesarean section scar. The patient presented with life-threatening vaginal bleeding and was treated with gonadotropin releasing hormone agonist and subsequent angioembolisation coiling. PMID:23839607

Hilal, Kiran; Masroor, Imrana; Aziz, Aliya; Sayani, Raza



Post Contrast Susceptibility-Weighted Imaging: A Novel technique for the Detection of Arteriovenous Shunting in Vascular Malformations of the Brain  

PubMed Central

Purpose To determine the utility of post contrast susceptibility-weighted magnetic resonance imaging (PCSWI) in the evaluation of vascular malformations of the brain (BVM). Materials and Methods We retrospectively evaluated PCSWI and digital subtraction angiography (DSA) data from 16 consecutive patients with known or suspected BVM, which had been entered into a prospectively maintained database during a 1-year period. There had been no intervening treatment or change in patients’ symptoms between the PCSWI and DSA studies. The utility of PCSWI in the detection of AVS was compared to that of routine non-contrast susceptibility weighted imaging (SWI), time of flight Magnetic Resonance angiography (TOFMRA) and contrast enhanced Magnetic Resonance angiography (CEMRA) using DSA results as the reference standard. The presence of AVS in PCSWI or SWI sequences was defined by the presence of abnormal signal hyperintensity in the venous structures adjacent to the BVM. Results A total of 17 BVMs were identified by DSA (9 newly diagnosed arteriovenous malformations, 3 dural arteriovenous fistulas, 4 treated arteriovenous malformations with residual AVS and 1 complex developmental venous anomaly). PCSWI was 100% sensitive and 100% specific with 100% positive predictive value (PPV) and 100% negative predictive value (NPV) for the detection of AVS in these BVMs. The PCSWI/SWI signal intensity ratio in the most prominent early draining venous structure was 1.2 ± 0.32. Conclusion PCSWI appears to be superior to SWI, TOFMRA and CEMRA in detecting AVS in BVMs and may be useful in the initial diagnosis and follow-up of patients with BVMs.

Jagadeesan, Bharathi D.; Delgado Almandoz, Josser E.; Benzinger, Tammie L.S.; Moran, Christopher J.



Diffuse type pulmonary arteriovenous malformations: report of one case.  


Pulmonary arteriovenous malformations are direct communications between pulmonary arteries and veins via a tortuous vascular space. They can cause severe pulmonary and neurologic complications. Most PAVMs are located in the lower lobes and can be seen on radiography or angiography. However, a few patients with PAVMs have a more severe and diffuse pattern of disease. These patients generally present with more profound cyanosis and a poorer prognosis. The widespread distribution and small size of these lesions make both diagnosis and management very difficult. We report a 12-year-old patient with diffuse bilateral PAVMs confirmed by contrast echocardiography and technetium-labeled macroaggregated albumin perfusion scan. PMID:16302574

Yu, Chang-Hsien; Chen, Ming-Ren; Lin, Shuan-Pei; Shih, Bing-Fu


Etiology and Management of Branch Retinal Vein Occlusion  

Microsoft Academic Search

Retinal vein occlusion is one of the vascular disorders affecting vision. Branch retinal vein occlusion and central retinal vein occlusion are the two basic types of vein occlusion. Branch retinal vein occlusion is three times more common than central retinal vein occlusion and is second only to diabetic retinopathy as the most common retinal vascular cause of visual impairment. The

Sadaf Hamid; Sajid Ali Mirza; Ishrat Shokh


Brain Malformations  


Most brain malformations begin long before a baby is born. Something damages the developing nervous system or causes it ... medicines, infections or radiation during pregnancy interferes with brain development. Types of brain malformations include missing parts ...


Prenatal Diagnosis of an Aneurysm of the Vein of Galen by Three-Dimensional Power and Color Doppler Ultrasonography  

PubMed Central

Aneurism of the vein of Galen is a complex arteriovenous malformation which is of multiply communications between of the vein of Galen and the cerebral arteries. It represents less than 1% of the cerebral arteriovenous malformations. Few cases using three-dimensional (3D) power and color Doppler ultrasound have been reported in the literature. We present a case of an aneurysm of the vein of Galen diagnosed at 25th week of pregnancy. We demonstrate the main findings of 3D power and color Doppler ultrasonography in this anomaly. A 36-year-old pregnant woman, gravida 3, para 2 was referred to our institution because of a midline cystic mass diagnosed in a previous ultrasonography undertaken at 24 weeks’ gestation. The ultrasonographic finding consisted of a male fetus with a midline cystic mass, with positive flow detection by color Doppler and ventriculomegaly due to the compressive effects of the malformation. The 3D color and power Doppler ultrasonography allowed us to reconstruct the architecture of the vascular malformation, and it showed the spatial relationships of aneurysm of the vein of Galen with the other structures of the brain. Pregnancy was interrupted at 29 weeks’ gestation because of presence of cardiomegaly. A male newborn survived for 36 hours only. The 3D ultrasound can be used as advent image technique in prenatal diagnosis of aneurysm of the vein of Galen.

Rios, Livia Teresa Moreira; Araujo, Edward; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes; Martins, Marilia da Gloria



Congenital Absence of Inferior Vena Cava with Azygos Continuation Revealed by Vascular Echo in a Patient with Pulmonary Thromboembolism and Deep Vein Thrombosis: A Case Report  

PubMed Central

A 44-year-old man with an isolated anomaly of azygos continuation of the inferior vena cava (IVC) presented with dyspnea due to pulmonary thromboembolism (PTE) and deep-vein thrombosis (DVT). Sono-graphic examination disclosed not only pulmonary hypertension and DVT, but also infrahepatic interruption of the IVC with azygos continuation. A rare anomaly of azygos continuation of IVC could cause DVT and PTE. Vascular echo could play an important role in the examination of DVT and/or venous anomalies.



Vascular response of retinal arteries and veins to acute hypoxia of 8,000, 10,000, 12,500, and 15,000 feet of simulated altitude.  


Computerized scanning microdensitometry of fundus photographs was used to study the effect of acute hypoxia on vessel diameters of 238 retinal arteries and 227 veins in 40 men aged 18-23 years. Fundus photography was performed at sea level and at simulated altitudes in a low-pressure chamber, randomly selecting 10 men to each of four altitudes--8,000, 10,000, 12,500, and 15,000 ft (2,400, 3,000, 3,800, and 4,500 m). After 15 min of hypoxic exposure, the caliber of small arteries (less than 75 microns) increased 4% (p less than 0.01) and that of large arteries (greater than or equal to 75 microns) 7% (p less than 0.05), already at 8,000 ft (2,400 m). The caliber of large veins did not change until an increase of 6% (p less than 0.01) was observed at 15,000 ft (4,500 m). Although large arteries increased 7% (p less than 0.05) and 8% (p less than 0.01) in diameter at 10,000 ft (3,000 m) and 15,000 ft and small veins 9% (p less than 0.05) and 12% (p less than 0.01) at the same altitudes, respectively, no change was observed at 12,500 ft (3,800 m). Thus, the dilating effect of hypobaric hypoxia was nonlinear from sea level to 15,000 ft of simulated altitude. As an overall response to the four simulated altitudes the vasodilation was negatively correlated to the vessel diameter at sea level (r = -0.20) in both arteries and veins (p less than 0.01). The variability of hypoxic vascular response was as great within different parts of individual retinas as between different retinas. PMID:2310357

Brinchmann-Hansen, O; Myhre, K



Injury to Human Endothelial Cells in Culture under Conditions Simulating the Use of Vein Grafts for Vascular Surgery  

Microsoft Academic Search

In order to evaluate the effects of various vein graft preparation media at various temperatures, the 51Cr release from cultured human endothelial cells, and the percentage of loosened cells were determined after incubation of the cells with the media. Scanning electron microscopy (SEM) was carried out to visualize any injuring effect of the media. Incubation was performed with either heparinized

S. Solberg; T. Larsen; L. Jørgensen; D. Sørlie



Gp38k, a Protein Synthesized by Vascular Smooth Muscle Cells, Stimulates Directional Migration of Human Umbilical Vein Endothelial Cells  

Microsoft Academic Search

Gp38k is a 383-amino-acid secreted glycoprotein expressed by cultured vascular smooth muscle cells during the time of transition from a proliferating monolayer culture to a nonproliferating multilayered (differentiated) culture. Expression continues as the cell culture forms multicellular nodules. Because this transition period involves active cell migration, we evaluated the effects of exogenously added gp38k on vascular endothelial cell (HUVEC) migration

Katherine M. Malinda; Lourdes Ponce; Hynda K. Kleinman; Lisa M. Shackelton; Albert J. T. Millis



Vascular holism: The epidemiology of vascular disease  

Microsoft Academic Search

This article reviews the distinguishing features of epidemiology and clinical medicine and their interdependence in clinical epidemiology as applied to vascular disease. Selected literature is reviewed to emphasize the principles of clinical epidemiology for five vascular disorders: abdominal aortic aneurysms, lower extremity peripheral arterial occlusive disease, cerebrovascular disease, deep vein thrombosis and pulmonary embolism, and varicose veins. These vascular disorders

Robert W. Barnes



Binding of ATP to vascular endothelial growth factor isoform VEGF-A165 is essential for inducing proliferation of human umbilical vein endothelial cells  

PubMed Central

Background ATP binding is essential for the bioactivity of several growth factors including nerve growth factor, fibroblast growth factor-2 and brain-derived neurotrophic factor. Vascular endothelial growth factor isoform 165 (VEGF-A165) induces the proliferation of human umbilical vein endothelial cells, however a dependence on ATP-binding is currently unknown. The aim of the present study was to determine if ATP binding is essential for the bioactivity of VEGF-A165. Results We found evidence that ATP binding toVEGF-A165 induced a conformational change in the secondary structure of the growth factor. This binding appears to be significant at the biological level, as we found evidence that nanomolar levels of ATP (4-8 nm) are required for the VEGF-A165-induced proliferation of human umbilical vein endothelial cells. At these levels, purinergic signaling by ATP via P2 receptors can be excluded. Addition of alkaline phosphate to cell culture lowered the ATP concentration in the cell culture medium to 1.8 nM and inhibited cell proliferation. Conclusions We propose that proliferation of endothelial cells is induced by a VEGF-A165-ATP complex, rather than VEGF-A165 alone.



[Anorectal malformations].  


Anorectal malformations (ARM) are the result of an abnormal development of the terminal part of the digestive tract interesting anus and/or rectum that occur early between the sixth and tenth week of embryonic development. They carry a malformation spectrum of severity depending on the level of disruption of the anorectal canal and of the associated caudal malformations (sacrum and spine). ARM are associated in over half the cases with other malformations that can be integrated in some cases in known syndromes. If surgical treatment to restore anatomy as normal as possible is indispensable, post-operative care is essential for these patients whose defecation mechanisms are altered, to reach if not continence, at least a socially acceptable cleanliness. PMID:23992833

Cretolle, C; Rousseau, V; Lottmann, H; Irtan, S; Lortat-Jacob, S; Alova, I; Michel, J L; Aigrain, Y; Podevin, G; Lehur, P A; Sarnacki, S



Chiari Malformation  


... signs and symptoms may not occur until late childhood or adulthood. The most common pediatric form, called ... I, signs and symptoms usually appear during late childhood or adulthood. Chiari malformation type II is usually ...


Chiari Malformation  


... Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls balance. ... of the skull is smaller than normal, the cerebellum and brain stem can be pushed downward. The ...


Complex vascular anomalies.  


The classification system for vascular anomalies now used by experts worldwide comprises two distinct disease entities that differ in their biologic and pathologic features: vascular tumors and vascular malformations. Vascular tumors include infantile and congenital hemangiomas, tufted angiomas, and kaposiform hemangioendotheliomas. Infantile hemangiomas, the most common vascular anomaly, generally have a predetermined life cycle (proliferation and subsequent involution). GLUT-1, a glucose transporter, is a marker for these specific lesions during all phases of development. Vascular malformations are classified according to their vascular tissue of origin and include capillary, venous, arteriovenous, lymphatic, and mixed malformations. Complex lymphatic malformations and complex mixed malformations, which may have most vascular components, are the most difficult vascular malformations to successfully treat. These lesions are present at birth and often expand or grow in response to trauma, infection, or hormonal changes. Imaging advancements have enabled more accurate assessments and improved management of vascular anomalies. In addition, many lesions are now being managed with targeted pharmacologic therapy. Propranolol and steroids are used for complex or disfiguring tumors, and new anti-angiogenesis inhibitors such as sirolimus are selectively used to treat lymphatic and venous lymphatic malformations that are poorly responsive to sclerotherapy, embolization, and surgical excision. Multimodal therapies are often essential for complex lesions and require the combined expertise of an interdisciplinary team. PMID:23989523

Azizkhan, Richard G



Non-penetrating Vascular Clips Anastomosis Inhibited Intimal Thickening Under Poor Runoff Conditions in Canine Autogenous Vein Grafts  

Microsoft Academic Search

Objective Late graft failure is still a significant problem, particularly in cases with poor runoff vessels. The main cause of late graft failure is intimal thickening of the anastomotic region. Vascular closure system (VCS) clips may provide ideal anastomosis, since they do not penetrate the wall. Therefore, we examined whether the VCS clips affect intimal thickening under poor runoff conditions

K. Komori; T. Shoji; T. Furuyama; Y. Yonemitsu; E. Mori; T. Yamaoka; T. Matsumoto; K. Sugimachi



Vascular endothelial growth factor C is required for sprouting of the first lymphatic vessels from embryonic veins  

Microsoft Academic Search

Lymphatic vessels are essential for immune surveillance, tissue fluid homeostasis and fat absorption. Defects in lymphatic vessel formation or function cause lymphedema. Here we show that the vascular endothelial growth factor C (VEGF-C) is required for the initial steps in lymphatic development. In Vegfc?\\/? mice, endothelial cells commit to the lymphatic lineage but do not sprout to form lymph vessels.

Marika J Karkkainen; Paula Haiko; Kirsi Sainio; Juha Partanen; Jussi Taipale; Tatiana V Petrova; Michael Jeltsch; David G Jackson; Marja Talikka; Heikki Rauvala; Christer Betsholtz; Kari Alitalo



The persistent embryonic vein in Klippel-Trenaunay syndrome.  


Klippel-Trenaunay syndrome (KTS) is a congenital malformation syndrome with prominent vascular anomalies. A persistent embryonic vein (PEV) may be located on the affected leg(s) of patients with KTS. Our understanding of PEVs of the legs is limited and their nomenclature is confusing. The objective of this study was to obtain further insight in the prevalence, nomenclature and etiology of PEVs of the legs in KTS and to propose a standardized description of anomalous leg veins in KTS. We investigated 70 KTS patients for the presence of PEVs (lateral marginal vein, LMV) of the legs by duplex ultrasonography. We performed histopathological analysis of a surgically excised PEV (LMV) of a typical KTS patient, and we conducted an extensive literature study. Duplex ultrasonography showed LMVs in 12/70 (17.1%) patients. The terms used to describe PEVs in the leg are quite variable, while indicating only two types: lateral marginal vein (LMV) and persistent sciatic vein (PSV). The histology of the excised LMV showed remarkable similarity with that of varicose veins found in the general population. In conclusion, the prevalence of LMVs in our KTS cohort is 17.1%. Two PEVs can be found in the legs and we propose nomenclature based on anatomical criteria, thereby using only the terms persistent lateral marginal vein and persistent sciatic vein, combined with the patency of the deep venous system. We hypothesize that PEVs are most likely caused by a genetic defect leading to abnormal venous pattern formation, which is further supported by our histopathological findings. PMID:23966121

Oduber, Charlène Eu; Young-Afat, Danny A; van der Wal, Allard C; van Steensel, Maurice Am; Hennekam, Raoul Cm; van der Horst, Chantal Mam



Arteriovenous malformation of the spinal cord  

Microsoft Academic Search

We report a case of spinal arteriovenous malformation (AVM) in which detailed morphological examination of the intramedullary vascular lesion was carried out employing serial section studies. The relationship of the malformation to parenchymal lesions was evaluated. An abnormal vessel at the spinomedullary transition, whose lamina elastica was partially interrupted, was suggestive of a shunt vessel. The location of the intramedullary

Tsuyoshi Ishida; Shigeo Murayama; Kazuyoshi Yamaguchi; Yoshinori Urano; Makoto Iwata



Capillary malformation-arteriovenous malformation syndrome: a report of 2 cases, diagnostic criteria, and management.  


Capillary malformation-arteriovenous malformation syndrome is a rare type of vascular malformation first described in 2003. It is an autosomal dominant inherited disorder that has been reported in association with heterozygous mutations in the RASA1 gene, which encodes the protein RASp21. The clinical picture is characterized by multiple small capillary malformations which are associated with either arteriovenous malformations or arteriovenous fistulas in both the affected individual and other members of their family. We describe 2 new familial cases of this syndrome that were clinically and genetically diagnosed and studied in our hospital. PMID:23933248

Català, A; Roé, E; Vikkula, M; Baselga, E



Familial cerebral cavernous malformation.  


Cavernous malformations (CMs) occur in approximately 0.5% of the general population and represent 5-10% of the central nervous system vascular malformations. The majority of CMs appear sporadically but genetically determined familial forms account for 10% to 15% of all cases. The aim of this study was to discuss the clinical, pathological and genetic aspects of familial cerebral cavernous malformations (CCMs). We report on five members of a family who underwent surgery due to CCMs. However, only two members were treated in our Department. The age of onset of symptoms in these cases (4 men and 1 women) ranged from 3 to 28 years. Three members of the family were asymptomatic but it turned out that they were obligatory gene carriers and in one of them the cavernous malformation was confirmed by neuroimaging study. The clinical symptoms of CCMs included seizure (three patients) and focal neurological deficit (two patients). Multiple CCMs were identified in two symptomatic patients (two lesions) and in one asymptomatic patient (three lesions). The lesions were located superficially (4), in the basal ganglia (1), in the brainstem (2) and in the cerebellar vermis (1). In two patients, the subsequent imaging studies showed a single de novo CCM formation. Only one patient with mutation of CCM2 gene was treated surgically. In patients with cavernous malformations the detailed clinical and family history of neurological events ought to be collected. This is particular important in patients with multiple changes or with de novo CCMs formation, identified in subsequent imaging studies. A well-documented family history can help to establish the final diagnosis and makes it possible to offer all members of the family proper neurological and genetic care. PMID:22773461

Dziedzic, Tomasz; Kunert, Przemys?aw; Matyja, Ewa; Ziora-Jakutowicz, Karolina; Sidoti, Antonella; Marchel, Andrzej



Chiari Malformation  


... of the back of the head or the neck and contains brain matter. The covering of the brain or spinal ... fusion of segments of the bones in the neck, and extra folds in the brain. How common are Chiari malformations? In the past, ...


Portal Vein Embolization Using a Nitinol Plug (Amplatzer Vascular Plug) in Combination with Histoacryl Glue and Iodinized Oil: Adequate Hypertrophy with a Reduced Risk of Nontarget Embolization  

SciTech Connect

The purpose of this study was to assess whether portal vein embolization (PVE) using a nitinol vascular plug in combination with histoacryl glue and iodinized oil minimizes the risk of nontarget embolization while obtaining good levels of future liver remnant (FLR) hypertrophy. Between November 2005 and August 2008, 16 patients (8 females, 8 males; mean age, 63 {+-} 3.6 years), each with a small FLR, underwent right ipsilateral transhepatic PVE prior to major hepatectomy. Proximal PVE was initially performed by placement of a nitinol vascular plug, followed by distal embolization using a mixture of histoacryl glue and iodinized oil. Pre- and 6 weeks postprocedural FLR volumes were calculated using computed tomographic imaging. Selection for surgery required an FLR of 0.5% of the patient's body mass. Clinical course and outcome of surgical resection for all patients were recorded. At surgery, the ease of hepatectomy was subjectively assessed in comparison to previous experience following PVE with alternative embolic agents. PVE was successful in all patients. Mean procedure time was 30.4 {+-} 2.5 min. Mean absolute increase in FLR volume was 68.9% {+-} 12.0% (p = 0.00005). There was no evidence of nontarget embolization during the procedure or on subsequent imaging. Nine patients proceeded to extended hepatectomy. Six patients demonstrated disease progression. One patient did not achieve sufficient hypertrophy in relation to body mass to undergo hepatic resection. At surgery, the hepatobiliary surgeons observed less periportal inflammation compared to previous experience with alternative embolic agents, facilitating dissection at extended hepatectomy. In conclusion, ipsilateral transhepatic PVE using a single nitinol plug in combination with histoacryl glue and iodinized oil simplifies the procedure, offering short procedural times with minimal risk of nontarget embolization. Excellent levels of FLR hypertrophy are achieved enabling safe extended hepatectomy.

Bent, Clare L., E-mail:; Low, Deborah; Matson, Matthew B.; Renfrew, Ian; Fotheringham, Tim [Barts and The London NHS Trust, Department of Diagnostic Imaging (United Kingdom)



Periodontal manifestations and management of a patient with AV malformation  

PubMed Central

Arterio-venous malformation (AVM) is an abnormal communication between an artery and a vein. The incidence of its occurrence in oral and maxillofacial region is rare, and if present, the most common sign is gingival bleeding. A 12-year-old female patient presented with an extra oral swelling in relation with upper lip. Intra oral examination showed non tender gingival swelling with spontaneous bleeding associated with maxillary arch. On initiation of phase I therapy using hand instruments, spontaneous brisk bleeding was encountered which was difficult to control. Because of severe nature of hemorrhage encountered, some type of vascular abnormality was suspected. Ultrasonography followed by angiography confirmed AVM in relation with upper lip. Embolization of lesion was followed by gingivectomy procedure and no recurrence was reported during one year of follow-up. Thus, proper recognition and therapeutic intervention is essential to avoid serious complications and potentially tragic outcome in such situations.

Narang, Sumit; Gupta, Ruby; Narang, Anu; Nema, Ram Narayan



Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative role of embolisation  

PubMed Central

Summary Valavanis A, Pangalu A, Tanaka M. Endovascular treatment of cerebral arteriovenous malformations with emphasis on the curative role of embolisation. Schweiz Arch Neurol Psychiatr 2004;155:341-7. Cerebral arteriovenous malformations are complex and only partially understood vascular lesions of the central nervous system with a natural history characterised by significant morbidity and mortality mainly due to an increased haemorrhagic risk. Microneurosurgical removal, radiosurgical obliteration and neuroendovascular embolisation are the principal therapeutic modalities applied individually or in various combinations according to varying selection criteria for the treatment of cerebral arteriovenous malformations. In this context embolisation plays a central role either as a complementary or as the sole treatment technique. This report summarises the evolutive 18 years of continuous experience of the senior author with the neuroradiological evaluation and endovascular treatment of 644 patients with a cerebral arteriovenous malformation. Special emphasis is given to the underlying concepts and specific endovascular techniques developed for the complete, i.e. curative embolisation of cerebral arteriovenous malformations. Precise angiographic analysis of the vascular composition and intrinsic angioarchitecture of the nidus of the arteriovenous malformation by superselective microcatheterisation is required to identify the types of feeding arteries and patterns of their supply, the number and vascular connections of nidal compartments, the types of arteriovenous shunts, the morphology of the vascular spaces composing the nidus and the number and exit patterns of draining veins. Complete angiographic investigation for recognition of secondarily induced phenomena of the cerebral vasculature, such as arterial and venous high-flow angiopathy and so-called perinidal angiogenesis is essential for a comprehensive evaluation and assessment of the associated haemorrhagic risk. Based on a precise topographic classification, detailed angioarchitectural analysis, application of superselective multimicrocatheterisation techniques along with a controlled intranidal injection of non-absorbable liquid embolic materials, nearly 40% of cerebral arteriovenous malformations can be completely and stably obliterated and therefore curatively treated by single session or multistaged embolisation with a morbidity of 1.3% and a mortality of 1.3%, which are lower than the known natural history of this disease.

Valavanis, A.; Pangalu, A.; Tanaka, M.



Arteriovenous Malformation Management  

SciTech Connect

Arteriovenous malformations (AVM) are rare vascular lesions that can present with a myriad of clinical presentations. In our institutions, initial workup consists of a clinical exam, color Doppler imaging, and magnetic resonance imaging. After the initial noninvasive workup, arteriography, at times closed system venography, and ethanol endovascular repair of the AVM is performed under general anesthesia. Depending on the size of the lesion, additional Swan-Ganz line and arterial line monitoring are performed. Patients are usually observed overnight and uneventfully discharged the following day if no complication occurs. Patients are followed at periodic intervals despite cure of their lesion. Long-term follow-up is essential in AVM management.

Yakes, Wayne F. [Interventional Radiology and Interventional Neuroradiology, Radiology Imaging Associates, P.C., Colorado NeurologicalInstitute, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80110 (United States); Rossi, Plinio [Department of Radiology, Universita Degli Studi Di Roma, 'La Sapienza', 00161 Rome (Italy); Odink, Henk [Department of Radiology, De Wever Hospital, Henri Dunanstrat 5, 6419 PC Heerlen (Netherlands)



Comparison of tissue factor and prostacyclin production by human umbilical vein endothelial cells on Dacron vascular prostheses and Dacron smooth films.  


The functional capacity of human umbilical vein endothelial cells (HUVEC) grown on Dacron (polyethylene terephthalate; PET) vascular prosthetic material was compared with the function of cells on smooth surfaced PET, tissue culture polystyrene (TCPS), and Natrix-coated TCPS. Prosthetic materials include two knitted fabrics (Bionit I and II) and two woven preparations (DeBakey Soft Woven and Extra Low Porosity). Two entities produced by HUVEC that influence blood coagulation were assessed: the procoagulant tissue factor (TF) and the anticoagulant prostacyclin (PGI2). Although TF activity was stimulated on all substrates by endotoxin (LPS), there was no difference among prostheses and no difference among smooth surface materials, but TF was reduced in cells on the prosthetic materials relative to those on smooth surface substrates. The reduced TF production by HUVEC on prosthetic material could be reversed by returning them to TCPS. In contrast, PGI2 production on prostheses was comparable to that on smooth surfaces for both stimulated and unstimulated cells. Stimulation with histamine (1 microM) gave a 2.4-fold increase in PGI2 whereas mellitin (10 micrograms/ml) increased production 12.5-fold. The differential response of HUVEC with regard to these two coagulation factors, one of which is secreted and the other membrane bound, may reflect the distorted shape of cells on fibers of the prosthesis. PMID:7829552

Tunstall, A; Eberhart, R C; Prager, M D



An interesting clinical case: variant of the cephalic vein emptying into the internal jugular vein.  


This case report describes a 45-year-old patient who was referred to our center for surgical creation of long-term vascular access. Angiographic mapping revealed the left cephalic vein draining directly into the internal jugular vein rather than the axillary vein. The patient was scheduled for an ulnar artery to cephalic vein fistula. PMID:22780845

Lum, Craig; Ladenheim, Eric D



Rare malformation of glans penis: arteriovenous malformation.  


Pediatric glans penis malformations, especially arteriovenous malformations (AVM), are very rare. Herein, we report two rare cases. A 14-year-old boy attended our outpatient clinic with chief complaints of purple swelling and rapidly growing lesion on the glans penis. The lesion was excised surgically after physical and radiological evaluations. Pathology reported AVM and the patient is being followed up. The second case is a 2-year-old boy who was admitted with a big lesion involving glans penis and genital area that has been present since birth. In physical and radiological evaluations, lesion on the glans penis was pulsatile. Parents of the patient did not want any surgery and patient has been in follow-up. Diagnosis of the vascular lesions on glans penis is very easy by physical and radiological examinations today. Long-term follow-up is very important for AVM. Clinicians must make a careful effort to document new glans lesions in the pediatric population and decrease anxiety in the parents of affected children. PMID:23771468

Akin, Y; Sarac, M; Yucel, S


Arteriovenous Malformation of the Pancreas  

PubMed Central

Pancreatic arteriovenous malformation (PAVM) is a very rare and mostly congenital lesion, with less than 80 cases described in the English-published literature. It is defined as a tumorous vascular abnormality that is constructed between an anomalous bypass anastomosis of the arterial and venous networks within the pancreas. It represents about 5% of all arteriovenous malformations found in the gastrointestinal tract. Herein, we present a 64-year-old patient with symptomatic PAVM involving the body and tail of the organ, which was successfully treated by transcatheter arterial embolization. The disease spectrum and review of the literature are also presented.

Charalabopoulos, Alexandros; Macheras, Nikolas; Krivan, Sylvia; Petropoulos, Konstantinos; Misiakos, Evangelos; Macheras, Anastasios



Glioblastoma Mimicking an Arteriovenous Malformation  

PubMed Central

Abnormal cerebral vasculature can be a manifestation of a vascular malformation or a neoplastic process. We report the case of a patient with angiography-negative subarachnoid hemorrhage (SAH) who re-presented 3?years later with a large intraparenchymal hemorrhage. Although imaging following the intraparenchymal hemorrhage was suggestive of arteriovenous malformation, the patient was ultimately found to have an extensive glioblastoma associated with abnormal tumor vasculature. The case emphasizes the need for magnetic resonance imaging to investigate angiography-negative SAH in suspicious cases to rule out occult etiologies, such as neoplasm. We also discuss diagnostic pitfalls when brain tumors are associated with hemorrhage and abnormal vasculature.

Khanna, Arjun; Venteicher, Andrew S.; Walcott, Brian P.; Kahle, Kristopher T.; Mordes, Daniel A.; William, Christopher M.; Ghogawala, Zoher; Ogilvy, Christopher S.



Management of venous malformations.  


Venous malformations (VMs) frequently occur in the head and neck with a predilection for the parotid gland, submandibular triangle, buccal space, muscles of mastication, lips, and upper aerodigestive tract. They are composed of congenitally disrupted ectatic veins with inappropriate connections and tubular channels. Because VMs have poorly defined boundaries and a tendency to infiltrate normal tissue, they require calculated treatment decisions in the effort to preserve surrounding architecture. Sclerotherapy, surgical excision, neodymium:yttrium aluminum garnet laser therapy, or a combination of these modalities is employed in the management of VMs. Although many small VMs can be cured, the objective is often to control the disease with periodic therapy. Location, size, and proximity to vital structures dictate the type of therapy chosen. Vigilance with long-term follow up is important. This review outlines current diagnostic and therapeutic approaches to simple and extensive cervicofacial VMs. PMID:23188688

Richter, Gresham T; Braswell, Leah



Persistent sciatic artery aneurysm treated with concomitant tibial bypass and vascular plug embolization.  


The presence of a persistent sciatic artery is a rare congenital vascular malformation. Complications associated with aneurysmal degeneration of this aberrant vessel include rupture, thrombosis, and embolization with obliteration of outflow vessels. We describe the case of an 82-year-old female presenting with critical limb ischemia due to embolization from a partially thrombosed persistent sciatic artery aneurysm. Successful treatment was achieved via a common femoral to posterior tibial artery bypass with the great saphenous vein and vascular plug embolization of the aneurysm. PMID:19560309

McEnaney, Ryan M; Baril, Donald T; Gupta, Navyash; Marone, Luke K; Makaroun, Michel S; Chaer, Rabih A



Surgical treatment of venous malformations in Klippel-Trénaunay syndrome  

Microsoft Academic Search

Purpose: Klippel-Trénaunay syndrome (KTS) is a complex congenital anomaly, characterized by varicosities and venous malformations (VMs) of one or more limbs, port-wine stains, and soft tissue and bone hypertrophy. Venous drainage is frequently abnormal because of embryonic veins, agenesis, hypoplasia, valvular incompetence, or aneurysms of deep veins. We previously reported on the surgical management of KTS. In this article, we

Audra A Noel; Peter Gloviczki; Kenneth J Cherry; Thom W Rooke; Anthony W Stanson; David J Driscoll



[Polysplenia syndrome: two cases in adults revealed by biliary and pancreatic malformations].  


Polysplenia Syndrome (PS) associates multiple spleens with other malformations usually cardiac, vascular, visceral and biliary. The diversity of these malformations and their embryological mechanisms are described in relation to two cases of PS that were diagnosed in adults. PMID:18166868

Puche, Pierre; Jacquet, Eric; Godlewski, Guilhem; Carabalona, Jean-Pierre; Domergue, Jacques; Navarro, Francis; Prudhomme, Michel



Clinically Unsuspected Venous Malformations Limited to the Submandibular Triangle: CT Findings  

Microsoft Academic Search

PURPOSE: To present the CT characteristics of histologically confirmed venous vascular malfor- mations limited to the submandibular triangle in patients without clinical stigmata of venous vascular malformations. METHODS: The clinical records and CT scans of five women with venous vascular malformations limited to the submandibular triangle were reviewed. Patients ranged from 39 to 70 years of age. None of the

Martin J. Fine; Roy A. Holliday; J. Thomas Roland



Varicose Veins  


... Veins Explore Varicose Veins What Are … Related Vein Problems Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Spanish Version Related Topics Overweight and Obesity How the Heart Works Related Media Videos Widgets Quizzes Send a link to NHLBI ...


Muscle Hemangiomatosis Presenting as a Severe Feature in a Patient with the Pten Mutation: Expanding the Phenotype of Vascular Malformations in Bannayan-Riley-Ruvalcaba Syndrome  

PubMed Central

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a rare autosomal, dominantly-inherited, hamartoma syndrome with distinct phenotypic features. Mutations in the PTEN gene have been identified in PTEN hamartoma tumor syndromes. Our aim was to determine the correlation of phenotype-genotype relationships in a BRRS case. We have evaluated a PTEN mutation in a patient with vascular anomalies and the phenotypic findings of BRRS. We described an 8-year-old girl with the clinical features of BRRS, specifically with vascular anomalies. The mutation in the PTEN gene was identified by DNA sequencing. In our patient, we defined a de novo nonsense R335X (c.1003 C>T) mutation in exon 8, which results in a premature termination codon. Due to vascular anomalies and hemangioma, the patient’s left leg was amputated 1 year after the hemangioma diagnosis. Bannayan - Riley - Ruvalcaba syndrome patients with macrocephaly and vascular anomalies should be considered for PTEN mutation analysis and special medical care.

Soysal, Y; Acun, T; Lourenco, CM; Marques, W; Yak?c?er, MC



Muscle hemangiomatosis presenting as a severe feature in a patient with the pten mutation: expanding the phenotype of vascular malformations in bannayan-riley-ruvalcaba syndrome.  


Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a rare autosomal, dominantly-inherited, hamartoma syndrome with distinct phenotypic features. Mutations in the PTEN gene have been identified in PTEN hamartoma tumor syndromes. Our aim was to determine the correlation of phenotype-genotype relationships in a BRRS case. We have evaluated a PTEN mutation in a patient with vascular anomalies and the phenotypic findings of BRRS. We described an 8-year-old girl with the clinical features of BRRS, specifically with vascular anomalies. The mutation in the PTEN gene was identified by DNA sequencing. In our patient, we defined a de novo nonsense R335X (c.1003 C>T) mutation in exon 8, which results in a premature termination codon. Due to vascular anomalies and hemangioma, the patient's left leg was amputated 1 year after the hemangioma diagnosis. Bannayan - Riley - Ruvalcaba syndrome patients with macrocephaly and vascular anomalies should be considered for PTEN mutation analysis and special medical care. PMID:24052722

Soysal, Y; Acun, T; Lourenço, Cm; Marques, W; Yak?c?er, Mc



Tertiary Lymphoid Organs in Lymphatic Malformations  

PubMed Central

Abstract Background Examine lymphatic malformation lymphoid aggregates for the expression of tertiary lymphoid organ markers. Determine how lymphoid aggregate density relates to lymphatic malformation clinical features. Methods and Results Retrospective cohort study. Tissue and clinical data were reviewed from 29 patients in the Vascular Anomaly Database who represented the spectrum of head and neck lymphatic malformations and had >5 years of follow-up. Archived formalin-fixed, paraffin-embedded lymphatic malformation tissue was immunohistochemically stained with antibodies for tertiary lymphoid organ markers, which included follicular and mature myeloid dendritic cells, high endothelial venules, segregated B and T-cells, lymphatic endothelial cells, and lymphoid homing chemokines (CXCL13, CCL21). Lymphoid aggregate density (count/mm2) was quantified by 2 independent, blinded reviewers. Lymphoid aggregate density and lymphatic malformation clinical features were characterized using analysis of variance. Larger lymphatic malformation tissue lymphoid aggregates stained consistently for tertiary lymphoid organ markers. In oral cavity and neck specimens from the same patients (n?=?9), there were more tertiary lymphoid organ in oral cavity than in neck specimens (p?=?0.0235). In lymphatic malformation neck tissue, de Serres stage 4 lymphatic malformations displayed the highest tertiary lymphoid organ density. No significant association was seen between tertiary lymphoid organ density and other clinical features. Conclusion This study demonstrates that some lymphoid aggregates within lymphatic malformations represent tertiary lymphoid organs. There was an association between tertiary lymphoid organ density and lymphatic malformation location. Further study is required to define the role of lymphoid neogenesis and tertiary lymphoid organ formation in lymphatic malformation pathogenesis.

Kirsh, Andrew L.; Cushing, Sharon L.; Chen, Eunice Y.; Schwartz, Stephen M.



Ten-Year Detection Rate of Brain Arteriovenous Malformations in a Large, Multiethnic, Defined Population  

PubMed Central

Background To evaluate whether increased neuroimaging use is associated with increased brain arteriovenous malformation (BAVM) detection, we examined detection rates in Kaiser Permanente Medical Care Program (KPMCP) of Northern California between 1995 and 2004. Methods We reviewed medical records, radiology reports and administrative databases to identify BAVM, intracranial aneurysms (IA: subarachnoid hemorrhage, SAH, and unruptured aneurysms) and other vascular malformations (OVM: dural fistulas, cavernous malformation, Vein of Galen malformation, venous malformation). Poisson regression (with robust standard errors) was used to test for trend. Random effects meta-analysis generated a pooled measure of BAVM detection rate from six studies. Results We identified 401 BAVMs (197 ruptured, 204 unruptured), 570 OVMs, and 2,892 IAs (2,079 SAH, 813 unruptured IA). Detection rates per 100,000 person-years were 1.4 (95% CI=1.3-1.6) for BAVM, 2.0 (1.8-2.3) for OVM, and 10.3 (9.9-10.7) for IA. Neuroimaging utilization increased 12% per year during the time period (P<0.001). Overall, rates increased for IAs (P<0.001), remained stable for OVMs (P=0.858), and decreased for BAVMs (P=0.001). Detection rates increased 15% per year for unruptured IA (P<0.001), with no change in SAH (P=0.903). However, rates decreased 7% per year for unruptured BAVM (P=0.016) and 3% per year for ruptured BAVM (P=0.005). Meta-analysis yielded a pooled BAVM detection rate of 1.3 (1.2-1.4) per 100,000, without heterogeneity between studies (P=0.25). Conclusions Rates for BAVM, OVM and IA in this large, multiethnic population were similar to other series. During 1995-2004, a period of increasing neuroimaging utilization, we did not observe an increased rate of detection of unruptured BAVM, despite increased detection of unruptured IA.

Gabriel, Rodney A.; Kim, Helen; Sidney, Stephen; McCulloch, Charles E.; Singh, Vineeta; Claiborne Johnston, S.; Ko, Nerissa U.; Achrol, Achal S.; Zaroff, Jonathan G.; Young, William L.



Patterns and distribution of isolated calf deep vein thrombosis  

Microsoft Academic Search

Purpose: In the search for calf deep vein thrombosis (DVT) with color-flow duplex scanning (CFDS), most vascular laboratories investigate only the posterior tibial and peroneal veins. Few laboratories assess the soleal and gastrocnemial veins. This study was designed to determine the patterns and distribution of isolated calf DVT, including the soleal and gastrocnemial veins. Methods: In the last 3 years,

Nicos Labropoulos; K. Michael Webb; Steven S. Kang; M. Ashraf Mansour; Dusty R. Filliung; Jeffrey Buckman; William H. Baker



Tools and procedures for ex vivo vein arterialization, preconditioning and tissue engineering: a step forward to translation to combat the consequences of vascular graft remodeling.  


The present contribution reviews recent progress in bioengineering approaches used to mimic arterial hemodynamic conditions in vascular grafts and vessel substitutes used in vascular surgery. While implantation of vascular bypasses is still the primary option for cardiac and vascular surgeons to recover blood perfusion in cardiac and peripheral ischemic tissues, effective techniques to reduce the impact of post-grafting vascular remodeling are insufficient. In our view, the design of specific bioreactors to perform vascular conditioning with complex stimulation patterns will provide valuable tools for comprehensive molecular analysis of vessel arterialization process. In addition, this approach will allow the future design of refined protocols to perform pre-conditioning of natural vessels, reseeding of human or animalderived decellularized vascular grafts or, finally, derivation of fully engineered arterial-compliant substitutes, with a reduced remodeling impact. PMID:22873197

Piola, Marco; Soncini, Monica; Prandi, Francesca; Polvani, Gianluca; Beniamino Fiore, Gianfranco; Pesce, Maurizio



Microsurgery for cerebral arteriovenous malformation management: a Siberian experience  

Microsoft Academic Search

Cerebral vascular malformations remain among the most difficult neurosurgical entities to treat. We report a retrospective study of the outcome in 95 consecutive patients with angiographically revealed arteriovenous malformations (AVMs). Fifty-four patients underwent microsurgical total AVM removal (group I). Forty-one patients who refused open surgery (group II) were managed either by endovascular embolisation (16 cases), radiosurgery (three) or followed up

Alexei L. Krivoshapkin; Evstafy G. Melidy



Vascular anomalies in children.  


Vascular anomalies are divided in two major categories: tumours (such as infantile hemangiomas) and malformations. Hemangiomas are common benign neoplasms that undergo a proliferative phase followed by stabilization and eventual spontaneous involution, whereas vascular malformations are rare structural anomalies representing morphogenetic errors of developing blood vessels and lymphatics. It is important to properly diagnose vascular anomalies early in childhood because of their distinct differences in morbidity, prognosis and need for a multidisciplinary management. We discuss a number of characteristic clinical features as clues for early diagnosis and identification of associated syndromes. PMID:22090176

Weibel, L



Vascular Occlusion Techniques during Liver Resection  

Microsoft Academic Search

Control of bleeding from the transected liver basically consists of vascular inflow occlusion and control of hepatic venous backflow from the caval vein. Central venous pressure determines the pressure in the hepatic veins and is an extremely important factor in controlling blood loss through venous backflow. Vascular inflow occlusion (Pringle maneuver) involves clamping of the portal vein and the hepatic

Thomas M. van Gulik; Wilmar de Graaf; Sander Dinant; Olivier R. C. Busch; Dirk J. Gouma



Vascular diseases of the spinal cord.  


Vascular disease affecting the spinal can cause substantial neurologic morbidity. Several vascular spinal cord ailments present as neurologic emergencies, and should thus be recognizable to the practicing neurologist. We review the epidemiology, presentation, management strategies, and prognosis of various pathologies, including infarction, dural arteriovenous fistula, arteriovenous malformation, cavernous malformation, compressive epidural hematoma, vasculitis, and genetic abnormalities. PMID:23186899

Rubin, Mark N; Rabinstein, Alejandro A



Vascular 5-HT1-like receptors that mediate contraction of the dog isolated saphenous vein and carotid arterial vasoconstriction in anaesthetized dogs are not of the 5-HT1A or 5-HT1D subtype.  

PubMed Central

1. There is controversy about whether 5-HT1A receptors mediate contraction of isolated cerebral blood vessels. We have therefore compared the vascular actions of the 5-HT1A receptor agonist, 8-hydroxy-2-(di-n-propyl-amino)-tetralin (8-OH-DPAT) with those of the 5-HT1-like receptor agonist, sumatriptan, on the dog isolated saphenous vein, which contains a 5-HT1-like receptor similar to those on cerebral blood vessels, and in the carotid circulation of the anaesthetized dog. 2. 5-Hydroxytryptamine (5-HT), sumatriptan and 8-OH-DPAT each caused contraction of dog isolated saphenous vein with a rank order of agonist potency of 5-HT greater than sumatriptan greater than 8-OH-DPAT and EC50 values (95% confidence limits) of 0.06 (0.04-0.08), 0.3 (0.1-0.8) and 3.9 (2.0-7.5) microM respectively. The maximum contractile effect produced by each agonist was similar. 3. The contractile effects of 5-HT, sumatriptan and 8-OH-DPAT in the dog isolated saphenous vein were resistant to antagonism by the 5-HT1A receptor antagonists spiperone, spiroxatrine and pindolol (all 1 microM). The 5-HT1D receptor ligands, metergoline (0.1 microM) rauwolscine (1 microM) and yohimbine (1 microM) had little or no antagonist activity. In contrast, the non-selective 5-HT1-like receptor blocking drug, methiothepin (0.03-0.3 microM) potently antagonized the contractile effects of 5-HT, sumatriptan and 8-OH-DPAT to a similar degree, suggesting that all three agonists act at the same receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

Perren, M. J.; Feniuk, W.; Humphrey, P. P.



Real-time imaging of de novo arteriovenous malformation in a mouse model of hereditary hemorrhagic telangiectasia.  


Arteriovenous malformations (AVMs) are vascular anomalies where arteries and veins are directly connected through a complex, tangled web of abnormal arteries and veins instead of a normal capillary network. AVMs in the brain, lung, and visceral organs, including the liver and gastrointestinal tract, result in considerable morbidity and mortality. AVMs are the underlying cause of three major clinical symptoms of a genetic vascular dysplasia termed hereditary hemorrhagic telangiectasia (HHT), which is characterized by recurrent nosebleeds, mucocutaneous telangiectases, and visceral AVMs and caused by mutations in one of several genes, including activin receptor-like kinase 1 (ALK1). It remains unknown why and how selective blood vessels form AVMs, and there have been technical limitations to observing the initial stages of AVM formation. Here we present in vivo evidence that physiological or environmental factors such as wounds in addition to the genetic ablation are required for Alk1-deficient vessels to develop to AVMs in adult mice. Using the dorsal skinfold window chamber system, we have demonstrated for what we believe to be the first time the entire course of AVM formation in subdermal blood vessels by using intravital bright-field images, hyperspectral imaging, fluorescence recordings of direct arterial flow through the AV shunts, and vascular casting techniques. We believe our data provide novel insights into the pathogenetic mechanisms of HHT and potential therapeutic approaches. PMID:19805914

Park, Sung Ok; Wankhede, Mamta; Lee, Young Jae; Choi, Eun-Jung; Fliess, Naime; Choe, Se-Woon; Oh, Seh-Hoon; Walter, Glenn; Raizada, Mohan K; Sorg, Brian S; Oh, S Paul



Multiple hamartomas associated with intracranial malformation.  


We examined a newborn infant with multiple hamartomas, including an epidermal nevus syndrome and a giant pigmented congenital nevocellular nevus, associated with other structural developmental abnormalities such as nevus flammeus, vascular malformation, cutis aplasia congenita of the scalp, cartilage hamartoma, and a lipodermoid of the conjunctiva. This child had a significant brain malformation, diagnosed by sonography and computerized tomography, consisting of a significant enlargement of the left hemisphere not associated with asymmetry of the skull or facial bones. We suggest a careful investigation of the intracranial structures by computerized tomography and/or ultrasonography in case of either extensive linear nevus sebaceous sequence and/or giant pigmented nevocellular nevus. PMID:3725699

Mimouni, F; Han, B K; Barnes, L; Ballard, J L; Dignan, P S; Kiessling, M A; Lucky, A W



[Unruptured brain arteriovenous malformations].  


Cerebral arteriovenous malformations (AVMs) often become symptomatic in young adults with a variety of neurological symptoms such as epileptic seizures, recurrent headaches, progressive neurological deficits or sudden intracranial hemorrhage. However, recent epidemiological data suggest a large number of AVMs are found without signs of hemorrhage and a relatively low rupture risk of less than 1% per year. Continuous technical progress has led to several specific treatment options for brain AVMs including endovascular embolization, microneurosurgery, and stereotactic radiotherapy, either alone or in any combination. Depending on AVM topography and vascular anatomy, interventional treatment strategies have shown successful occlusion rates ranging between 50 and 100% and a relatively low average procedural morbidity of 10% overall. For unruptured brain AVMs, however, the clinical benefit of invasive treatment remains as yet to be determined. To address this issue, A randomized trial of unruptured brain AVMs (ARUBA) is currently underway evaluating long-term outcome of best possible standard interventional therapy as compared to the natural history risk in a prospective multidisciplinary international study ( PMID:18786684

Stapf, C



The anatomy of the cardiac veins in mice  

PubMed Central

Although the cardiac coronary system in mice has been the studied in detail by many research laboratories, knowledge of the cardiac veins remains poor. This is because of the difficulty in marking the venous system with a technique that would allow visualization of these large vessels with thin walls. Here we present the visualization of the coronary venous system by perfusion of latex dye through the right caudal vein. Latex injected intravenously does not penetrate into the capillary system. Murine cardiac veins consist of several principal branches (with large diameters), the distal parts of which are located in the subepicardium. We have described the major branches of the left atrial veins, the vein of the left ventricle, the caudal veins, the vein of the right ventricle and the conal veins forming the conal venous circle or the prepulmonary conal venous arch running around the conus of the right ventricle. The venous system of the heart drains the blood to the coronary sinus (the left cranial caval vein) to the right atrium or to the right cranial caval vein. Systemic veins such as the left cranial caval, the right cranial caval and the caudal vein open to the right atrium. Knowledge of cardiac vein location may help to elucidate abnormal vein patterns in certain genetic malformations.

Ciszek, Bogdan; Skubiszewska, Daria; Ratajska, Anna



Inflammation in Retinal Vein Occlusion  

PubMed Central

Retinal vein occlusion is a common, vision-threatening vascular disorder. The role of inflammation in the pathogenesis and clinical consequences of retinal vein occlusion is a topic of growing interest. It has long been recognized that systemic inflammatory disorders, such as autoimmune disease, are a significant risk factor for this condition. A number of more recent laboratory and clinical studies have begun to elucidate the role inflammation may play in the molecular pathways responsible for the vision-impairing consequences of retinal vein occlusion, such as macular edema. This improved understanding of the role of inflammation in retinal vein occlusion has allowed the development of new treatments for the disorder, with additional therapeutic targets and strategies to be identified as our understanding of the topic increases.

Deobhakta, Avnish; Chang, Louis K.



An interconnected duplicated femoral vein and its clinical significance.  


Anatomical variations in the femoral vein are of great clinical importance especially in cases of deep vein thrombosis (DVT). Knowledge of the variable anatomy of the femoral vein is important to minimise false-negative findings on ultrasound examination in patients with DVT and help to explain the 'silent' DVT. Furthermore, the presence of a duplicated femoral vein itself is associated with higher incidence of DVT. These venous anomalies are usually due to the truncular venous malformation. In the present study, while dissecting the right lower limb, we found a case of variation of the femoral vein. In this case, besides a duplicated femoral vein, we also noticed a 3rd interconnecting channel near the apex of the femoral triangle joining the two veins. This variation has not been reported previously by other authors. Considering its uniqueness and clinical importance, we decided to report this case. PMID:23749717

Khan, Aaijaz Ahmed; Asari, Mohd Asnizam; Hassan, Asma; Aiman, Nurul



A Reappraisal of Saphenous Vein Grafting  

PubMed Central

Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

Yuan, Shi-Min; Jing, Hua



Varicose vein stripping  


... called the superficial saphenous vein is thick and rope-like. Vein stripping usually takes about 1 to ... high blood pressure in a vein (lipodermatosclerosis) Large, rope-like veins that cannot be treated with other, ...


Spinal arteriovenous malformation  

Microsoft Academic Search

An 11-year-old girl presented with acute onset of paraplegia with bowel and bladder incontinence. She had spinal tenderness\\u000a and a sensory level at mid thoracic region. MRI spine revealed an intradural extramedullary arterio-venous malformation with\\u000a hemorrhage into the intramedullary region. Hence a diagnosis of spinal arterio-venous malformation was entertained.

S. Balasubramanian; So. Shivbalan; Sandeep D. Jaipurkar



Intramedullary spinalcord cavernous malformations  

Microsoft Academic Search

Intramedullary spinal cord cavernous malformations are rare lesions and account for a small percentage of clinically evident cavernous malformations. However, the reported incidence rates likely underestimate their true rate of occurrence. The advent of magnetic resonance imaging has increased the diagnosis of these lesions as it has that of their intracranial counterparts. Our understanding of their natural history, however, is

Frank P. K. Hsu; Richard E. Clatterbuck; Louis J. Kim; Robert F. Spetzler



[Complications in varicose vein operations].  


Although operations on varicous veins are regarded as easy and low-risk, severe complications with the involvement of arteries, veins and nerves can occur during the course of such operations and, in reconstruction, demand the whole spectrum of vascular surgery. Therefore, surgeons operating on varicous veins and on out-patients should possess sufficient experience in vascular surgery and be able to admit their patients to a centre of vascular surgery in the case of severe complications without unnecessary loss of time. Beside a perfectly done operation sufficient preoperative diagnostic examinations and postoperative care of the patient have to be claimed. The treatment of varicous veins in a hospital must be possible also in the future. The extent of the procedure is usually greater during stationary treatment and bilateral operations are feasible. Therefore, from the economic point of view, a stationary assignment for a few days does not seem more expensive than several single operations with subsequent outpatient treatment and repeated diagnostic examinations in ambulatory settings. PMID:11503468

Balzer, K



Expression of thymidine kinase mediated by a novel non-viral delivery system under the control of vascular endothelial growth factor receptor 2 promoter selectively kills human umbilical vein endothelial cells  

PubMed Central

AIM: To investigate the killing efficiency of a recombinant plasmid containing a thymidine kinase (TK) domain insert driven by the vascular endothelial growth factor receptor 2 (VEGFR2) promoter (KDR) on vascular endothelial cells. METHODS: The KDR-TK fragment was extracted from pBluescript II KDR-TK plasmid by enzymatic digestion with XhoI and SalI. The enhanced green fluorescence protein (EGFP) carrier was extracted from pEGFP by the same procedure. The KDR-TK was inserted into the pEGFP carrier to construct pEGFP-KDR-TK. Using ultrasound irradiation and microbubble, pEGFP-KDR-TK was transferred into human umbilical vein endothelial cells (HUVECs). The transient infection rate was estimated by green fluorescent protein (GFP) expression. Transfected HUVECs, non-transfected HUVECs, and HepG2 cells were cultured in the presence of different concentrations of ganciclovir (GCV), and the killing efficacy of HSV-TK/GCV was analyzed by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: The recombinant pEGFP-KDR-TK was successfully constructed by inserting the KDR-TK fragment into the pEGFP carrier. Transfected HUVECs showed cytoplasmic green fluorescence, and the transient transfection rate was about 20.3%. Pools of G418-resistant cells exhibited a higher sensitivity to the prodrug/GCV compared to non-transfected HUVECs or non-transfected HepG2 cells, respectively. CONCLUSION: KDR promoter and the suicide gene/prodrug system mediated by diagnostic ultrasound combined with microbubble can significantly kill HUVECs. Such therapy may present a novel and attractive approach to target gene therapy on tumor vessels.

Wang, Ying; Xu, Hui-Xiong; Lu, Ming-De; Tang, Qing



Multiple spinal cavernous malformations in Klippel-Trenaunay-Weber syndrome.  


Klippel-Trenaunay-Weber syndrome (KTWS) is a rare, congenital vascular disorder characterized by cutaneous haemangiomas, venous varicosities, and hypertrophy of the osseous and soft tissue. Various vascular anomalies of the central nervous system have been described in this syndrome. Two previous associations between KTWS and spinal cord cavernous malformations have been reported in the English literature. In this report, we present a patient in whom multiple cavernous malformations located in the conus medullaris region and cauda equina were associated with KTWS. General physical examination as well as neuroradiological and operative findings are described. PMID:23161195

Göksu, Ethem; Alpsoy, Erkan; Uçar, Tanju; Tuncer, Recai


Statins prevent pulsatile stretch-induced proliferation of human saphenous vein smooth muscle cells via inhibition of Rho\\/Rho-kinase pathway  

Microsoft Academic Search

Objective: Pulsatile forces regulate vascular remodeling and trigger vascular diseases such as saphenous vein graft disease. The saphenous vein is exposed to high pressure and pulsatility only after implantation. Statins have been proved to reduce the incidence of vein graft failure. Thus, we investigated the molecular mechanisms of pulsatile stretch-induced saphenous vein smooth muscle cell (SMC) proliferation and potential beneficial

Toshiyuki Kozai; Masato Eto; Zhihong Yang; Hiroaki Shimokawa; Thomas F. Luscher



Genetic Variation in VEGF Does Not Contribute Significantly to the Risk of Congenital Cardiovascular Malformation  

Microsoft Academic Search

Several previous studies have investigated the role of common promoter variants in the vascular endothelial growth factor (VEGF) gene in causing congenital cardiovascular malformation (CVM). However, results have been discrepant between studies and no study to date has comprehensively characterised variation throughout the gene. We genotyped 771 CVM cases, of whom 595 had the outflow tract malformation Tetralogy of Fallot

Helen R. Griffin; Darroch H. Hall; Ana Topf; James Eden; A. Graham Stuart; Jonathan Parsons; Ian Peart; John E. Deanfield; John O'Sullivan; Sonya V. Babu-Narayan; Michael A. Gatzoulis; Frances A. Bu'Lock; Shoumo Bhattacharya; Jamie Bentham; Martin Farrall; Javier Granados Riveron; J. David Brook; John Burn; Heather J. Cordell; Judith A. Goodship; Bernard Keavney; Pieter H. Reitsma



Interventional treatment of pulmonary arteriovenous malformations  

PubMed Central

Pulmonary arteriovenous malformations (PAVM) are congenital vascular communications in the lungs. They act as right to left shunts so that the blood running through these malformations is not oxygenated or filtered. These patients are typically hypoxaemic with exercise intolerance and are at high risk of paradoxical emboli to the brain and other organs. These malformations are most commonly seen in hereditary haemorrhagic telangiectasia (HHT) (Mb. Osler-Weber-Rendu syndrome). Nowadays, the generally accepted treatment strategy of first choice is embolization of the afferent arteries to the arteriovenous malformations. It is a minimally invasive procedure and at the same time a lung preserving treatment with a very high technical success, high effectiveness and low morbidity and mortality. Embolization prevents cerebral stroke and abscess as well as pulmonary haemorrhage and further raises the functional level. Embolization is a well-established method of treating PAVM, with a significant effect on oxygenation of the blood. Screening for PAVM in patients at risk is recommended, especially in patients with HHT.

Andersen, Poul Erik; Kjeldsen, Anette Dr?hse



Haemangiomas and Associated Congenital Malformations in a Large Population-Based Sample of Infants.  

National Technical Information Service (NTIS)

Haemangiomas are common, benign, vascular tumors, observed in 4-12 percent of infants during the first year of life. Most cases progress without complication, yet a small proportion experience life-threatening complications. Concomitant congenital malform...

A. T. Bukowinski C. J. Sevick D. J. Slymen J. E. Alcaraz M. A. Ryan



Vein filter  

US Patent & Trademark Office Database

A vein filter having improved collectability of chyme blood or thrombi and stability of indwelling. The filter includes at least 3 wires radially spreading backward of a head member and connected such that the intervals between any adjacent two wires are connected with threads of an equal length at a substantially equal distance from the head member. At respective connection parts where the threads are connected to the wires, hook parts to be hooked on the inner wall of a blood vessel are provided. The head member is on the apex of a shaft extending back and the rear end of each wire is connected to a slide member slidable along the shaft. The wires are preferably made of shape memory alloy or stainless spring steel.

Okada; Masayosi (Osaka, JP)



Macrocephaly-capillary malformation syndrome: Description of a case and review of clinical diagnostic criteria  

Microsoft Academic Search

Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable somatic and cerebral asymmetry, primary megalencephaly, characteristic facial features, an abnormal neurocognitive profile and cutaneous vascular malformations. It was previously known under the name macrocephaly-cutis marmorata telangiectatica congenital (M-CMTC). However a recent review of the previously reported cases has suggested that the vascular anomalies are not true CMTC but rather capillary

Laura Papetti; Luigi Tarani; Francesco Nicita; Martino Ruggieri; Chiara Mattiucci; Francesca Mancini; Fabiana Ursitti; Alberto Spalice


Management of macular edema secondary to central retinal vein occlusion: an evidence-based  

Microsoft Academic Search

Retinal vein occlusions are common retinal vascular disorders with the potential for significant vision-related morbidity.\\u000a Retinal vein occlusions are classified as either branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO),\\u000a or hemiretinal vein occlusion (HRVO) based on the specific occlusion site. Decreased vision in patients afflicted with CRVO\\u000a may result from retinal ischemia and\\/or the accumulation of fluid

Ahmad A. Aref; Ingrid U. Scott



Management of macular edema secondary to branch retinal vein occlusion: an evidence-based update  

Microsoft Academic Search

Retinal vein occlusions are common retinal vascular disorders with the potential for significant vision-related morbidity.\\u000a Retinal vein occlusions are classified as either branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO),\\u000a or hemiretinal vein occlusion (HRVO) based on the specific occlusion site. The most common cause of decreased vision in patients\\u000a afflicted with BRVO is the accumulation of fluid

Ahmad A. Aref; Ingrid U. Scott



Standard anticoagulation for mesenteric vein thrombosis, revealing a 'zebra' diagnosis: hereditary haemorrhagic telangiectasia--the dripping truth!  


A 60-year-old man was treated in the hospital for mesenteric vein thrombosis and discharged home on anticoagulation. On warfarin the patient started to bleed profusely from the nose and tongue. He was evaluated by ENT (ears, nose and throat); a nasal endoscopy revealed several vascular ectasias. Subsequent detailed history and general physical examination established the diagnosis of hereditary haemorrhagic telangiectasia also known as Osler-Weber-Rendu syndrome. On further evaluation, pulmonary arteriovenous malformations were diagnosed on imaging and treated by intervention radiology. In hindsight, the diagnosis could have been made in the general practitioner's office with just a routine thorough history and a physical examination at a new patient visit. We report this case to stress upon the importance of vigilant clinical, medical and family history and a thorough examination to establish an early diagnosis of this not-so-rare entity. PMID:24165501

Aggarwal, Aakash; Kahlon, Arundeep Singh; Rane, Meghan; Banas, Emerald



Proposition of a new classification of the cerebral veins based on their termination.  


The existing classifications of cerebral veins have certain problems, including limited adequacy to uniquely describe neurovascular networks in three dimensions (3D), mixture of deep and superficial veins, and ambiguity of territories-based parcellations as veins may course on multiple territories. Classification discrepancies exist in subdivision, region drained, and parcellation criteria. Recent developments in diagnostic imaging and computers enable to acquire, create, and manipulate complete vascular networks, which also call for a new classification of cerebral veins. We propose a new classification suitable for the description of the complete cerebral veins, providing a clear separation of the superficial cortical veins from deep veins, and facilitating presentation and exploration of cerebral veins in 3D with respect to surrounding neuroanatomy. It is based on terminating vascular subsystems (rather than draining regions). It divides the cerebral veins into cortical, deep, and posterior fossa veins. The cortical veins are subdivided into two groups: terminating in dural sinuses and terminating in deep veins. The posterior fossa veins are subdivided also into two groups: terminating in dural sinuses and terminating in deep veins. This classification was illustrated with a cerebrovascular model containing over 1,300 vessels. This new classification has many advantages. It is simple, clear and didactically useful; avoids mixture of superficial and deep veins; shows overall hierarchical structure and topographical relationships including tributaries; is useful in analysis of 3D vascular trees extracted from imaging; and may be used in conjunction with the existing parcellations. PMID:21769635

Nowinski, Wieslaw L



Functional characterization of Klippel-Trenaunay syndrome gene AGGF1 identifies a novel angiogenic signaling pathway for specification of vein differentiation and angiogenesis during embryogenesis.  


Specification of arteries and veins is a key process for establishing functional vasculature during embryogenesis and involves distinctly different signaling mechanisms. Vascular endothelial growth factor-A (VEGFA) is required for differentiation of arteries; however, the upstream angiogenic factor for vein specification is unknown. Klippel-Trenaunay syndrome (KTS) is a congenital vascular disease associated with capillary and venous malformations (VMs), but not with arterial defects. We have previously reported that upregulation of angiogenic factor AGGF1 is associated with KTS, but the molecular mechanism is not clear. Here, we show that AGGF1 is involved in establishing venous identity in zebrafish embryos. Overexpression of AGGF1 led to increased angiogenesis and increased lumen diameter of veins, whereas knockdown of AGGF1 expression resulted in defective vasculogenesis and angiogenesis. Overexpression of AGGF1 increased expression of venous markers (e.g. flt4), but had little effect on arterial markers (e.g. notch5). Knockdown of AGGF1 expression resulted in a loss of venous identity (loss of expression of flt4, ephb4 and dab2), but had no effect on the expression of arterial development. We further show that AGGF1 activates AKT, and that decreased AGGF1 expression inhibits AKT activation. Overexpression of constitutively active AKT rescues the loss of venous identity caused by AGGF1 downregulation. Our study establishes AGGF1 as an angiogenic factor with an important role in the specification of vein identity and suggests that AGGF1-mediated AKT signaling is responsible for establishing venous cell fate. We propose that increased AGGF1 expression leads to increased vein differentiation by inducing activation of AKT signaling, resulting in VMs s in KTS patients. PMID:23197652

Chen, Di; Li, Lei; Tu, Xin; Yin, Zhan; Wang, Qing



Congenital absence of the portal vein associated with focal nodular hyperplasia of the liver and cystic dysplasia of the kidney  

Microsoft Academic Search

Congenital absence of portal vein is a rare malformation. To date, 16 cases have been reported – all in association with\\u000a other anomalies, i.e. benign or malignant hepatic neoplasms in 6 cases and cardiac malformations in 12. This case report described\\u000a a girl with congenital absence of portal vein, focal nodular hyperplasia of the liver and cystic kidney dysplasia. Angiography

G. Guariso; S. Fiorio; G. Altavilla; P. G. Gamba; T. Toffolutti; M. Chiesura-Corona; U. Tedeschi; L. Zancan



[Vascular anomaly of the iris].  


A 48-year-old man presented with a vascular anomaly of the iris in the left eye. Slit-lamp microscopy revealed dilated and tortuous vessels of the iris between 12 and 4 o'clock. Fluorescein angiography confirmed a diagnosis of arteriovenous (AV) malformation of the iris. The vessel originated at the iris base, passed to the pupillary margin and returned to the base. Such AV-malformations of the iris are very rare, benign vascular anomalies that have to be distinguished from other, potentially malignant pathologies of the iris (e. g. tortuous vessels in iris melanoma). PMID:22526009

Ponto, K A; Mirshahi, A



Persistent embryonic veins in arteriovenous malformations of the brain  

Microsoft Academic Search

Summary The course and direction of persistent foetal venous channels are easily defined in the relatively simple segmental portions of the nervous system, such as the spinal cord, the myelencephalon, the metencephalon, and the mesencephalon. In sites were embryonic development is more complicated, like the diencephalon and the telencephalon, rapid growth and folding of the cortex complicate the patterns of

C. Vidyasagar



Reoperation for Chiari Malformations  

Microsoft Academic Search

Background: We undertook this study to characterize those patients who required reoperations for Chiari malformation and to determine whether modifications in surgical technique at the initial procedure might have obviated the need for repeat surgery. Methods: We reviewed the hospital records, imaging studies, operative reports, and follow-up data of those patients who were undergoing a second operation as part of

David Sacco; R. Michael Scott



Endovascular management of spinal arteriovenous malformations.  


Spinal arteriovenous malformations (sAVMs) are rare vascular lesions whose natural history remains incompletely defined. Several classification schemes for sAVMs have evolved based on an improved understanding of the anatomic characteristics as well as pathophysiologic behavior of these arteriovenous shunts. Advances in endovascular technology have inspired the adoption of interventional techniques both as stand-alone treatment and as part of a multi-modality management paradigm for sAVMs. Further refinements in liquid embolic agents as well as improved microcatheter navigability will contribute to an ever-expanding role for endovascular intervention in the management of these lesions. PMID:22935350

Ducruet, Andrew F; Crowley, R Webster; McDougall, Cameron G; Albuquerque, Felipe C



Central retinal vein occlusion and thrombophilia  

Microsoft Academic Search

Central retinal vein occlusion is one of the commonest vascular diseases of the eye. The pathogenesis is multifactorial with both local factors and systemic diseases being aetiologically important. Many thrombophilic conditions have recently been identified and studies looking at their potential role in CRVO have been undertaken. The aim of this review is to critically appraise these studies as to

C D Fegan



Uncommon cavernous malformation of the optic chiasm: a case report.  


Cavernous malformation (CM) is a vascular malformation disorder characterized by a berry-like mass of expanded blood vessels. CM, originating from the optic chiasm. usually leads to chiasma syndrome presenting with bitemporal hemianopsia. We report a 28-year-old male presenting with left homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed an occupied lesion located in the right side of the optic chiasm, and a clinical diagnosis of chiasmal CM was made. Microsurgical excision was performed via anterolateral pterional craniotomy. The patient showed good recovery with slight improvement of the visual field deficits after the operation. No CM recurrence was discovered during the follow-up MRI scans. PMID:22892383

Ning, Xianbin; Xu, Kan; Luo, Qi; Qu, Limei; Yu, Jinlu



Uncommon cavernous malformation of the optic chiasm: a case report  

PubMed Central

Cavernous malformation (CM) is a vascular malformation disorder characterized by a berry-like mass of expanded blood vessels. CM, originating from the optic chiasm. usually leads to chiasma syndrome presenting with bitemporal hemianopsia. We report a 28-year-old male presenting with left homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed an occupied lesion located in the right side of the optic chiasm, and a clinical diagnosis of chiasmal CM was made. Microsurgical excision was performed via anterolateral pterional craniotomy. The patient showed good recovery with slight improvement of the visual field deficits after the operation. No CM recurrence was discovered during the follow-up MRI scans.



Ebstein’s malformation  

Microsoft Academic Search

Opinion statement  Ebstein’s malformation of the tricuspid valve is a complex and heterogeneous disorder that has diverse hemodynamic and arrhythmic\\u000a manifestations. Hemodynamic dysfunction is due to valvar regurgitation and decreased pulmonary blood flow, varying in severity\\u000a from mild tricuspid insufficiency to severe dysplasia of the right ventricle without forward flow. Atrioventricular reentrant\\u000a tachycardia and atrial tachyarrhythmias are commonly associated with Ebstein’s

Adel K. Younoszai; Michael M. Brook; Norman H. Silverman



ArterioVenous Malformations  

Microsoft Academic Search

Intracranial arterio-venous malformations (AVM) are relatively uncommon, but increasingly recognized lesions that can cause\\u000a serious neurological symptoms or death. Although AVM can initially present with hemorrhages or seizures, an increasing number\\u000a is detected before symptomatic bleeding due to the recently developed imaging techniques. Over the last decades, the management\\u000a of AVM has been widely modified due to the availability of

Markus W. Gross; Rita Engenhart-Cabillic


Treatment of congenital malformations.  


The prevalence of müllerian malformations is 1 in 200, or 0.5%. A third of the anomalies are septate, a third bicornuate uteri, 10% arcuate uterus, 10% didelphis and unicornuate uterus, and < 5% uterine and vaginal aplasia. Correct diagnosis of the malformation is most important but often very difficult. Correct treatment can only be performed if the malformation is clear. Longitudinal vaginal septums have to be removed due to potential obstetric problems. Transverse vaginal septums can cause hematocolpos and pain and have to be incised crosswise and excised so as not to shorten the vagina at the same time. Congenital vaginal agenesis occurs in Mayer-Rokitansky-Kuster-Hauser syndrome patients and in androgen insensitivity syndrome. The first choice for surgical treatment should be the new laparoscopic-assisted creation of a neovagina. Septate uterus has to be distinguished from a bicornuate uterus. Even if it is not proven to be a cause for infertility, the chance of miscarriage can be diminished by performing hysteroscopic metroplasty. Repair of a uterine septum in infertility patients often improves pregnancy rates. In contrast, surgical repair of a bicornuate uterus requires an abdominal metroplasty. This should only be performed if the patient has recurrent fetal loss due to the uterine structural defect. In a unicornuate uterus it is most important to determine if there is a second uterine horn that can cause cyclic pain if it has functioning endometrium. The only surgical option in these cases is to remove the rudimentary uterus with endometrium and hematometra, respectively. PMID:21437824

Brucker, Sara Yvonne; Rall, Katharina; Campo, Rudi; Oppelt, Peter; Isaacson, Keith



Cerebral cavernous malformations: from molecular pathogenesis to genetic counselling and clinical management  

PubMed Central

Cerebral cavernous (or capillary-venous) malformations (CCM) have a prevalence of about 0.1–0.5% in the general population. Genes mutated in CCM encode proteins that modulate junction formation between vascular endothelial cells. Mutations lead to the development of abnormal vascular structures. In this article, we review the clinical features, molecular and genetic basis of the disease, and management.

Haasdijk, Remco A; Cheng, Caroline; Maat-Kievit, Anneke J; Duckers, Henricus J



Chiari II Malformation and Syringomyelia  

Microsoft Academic Search

The Chiari II malformation was described at the end of the nineteenth century (1891–1896) by Hans Chiari, a German pathologist,\\u000a as a congenital malformation in a post-mortem examination of a child who died from a constellation of malformations including\\u000a prolapse of the cerebellum, part of the brain stem and part of the hindbrain, involving the upper part of the cervical

Spyros Sgouros


Prototype vein contrast enhancer  

NASA Astrophysics Data System (ADS)

A proof-of-principle prototype Vein Contrast Enhancer (VCE) has been designed and constructed. The VCE is an instrument that makes vein access easier by capturing an infrared image of peripheral veins, enhancing the vein-contrast using software image processing, and projecting the enhanced vein-image back onto the skin using a modified commercial projector. The prototype uses software alignment to achieve alignment accuracy between the captured infrared image and the projected visible image of better than 0.06 mm. Figure 1 shows the prototype demonstrated in our laboratory.

Zeman, Herbert D.; Lovhoiden, Gunnar; Vrancken, Carlos



[Vascular "tumors" and the rules of their surgical management].  


After defining vascular tumors and malformations, formerly called angiomas, the authors adopt the classification of the International Society for the Study of vascular Anomalies. The various groups of malformations, after definition of the subject and the problems raised, are illustrated by a number of clinical cases and the rules of surgical management are discussed. Capillary malformations, formerly called portwine stains, can be treated by dye laser, but sometimes tissue and orthognathic reconstructive surgery in the presence of a skeletal malformation. Lymphatic malformations (lymphangiomas), optimally assessed by CT or MRI, can be treated by a variety of approaches: sclerotherapy, surgery. Venous malformations raise very different problems in the cervicocephalic region and on the limbs and trunk, but always require a multidisciplinary approach with, according to the site, size and repercussions, Ethibloc percutaneous sclerotherapy, embolization, surgery. Arteriovenous malformations require complete surgical treatment, usually preceded by embolization; reconstruction consists of local flaps or skin expansion in simple cases, and revascularized free flaps in difficult cases. If the malformation is cosmetically and functionally acceptable, the authors propose conservative management. The first-line treatment of haemangiomas is pharmacological (corticosteroids, interferon), but surgery may be indicated in two situations: early and late. There is a renewed interest in early surgery, subtended by several factors including cosmetic concerns and the development of new technologies, including the Cavitron. Late surgery retains its classical cosmetic and functional indications. Two key-words dominate the rules of therapeutic management of all types of vascular malformations: a multidisciplinary approach and modesty. PMID:9926477

Enjolras, O; Deffrennes, D; Borsik, M; Diner, P; Laurian, C



[Thymic carcinoma with vascular resection].  


Thymic carcinomas are rare neplasm. The standard treatment for advanced thymic carcinoma has not yet been established, and the prognosis is poor. We report 3 cases of thymic carcinoma involving major vessely. Case 1:The aortic arch and the innominate vein were involved. Case 2:The left brachiocephalic vein was involved. Case 3:Tumor invaded to superior vena cava. Complete resection of the tumor was possible with vascular reconstruction. PMID:22647333

Yamaki, Minoru; Noriyuki, Toshio; Hamamoto, Masaki; Yonehara, Syuji



Tunneled-cuffed catheter implanted into the accessory hemiazygos vein because of occlusion of the left innominate vein.  


Hemodialyzed patients are at risk of multiple catheterizations. Nephrologists performing such procedures need to be familiar with congenital and acquired vascular abnormalities. We describe a successful insertion and use of a cuffed-tunneled catheter in a patient with unusual anatomy of the central venous system. Computed tomography angiography revealed thrombosis of the right subclavian vein and bilateral occlusion of innominate veins. The left internal jugular and subclavian veins joined to form a large vessel that drained through the accessory hemiazygos and azygos veins into the superior vena cava. The catheter was implanted through the left internal jugular vein into the accessory hemiazygos vein. The presented case demonstrates that the catheter can be implanted into distended collateral, especially when no other location is possible. PMID:22099255

Letachowicz, Krzysztof; Ko?odziej, Marian; Mi?dzybrodzki, Krzysztof; Letachowicz, Waldemar; Weyde, Wac?aw; S?siadek, Marek; Klinger, Marian



Prevention or Reversal of Deep Venous Insufficiency and Treatment: Why Are Spider Veins of the Legs a Serious and A Dangerous Medical Condition?  

Microsoft Academic Search

Spider veins (also known as spider hemangiomas) unlike varicose veins (dilated pre-existing veins) are acquired lesions caused by venous hypertension leading to proliferation of blood vessels in the skin and subcutaneous tissues due to the release of endothelial growth factors causing vascular neogenesis. More than 60% of the patients with spider veins of the legs have significant symptoms including pain,

Waheed Ahmad


21 CFR 870.3300 - Vascular embolization device.  

Code of Federal Regulations, 2013 CFR

...a) Identification . A vascular embolization device is an intravascular implant intended to control hemorrhaging due to aneurysms, certain types of tumors (e.g., nephroma, hepatoma, uterine fibroids), and arteriovenous malformations....



Case report: Combined transarterial and direct approaches for embolization of a large mandibular arteriovenous malformation  

PubMed Central

Arteriovenous malformations (AVMs) that involve the mandible are difficult lesions to treat, with traditional options being surgery and embolization. This article describes a large mandibular AVM that was treated with embolization using transarterial as well as direct puncture approaches. Follow-up imaging showed thrombosis of the vascular spaces of the malformation. There were no complications. The patient is doing well and is on follow-up.

Koshy, Chiramel George; Keshava, Shyamkumar N; Moses, Vinu; Sen, Sudipta



Conus Medullaris Spinal Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome  

PubMed Central

Summary We describe a 24-year-old woman who presented with twice previously unverified subarachnoid hemorrhages from the conus me-dullaris spinal arteriovenous malformation with Parkes-Weber-syndrome. Spinal MRI examination is considered to be necessary for the diagnosis of Klippel-Trenaunay-Weber syndro-me. For diagnosis of the spinal cord arteriovenous malformation, it is indispensable to search carefully for the presence of accompanying lesions. Transarterial glue embolization is effective for the management of the spinal vascular lesion.

Iizuka, Y.; Suzuki, M.; Komura, S.; Takada, T.; Shimoji, K.



Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus.  

PubMed Central

Arteriovenous malformations or fistulae shunting arterial blood from branches of the external and internal carotid and vertebral arteries into the transverse-sigmoid sinus may produce different clinical syndromes. The literature is reviewed with 96 patients including six personal cases. Usually these malformations have a congenital origin and only in 4% of the series was there a previous history of a severe head injury. Clinical groups are defined and the role of angiography assessed. Direct surgical approach with occlusion or removal of the vascular malformation is the treatment of choice. Possible methods of treatment by selective embolization are discussed. Images

Obrador, S; Soto, M; Silvela, J



Macrocephaly-capillary malformation: a report of four Chinese patients and literature review.  


We report a series of four patients with macrocephaly-capillary malformation (M-CM) who are the first ever reported M-CM patients among Chinese individuals. The salient clinical features and recent diagnostic criteria are discussed. M-CM is a multisystem disease characterized by macrocephaly and cutaneous vascular malformation. Neurodevelopmental abnormalities such as developmental delay, structural brain malformation, and hydrocephalus are common, and thus vigilant clinical and neuroradiological assessment is essential during the first few years of life. Cardiac and tumour surveillance would also be beneficial in selected cases. PMID:22258436

Luk, Ho Ming; Lo, Ivan F M; Lai, Carman W S; Yeung, Wai Lan; Lam, Stephen T S



Cerebral cavernous malformations: from CCM genes to endothelial cell homeostasis.  


Cerebral cavernous malformations (CCMs) are vascular lesions that can occur sporadically or as a consequence of inherited loss-of-function mutations, predominantly in the genes CCM1 (KRIT1), CCM2 (MGC4607, OSM, Malcavernin), or CCM3 (PDCD10, TFAR15). Inherited, familial CCM is characterized by the development of multiple lesions throughout a patient's life leading to recurrent cerebral hemorrhages. Recently, roles for the CCM proteins in maintaining vascular barrier functions and quiescence have been elucidated, and in this review we summarize the genetics and pathophysiology of this disease and discuss the molecular mechanisms through which CCM proteins may act within blood vessels. PMID:23506982

Fischer, Andreas; Zalvide, Juan; Faurobert, Eva; Albiges-Rizo, Corinne; Tournier-Lasserve, Elisabeth



Uterine arteriovenous malformation.  


Uterine arteriovenous malformation (AVM) is a little known condition of which, to date, very few cases have been described. It has a very diverse symptomatology, even though in most cases, it is diagnosed during a severe and acute haemorrhagic event. Its treatment can vary from expectant management to hysterectomy; however, current evidence suggests that the embolisation of uterine arteries is the most effective approach, especially if fertility is to be preserved. We present a case report classified as AVM, with additional images that show the appearance of this pathology in a short span of time. This case has a number of peculiarities: unusual persistence of human chorionic gonadotropin hormone (?-HCG), asymptomatic patient, quick establishment of the lesion and its duration with unchanging characteristics and finally its spontaneous resolution without further consequences. This entity shows an aetiopathogenesis, that is, not well established or described. We discuss its physiopathology and aetiopathogenesis. PMID:23396842

Sellers, Francisco; Palacios-Marqués, Ana; Moliner, Belen; Bernabeu, Rafael



Clinical-radiological evaluation of sequelae of stereotactic radiosurgery for intracranial arteriovenous malformations  

SciTech Connect

Stereotactic heavy-charged-particle Bragg peak radiosurgery has been used to treat 322 patients with surgically-inaccessible intracranial vascular malformations. (The clinical results of this method for the treatment of angiographically demonstrable arteriovenous malformations (AVMs) and angiographically occult vascular malformations (AOVMs) of the brain are described in separate reports of this symposium). The great majority of patients have had an uneventful post-treatment course with satisfactory health outcomes. However, several categories of delayed sequelae of stereotactic radiosurgery have been identified, involving the vascular structures essential for the integrity of the brain tissue and the brain parenchyma directly. These categories reflect both reaction to injury and to alterations in regional hemodynamic status, and include vasogenic edema, occlusion of functional vasculature, radiation necrosis, and local or remote effects on cerebral arterial aneurysms. 10 refs., 7 figs., 1 tab.

Levy, R.P.; Fabrikant, J.I.; Frankel, K.A.; Phillips, M.H.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.



Controversies in Chiari I malformations  

PubMed Central

Background: The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches. Recently, some surgeons “over-operated” on asymptomatic patients with Chiari I malformations, or even on those without the requisite radiographic diagnostic features for Chiari I malformations: unfortunately, only a subset were admonished for indiscriminate surgery. Nevertheless, when this hindbrain malformation is truly symptomatic, contributing to impaired cerebrospinal fluid (CSF) circulation, various valid surgical management strategies may be adopted. Methods: This review focuses on the current literature regarding the clinical presentation, diagnosis, and surgical management of Chiari I malformation. Variations in the surgical technique are also presented and critiqued. Results: The recommended treatment for Chiari I malformations I consists of decompressive suboccipital craniectomy and duroplasty when abnormal cine-flow MRI is observed preoperatively and blockage of CSF flow persists intraoperatively despite bony decompression. Conclusions: Controversy continues regarding the optimal surgical technique to address Chiari malformations I. Proper diagnostic studies and patient selection are needed to optimize patient outcomes, while avoiding unnecessary surgical procedures.

Baisden, Jamie



Posttransplant Complex Inferior Venacava Balloon Dilatation After Hepatic Vein Stenting  

SciTech Connect

Orthotopic and living related liver transplantation is an established mode of treatment of end-stage liver disease. One of the major causes of postoperative complications is vascular anastomotic stenosis. One such set of such complications relates to hepatic vein, inferior vena cava (IVC), or portal vein stenosis, with a reported incidence of 1-3%. The incidence of vascular complications is reported to be higher in living donor versus cadaveric liver transplants. We encountered a patient with hepatic venous outflow tract obstruction, where the hepatic vein had been previously stented, but the patient continued to have symptoms due to additional IVC obstruction. The patient required double-balloon dilatation of the IVC simultaneously from the internal jugular vein and IVC.

Kohli, Vikas, E-mail: [Indraprastha Apollo Hospital, Pediatric Cardiology and Congenital Cardiac Surgery Unit (India); Wadhawan, Manav [Indraprastha Apollo Hospital, Department of Gastroenterology and Hepatology (India); Gupta, Subhash [Indraprastha Apollo Hospital, Department of Liver Transplant (India); Roy, Vipul [Indraprastha Apollo Hospital, Department of Cardiology (India)



[Branch retinal vein occlusion: high time for cardiovascular risk management].  


Cardiovascular risk management is common in patients suffering from manifest cardiovascular disease, hypertension, hyperlipidaemia and diabetes mellitus. It is generally accepted that medication is the most effective treatment for reducing cardiovascular morbidity and mortality in these patients. Remarkably, cardiovascular risk management is rare in patients suffering from branch retinal vein occlusion. This common retinal vascular disorder in middle aged and elderly people occurs where a thickened retinal artery compresses the affected vein. Although thrombosis is involved, procoagulant disorders are only present in selected cases. On the other hand, prior diabetes, hypertension, and peripheral artery disease are associated with an increased risk of developing branch retinal vein occlusion up to a decade later, and retinal vascular disorder is associated with an increased risk of subsequently developing hypertension, diabetes, congestive heart failure, and cerebrovascular disease later on. Therefore, branch retinal vein occlusion is a marker of developing cardiovascular disease and warrants adequate cardiovascular risk management. PMID:23693011

Bredie, Sebastian J H



Analysis and Classification of Cerebellar Malformations  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Because of improved visualization of posterior fossa struc- tures with MR imaging, cerebellar malformations are recognized with increasing frequency. Herein we attempt to describe and propose a rational classification of cerebellar malformations. METHODS: MR images obtained in 70 patients with cerebellar malformations were retro- spectively reviewed. The cerebellar malformations were initially divided into those with hyp- oplasia

Sandeep Patel; A. James Barkovich



Surgical treatment of intracranial arteriovenous malformation.  


The surgical indication and techniques of intracranial arteriovenous malformations are discussed, on the basis of 203 experiences with AVMs. A special key point in our surgical techniques is described as follows. The feeding arteries of the AVM--or the main artery at the base of the brain, which is the original source of the feeding artery--are identified and prepared, and then temporary clips are placed on these arteries to produce vascular occlusion prior to the dissection of the AVM itself. During these procedures, 20% of mannitol should be administered to prolong the permissible time of cerebral artery occlusion. The administration method of mannitol is described in detail including dose and time schedule. The new prolongation method of temporary occlusion time, for which mannitol with fluorochemicals permits longer occlusion time, is also introduced. PMID:6129587

Suzuki, J; Onuma, T; Kayama, T



A Palm Vein Recognition System  

Microsoft Academic Search

Palm vein pattern recognition is one of the newest bometric techniques researched today. This paper presents a palm vein recognition system that uses blood vessel patterns as personal identifying factor. The vein information is hard to duplicate since veins are internal to the human body. The design details of the palm vein capture device are researched, and preprocessing and feature

Huan Zhang; Dewen Hu



Pathobiology of human cerebrovascular malformations: basic mechanisms and clinical relevance.  


Cerebrovascular malformations affect more than 3% of the population, exposing them to a lifetime risk of hemorrhagic stroke, seizures, and focal neurological deficits. Cerebral cavernous malformations (CCMs) exhibit an immature vessel wall, a brittle hemorrhagic tendency, and epileptogenesis, whereas arteriovenous malformations (AVMs) lack capillary beds and manifest apoplectic bleeding under high-flow conditions. There are also more benign venous anomalies, capillary malformations, and lesions with mixed and transitional features. Advances have been made toward understanding the natural history, radiological and pathological correlates, and clinical management. Yet, mechanisms of lesion genesis and clinical manifestations remain largely unknown, and the clinical behavior in individual patients is highly unpredictable. Lesion pathogenesis likely involves abnormal assembly or maintenance of blood vessels, resulting in dysmorphic vessel phenotypes. Familial CCM disease is in part caused by mutations in a cytoskeletal-related protein that is likely integral to interendothelial cell connectivity and maturation of the vascular wall. Rare familial forms of AVM disease have been correlated with two different transforming growth factor-beta receptor components, possibly causing disturbance in signaling during vascular assembly. Relevance of these mechanisms to the more common and otherwise identical sporadic CCM and AVM lesions is being explored. In this report, basic mechanisms of vasculogenesis and angiogenesis and how they possibly relate to the common cerebrovascular malformation lesions are reviewed. Novel concepts are discussed related to the cellular, molecular, and genetic substrates in CCM and AVM as well as to how this knowledge can be applied to predict, explain, and possibly modify clinical disease manifestations. PMID:15214969

Gault, Judith; Sarin, Hemant; Awadallah, Nabil A; Shenkar, Robert; Awad, Issam A



Retinal vein occlusions: a review for the internist  

Microsoft Academic Search

Retinal vein occlusion (RVO) is a disease that is often associated with a variety of systemic disorders including arterial\\u000a hypertension, diabetes mellitus, dyslipidemia and systemic vasculitis. There are various types of RVO, categorized on the\\u000a basis of the site of occlusion and on the type of consequent vascular damage. Central retinal vein occlusion (CRVO) is the\\u000a most clinically relevant type

Rossella Marcucci; Francesco Sofi; Elisa Grifoni; Andrea Sodi; Domenico Prisco


[Intralesional sclerotherapy of venous malformations in the hand with methyl tetradecyl sulfate].  


Congenital venous malformations (VM) at the hand are rare. VM consist of dysplastic venous vessels without progressive cellular proliferation. The therapy for VM is considerably different from that for vascular tumours (e.?g., haemangiomas). Treatment options for vascular malformations are antithrombotic medication, local compression, resection of the VM, and obliteration of the lumina by percutaneous sclerosation. Here, the percutaneous sclerosation for the treatment of VM with sodium tetradecyl sulfate has been illustrated and discussed on the basis of 2 case reports. PMID:21796585

Lögters, T T; Fürst, G; Hakimi, M; Windolf, J; Schädel-Höpfner, M



Arm vein reconstruction for limb salvage: long-term outcome.  

PubMed Central

A series of 42 consecutive patients undergoing infrainguinal vascular reconstruction for limb salvage using vein harvested from the arm were followed prospectively to determine the long-term graft patency and stenosis rates. Vein harvested from the arm ('arm vein') was used for secondary or tertiary reconstruction in 22 patients (52.4%). The outflow was to a single calf vessel in 37 grafts (88.1%). The cumulative primary, primary assisted and secondary graft patency rates were 35.6%, 49.6% and 59.5% at 2 years, respectively, and the limb salvage rate was 69.0% at 2 years. Eight grafts developed stenoses detected by a graft surveillance programme. Six stenoses were dilated successfully with percutaneous transluminal angioplasty (PTA) and one was treated with an interposition vein graft. Bypass using arm vein is time-consuming and technically demanding as multiple anastomoses are often required. Arm vein grafts, however, have no greater incidence of stenosis than long saphenous vein grafts and these stenoses may be dilated with PTA with good results. The long-term outcome suggests that an arm vein graft is an important treatment option in the absence of the long saphenous vein.

Tisi, P. V.; Crow, A. J.; Shearman, C. P.



Epidemiologic characteristics of kidney malformations  

Microsoft Academic Search

Infants with kidney agenesis or dysgenesis, infants with cystic kidneys, and infants with horse-shoe kidneys were studied, based on data from three large and population-based congenital malformation registers: a total of 2666 infants among 5.83 million births. There is a strong variability between programs of the rates of registered unilateral kidney malformations and these are strongly over-represented in dead infants

John Harris; Elisabeth Robert; Bengt Källén



Congenital malformations of human dermatoglyphs  

PubMed Central

A classification for congenital malformations of dermatoglyphs is presented, dividing them into ridge aplasia, ridge hypoplasia, ridge dissociation, ridges-off-the-end, and a combination of the last two. The medical and genetic significance of these are considered in the light both of previous published cases and of new material. Malformations of dermatoglyphs are important as physical signs in paediatric diagnosis. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6FIG. 7

David, T. J.



Neuroradiological diagnosis of Chiari malformations  

Microsoft Academic Search

Chiari malformations 1, 2, 3 represent different degrees of herniation of posterior fossa content into the cervical canal\\u000a (Chiari 1 and 2), or through an upper-cervical meningocele (Chiari 3), whereas Chiari 4 anomaly consists of hypoplasia of\\u000a the cerebellum. Chiari 1 malformation (CM1) is the commonest anomaly; it is probably related to a mesodermal defect that create\\u000a a congenitally small

Luisa Chiapparini; Veronica Saletti; Carlo Lazzaro Solero; Maria Grazia Bruzzone; Laura Grazia Valentini


Postpartum ovarian vein thrombosis.  


Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. The differential diagnosis is extensive because many diseases can present with similar symptoms. Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis. PMID:8285981

Chawla, K; Mond, D J; Lanzkowsky, L



Mutation in utp15 Disrupts Vascular Patterning in a p53-Dependent Manner in Zebrafish Embryos  

PubMed Central

Background Angiogenesis is the process by which the highly branched and functional vasculature arises from the major vessels, providing developing tissues with nutrients, oxygen, and removing metabolic waste. During embryogenesis, vascular patterning is dependent on a tightly regulated balance between pro- and anti-angiogenic signals, and failure of angiogenesis leads to embryonic lethality. Using the zebrafish as a model organism, we sought to identify genes that influence normal vascular patterning. Methodology and Principal Findings In a forward genetic screen, we identified mutant LA1908, which manifests massive apoptosis during early embryogenesis, abnormal expression of several markers of arterial-venous specification, delayed angiogenic sprouting of the intersegmental vessels (ISV), and malformation of the caudal vein plexus (CVP), indicating a critical role for LA1908 in cell survival and angiogenesis. Genetic mapping and sequencing identified a G to A transition in the splice site preceding exon 11 of utp15 in LA1908 mutant embryos. Overexpression of wild type utp15 mRNA suppresses all observed mutant phenotypes, demonstrating a causative relationship between utp15 and LA1908. Furthermore, we found that injecting morpholino oligonucleotides inhibiting p53 translation prevents cell death and rescues the vascular abnormalities, indicating that p53 is downstream of Utp15 deficiency in mediating the LA1908 phenotypes. Conclusions and Significance Taken together, our data demonstrate an early embryonic effect of Utp15 deficiency on cell survival and the normal patterning of the vasculature and highlight an anti-angiogenic role of p53 in developing embryos.

Mouillesseaux, Kevin; Chen, Jau-Nian



Azygos vein to pulmonary vein fistula is a pathway for cerebral embolism.  


A 43-year-old man was admitted for right upper and lower limb weakness and aphasia. He had suffered dizziness and transient blindness 6 months ago and had also been found lying in the bathroom on another occasion. Multiple cerebral infarctions were confirmed by brain CT scan and MRI. Diffuse nodes in the mediastinum and postperitoneum had been found in pulmonary CT scans and MRI scans since 1999. Pulmonary CT scan revealed multiple bilateral pneumatoceles in the lungs. Contrast CT scan showed an enlarged azygos vein on the right side of the spinal column and an enlarged azygos arch. CT scan-guided biopsy revealed a few fibers, fat, and vascular tissues in the mass. Transcranial Doppler bubble test showed gas microembolic signals in both middle cerebral arteries. Pulmonary digital subtraction angiogram confirmed an enlarged azygos vein. A fistula was found between the pulmonary and azygos veins with turbulent flow from pulmonary to azygos at rest. Cavography revealed that the pulmonary vein appeared simultaneously with the superior cava vein during Valsalva maneuver. In summary, the pathway of cerebral embolism was based on three pathologic mechanisms: (1) increased inferior vena cava pressure, (2) enlarged right azygos aneurysm, and (3) the presence of a fistula between the azygos and pulmonary veins. PMID:20822995

Huang, Yining; Sun, Wei; Li, Fan; Sun, Weiping



Vein quality in infrainguinal revascularisation: assessment by angioscopy and histology.  

PubMed Central

The concept of vein quality has been slow to gain widespread acceptance, but an increasing body of evidence suggests that vein quality is relevant to the success of bypass grafting for peripheral vascular disease. The angioscope represents an additional tool for monitoring and preparing vein grafts during infrainguinal revascularisation. Within the overall theme of vein quality, this paper presents the cumulative experience with vascular endoscopy at Bristol Royal Infirmary. In clinical studies, the diagnostic role of angioscopy in quality control was evaluated by grafting preexisting, angioscopically detected, intraluminal abnormalities and correlating them with histological appearances. There were significant associations between angioscopy/histology grades and graft patency. To enable quantification of images, an innovative computerised video image processing method has been developed and validated against simultaneous ultrasound measurements of segments of saphenous vein. The therapeutic applications of angioscopy in vein graft preparation were studied prospectively in patients undergoing in situ femoropopliteal/distal bypasses by randomisation to full angioscopic or conventional preparation. There was a significant reduction in wound morbidity. Completion angioscopy and arteriography were complementary in the detection of technical defects. Harvested vein was maintained in organ culture to assess further the influence of pre-existing pathology and the potentially traumatic effects of angioscopy on development of neointimal hyperplasia. There was a significant correlation between the extent of pre-existing abnormality and smooth muscle cell proliferative activity in culture and although angioscopy caused endothelial cell loss, this did not stimulate neointimal hyperplasia in vitro. This work confirms that vein quality can be evaluated prospectively by angioscopy and that substandard vein is associated with inferior patency rates. Angioscopic and histological evaluation, together with vein organ culture studies, have definite application in helping to elucidate the mechanisms underlying graft failure. Images Figure 1 Figure 2 Figure 3 Figure 5 Figure 6 Figure 8

Wilson, Y. G.



[Unusual presentation of rib malformation].  


Rib malformation and anatomical variations are not well known and are still often underdiagnosed. Usually, rib malformations are fortuitously discovered. We describe here the case of a girl, 4 years and 4 months old, who presented at the emergency unit for fever and an anterior tumefaction of the ribcage, without any other symptoms. She was eupneic with a normal pulmonary auscultation and viral tonsillitis with a negative streptococcus test. The thoracic tumefaction was parasternal, painless, and fixed and measured approximately 2.5 × 2cm. Ultrasound findings consisted of a duplicated and hypoechogenic hypertrophy of the sterno-costal cartilage of the 4th left rib. Magnetic resonance imaging (MRI) confirmed the diagnosis of chondral bifidity of the sterno-costal junction of the 4th left rib. Fever, due to the viral tonsillitis, disappeared after 4 days. Rib malformations are rare, often anterior, unilateral, and preferentially located on the 3rd or the 4th rib. The main malformative rib lesions are bifid ribs, rib spurs, and widened ribs. Very rarely, they can be associated with Gorlin-Goltz syndrome or with other malformations such as VATER complex. The main differential diagnoses of these rib malformations are traumatic, tumoral, and infectious etiologies. In case of tumoral diseases, the topography of the lesion focuses the etiologic diagnosis: whereas an anterior and cartilaginous lesion is always benign, a lateral or posterior lesion can be an Ewing sarcoma. Rib malformation investigation consists in meticulous questioning, a complete clinical examination looking for any associated anomaly, completed by basic imaging explorations such as plain thoracic radiography focused on the ribcage and ultrasound. Finally, complementary computerized tomography or preferably MRI, depending on the anatomic location of the lesion, confirms the final diagnosis, as presented in our case report, and removes any uncertainty. PMID:23037576

Cosson, M-A; Breton, S; Aprahamian, A; Grevent, D; Cheron, G



Hydrocephalus Secondary to Hydrodynamic Disequilibrium in an Adult Patient with a Choroidal-Type Arteriovenous Malformation  

PubMed Central

Summary We describe an adult patient with an unruptured choroidal-type arteriovenous malformation (AVM) associated with progressive hydrocephalus. There was no evidence of mechanical obstruction of the ventricular system by the AVM nidus itself or a draining vein. However significant reflux into periventricular and transmedullary veins was demonstrated. Following partial targeted embolization of the AVM, no further reflux was observed, the patient’s clinical deficits resolved, and the hydrocephalus improved. We suggest a hydrodynamic disorder as a potential pathomechanism of hydrocephalus in this adult patient with an unruptured AVM.

Ebinu, J.O.; Matouk, C.C.; Wallace, M.C.; terBrugge, K.G.; Krings, T.



Hypofractionated stereotactic radiotherapy for large arteriovenous malformations  

PubMed Central

Cerebral arteriovenous malformations (AVMs) are abnormal connections between the arteries and veins, with possible serious consequences of intracranial hemorrhage. The curative treatment for AVMs includes microsurgery and radiosurgery, sometimes with embolization as an adjunct. However, controversies exist with the treatment options available for large to giant AVMs. Hypofractionated stereotactic radiotherapy (HSRT) is one treatment option for such difficult lesions. We aim to review recent literature, looking at the treatment outcome of HSRT in terms of AVM obliteration rate and complications. The rate of AVM obliteration utilizing HSRT as a primary treatment was comparable with that of stereotactic radiosurgery (SRS). For those not totally obliterated, HSRT makes them smaller and turns some lesions manageable by single-dose SRS or microsurgery. Higher doses per fraction seemed to exhibit better response. However, patients receiving higher total dose may be at risk for higher rates of complications. Fractionated regimens of 7 Gy × 4 and 6–6.5 Gy × 5 may be accepted compromises between obliteration and complication. Embolization may not be beneficial prior to HSRT in terms of obliteration rate or the volume reduction. Future work should aim on a prospectively designed study for larger patient groups and long-term follow-up results.

Wang, Huan-Chih; Chang, Rachel J.; Xiao, Furen



Interventional Vascular Radiology in Musculoskeletal Lesions  

Microsoft Academic Search

\\u000a Vascular malformations are errors of vascular morphogenesis (Fishman and \\u000a Mulliken 1993}; Mulliken and Glowacki 1982). Although generally considered to be present at birth, they are usually not apparent, and become evident or symptomatic\\u000a only later in life. They grow in proportion to the growth of the affected child, but may increase in size secondary to specifi\\u000a c triggering factors, including

Paula Klurfan; Karel G. TerBrugge; Kongteng Tan; Martin E. Simons


Popliteal vein aneurysm.  


The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W



Acute portal vein thrombosis.  


The findings in acute portal vein thrombosis in a patient with chronic calcific pancreatitis and two episodes of pancreatic surgery are described. The diagnosis was made by ultrasound, which showed a dilated portal vein filled with low-level echoes, surrounding hepatic oedema, hypertrophy of the hepatic artery, splenomegaly, collateral vessels and ascites. This was confirmed by computed tomography. The ultrasonic differences in appearance between acute and chronic portal vein thrombosis are discussed, in the context of portal hypertension. The diagnosis of acute portal vein thrombosis should be considered in patients in the appropriate situation who suffer a sudden clinical deterioration with right upper quadrant or abdominal pain. Ultrasound is recommended as the imaging modality of first choice because of the flexibility of its scanning plane and its real time and Doppler capabilities. Computed tomography is valuable in patients with an ileus or heavy pancreatic calcification and for its ability to demonstrate patent vessels on intravenous injection of contrast medium. PMID:3319354

Albertyn, L E



Deep Vein Thrombosis  


... Vein Thrombosis (DVT) Common Signs and Symptoms of PE PE can be fatal, if you experience these signs ... signs and symptoms of these disorders (DVT and PE) can vary by individual and event. Some individuals ...


Vascular tumors of infancy and childhood: beyond capillary hemangioma  

Microsoft Academic Search

Vascular tumors of infancy and childhood represent a number of clinicopathologically distinct entities for which precise histopathological diagnosis is often essential in determining effective therapeutic approach. Unfortunately, pathologists and clinicians alike have traditionally tended to lump these tumors, in addition to small vessel vascular malformations, under overly generic terms like capillary hemangioma that do little, if anything, to guide proper

Paula E. North; Milton Waner; Lisa Buckmiller; Charles A. James; Martin C. Mihm



Neurocutaneous vascular syndromes.  


There have been significant recent advances in the past several years in the field of neurocutaneous vascular syndromes, including the development of more stringent diagnostic criteria for PHACE syndrome, the renaming of macrocephaly-cutis marmorata telangiectatica congenita to macrocephaly-capillary malformation to accurately reflect the true nature of the syndrome, and discovery of new genetic mutations such as RASA-1. There have also been advances in the understanding and management of Sturge-Weber syndrome.PHACE syndrome is a constellation of neurologic, arterial, cardiac, ophthalmologic, and sternal abnormalities associated with infantile hemangiomas. PHACE is an acronym for Posterior fossa malformation, Hemangioma, Arterial anomalies, Coarctation of the aorta, Eye abnormalities. Some authors include an "S" for PHACE(S) to denote the association of ventral defects including Sternal clefting and Supraumbilical raphe.The accurate diagnosis and work-up of these patients require coordination of care across multiple disciplines, including neuroradiology, radiology, dermatology, neurology, surgery, and interventional radiology, among others.This paper is meant to update clinicians and researchers about important advances in these rare, important vascular syndromes, to improve care, and lay the foundation for future directions for research. PMID:20582592

Puttgen, Katherine B; Lin, Doris D M



Arteriovenous malformation of the mandible and parotid gland  

PubMed Central

Arteriovenous malformations (AVMs) of the jaws are relatively rare, with fewer than 200 cases reported in the literature. Their real importance lies in their potential to result in exsanguination, which usually follows an unrelated treatment, such as tooth extraction, surgical intervention, puncture wound or blunt injury in involved areas, with the dentist unaware of the existence of the AVM. The present case illustrates an AVM in an 18-year-old female with swelling on the right side of the face. This case report is unique because although there was no history of bleeding episodes, thorough examination and investigation diagnosed it as high-flow vascular malformation. We ascertain the importance of dentists' awareness of the fatal outcome of these lesions and emphasize that, prior to performing any procedure, necessary investigations should always be done.

Shailaja, S R; Manika; Manjula, M; Kumar, L V



Vascular Complications in Renal Transplantation: A Single-Center Experience in 1367 Renal Transplantations and Review of the Literature  

Microsoft Academic Search

Renal transplantation is the treatment of choice for end-stage renal disease. Vascular complications in renal transplantation are not uncommon and may often lead to allograft loss. The most common vascular complications are transplant renal artery stenosis, transplant renal artery thrombosis, transplant renal vein thrombosis, biopsy-induced vascular injuries, pseudoaneurysm formation, and hematomas. Transplant renal artery and vein thrombosis have an early

D. Dimitroulis; J. Bokos; G. Zavos; N. Nikiteas; N. P. Karidis; P. Katsaronis; A. Kostakis



Macrocephaly-capillary malformation syndrome: description of a case and review of clinical diagnostic criteria.  


Macrocephaly-capillary malformation (M-CM) is characterized by prenatal overgrowth, variable somatic and cerebral asymmetry, primary megalencephaly, characteristic facial features, an abnormal neurocognitive profile and cutaneous vascular malformations. It was previously known under the name macrocephaly-cutis marmorata telangiectatica congenital (M-CMTC). However a recent review of the previously reported cases has suggested that the vascular anomalies are not true CMTC but rather capillary malformations. The diagnosis is primary clinical and different criteria have been proposed for this purpose. However, M-CM is frequently associated with structural brain abnormalities that should be properly investigated and monitored because of their possible progressive development. We report the neuroradiological and morphological features observed in a girl with M-CM and we compared them with proposed diagnostic criteria found in the literature. PMID:21354731

Papetti, Laura; Tarani, Luigi; Nicita, Francesco; Ruggieri, Martino; Mattiucci, Chiara; Mancini, Francesca; Ursitti, Fabiana; Spalice, Alberto



Nonischemic Central Retinal Vein Occlusion in an Adolescent Patient with Ulcerative Colitis  

PubMed Central

Inflammatory bowel disease (IBD) can present with extraintestinal manifestations occasionally involving the eye. Retinal vein occlusions are rarely seen and have never been reported in the pediatric population though vascular thrombosis can be associated with IBD. Here, we present a case of what we believe is the youngest reported patient with nonischemic central retinal vein occlusion (CRVO).

Vayalambrone, Deepak; Ivanova, Tsveta; Misra, Aseema



A New Device for Vascular Embolization: Report on Case of Two Pulmonary Arteriovenous Fistulas Embolization Using the Amplatzer Vascular Plug  

Microsoft Academic Search

A pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation commonly treated by embolization with coils or balloons to prevent the risk of several serious complications such as cerebral embolism and brain abscess. A 32-year-old female with two PAVFs and neurological ischemic manifestations has been successfully treated by transcatheter embolization of both fistulas using a new device (Amplatzer Vascular Plug).

Michele Rossi; Alberto Rebonato; Laura Greco; Giulio Stefanini; Michele Citone; Annnarita Speranza; Vincenzo David



Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects.  


OBJECTIVE: Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. MATERIAL AND METHOD: During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. RESULTS: The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. CONCLUSION: In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as "lower type persistent sciatic vein". Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade. PMID:23748841

Koç, Turan; Gilan, Ismail Ya?murhan; Külekçi, Gökçe Deniz; Kurto?lu, Zeliha



Hemorrhoids and varicose veins: a review of treatment options.  


Hemorrhoids and varicose veins are common conditions seen by general practitioners. Both conditions have several treatment modalities for the physician to choose from. Varicose veins are treated with mechanical compression stockings. There are several over-the-counter topical agents available for hemorrhoids. Conservative therapies for both conditions include diet, lifestyle changes, and hydrotherapy which require a high degree of patient compliance to be effective. When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, or rubber band ligation. Injection sclerotherapy is the non-surgical treatment for primary varicose veins. Non-surgical modalities require physicians to be specially trained, own specialized equipment, and assume associated risks. If a non-surgical approach fails, the patient is often referred to a surgeon. The costly and uncomfortable nature of treatment options often lead a patient to postpone evaluation until aggressive intervention is necessary. Oral dietary supplementation is an attractive addition to the traditional treatment of hemorrhoids and varicose veins. The loss of vascular integrity is associated with the pathogenesis of both hemorrhoids and varicose veins. Several botanical extracts have been shown to improve microcirculation, capillary flow, and vascular tone, and to strengthen the connective tissue of the perivascular amorphous substrate. Oral supplementation with Aesculus hippocastanum, Ruscus aculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent time-consuming, painful, and expensive complications of varicose veins and hemorrhoids. PMID:11302778

MacKay, D



Regulation of cardiovascular development and integrity by the heart of glass–cerebral cavernous malformation protein pathway  

Microsoft Academic Search

Cerebral cavernous malformations (CCMs) are human vascular malformations caused by mutations in three genes of unknown function: KRIT1, CCM2 and PDCD10. Here we show that the heart of glass (HEG1) receptor, which in zebrafish has been linked to ccm gene function, is selectively expressed in endothelial cells. Heg1?\\/? mice showed defective integrity of the heart, blood vessels and lymphatic vessels.

Benjamin Kleaveland; Xiangjian Zheng; Jian J Liu; Yannick Blum; Jennifer J Tung; Zhiying Zou; Shawn M Sweeney; Mei Chen; Lili Guo; Min-min Lu; Diane Zhou; Jan Kitajewski; Markus Affolter; Mark H Ginsberg; Mark L Kahn



The ultrasound appearances of neonatal renal vein thrombosis  

Microsoft Academic Search

Renal vein thrombosis (RVT) is the most frequently occurring vascular condition in the new-born kidney. The predisposing factors include dehydration, sepsis, birth asphyxia, maternal diabetes, polycythaemia and the presence of an indwelling umbilical venous catheter. (RVT) may present clinically with a flank mass, haematuria, hypertension or renal failure. Many imaging modalities have been employed, but ultrasound is the technique most



A quantitative approach to lower extremity vein repair  

Microsoft Academic Search

Objective: We prospectively investigated the patency of venous repair in a quantitative fashion with measurement of vein blood flow velocities after lower extremity injuries caused by either military or civilian trauma. Material and Methods: During a 10-year study period (March 1990 to December 2000), surgical intervention was performed after lower extremity vascular injuries in 130 patients. Most of these patients

Erkan Kuralay; Ufuk Demirkiliç; Ertugrul Özal; Bilgehan Savas Öz; Faruk Cingöz; Celalettin Gunay; Vedat Yildirim; Mehmet Arslan; Harun Tatar



Ileocolic Arteriovenous Fistula with Superior Mesenteric Vein Aneurism: Endovascular Treatment  

Microsoft Academic Search

We report a case of a venous aneurysm secondary to an acquired ileocolic arteriovenous fistula in a 64-year-old woman with recurrent abdominal pain and history of appendectomy. The aneurysm was diagnosed by ultrasound and computed tomography. Angiography showed an arteriovenous fistula between ileocolic branches of the superior mesenteric artery and vein. This vascular abnormality was successfully treated with coil embolization.

Miguel Angel De Gregorio; Maria José Gimeno; Joaquin Medrano; Caudio Schönholz; Juan Rodriguez; Horacio D’Agostino



Cyclopism as a Hereditary Malformation  

Microsoft Academic Search

CYCLOPISM is a malformation which has been recognized for many years and which may have furnished the model for the Homeric monsters. It has been suggested that this developmental disorder is hereditary, but until recently there has been no proof of this.

Peter Pfitzer; Horst Müntefering



Pelvic Vein Embolisation in the Management of Varicose Veins  

SciTech Connect

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

Ratnam, Lakshmi A. [St. George's Hospital, Department of Radiology (United Kingdom); Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S. [Stirling House, Whiteley Clinic (United Kingdom); Hussain, Fuad F. [Royal Surrey County Hospital, Department of Radiology (United Kingdom); Whiteley, Mark S. [Stirling House, Whiteley Clinic (United Kingdom); Lopez, Anthony, E-mail: [Royal Surrey County Hospital, Department of Radiology (United Kingdom)



Intralesional photocoagulation of vascular anomalies of the tongue  

Microsoft Academic Search

Vascular anomalies remain a challenge for patients and reconstructive surgeons. Recently, promising results have been reported using intralesional photocoagulation (ILP) to treat large, deep vascular lesions. We report our experience in treating 12 patients with vascular anomalies of the tongue (10 venous malformations and two haemangiomas) using intralesional photocoagulation. All patients were treated with a Nd:YAG (neodymium:yttrium–aluminium–garnet) (1064 nm) laser

C.-J. Chang; D. M. Fisher; Y.-R. Chen



Current classification and terminology of pediatric vascular anomalies.  


OBJECTIVE. The purpose of this article is to review new terminology to diagnose, classify, and refer patients with vascular anomalies for additional imaging, intervention, and treatment. CONCLUSION. In recent decades, much has been learned regarding the histopathology, cause, and treatment of vascular anomalies. As information has been gleaned, a new classification system has emerged that divides vascular anomalies into neoplasms and malformations. Its utility is based on accurate initial diagnosis that correlates consistently with clinical presentation, disease course, and treatment. PMID:24147487

Kollipara, Ramya; Dinneen, Laura; Rentas, Kenny E; Saettele, Megan R; Patel, Suchit A; Rivard, Douglas C; Lowe, Lisa H



Differential Effects of 17Estradiol on Function and Expression of Estrogen Receptor , Estrogen Receptor , and GPR30 in Arteries and Veins of Patients With Atherosclerosis  

Microsoft Academic Search

Venous complications have been implicated in the adverse effects of hormone replacement therapy. This study investigated acute effects of the natural estrogen, 17-estradiol, on function, estrogen receptors\\/GPR30 expression, and kinase activation in vascular rings and cultured smooth muscle cells from arteries and veins of patients with coronary artery disease. Changes in vascular tone of internal mammary arteries and saphenous veins

Elvira Haas; Matthias R. Meyer; Ulrich Schurr; Indranil Bhattacharya; Roberta Minotti; Hung H. Nguyen; Andres Heigl; Mario Lachat; Michele Genoni; Matthias Barton


Vascular anomalies in pediatric patients: updated classification, imaging, and therapy.  


Recent advances in knowledge regarding histopathology, cause, and treatment of pediatric vascular anomalies have led to substantial changes in classification and terminology. Over the past two decades, various subspecialists have adopted a new classification system proposed by the International Society for the Study of Vascular Anomalies (ISSVA). The ISSVA classification of vascular anomalies divides vascular anomalies into two categories: vascular neoplasms and malformations. It has been widely adopted by various pediatric subspecialists, because it reliably correlates patient presentation and disease progression, with more accurate histology, diagnosis, imaging, and treatment. PMID:23830791

Kollipara, Ramya; Odhav, Ashika; Rentas, Kenny E; Rivard, Douglas C; Lowe, Lisa H; Dinneen, Laura



Comparison of contrast echocardiography versus cardiac catheterization for detection of pulmonary arteriovenous malformations.  


Because clinical diagnosis of pulmonary arteriovenous malformations (AVMs) is difficult and cardiac catheterization invasive, contrast echo has been used to aid in the diagnosis. Correlation between contrast echo and catheterization data in these patients remains poorly defined. We examined the ability to detect pulmonary AVMs by contrast echocardiography, pulmonary angiography, and pulmonary vein saturations in patients who have undergone cavopulmonary (Glenn) shunts. Pulmonary vein saturations were obtained from catheterization reports. Blinded observers reviewed angiographic and contrast echo data retrospectively in 27 patients who had undergone a Glenn shunt and in 19 controls with biventricular hearts. Contrast echo was positive in 68 of 99 lungs (69%). Angiography showed AVMs in 65 of 98 lungs (66%). Pulmonary vein desaturation was found in 13 of 45 lungs sampled (29%). Only 10 of 38 lungs with positive contrast echo had pulmonary vein desaturation, but only 1 patient had pulmonary vein desaturation without positive contrast echo. The degree of desaturation did not correlate with severity of contrast echo return; 6 of 11 patients with 3+ contrast echo studies had normal pulmonary vein saturations. In a control group of patients with biventricular hearts, only 1 of 19 (5.3%) contrast echos was weakly positive. Contrast echo correlates poorly with angiography and pulmonary vein saturation for evaluation of AVMs. Contrast echo is extremely sensitive and often positive despite normal pulmonary vein saturation. Assessment of pulmonary vein desaturation in 100% oxygen may improve its sensitivity and correlation with contrast echo. Additional studies are needed to follow patients with mildly positive contrast echo studies to enable determination of their clinical relevance. PMID:11809429

Feinstein, Jeffrey A; Moore, Phillip; Rosenthal, David N; Puchalski, Michael; Brook, Michael M



Preoperative assessment of alternative veins.  


Duplex ultrasonography, with or without color flow, has replaced phlebography as the technique of choice to select veins for autogenous bypass grafts. Although anatomic location and length are well-defined by ultrasound, evaluation of the venous wall itself is still imperfect. In situ diameters are less than those of arterialized veins. Ultrasonic search is most valuable in the examination of patients with good veins obscured by a layer of fat. Preoperative knowledge of variant anatomy and location of major veins and their branches facilitates bypass surgery. The preoperative vein mapping should be available in the operating room to guide the placement of incisions for unroofing and exploration directly over veins and vein segments that have a high likelihood of being usable. The finding of a useful vein when none is apparent on physical examination may enable the construction of an autogenous bypass in lieu of a less desirable prosthetic graft or leg amputation. PMID:8564029

Salles-Cunha, S X; Beebe, H G; Andros, G



Elastomechanical properties of bovine veins.  


Veins have historically been discussed in qualitative, relative terms: "more compliant" than arteries, subject to "lower pressures". The structural and compositional differences between arteries and veins are directly related to the different functions of these vessels. Veins are often used as grafts to reroute flow from atherosclerotic arteries, and venous elasticity plays a role in the development of conditions such as varicose veins and valvular insufficiency. It is therefore of clinical interest to determine the elastomechanical properties of veins. In the current study, both tensile and vibration testing are used to obtain elastic moduli of bovine veins. Representative stress-strain data are shown, and the mechanical and failure properties reported. Nonlinear and viscoelastic behavior is observed, though most properties show little strain rate dependence. These data suggest parameters for constitutive modeling of veins and may inform the design and testing of prosthetic venous valves as well as vein grafts. PMID:20129420

Rossmann, Jenn Stroud



Retinal Vein Occlusions  

Microsoft Academic Search

Retinal vein occlusion (RVO) is a common cause of vision loss in elderly people. The complex pathogenesis of central RVO (CRVO), hemi-RVO (HRVO) and branch RVO (BRVO) makes it an interdisciplinary task. Treatment of RVO should aim at eliminating the complications and vision-disturbing effects of RVO but also include prophylactic measures in order to avoid recurrence of the disease. Problems

Wolf Buehl; Stefan Sacu; Ursula Schmidt-Erfurth



Use of the TriSpan Coil to Facilitate the Transcatheter Occlusion of Pulmonary Arteriovenous Malformation  

SciTech Connect

Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation of the lung which may occur as an isolated entity or in association with hereditary hemorrhagic telangiectasia (HHT). Because of considerable risk of serious complications such as cerebral embolism, brain abscess and pulmonary hemorrhage, definitive treatment should be considered in most patients. Embolization with coils or detachable balloons is currently the preferred treatment. Paradoxical embolization of coils and balloons may happen, especially in patients with PAVMs with large feeding arteries. In this report we present our initial experience with the use of the TriSpan coil to lower the risk of coil migration during the transcatheter occlusion of PAVMs.

Cil, Barbaros E., E-mail:, E-mail:; Erdogan, Cueneyt; Akmangit, Ilkay; Cekirge, Saruhan; Balkanci, Ferhun [Hacettepe University School of Medicine, Department of Radiology (Turkey)



The management of arteriovenous malformations.  


Arteriovenous malformations (AVM) can occur in the entire central nervous system with a predilection of the supratentorial intracranial compartment. Intracerebral hemorrhage is the most common clinical presentation of AVM and associated with a high morbidity and mortality rate. Correct management of these lesions is therefore of utmost importance. In this review, the authors present actual diagnostic and interdisciplinary treatment modalities based on their experience in a major neurovascular center and taking into consideration actual literature data. Different treatment strategies are discussed. PMID:21464810

Sandalcioglu, I E; Wanke, I; Zappala, V; Forsting, M; Sure, U



Surgical management of scalp arterio-venous malformation and scalp venous malformation: An experience of eleven cases  

PubMed Central

Aims: Scalp arterio-venous malformation (AVM) and scalp venous malformation (SVM) are rare conditions that usually need surgical treatment. Here, we have reported our experience of the surgical management of such lesions with a short review of the literature. Materials and Methods: In this prospective study, 11 patients with scalp AVM and SVM, who underwent surgical excision of lesion in our hospital from 2006 to 2012, were included. All suspected high-flow AVM were investigated with the selective internal and external carotid digital subtraction angiogram (DSA) ± computed tomography (CT) scan of brain with CT angiogram or magnetic resonance imaging (MRI) of brain with MR angiogram, and all suspected low-flow vascular malformation (VM) was investigated with MRI of brain + MR angiogram. Eight were high-flow and three were low-flow VM. Results: All lesions were successfully excised. Scalp cosmetic aspects were acceptable in all cases. There was no major post-operative complication or recurrence till last follow-up. Conclusions: With preoperative appropriate surgical planning, scalp AVM and SVM can be excised without major complication.

Chowdhury, Forhad Hossain; Haque, Mohammod Raziul; Kawsar, Khandkar Ali; Sarker, Mainul Haque; Momtazul Haque, A. F. M.



Deep Vein Thrombosis and Pulmonary Embolism  


... A A Fact Sheet: Deep Vein Thrombosis and Pulmonary Embolism Who is at risk for Deep Vein Thrombosis ... vein thrombosis How can Deep Vein Thrombosis and Pulmonary Embolism be prevented? If you're at risk, you ...


Onyx® in endovascular treatment of cerebral arteriovenous malformations - a review  

PubMed Central

Summary Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.

Szajner, Maciej; Roman, Tomasz; Markowicz, Justyna; Szczerbo-Trojanowska, Malgorzata



Human Greater and Canine Lateral Saphenous Veins  

Microsoft Academic Search

Canine lateral saphenous vein and human greater saphenous vein were studied together to determine similarities and differences. Helical strips of both vessels contracted to norepinephrine with similar sensitivity. Canine veins developed more isometric tension than human veins treated similarly. Histological studies show canine veins to have little connective tissue and a single circular layer of smooth muscle. Human veins have

Michael R. Goldberg; Paul D. Joiner; Albert L. Hyman; Philip J. Kadowitz



MDCT Findings of Right Circumaortic Renal Vein with Ectopic Kidney  

PubMed Central

Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.

Kim, Min-Kyun; Ku, Young Mi; Chun, Chang Woo



Pulsatile Tinnitus Caused by a Dilated Mastoid Emissary Vein  

PubMed Central

Although pulsatile tinnitus can be audible, objective demonstration of this heartbeat-synchronous sound has rarely been successful. We report a rare case of pulsatile tinnitus in a 44-yr-old female patient, which was induced by a large mastoid emissary vein (MEV) and objectively documented by Doppler sonography of the left posterior auricular region. The tinnitus was intermittent and the patient could adapt to the tinnitus without intervention on the mastoid emissary vein. These findings suggest that a single large MEV can cause pulsatile tinnitus in the absence of other vascular abnormalities, and imaging studies of the posterior fossa and Doppler ultrasonography can aid the diagnosis in such cases.

Lee, Seung-Hwan; Kim, Sam Soo; Sung, Kun-Yong



The Chiari II malformation: cause and impact  

Microsoft Academic Search

IntroductionIt is the Chiari II malformation and its effects that determine the quality of life of the individual born with spina bifida.DiscussionThe cause of this malformation has been a source of debate for many years. Understanding the cause enables strategies for the management of problems created by this malformation to be developed. An open neural tube defect allows fluid to

David G. McLone; Mark S. Dias



Radiological Evaluation of Myelomeningocele — Chiari II Malformation  

Microsoft Academic Search

Myelomeningocele (MMC) is a malformation characterized by the failure of closure of the neural tube, usually (but not only)\\u000a at the lumbo-sacral level. Synonyms are spina bifida aperta, open spinal dysra — phism, and Chiari II malformation complex.\\u000a MMC is typically associated with a metamerically consistent paraplegia, a posterior fossa deformity known as the Chiari II\\u000a malformation, hydrocephalus, and a

Charles Raybaud; Elka Miller


[Malformations of the esophagus: diagnosis and therapy].  


Esophageal malformations are rare and can occur sporadically or as a component of various syndromes. The variations and classifications are manifold. With the available modern operation techniques most malformations can be resolved with good results. However, esophageal malformations are often combined with further malformations which limit the prognosis. The separation of the trachea and esophagus after gastrulation is not yet completely researched. The results so far indicate that the localized expression of various homeodomain transcription factors is essential for normal development of the trachea and esophagus. PMID:23423505

Falkeis, C; Hager, T; Freund-Unsinn, K; Wohlschläger, J; Veits, L; Hager, J



Cerebral vein thrombosis  

Microsoft Academic Search

Advances in neuroimaging have modified our knowledge on cerebral vein thrombosis (CVT). This disease is now diagnosed more\\u000a frequently, and increasing evidence as to what are the most common risk factors and on the natural history of the disease\\u000a is becoming available. Most patients with CVT have a benign prognosis: only a minority of patients die during the acute phase

Francesco Dentali; Walter Ageno



Maternal distress and congenital malformations: do mothers of malformed fetuses have more problems?  

Microsoft Academic Search

As compared with 580 randomly chosen pregnant women without malformed offspring, 161 women with malformed offspring at the index pregnancy had a more frequent history of previous multiple offspring deaths and somewhat increased maternal age but were not different on social class, marital or cohabitation status or parity. As compared with demographically similar reproducing women (n=54) interviewed, malformation cases (n=98)

Gun Torstensson Nimby; Louise Lundberg; Tomas Sveger; Thomas F McNeil



Staphylococcal Sepsis with Multiple Abscesses, Urinary Tract Infection, and Bilateral Renal Vein Thrombosis in a Patient with Uncontrolled Diabetes Mellitus  

PubMed Central

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

Khan, Malik A. A.; Hunter, Jonathan Michael; Tan, Christopher; Seleem, Mostafa; Stride, Peter J. O.



Ten frequently asked questions about MRI evaluation of soft-tissue vascular anomalies.  


OBJECTIVE. The objective of this article was to address 10 frequently asked questions that radiologists face when planning, performing, and interpreting an MRI study in a patient with a soft-tissue vascular anomaly. CONCLUSION. MRI permits a comprehensive assessment of vascular anomalies. It is important for radiologists to be familiar with the classification and correct nomenclature of vascular anomalies as well as the MRI protocol and distinct imaging findings of the different vascular malformations and tumors. PMID:24059392

Flors, Lucia; Leiva-Salinas, Carlos; Norton, Patrick T; Park, Auh Whan; Ogur, Torel; Hagspiel, Klaus D



Phenotypic heterogeneity in the endothelium of the human vortex vein system.  


The vortex vein system is the drainage pathway for the choroidal circulation and serves an important function in the effective drainage of the exceptionally high blood flow from the choroidal circulation. As there are only 4-6 vortex veins, a large volume of blood must be drained from many choroidal veins into each individual vortex vein. The vortex vein system must also cope with passing through tissues of different rigidity and significant pressure gradient as it transverses from the intrao-cular to the extra-ocular compartments. However, little is known about how the vortex vein system works under such complex situations in both physiological and pathological condition. Endothelial cells play a vital role in other vascular systems, but they have not been studied in detail in the vortex vein system. The purpose of this study is to characterise the intracellular structures and morphology in both the intra-and extra-ocular regions of the human vortex vein system. We hypothesise the presence of endothelial phenotypic heterogeneity through the vortex vein system. The inferior temporal vortex vein system from human donor eyes were obtained and studied histologically using confocal microscopy. The f-actin cytoskeleton and nuclei were labelled using Alexa Fluor conjugated Phalloidin and YO-PRO-1. Eight regions of the vortex vein system were examined with the venous endothelium studied in detail with quantitative data obtained for endothelial cell and nuclei size and shape. Significant endothelial phenotypic heterogeneity was found throughout the vortex vein system with the most obvious differences observed between the ampulla and its downstream regions. Variation in the distribution pattern of smooth muscle cells, in particular the absence of smooth muscle cells around the ampulla, was noted. Our results suggest the presence of significantly different haemodynamic forces in different regions of the vortex vein system and indicate that the vortex vein system may play important roles in regulation of the choroidal circulation. PMID:23872432

Yu, Paula K; Tan, Priscilla E Z; Cringle, Stephen J; McAllister, Ian L; Yu, Dao-Yi



Multifocal Cerebral Venous Malformations and Associated Developmental Venous Anomalies in a Case of Blue Rubber Bleb Nevus Syndrome  

PubMed Central

Summary We report a sporadic case of probable BRBN (blue rubber bleb nevus syndrome) with multiple CNS (central nervous system) involvement. These features consisted of multiple VMs (venous malformations) and DVAs (developmental venous anomalies) in supratentorial brain, cerebellum, and diencephalon. Since its first description by Bean, there have been many cases of BRBN manifesting with gastrointestinal bleeding with or without associated hemorrhage. Cases with CNS involvement were rarely reported and many of the descriptions were confusing with different terminologies used to describe them such as capillary venous malformation, hemangiomas, and vascular malformations. The lesions illustrated are venous malformations similar to our case. The association of DVA was recognized in some cases; they are likely to be underestimated when revisiting the published case illustrations. Although our case is sporadic, the link with HHT1 is unlikely despite the involvement of the same chromosome (Ch 9).

Chung, J.I.; Alvarez, H.; Lasjaunias, P.



Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: a case series  

Microsoft Academic Search

BACKGROUND: The mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, although intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema. METHODS: A series of 54 consecutive patients (54 eyes) with branch retinal vein occlusion was studied prospectively. All patients underwent pars plana vitrectomy

Hidetaka Noma; Hideharu Funatsu; Tatsuya Mimura; Shuichiro Eguchi; Katsunori Shimada



Azygos Vein Dialysis Catheter Placement Using the Translumbar Approach in a Patient with Inferior Vena Cava Occlusion  

SciTech Connect

We describe percutaneous, translumbar placement of a 14-Fr dialysis catheter into an ascending lumbar vein to achieve tip position in an enlarged azygos vein. The patient had thrombosis of all traditional vascular sites, as well as the inferior vena cava. This catheter functioned well for 7 months before fatal catheter-related infection developed.

Jaber, Mohammad R., E-mail: [Loma Linda University Medical Center, Department of Internal Medicine (United States); Thomson, Matthew J.; Smith, Douglas C. [Loma Linda University Medical Center, Department of Radiology (United States)



Diffuse malformations of cortical development.  


Malformations of cortical development (MCD) represent a major cause of developmental disabilities and severe epilepsy. Advances in imaging and genetics have improved the diagnosis and classification of these conditions. Up to now, eight genes have been involved in different types of MCD. Lissencephaly-pachygyria and subcortical band heterotopia (SBH) represent a malformative spectrum resulting from mutations of either LIS1 or DCX genes. LIS1 mutations cause a more severe malformation in the posterior brain regions. DCX mutations usually cause anteriorly predominant lissencephaly in males and SBH in female patients. Additional forms are X-linked lissencephaly with corpus callosum agenesis and ambiguous genitalia associated with mutations of the ARX gene. Lissencephaly with cerebellar hypoplasia (LCH) encompass heterogeneous disorders named LCH types a to d. LCHa is related to mutation in LIS1 or DCX, LCHb with mutation of the RELN gene, and LCHd could be related to the TUBA1A gene. Polymicrogyria encompasses a wide range of clinical, etiological, and histological findings. Among several syndromes, recessive bilateral fronto-parietal polymicrogyria has been associated with mutations of the GPR56 gene. Bilateral perisylvian polymicrogyria has been associated with mutations in the SRPX2 gene in a few individuals and with linkage to chromosome Xq28 in a some other families. X-linked bilateral periventricular nodular heterotopia (PNH) consists of PNH with focal epilepsy in females and prenatal lethality in males. Filamin A (FLNA) mutations have been reported in some families and in sporadic patients. It is possible to infer the most likely causative gene by brain imaging studies and other clinical findings. PMID:23622213

Bahi-Buisson, Nadia; Guerrini, Renzo



Free vascularized bone graft for nonunion of the scaphoid  

Microsoft Academic Search

We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft consisted of periosteum, full-thickness cortex, and the underlying cancellous bone and was harvested from the supracondylar region of the femur. The graft was nourished by the articular branch of the descending geniculate artery and vein. Unlike the currently used vascularized bone grafts, this graft can

Kazuteru Doi; Tatsunori Oda; Tan Soo-Heong; Vipul Nanda



Vascular smooth muscle function: The physiology and pathology of vasoconstriction  

Microsoft Academic Search

Vascular smooth muscle is the contractile component of arteries and veins. The control of contraction and relaxation is dependent upon intracellular and extracellular signals. Abnormal contractions can cause and or contribute to pathology such as hypertension, ischemia and infarction. In this review, we address the vascular pathogenesis associated with hypertension and subarachnoid hemorrhage induced cerebral vasospasm. Hypertension is a multifactorial

Joseph F. Clark; Gail Pyne-Geithman



The cutoff value of saphenous vein diameter to predict reflux  

PubMed Central

Purpose Increased saphenous vein diameter is a common consequence of saphenous vein reflux. Until now, there have been no reports about the correlation between diameter and reflux of saphenous vein in Korea. The aim of this study was to investigate the correlation between saphenous vein reflux and diameter changes. Methods From April 2009 to August 2012, 777 patients were sent to the vascular laboratory for evaluation of venous reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral tracings. Receiver operating characteristics curve analysis was applied to determine the best saphenous vein diameter cutoff for predicting reflux. Results The mean diameters of normal great saphenous vein (GSV) and refluxed GSV were 5.0 ± 2.4 mm and 6.4 ± 2.0 mm, respectively. The mean diameters of normal small saphenous vein (SSV) and refluxed SSV were 3.1 ± 1.3 mm and 5.2 ± 2.7 mm, respectively. The diameter differences between the normal and refluxed GSV and SSV were 1.4 mm and 2.1 mm, respectively, and these differences were statistically significant (P < 0.0001). A GSV threshold diameter of 5.05 mm had the best positive predictive value for reflux. The sensitivity and specificity at 5.05 mm were 76% and 60%, respectively. The best SSV diameter for predicting reflux was 3.55 mm. The sensitivity and specificity at 3.55 mm were 87% and 71%, respectively. Conclusion GSV diameter of ?5.05 mm had the best positive predictive value for pathologic reflux. For pathologic reflux of SSV, the best cutoff diameter was 3.55 mm.

Park, Ho-Chul



Vascular Access for HD and CRRT  

Microsoft Academic Search

A good functioning vascular access is an essential component for adequate renal replacement therapy (RRT) in acute kidney injury. Tunneled, cuffed catheters are preferred if the anticipated duration of RRT is more than 3 weeks. The right jugular vein is the preferred insertion site for the temporary dialysis catheter (TDC), with ultrasound-guided insertion reducing the risk of mechanical complications. The

M. Schetz



Maternal distress and congenital malformations: do mothers of malformed fetuses have more problems?  


As compared with 580 randomly chosen pregnant women without malformed offspring. 161 women with malformed offspring at the index pregnancy had a more frequent history of previous multiple offspring deaths and somewhat increased maternal age but were not different on social class, marital or cohabitation status or parity. As compared with demographically similar reproducing women (n = 54) interviewed, malformation cases (n = 98) reported having had significantly more strong stress before identification of the malformation, as well as a clear tendency toward less appropriate timing of the pregnancy. Women with malformed offspring represent a psychosocially vulnerable group and should receive special clinical and personal support. PMID:10404467

Nimby, G T; Lundberg, L; Sveger, T; McNeil, T F


Cutaneous Venous Malformations Related to KRIT1 Mutation: Case Report and Literature Review.  


Cavernous malformations (CMs) are vascular anomalies of the nervous system mostly located in the brain. Cerebral cavernous malformations can present sporadically or familial, as a consequence of an autosomal dominant condition, with incomplete penetrance and variable clinical expression. Occasionally, extraneural manifestations of CMs involving the skin have been described. We report the case of two siblings presenting in adulthood diffuse cutaneous vascular lesions associated with cerebral CMs that, after surgical excision and histopathologic analysis, resulted to cavernous haemangiomas. Genomic DNA was extracted from peripheral blood, and molecular evaluation of KRIT1 gene was performed. Although no signs of neurological impairment were reported, cerebral MRI revealed multiple images in both patients, suggestive of cavernous haemangiomas. The genetic study demonstrated a nonsense mutation (c.535C>T) in the KRIT1 (Krev-1/rap1 interaction trapped 1) gene. Few reports describe extraneural manifestations of Cavernous malformation syndrome (CMs) related to a KRIT1 mutation; these involve the skin and are associated with hyperkeratotic cutaneous capillary-venous malformation. CMs should be suspected in patients developing multiple nodular cutaneous venous lesions in adulthood. PMID:23828392

Grippaudo, Francesca Romana; Piane, Maria; Amoroso, Matteo; Longo, Benedetto; Penco, Silvana; Chessa, Luciana; Giubettini, Maria; Santanelli, Fabio



Tetralogy of Fallot associated with macrocephaly-capillary malformation syndrome: a case report and review of the literature  

Microsoft Academic Search

INTRODUCTION: Macrocephaly-capillary malformation syndrome is characterized by cutaneous vascular lesions, including cutis marmorata telangiectatica and hemangiomas, associated with congenital anomalies, including macrocephaly, macrosomia, asymmetry and mental retardation. In addition to these cardinal signs, several other clinical conditions have been reported in people with this condition. However, to the best of our knowledge, the presence of tetralogy of Fallot has not

Jesus E Dueñas-Arias; Eliakym Arámbula-Meraz; Luis O Frías-Castro; Rosalio Ramos-Payán; Jose A Quibrera-Matienzo; Fred Luque-Ortega; E Maribel Aguilar-Medina



Treatment of macular edema due to retinal vein occlusions  

PubMed Central

Retinal vein occlusion (RVO) is a prevalent retinal vascular disease, second only to diabetic retinopathy. Previously there was no treatment for central retinal vein occlusion (CRVO) and patients were simply observed for the development of severe complications, generally resulting in poor visual outcomes. The only treatment for branch vein occlusion (BRVO) was grid laser photocoagulation, which reduces edema very slowly and provides benefit in some, but not all patients. Within the past year, clinical trials have demonstrated the effects of three new pharmacologic treatments, ranibizumab, triamcinolone acetonide, and dexamethasone implants. The benefit/risk ratio is best for intraocular injections of ranibizumab, making this first-line therapy for most patients with CRVO or BRVO, while intraocular steroids are likely to play adjunctive roles. Standard care for patients with RVO has changed and will continue to evolve as results with other new agents are revealed.

Channa, Roomasa; Smith, Michael; Campochiaro, Peter A



Treatment of macular edema due to retinal vein occlusions.  


Retinal vein occlusion (RVO) is a prevalent retinal vascular disease, second only to diabetic retinopathy. Previously there was no treatment for central retinal vein occlusion (CRVO) and patients were simply observed for the development of severe complications, generally resulting in poor visual outcomes. The only treatment for branch vein occlusion (BRVO) was grid laser photocoagulation, which reduces edema very slowly and provides benefit in some, but not all patients. Within the past year, clinical trials have demonstrated the effects of three new pharmacologic treatments, ranibizumab, triamcinolone acetonide, and dexamethasone implants. The benefit/risk ratio is best for intraocular injections of ranibizumab, making this first-line therapy for most patients with CRVO or BRVO, while intraocular steroids are likely to play adjunctive roles. Standard care for patients with RVO has changed and will continue to evolve as results with other new agents are revealed. PMID:21629578

Channa, Roomasa; Smith, Michael; Campochiaro, Peter A



A Framework for Detecting Malformed SMS Attack  

Microsoft Academic Search

Malformed messages in different protocols pose a serious threat because they are used to remotely launch malicious activity. Furthermore, they are capable of crashing servers and end points, sometimes with a single message. Recently, it was shown that a malformed SMS can crash a mobile phone or gain unfettered access to it. In spite of this, little research has been

M Zubair Rafique; Muhammad Khurram Khan; Khaled Alghathbar; Muddassar Farooq



Congenital malformations due to antiepileptic drugs  

Microsoft Academic Search

To identify the major risk factors for the increased incidence of congenital malformations in offspring of mothers being treated for epilepsy with antiepileptic drugs (AEDs) during pregnancy and, to determine the relative teratogenic risk of AEDs, we prospectively analyzed 983 offspring born in Japan, Italy, and Canada. The incidence of congenital malformations in offspring without drug exposure was 3.1%, versus

S Kaneko; D Battino; E Andermann; K Wada; R Kan; A Takeda; Y Nakane; Y Ogawa; G Avanzini; C Fumarola; T Granata; F Molteni; G Pardi; L Minotti; R Canger; L Dansky; M Oguni; I Lopes-Cendas; A Sherwin; F Andermann; M.-H Seni; M Okada; T Teranishi



Early presentation of an extremity arteriovenous malformation  

Microsoft Academic Search

We report a very rare case of a high flow arteriovenous malformation (AVM) of the upper limb that caused high output cardiac failure at birth. There was early transfer of the baby to the care of a multidisciplinary team. After radiological intervention, the arm distal to the malformation became ischaemic and an urgent amputation through the upper-humerus followed. Methods of

Jill B. Webb; Mary O'Brien; Philip R. John; Hiroshi Nishikawa



Imaging of head and neck venous malformations  

Microsoft Academic Search

Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated

Christine M. Flis; Stephen E. Connor



Maternal Age and Malformations in Singleton Births  

Microsoft Academic Search

Objective: To examine the effect of maternal age on inci- dence of nonchromosomal fetal malformations. Methods: Malformations detected at birth or in the new- born nursery were catalogued prospectively for 102,728 pregnancies, including abortions, stillbirths, and live births, from January 1, 1988 to December 31, 1994. Maternal age was divided into seven epochs. Relative risks (RRs) were used to compare




Maternal age and malformations in singleton births  

Microsoft Academic Search

Objective: To examine the effect of maternal age on incidence of nonchromosomal fetal malformations.Methods: Malformations detected at birth or in the newborn nursery were catalogued prospectively for 102,728 pregnancies, including abortions, stillbirths, and live births, from January 1, 1988 to December 31, 1994. Maternal age was divided into seven epochs. Relative risks (RRs) were used to compare demographic variables and

Lisa M Hollier; Kenneth J Leveno; Mary Ann Kelly; Donald D MCIntire; F. Gary Cunningham



Identification of brain malformations: neuropathological approach  

Microsoft Academic Search

IntroductionThe sophistication of prenatal brain imaging (US, MRI) has awakened interest in fetal neuropathology and changed the concept of brain malformations, defined until recently through descriptive terms and considered as senseless accidents of development. Usually, most CNS malformations are documented from a clinical and radiological point of view. However, only a detailed neuropathological study permits their exact phenotype to be

Férechté Encha-Razavi



Impaired cerebral vasoreactivity after embolization of arteriovenous malformations: assessment with serial acetazolamide challenge xenon CT  

SciTech Connect

Embolization of a portion of the nidus of an arteriovenous malformation not only may alter hemodynamics within the nidus, but also may change blood flow dynamics in adjacent normal vessels. Sequential acetazolamide-challenge xenon CT cerebral blood flow studies were performed in eight patients before and after embolization of arteriovenous malformations to assess the hemodynamic effects on the major vascular territories supplying the malformation. Acetazolamide is a potent cerebral vasodilator, and its administration combined with cerebral blood flow studies allows assessment of cerebral vasoreactivity. In seven of the eight patients, one or more parenchymal areas exhibited a normal cerebral blood flow augmentation response to acetazolamide before embolization, but diminished acetazolamide flow augmentation was seen after embolization, indicating abnormal vasoreactivity. We found that the decrease in vasoreactivity peaked 6-10 days after embolization. In one of the eight patients, a temporary delayed neurologic deficit developed during a period of impaired cerebral vasoreactivity following embolization. Our results suggest that embolization of an arteriovenous malformation can induce vasoreactivity changes in adjacent normal vessels. Because these changes appear to be somewhat time-dependent, an appropriate interval should be observed between embolization stages or before surgical resection of an arteriovenous malformation following embolization to allow hemodynamic equilibration to occur. Acetazolamide challenge combined with serial cerebral blood flow studies following embolization enables determination of this hemodynamic equilibration.

Tarr, R.W.; Johnson, D.W.; Horton, J.A.; Yonas, H.; Pentheny, S.; Durham, S.; Jungreis, C.A.; Hecht, S.T. (Presbyterian-Univ. Hospital, Pittsburgh, PA (USA))



Germline Mutations in RASA1 Are Not Found in Patients with Klippel-Trenaunay Syndrome or Capillary Malformation with Limb Overgrowth  

PubMed Central

The RASA1 gene encodes p120RASGAP, a multidomain cytoplasmic protein that acts as a negative regulator of the RAS signalling pathway. Heterozygous loss-of-function RASA1 mutations were identified in patients with Parkes Weber syndrome and multifocal capillary malformations. This syndrome is characterised by a capillary blush on an extremity, arteriovenous microfistulas, and bony and soft tissue hypertrophy. The aim of this study was to test RASA1 in 2 disorders characterised by asymmetric limb enlargement and vascular malformations, namely Klippel-Trenaunay syndrome and regional capillary malformation with overgrowth. We did not identify any clear pathogenic change in these patients. Thus, besides clinical and radiological criteria, RASA1 testing constitutes an additional tool to differentiate Parkes Weber syndrome of capillary malformation-arteriovenous malformation (CM-AVM) from overlapping disorders.

Revencu, N.; Boon, L.M.; Dompmartin, A.; Rieu, P.; Busch, W.L.; Dubois, J.; Forzano, F.; van Hagen, J.M.; Halbach, S.; Kuechler, A.; Lachmeijer, A.M.A.; Lahde, J.; Russell, L.; Simola, K.O.J.; Mulliken, J.B.; Vikkula, M.



Germline Mutations in RASA1 Are Not Found in Patients with Klippel-Trenaunay Syndrome or Capillary Malformation with Limb Overgrowth.  


The RASA1 gene encodes p120RASGAP, a multidomain cytoplasmic protein that acts as a negative regulator of the RAS signalling pathway. Heterozygous loss-of-function RASA1 mutations were identified in patients with Parkes Weber syndrome and multifocal capillary malformations. This syndrome is characterised by a capillary blush on an extremity, arteriovenous microfistulas, and bony and soft tissue hypertrophy. The aim of this study was to test RASA1 in 2 disorders characterised by asymmetric limb enlargement and vascular malformations, namely Klippel-Trenaunay syndrome and regional capillary malformation with overgrowth. We did not identify any clear pathogenic change in these patients. Thus, besides clinical and radiological criteria, RASA1 testing constitutes an additional tool to differentiate Parkes Weber syndrome of capillary malformation-arteriovenous malformation (CM-AVM) from overlapping disorders. PMID:23801933

Revencu, N; Boon, L M; Dompmartin, A; Rieu, P; Busch, W L; Dubois, J; Forzano, F; van Hagen, J M; Halbach, S; Kuechler, A; Lachmeijer, A M A; Lähde, J; Russell, L; Simola, K O J; Mulliken, J B; Vikkula, M



Intracranial aneurysms: links among inflammation, hemodynamics and vascular remodeling  

PubMed Central

Abnormal vascular remodeling mediated by inflammatory cells has been identified as a key pathologic component of various vascular diseases, including abdominal aortic aneurysms, brain arteriovenous malformations and atherosclerosis. Based on findings from observational studies that analysed human intracranial aneurysms and experimental studies that utilized animal models, an emerging concept suggests that a key component of the pathophysiology of intracranial aneurysms is sustained abnormal vascular remodeling coupled with inflammation. This concept may provide a new treatment strategy to utilize agents to inhibit inflammation or cytokines produced by inflammatory cells such as matrix metalloproteinases. Such an approach would aim to stabilize these vascular lesions and prevent future expansion or rupture.

Hashimoto, Tomoki; Meng, Hui; Young, William L.



Bleeding Scrotal Vascular Lesions: Interventional Management with Transcatheter Embolization  

SciTech Connect

Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly rare. The imaging modalities useful in the diagnosis and management of scrotal vascular lesions are grayscale sonography, color Doppler sonography, magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. We present two cases of scrotal vascular lesions involving the extratesticular scrotal soft tissues. Patients presented with bleeding and were treated by radiological interventional technique. We emphasize the importance of superselective catheterization and distal embolization.

Jaganathan, Sriram; Gamanagatti, Shivanand, E-mail:; Mukund, Amar [All India Institute of Medical Sciences, Department of Radiodiagnosis (India); Dhar, Anita [All India Institute of Medical Sciences, Department of Surgery (India)



Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula  

PubMed Central

Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7?mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29?mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8?cm?×?2.5?cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9?mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

Mohd-Tahir, Fadzillah; Siti-Raihan, Ishak; Wan Hazabbah, W. H.



Pure arterial malformation of the posterior cerebral artery: importance of its recognition.  


The finding of dilated, elongated, and tortuous vessels on brain imaging should prompt clinicians to determine what vascular anomaly is present. Importantly, not all suspicious serpentine flow voids are manifestations of arteriovenous malformations or arteriovenous fistulas. Other types of intracranial vasculopathies should also be considered. The authors report a rare case of dilated, tortuous, and redundant left posterior communicating artery and left P2 segment of the posterior cerebral artery identified in a young healthy adult that remained stable over a 30-year period. Dynamic and 3D images were critical for determining the type of vascular anomaly and for guiding appropriate management. The authors propose that this case represents a pure arterial malformation and discuss its distinguishing features. PMID:23746101

McLaughlin, Nancy; Raychev, Radoslav; Duckwiler, Gary; Martin, Neil A



The epidemiological profile of the Vascular Birthmark Clinic at the Alberta Children's Hospital  

PubMed Central

BACKGROUND: The Vascular Birthmark (VBM) Clinic at the Alberta Children’s Hospital (Calgary, Alberta) is a multidisciplinary clinic dedicated to the evaluation of children with vascular anomalies. OBJECTIVE: To review the characteristics of patients seen at the VBM Clinic. METHOD: A retrospective data analysis of all pediatric patients presenting to the VBM Clinic between 1998 and 2009 was performed. Data including demographic, referring, diagnostic and treatment information were obtained from the clinic’s database. RESULTS: Of 932 patients, 621 with hemangiomas and 311 patients with vascular malformations were found in the database. Hemangiomas were more commonly found in girls (68.5%), and most commonly located on the head and neck (54%), with most patients (72.6%) having only one lesion. Of the patients with hemangiomas, 14.7% underwent diagnostic imaging investigation and 23.7% received treatment including medications, surgery, pulsed-dye laser or dressings. The sex distribution among the 311 patients with vascular malformations was almost equal. Venous malformations accounted for 38.9% of patients, isolated capillary malformations for 31.5%, lymphatic malformations for 11.6%, mixed low-flow malformations for 14.8% and arteriovenous malformations for 2.9%. Overall, 37.9% of patients underwent diagnostic imaging investigation and 42.4% received treatment – either pulsed-dye laser, surgical excision, sclerotherapy or other treatment. CONCLUSIONS: Hemangiomas and vascular malformations can occur at any anatomical site. There is a large variation in clinical presentation necessitating expertise in a variety of diagnostic approaches and treatment modalities. Vascular anomalies are best managed in a multidisciplinary setting.

Fraulin, Frankie OG; Flannigan, Ryan K; Sharma, Vishal K; McPhalen, Donald F; Harrop, Robertson A



North American Reporting Center for Amphibian Malformations  

NSDL National Science Digital Library

Created in June, 1997 and funded by the US Geological Survey and Environmental Protection Agency, this site is a response to the discovery of numerous deformed amphibians (mostly frogs) in areas as widespread as Minnesota, California, and Florida. Malformations include extra or missing limbs, missing eyes, and split limbs. The site is intended to serve as a central repository for data on the type and relative frequency of such malformations throughout the US. Researchers hope to use the site to help discover the cause(s) of these deformities. The site contains a map of where malformations have been reported, background on the occurrence and possible causes of defects, numerous images of malformed amphibians, a searchable bibliography, instructions on how to report the discovery of a malformed amphibian, and links to eight related web sites. NARCAM's site also contains a toll-free number for citizen reports.

Center., Northern P.



[Vascular grafts as access for hemodialysis].  


Prosthetic arteriovenous grafts have an inferior patency rate and greater morbidity than those with autogenous vessels and are therefore considered as secondary or tertiary vascular access for hemodialysis in patients with fatigued or unsuitable superficial arm veins. Prior access planning in accordance of patient characteristics, careful operative procedure and appropriate revision of complications can ensure long-term functioning of a vascular access using a large variety of possible prosthetic conduits. Arteriovenous grafts remain essential in vascular access surgery and their role may be increasing with higher comorbidities of patients and should be preferred to tunnelled cuffed catheters. This article reviews the indications, alternative configurations and characteristics of arteriovenous grafts. PMID:22930063

Zanow, J; Settmacher, U



Presumed bilateral branch retinal vein occlusions secondary to antiepileptic agents  

PubMed Central

A 61-year-old man presented to the ophthalmology department having developed bilateral branch retinal vein occlusions. Baseline blood tests revealed no abnormality; however, subsequent investigations showed a raised plasma homocysteine (HC) level. The patient has been treated for refractory epilepsy for a number of years. Although antiepileptic medications have been shown to reduce folate levels and result in a raised HC level, this has not previously been shown to be to a level causing a retinal vascular event.

Hussain, Rumana N; Banerjee, Somnath



Stereotactic helium-ion radiosurgery for the treatment of intracranial arteriovenous malformations  

SciTech Connect

One of the more challenging problems of vascular neurosurgery is the management of surgically-inaccessible arteriovenous malformations (AVMs) of the brain. At Lawrence Berkeley Laboratory, we have developed the method of stereotactic heavy-charged-particle (helium-ion) Bragg peak radiosurgery for treatment of inoperable intracranial AVMs in over 300 patients since 1980 (Fabrikant et al. 1989, Fabrikant et al. 1985, Levy et al. 1989). This report describes patient selection, treatment method, clinical and neuroradiologic results and complications encountered. 4 refs.

Fabrikant, J.I.; Levy, R.P.; Frankel, K.A.; Phillips, M.H.; Lyman, J.T.; Chuang, F.Y.S.; Steinberg, G.K.; Marks, M.P.



Chronic retinal vein occlusion in glaucoma  

Microsoft Academic Search

Asymptomatic chronic retinal vein occlusion that occurs in chronic simple glaucoma is described. The condition is characterized by marked elevation of retinal vein pressure with collateral vessels and vein loops at the optic disc in cases of central vein occlusion, or retinal veno-venous anastomoses along a horizontal line temporal and nasal to the disc in hemisphere vein occlusion. No patient

R A Hitchings; G L Spaeth



Biomechanical stress-induced apoptosis in vein grafts involves p38 mitogen-activated protein kinases  

Microsoft Academic Search

The present study was designed to inves- tigate whether apoptosis occurs in early-stage vein grafts and to determine the mechanisms by which mechanical stress contributes to apoptosis in vascular smooth muscle cells (SMCs). Apoptosis in vessel walls of mouse vein grafts was confirmed by morphological changes and by terminal deoxynucleotidyl transferase- mediated dUTP-biotin nick end labeling (TUNEL). TUNEL1 cells in



The in vitro effects of remifentanil and fentanyl on isolated human right atria and saphenous veins  

Microsoft Academic Search

Objective: To determine the myocardial and vascular effects of remifentanil and fentanyl in human atria and saphenous veins.Design: In vitro, prospective with repeated measures.Setting: University research laboratory.Interventions: The direct effects of remifentanil and fentanyl on the electrical stimulation-induced contraction of nonfailing human atrium and saphenous veins contracted with 5-hydroxytryptamine were studied.Measurements and Main Results: In human atrial trabeculae, cumulative (10?9-10?5

Ates Duman; Ayse Saide Sahin; K?smet Esra Atalik; Cemile Öztin Ögün; Hasan Basri Ulusoy; Kadir Durgut; Selmin Ökesli



Endovascular Treatment of Acute Portal Vein Thrombosis After Liver Transplantation in a Child  

SciTech Connect

Although operative techniques in hepatic transplantation have reduced the time and mortality on waiting lists, the rate of vascular complications associated with these techniques has increased. Stenosis or thrombosis of the portal vein is an infrequent complication, and if present, surgical treatment is considered the traditional management. This article describes a case of acute portal vein thrombosis after liver transplantation from a living donor to a child managed by percutaneous techniques.

Carnevale, Francisco Cesar, E-mail:; Borges, Marcus Vinicius [University of Sao Paulo, Division of Interventional Radiology, Radiology Institute, Hospital das Clinicas (Brazil); Moreira, Airton Mota [University of Sao Paulo, Division of Interventional Radiology, Children's Institute, Hospital das Clinicas (Brazil); Cerri, Giovanni Guido [University of Sao Paulo, Radiology Institute, Hospital das Clinicas (Brazil); Maksoud, Joao Gilberto [Hospital das Clinicas, University of Sao Paulo, Division of Pediatric Surgery, Children's Institute (Brazil)



Hepatic vascular anomalies in infancy: A twenty-seven-year experience  

Microsoft Academic Search

OBJECTIVE: Infantile hemangioma and arteriovenous malformation (AVM) of the liver have a similar presentation but a different natural history, and therefore require different treatment. This study was undertaken to clarify differential diagnosis and management of these two biologically distinct vascular disorders. STUDY DESIGN: We retrospectively analyzed the records of 43 children with hepatic vascular anomalies treated during the past 27

Laurence M. Boon; Patricia E. Burrows; Harriet J. Paltiel; Dennis P. Lund; R. Alan B. Ezekowitz; Judah Folkman; John B. Mulliken



Fast-flow lingual vascular anomalies in the young patient: is imaging diagnostic?  

Microsoft Academic Search

Aim. To describe the imaging findings (MR imaging and angiography) of high-flow vascular anomalies of the tongue, hemangiomas and arteriovenous malformations (AVMs), with emphasis on the discrepant imaging findings in lingual AVMs. Materials and methods. Retrospective review of clinical records, histologic reports and imaging studies of five consecutive patients with high-flow lingual vascular anomalies. Results. One patient had hemangioma (aged

Pek-Lan Khong; Patricia E. Burrows; Harry P. Kozakewich; John B. Mulliken



Perceptual enhancement of arteriovenous malformation in MRI angiography displays  

NASA Astrophysics Data System (ADS)

The importance of presenting medical images in an intuitive and usable manner during a procedure is essential. However, most medical visualization interfaces, particularly those designed for minimally-invasive surgery, suffer from a number of issues as a consequence of disregarding the human perceptual, cognitive, and motor system's limitations. This matter is even more prominent when human visual system is overlooked during the design cycle. One example is the visualization of the neuro-vascular structures in MR angiography (MRA) images. This study investigates perceptual performance in the usability of a display to visualize blood vessels in MRA volumes using a contour enhancement technique. Our results show that when contours are enhanced, our participants, in general, can perform faster with higher level of accuracy when judging the connectivity of different vessels. One clinical outcome of such perceptual enhancement is improvement of spatial reasoning needed for planning complex neuro-vascular operations such as treating Arteriovenous Malformations (AVMs). The success of an AVM intervention greatly depends on fully understanding the anatomy of vascular structures. However, poor visualization of pre-operative MRA images makes the planning of such a treatment quite challenging.

Abhari, Kamyar; Baxter, John S. H.; Eagleson, Roy; Peters, Terry; de Ribaupierre, Sandrine



A New Device for Vascular Embolization: Report on Case of Two Pulmonary Arteriovenous Fistulas Embolization Using the Amplatzer Vascular Plug  

Microsoft Academic Search

A pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation commonly treated by embolization with coils or balloons\\u000a to prevent the risk of several serious complications such as cerebral embolism and brain abscess. A 32-year-old female with\\u000a two PAVFs and neurological ischemic manifestations has been successfully treated by transcatheter embolization of both fistulas\\u000a using a new device (Amplatzer Vascular Plug).

Michele Rossi; Alberto Rebonato; Laura Greco; Giulio Stefanini; Michele Citone; Annnarita Speranza; Vincenzo David



An early venous abnormality: a potential cause of arteriovenous malformation recurrence.  


In adults, complete surgical resection of arteriovenous malformations (AVMs) is generally curative. Recurrence of AVMs is extremely rare and most often delayed over many years. The authors report the case of a man in his 20s with rapid AVM recurrence and dual blood supply from the dura and intracerebral vessels. Early recurrence of the AVM allowed documentation of the early events associated with this recurrence. This was evidenced by the first appearance of an early vein without any signs of abnormal vasculature, suggesting that abnormality of the venous drainage system might be an inciting event in the recurrence and perhaps genesis of AVMs. PMID:22967676

Weingarten, David; Pakbaz, Sean; Cho, Aaron; U, Hoi Sang



Somatic uniparental isodisomy explains multifocality of glomuvenous malformations.  


Inherited vascular malformations are commonly autosomal dominantly inherited with high, but incomplete, penetrance; they often present as multiple lesions. We hypothesized that Knudson's two-hit model could explain this multifocality and partial penetrance. We performed a systematic analysis of inherited glomuvenous malformations (GVMs) by using multiple approaches, including a sensitive allele-specific pairwise SNP-chip method. Overall, we identified 16 somatic mutations, most of which were not intragenic but were cases of acquired uniparental isodisomy (aUPID) involving chromosome 1p. The breakpoint of each aUPID is located in an A- and T-rich, high-DNA-flexibility region (1p13.1-1p12). This region corresponds to a possible new fragile site. Occurrences of these mutations render the inherited glomulin variant in 1p22.1 homozygous in the affected tissues without loss of genetic material. This finding demonstrates that a double hit is needed to trigger formation of a GVM. It also suggests that somatic UPID, only detectable by sensitive pairwise analysis in heterogeneous tissues, might be a common phenomenon in human cells. Thus, aUPID might play a role in the pathogenesis of various nonmalignant disorders and might explain local impaired function and/or clinical variability. Furthermore, these data suggest that pairwise analysis of blood and tissue, even on heterogeneous tissue, can be used for localizing double-hit mutations in disease-causing genes. PMID:23375657

Amyere, Mustapha; Aerts, Virginie; Brouillard, Pascal; McIntyre, Brendan A S; Duhoux, François P; Wassef, Michel; Enjolras, Odile; Mulliken, John B; Devuyst, Olivier; Antoine-Poirel, Hélène; Boon, Laurence M; Vikkula, Miikka



Prenatal exposure to thalidomide, altered vasculogenesis, and CNS malformations.  


Malformations of cortical development (MCD) result from abnormal neuronal positioning during corticogenesis. MCD are believed to be the morphological and perhaps physiological bases of several neurological diseases, spanning from mental retardation to autism and epilepsy. In view of the fact that during development, an appropriate blood supply is necessary to drive organogenesis in other organs, we hypothesized that vasculogenesis plays an important role in brain development and that E15 exposure in rats to the angiogenesis inhibitor thalidomide would cause postnatal MCD. Our results demonstrate that thalidomide inhibits angiogenesis in vitro at concentrations that result in significant morphological alterations in cortical and hippocampal regions of rats prenatally exposed to this vasculotoxin. Abnormal neuronal development was associated with vascular malformations and a leaky blood-brain barrier. Protein extravasation and uptake of fluorescent albumin by neurons, but not glia, was commonly associated with abnormal cortical development. Neuronal hyperexcitability was also a hallmark of these abnormal cortical regions. Our results suggest that prenatal vasculogenesis is required to support normal neuronal migration and maturation. Altering this process leads to failure of normal cerebrovascular development and may have a profound implication for CNS maturation. PMID:16859833

Hallene, K L; Oby, E; Lee, B J; Santaguida, S; Bassanini, S; Cipolla, M; Marchi, N; Hossain, M; Battaglia, G; Janigro, D



Treatment of Arteriovenous Malformations with Hydrocoils in a Swine Model  

PubMed Central

Summary Arteriovenous malformations (AVM) of the brain are the most common symptomatic congenital vascular malformation of the central nervous system, with significant associated morbidity and mortality. This study compared the feasibility and efficacy of treating AVMs by embolization with hydrocoils with similar treatment with bare platinum coils, using the swine rete mirabile as a model. A right carotid–jugular fistula was created in ten swine. A microcatheter was positioned into the rete mirabile, which was unilaterally (contralateral to the fistula) embolized with hydrocoils in six and bare platinum coils in four swine. Angiograms were evaluated during and immediately after embolization. Embolization with complete cessation of blood flow in the unilateral rete mirabile was achieved in all animals treated with hydrocoils. The number of coils needed varied from four to seven (diameter 2–4 mm; mean coil length 22.3 cm). Embolization with platinum coils of similar number (seven) and slightly longer length (mean 37.75 cm) had a minimal effect on blood flow, resulting in occlusion of only small compartments. No immediate complications were noted with either coil. Hydrocoils are more effective in achieving embolization than bare platinum coils. Expansion of the hydrocoil over only a few minutes allows precise placement and stabilization of the coil before detachment. Hydrocoils can be safely placed into small vessels. This approach may be particularly useful to decrease the flow rate, as a first stage of AVM embolization in high flow AVMs that contain arteriovenous fistulae.

Amiridze, N.S.; Darwish, R.; Griffith, G.M.; Zoarskia, G.H.



Fetal MRI clues to diagnose cloacal malformations  

Microsoft Academic Search

Background  Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis.\\u000a \\u000a \\u000a \\u000a Objective  To define the prenatal MRI findings in cloacal malformations.\\u000a \\u000a \\u000a \\u000a Materials and methods  We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution.\\u000a Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was

Maria A. Calvo-Garcia; Beth M. Kline-Fath; Marc A. Levitt; Foong-Yen Lim; Leann E. Linam; Manish N. Patel; Steven Kraus; Timothy M. Crombleholme; Alberto Peña


Preliminary experiences using the MGuard stent platform in saphenous vein graft lesions.  


The MGuard stent has been designed as a plaque trapping device to treat athero-thrombotic lesions in saphenous vein grafts and native coronary lesions. It was utilized in seven coronary bypass patients to treat eight vein grafts. The average graft age was 15 years. Procedural success was 100% without any intraprocedural, in-hospital, and/or 30-day major adverse cardiac events (e.g. death, myocardial infarction, and need for repeat graft revascularization). No patient experienced distal embolization and/or procedure-related CK enzymatic rise. This strategy seems to be a promising approach in percutaneous vascular management of vein graft lesions. PMID:19434749

Vaknin-Assa, Hana; Assali, Abid; Kornowski, Ran



Arteriovenous Malformation of the Vulva: A Case Report.  


OBJECTIVE: To report the case of a patient with a large and symptomatic vulvar lesion, necessitating surgical excision. CASE: We report the case of a 57-year-old postmenopausal woman with a 6-month history of an enlarging vulvar lesion associated with vulvar pruritus. On examination, a pedunculated 7 × 5 × 4-cm soft tissue mass attached to the left labium majus was noted. Surgical excision was performed and histopathologic evaluation revealed variably dilated, submucosal vessels with thick muscular walls and intimal thickening, but without endothelial atypia or multilayering. These findings were consistent with a final diagnosis of arteriovenous malformation of the vulva. CONCLUSIONS: Given the complex anatomy of the vulva, the differential diagnosis for vulvar vascular lesions can be challenging. Hence, surgical excision and histopathologic evaluation become imperative to distinguish them from other dermatologic and neoplastic conditions of the vulva. PMID:23645069

Pereira, Nigel; Dormosh, Mayes; Mirmanesh, Michael; Guilfoil, Daniel S



Biomechanical response of femoral vein to chronic elevation of blood pressure in rabbits.  


Venous diseases like iliofemoral deep vein thrombosis and valvular dysfunction induce venous hypertension. To know the effects of the hypertension on venous mechanics, blood pressure in the left femoral vein in the rabbit was chronically elevated by the constriction of the left external iliac vein. Wall dimensions and biomechanical properties of the femoral vein were studied in vitro at 1, 2, or 4 wk after surgery. Blood pressure measured immediately before the animal was killed was significantly higher in the left femoral vein than in the sham-operated, contralateral vein. Wall thickness was increased by blood pressure elevation even at 1 wk, which restored circumferential wall stress to a control level. The stress was kept at normal up to 4 wk. Vascular tone and vascular contractility were increased by the elevation of blood pressure; however, wall elasticity and compliance were kept at a normal level. These results are very similar to those observed in hypertensive arteries, indicating that not only arteries but veins optimally operate against blood pressure elevation. PMID:12388229

Hayashi, K; Mori, K; Miyazaki, H



Difference in the Effects of Low Temperatures on the Tension of Human Pulmonary Artery and Vein Ring Segments  

Microsoft Academic Search

Background: Although limited data suggest that pulmonary flushing with organ preservation solutions should not be performed at too low temperatures, the influence of temperature on pulmonary vascular tone is unclear. Objective: The purpose of this study was to examine the effect of low temperatures of the tension of human pulmonary artery and vein ring segments and the vascular resistance of

Satoshi Suzuki; Makoto Sugita; Sadafumi Ono; Chun Song; Takashi Kondo; Shigefumi Fujimura



Mechanisms of vein graft adaptation to the arterial circulation: Insights into the neointimal algorithm and management strategies  

PubMed Central

For patients with coronary artery disease or limb ischemia, placement of a vein graft as a conduit for a bypass is an important and generally durable strategy among the options for arterial reconstructive surgery. Vein grafts adapt to the arterial environment; limited formation of intimal hyperplasia in the vein graft wall is thought to be an important component of successful vein graft adaptation. However, it is also known that abnormal, or uncontrolled, adaptation may lead to abnormal vessel wall remodeling with excessive neointimal hyperplasia, and ultimately vein graft failure and clinical complications. Therefore, understanding the venous-specific pathophysiological and molecular mechanisms of vein graft adaptation are important for clinical vein graft management. Of particular importance, it is currently unknown whether several specific distinct molecular differences in venous mechanisms of adaptation exist that are distinct from arterial post-injury responses; in particular, the participation of the venous marker Eph-B4 and the vascular protective molecule Nogo-B may be involved in mechanisms of vessel remodeling specific to the vein. In this review, we describe 1) venous biology from embryonic development to the mature quiescent state; 2) sequential pathologies of vein graft neointima formation; and 3) novel candidates for strategies of vein graft management. We believe that the scientific inquiry of venous-specific adaptation mechanisms will ultimately provide improvements in vein graft outcomes.

Muto, Akihito; Model, Lynn; Ziegler, Kenneth; Eghbalieh, Sammy D.D.; Dardik, Alan



Vascular lesions.  


Advances in laser and light-based technology have increased their potential applications, safety and efficacy for the management of vascular lesions in dermatology. Light devices for vascular lesions include the variable-pulse 532 nm potassium titanyl phosphate laser, 577 to 595 nm pulsed dye laser, intense pulsed light devices, and 800 to 940 nm diode, long-pulse 755 nm alexandrite and 1,064 nm Nd:YAG lasers. This review will discuss the various different laser and light-based devices, and provide a focused treatment approach for the management of common congenital and acquired vascular lesions. PMID:21865800

Ting, Patricia T; Rao, Jaggi



Vascular Cures  


... Research Network . Innovating Results matter. We’re leaders in finding new ways to predict, treat and prevent vascular disease. Our newest program brings the power of genomics to find new ways to prevent death ...


Learning from the pulmonary veins.  


The purpose of this article is to review the basic embryology and anatomy of the pulmonary veins and the various imaging techniques used to evaluate the pulmonary veins, as well as the radiologic findings in diseases affecting these structures. Specific cases highlight the clinical importance of the imaging features, particularly the findings obtained with multidetector computed tomography (CT). Pulmonary vein disease can be broadly classified into congenital or acquired conditions. Congenital disease, which often goes unnoticed until patients are adults, mainly includes (a) anomalies in the number or diameter of the vessels and (b) abnormal drainage or connection with the pulmonary arterial tree. Acquired disease can be grouped into (a) stenosis and obstruction, (b) hypertension, (c) thrombosis, (d) calcifications, and (e) collateral circulation. Pulmonary vein stenosis or obstruction, which often has important clinical repercussions, is frequently a result of radiofrequency ablation complications, neoplastic infiltration, or fibrosing mediastinitis. The most common cause of pulmonary venous hypertension is chronic left ventricular failure. This condition is difficult to differentiate from veno-occlusive pulmonary disease, which requires a completely different treatment. Pulmonary vein thrombosis is a rare, potentially severe condition that can have a local or distant cause. Calcifications have been described in rheumatic mitral valve disease and chronic renal failure. Finally, the pulmonary veins can act as conduits for collateral circulation in cases of obstruction of the superior vena cava. Multidetector CT is an excellent modality for imaging evaluation of the pulmonary veins, even when the examination is not specifically tailored for their assessment. PMID:23842969

Porres, Diego Varona; Morenza, Oscar Persiva; Pallisa, Esther; Roque, Alberto; Andreu, Jorge; Martínez, Manel


Chiari malformation with thick occipital bone.  


A case of a Chiari malformation with an extraordinarily thick occipital bone is described. The thick occipital bone might make the posterior fossa narrow with consequent herniation of the cerebellar tonsils to the foramen magnum and formation of a syrinx. At dural plasty, well-developed marginal and occipital sinuses should be deliberately handled with the preservation of normal venous drainage. This case gives us the essence of the occurrence mechanisms of Chiari malformation and foramen magnum decompression. PMID:21339798

Yasuhara, Takao; Miyoshi, Yasuyuki; Date, Isao



Imaging diagnosis--split cord malformation.  


The features of a calf with a split cord malformation are described. Clinically, there was severe cervicothoracic kyphoscoliosis and an interscapular dermal sinus associated with cerebrospinal fluid drainage. Using magnetic resonance imaging, complete duplication of the spinal cord at the cervical intumescence was detected. There was associated syringohydromyelia, multiple cervicothoracic vertebral malformations resulting in kyphoscoliosis and rachischisis, herniation of the cerebellar vermis, meningoencephalocele, and calvarial defects. PMID:20166395

Zani, Davide D; De Zani, Donatella; Morandi, Nicola; Biggi, Marianna; Belloli, Angelo G; Riccaboni, Pietro; Rondena, Marco; Di Giancamillo, Mauro; Pravettoni, Davide


Maternal diabetes mellitus and infant malformations  

Microsoft Academic Search

OBJECTIVE:To investigate the effects of pregestational, as opposed to gestational, diabetes on infant malformations.METHODS:All women delivering infants at Parkland Hospital between January 1, 1991, and December 31, 2000, were ascertained. Screening for gestational diabetes was methodically employed throughout the study period using National Diabetes Data Group criteria for diagnosis of pregestational and gestational diabetes. Standardized definitions of major infant malformations

Jeanne S Sheffield; Erin L Butler-Koster; Brian M Casey; Donald D McIntire; Kenneth J Leveno



The Microcephaly-Capillary Malformation Syndrome  

PubMed Central

We report on three children from two families with a new pattern recognition malformation syndrome consisting of severe congenital microcephaly (MIC), intractable epilepsy including infantile spasms, and generalized capillary malformations that was first reported recently in this journal [Carter et al. (2011); Am J Med Genet A 155: 301–306]. Two of our reported patients are an affected brother and sister, suggesting this is an autosomal recessive severe congenital MIC syndrome.

Mirzaa, Ghayda M.; Paciorkowski, Alex R.; Smyser, Christopher D.; Willing, Marcia C.; Lind, Anne C.; Dobyns, William B.



Free vascularized thin corticoperiosteal graft.  


This paper describes a new thin corticoperiosteal graft harvested from the medial condylar and supracondylar areas of the femur. It is based on the articular branch of the descending genicular artery and vein and consists of periosteum with a thin (0.5 to 1.0 mm) layer of outer cortical bone. By retaining the cortex, the cambium layer is preserved, and this is thought to have a better osteogenic capacity than vascularized periosteal grafts. This graft was used to treat six patients with fracture nonunion of the upper extremity in which conventional treatment had failed. Uneventful bony union was achieved in all patients within 10 weeks. PMID:1989022

Sakai, K; Doi, K; Kawai, S



CD68 expression in aortocoronary saphenous vein bypass grafts.  


Atherosclerosis commonly affects the arteries harvested from patients 70 years of age or older. Saphenous vein grafts appear to maintain a higher patency rate after coronary artery bypass grafting in these subjects. The infiltration of macrophages is an early step in saphenous vein graft atherosclerosis; however, little is known regarding the underlying mechanisms of infiltration. The objective of the present report is to evaluate the presence of CD68-positive cells in the saphenous vein wall and correlate initial CD68-positive infiltration to specific clinical and biochemical parameters and the graft patency rate as estimated in patients undergoing coronary artery bypass grafting. A total of 309 patients were allocated into two groups: A1 patients, who were between 50 and 70 years of age, and A2 patients, who were 70 years or older at the time of vein harvesting. CD68 expression was evaluated by immunohistochemistry. There were no significant differences between A1 and A2 patients regarding macrophage expression within any of the analyzed vascular regions. Saphenous vein macrophages were never present in the tunica intima unless they were also expressed in the media or the adventitia. The patients with CD68-positive cells in the tunica intima had a significantly higher number of bypass stenoses when compared with the subjects who did not have CD68-positive cells in this layer. These findings suggest that the CD68-positive cells (those that have not yet developed into foam cells) present in the intima of saphenous vein grafts might serve as a very early marker of graft occlusion. PMID:23275124

Malinska, Agnieszka; Perek, Bartlomiej; Buczkowski, Piotr; Kowalska, Katarzyna; Ostalska-Nowicka, Danuta; Witkiewicz, Wojciech; Nowicki, Michal



Third-generation lentivirus vectors efficiently transduce and phenotypically modify vascular cells: implications for gene therapy  

Microsoft Academic Search

Grafting of saphenous vein (SV) conduits into the arterial circulation triggers a number of adaptive pathological changes characterized by progressive medial thickening, neointima formation and accelerated atheroma. Previous studies have shown that modification of vein graft biology is possible by adenovirus (Ad)-mediated gene transfer, although gene expression is transient. Advancement of vascular gene therapy to the clinic is compromised by

Kate L Dishart; Laura Denby; Sarah J George; Stuart A Nicklin; Satya Yendluri; Melanie J Tuerk; Michael P Kelley; Brian A Donahue; Andrew C Newby; Thomas Harding; Andrew H Baker



Spontaneous Thrombosis of an Orbital Arteriovenous Malformation Revealing Hereditary Haemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)  

PubMed Central

Summary Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.

Van Went, C.; Ozanne, A.; Saliou, G.; Dethorey, G.; De Monchy, I.; Krings, T.; Ducreux, D.; Labetoulle, M.



New frontiers of vascular grafting.  


Vascular grafting can be a very rewarding surgical technique: following surgery, most patients will maintain their autonomy and, in many cases, will be able to return to work. Should small diameter calibre substitutes be required, the autologous saphenous vein is the gold standard. If not available, the expanded PTFE is probably the best choice. For medium and large diameters, the polyesters (Dacron) are recommended provided they have a structure adapted to the needs of patients. However, progress in the last few years is not related to improvements in the grafts themselves. The only breakthrough has come with the success of graft seeding. This is the reason why other approaches have been proposed to restore or improve blood flow in atherosclerotic arteries: medication, sympathectomy, dilatation, laser endarterectomy, stent and spinal cord stimulation. All those approaches have more and more precise indications: they can supplement vascular grafting. PMID:2978038

Guidoin, R; Couture, J; Assayed, F; Gosselin, C


Pancreatectomy for metastasis to the pancreas from colorectal cancer and reconstruction of superior mesenteric vein: a case report  

PubMed Central

Introduction Tumors of the pancreatic head can infiltrate the superior mesenteric vein. In such cases, the deep veins of the lower limbs can serve as suitable autologous conduits for superior mesenteric vein reconstruction after its resection. Few data exist, however, describing the technique and the immediate patency of such reconstruction. Case report We present the case of a 70-year-old Caucasian man with a metachronous metastasis of colon cancer and infiltration of the uncinate pancreatic process, on the anterior surface of which the tumor was located. En bloc resection of the tumor was performed with resection of the superior mesenteric vein and reconstruction. A 10 cm segment of the superficial femoral vein was harvested for the reconstruction. The superficial femoral vein segment was inter-positioned in an end-to-end fashion. The post-operative conduit patency was documented ultrasonographically immediately post-operatively and after a six-month period. The vein donor limb presented subtle signs of post-operative venous hypertension with edema, which was managed with compression stockings and led to significant improvement after six months. Conclusion In cases of exploratory laparotomies with high clinical suspicion of pancreatic involvement, the potential need for vascular reconstruction dictates the preparation for leg vein harvest in advance. The superficial femoral vein provides a suitable conduit for the reconstruction of the superior mesenteric vein. This report supports the uncomplicated nature of this technique, since few data exist about this type of reconstruction.



The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery —A case report—  

Microsoft Academic Search

The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery was discovered during surgery\\u000a on a patient with nodular chronic pancreatitis. Such a rare anomaly has never been noted in the English literature so far\\u000a as we have been able to find. This malformation of the pancreatic uncinate process was considered to be due to excess

Yoshiaki Sugiura; Shingo Shima; Hajime Yonekawa; Yutaka Yoshizumi; Hasseau Ohtsuka; Toshiro Ogata



CASE REPORT Postoperative Use of the NormaTec Pneumatic Compression Device in Vascular Anomalies  

PubMed Central

Arteriovenous malformations have a wide range of clinical presentations and an unfortunately unpredictable response to both nonsurgical and surgical intervention. The authors report on the surgical treatment of a 19-year-old man with a complex lower extremity arteriovenous malformation, previously unsuccessfully treated with numerous local sclerotherapy and interventional radiology embolization procedures leading to massive tissue necrosis and deep infection. The patient was definitively treated with wide excision of the necrotic tissue, coils, and arteriovenous malformation, but with preservation of the tibial nerve and vascular supply to the foot. Significant postoperative complications were prevented with the use of a novel dynamic compression device employing peristaltic pulse pneumatic compression.

Talbot, Simon G.; Kerstein, David; Jacobs, Laura F.; Upton, Joseph



Cone-Beam CT: Vascular Applications.  


Cone-beam computed tomography (CBCT) provides three-dimensional rendering of opacified vascular structures that are very useful for catheter guidance and anatomical correlation in many arterial and venous procedures. CBCT has been shown to improve the technical success of transarterial chemoembolization (TACE), which may lead to better outcomes. Similarly, it is useful in planning for selective internal radiation therapy of the liver by defining the treatment volume and preventing misembolization. There is emerging application of CBCT fusion with magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) for use in catheterization or needle puncture of otherwise difficult to opacify vascular structures. CBCT also has a role in needle guidance for type II endoleak embolization, translumbar venous catheter placement, and embolization of vascular malformations. PMID:23993076

Angle, John F



Pulmonary veins in high-altitude residents: a morphometric study.  

PubMed Central

The thickness of the media of pulmonary veins and arteries was morphometrically assessed in 12 normal adults resident at altitudes over 3000 m and 12 resident at sea level. The pulmonary veins in the latter group were very thin walled. The average thickness of the pulmonary venous media in the group of highlanders was significantly thicker but this appeared to be due to prominent medial hypertrophy in seven individuals, five others having normal or near-normal pulmonary veins. In six of the 12 highlanders bundles of longitudinal smooth muscle cells occurred in the venous intima. There was close correlation between the thickness of the venous and that of the arterial media, suggesting an individual reactivity with a simultaneous response of all pulmonary vascular smooth muscle to high-altitude hypoxia. Hypertrophy of the media of pulmonary veins is likely to be an expression of venoconstriction and narrowing of the venous lumen may be enhanced by the development of longitudinal smooth muscle cells in the intima. Possibly venoconstriction is one of the factors responsible for high-altitude pulmonary oedema. Images

Wagenvoort, C A; Wagenvoort, N



Segmentation of arteries and veins on 4D CT perfusion scans for constructing arteriograms and venograms  

NASA Astrophysics Data System (ADS)

3D CT Angiography (CTA) scans are currently used to assess the cerebral arteries. An additional 4D CT Perfusion (CTP) scan is often acquired to determine perfusion parameters in the cerebral parenchyma. We propose a method to extract a three dimensional volume showing either the arteries (arteriogram) or the veins (venogram) from the 4D CTP scan. This would allow cerebrovascular assessment using the CTP scan and obviate the need for acquiring an additional CTA scan. Preprocessing steps consist of registration of the time volumes of the CTP scan using rigid registration and masking out extracranial structures, bone and air. Next a 3D volume is extracted containing the vessels (vascular volume) by using the absolute area under the first derivative curve in time. To segment the arteries and veins we use the time to peak of the contrast enhancement curve combined with region growing within a rough vessel segmentation. Finally the artery/vein segmentation is used to suppress either the veins or the arteries in the vascular volume to construct the arteriogram and venogram. To evaluate the method, 11 arteriograms and venograms were visually inspected by an expert observer, with special attention to the important cerebral arteries (Circle of Willis) and veins (straight and transverse sinus). Results show that the proposed method is effective in extracting the major cerebral arteries and veins from CTP scans.

Mendrik, Adriënne; Vonken, Evert-Jan; Waaijer, Annet; Smit, Ewoud; Prokop, Mathias; van Ginneken, Bram



Transfected Early Growth Response Gene-1 DNA Enzyme Prevents Stenosis and Occlusion of Autogenous Vein Graft In Vivo  

PubMed Central

The aim of this study was to detect the inhibitory action of the early growth response gene-1 DNA enzyme (EDRz) as a carrying agent by liposomes on vascular smooth muscle cell proliferation and intimal hyperplasia. An autogenous vein graft model was established. EDRz was transfected to the graft vein. The vein graft samples were obtained on each time point after surgery. The expression of the EDRz transfected in the vein graft was detected using a fluorescent microscope. Early growth response gene-1 (Egr-1) mRNA was measured using reverse transcription-PCR and in situ hybridization. And the protein expression of Egr-1 was detected by using western blot and immunohistochemistry analyses. EDRz was located at the media of the vein graft from 2 to 24?h, 7?h after grafting. The Egr-1 protein was mainly located in the medial VSMCs, monocytes, and endothelium cells during the early phase of the vein graft. The degree of VSMC proliferation and thickness of intima were obviously relieved compared with the no-gene therapy group. EDRz can reduce Egr-1 expression in autogenous vein grafts, effectively restrain VSMC proliferation and intimal hyperplasia, and prevent vascular stenosis and occlusion after vein graft.

Liu, Chengwei; Zhang, Xuesong; Wang, Shi; Cheng, Mingxun; Liu, Chuanyu; Wang, Shuqing; Hu, Xinhua; Zhang, Qiang



[Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage].  


Two cases of spinal arteriovenous malformation (AVM) with subarachnoid hemorrhage (SAH) are reported. The first case is that of a 14-year-old boy who was transferred to our hospital with a sudden onset of headache. Neurological examination revealed no motosensory deficit, but a brain CT showed a slight diffuse SAH. A left vertebral angiogram demonstrated intramedullary AVM in the cervical region of the spinal cord. This AVM was therefore occluded using a solid embolization material. The patient was then discharged without neurological deficit. The second case is that of a 67-year-old man who visited our hospital with a sudden onset of headache. Neurological examination revealed no motor or sensory deficit, but a brain CT showed SAH, which was dominant in the posterior fossa. Initial cerebral angiography demonstrated no abnormality such as cerebral aneurysm or AVM except for laterality of the C1 radiculo-meningeal artery. A second angiogram on day 11 demonstrated spinal arteriovenous fistula (AVF), which was fed by the left radiculo-meningeal artery and drained to the posterior spinal vein. Embolization for the AVF was performed using liquid material. He was then discharged without neurological deficit. These two cases revealed non-specific SAH symptoms and were indistinguishable from other ruptured aneurysms. Although the brain CT can show a slight SAH or posterior fossa dominant SAH, repeated angiography may be necessary to verify and conclude the diagnosis of spinal AVM. PMID:15352630

Hayashi, Kentaro; Takahata, Hideaki; Nakamura, Minoru



Arteriovenous Malformation Model in Swine: A Natural History Study  

PubMed Central

Summary The well-known porcine arteriovenous malformation (AVM) model introduced by Massoud et al has been widely used as an acute-phase model However; there are no data available on the patency rate in long-term follow-up. Therefore this study is dedicated to the natural history of porcine AVM model after creation. Three piglets (Yucatan micropigs, aged 12 to 14 months) were used in this study. The model was created by microsurgical anastomosis in an end-to-end fashion between the common carotid artery (CCA) and external jugular vein (EJV) on the left side, and by direct ligation of the left external carotid artery (ECA). Angiography was performed before and immediately after model creation, as well as at 44,103,188 and 245 days in all animals. A successful high-flow brain AVM model was established in all animals. The fistula created by end-to-end anastomosis remained intact and thus the successful AVM model maintained in all models over a follow-up period as long as more than eight months. The AVM-model in swine could be used as a chronic model to test the neurointerventional techniques of AVM treatment. We re-created the well known AVM-model by a terminal anastomosis between CCA and EJV and we hypothesize that the good long-term patency of the model is related to the type of anastomosis performed between CCA and EJV.

Klisch, J.; Yin, L.; Requejo, F.; Schumacher, M.



Inflammatory Cytokines in Vascular Dysfunction and Vascular Disease  

PubMed Central

The vascular inflammatory response involves complex interaction between inflammatory cells (neutrophils, lymphocytes, monocytes, macrophages), endothelial cells (ECs), vascular smooth muscle cells (VSMCs), and extracellular matrix (ECM). Vascular injury is associated with increased expression of adhesion molecules by ECs and recruitment of inflammatory cells, growth factors, and cytokines, with consequent effects on ECs, VSMCs and ECM. Cytokines include tumor necrosis factors, interleukins, lymphokines, monokines, interferons, colony stimulating factors, and transforming growth factors. Cytokines are produced by macrophages, T cells and monocytes, as well as platelets, ECs and VSMCs. Circulating cytokines interact with specific receptors on various cell types and activate JAK-STAT, NF-?B, and Smad signaling pathways leading to an inflammatory response involving cell adhesion, permeability and apoptosis. Cytokines also interact with mitochondria to increasie the production of reactive oxygen species. Cytokine-induced activation of these pathways in ECs modifies the production/activity of vasodilatory mediators such as nitric oxide, prostacyclin, endothelium-derived hyperpolarizing factor, and bradykinin, as well as vasoconstrictive mediators such as endothelin and angiotensin II. Cytokines interact with VSMCs to activate Ca2+, protein kinase C, Rho-Kinase, and MAPK pathways, which promote cell growth and migration, and VSM reactivity. Cytokines also interact with integrins and matrix metalloproteinases (MMPs) and modify ECM composition. Persistent increases in cytokines are associated with vascular dysfunction and vascular disease such as atherosclerosis, abdominal aortic aneurysm, varicose veins and hypertension. Genetic and pharmacological tools to decrease the production of cytokines or to diminish their effects using cytokine antagonists could provide new approaches in the management of inflammatory vascular disease.

Sprague, Alexander H.; Khalil, Raouf A.



Incidence of Central Vein Stenosis and Occlusion Following Upper Extremity PICC and Port Placement  

SciTech Connect

The purpose of this study was to determine the incidence of central vein stenosis and occlusion following upper extremity placement of peripherally inserted central venous catheters(PICCs) and venous ports. One hundred fifty-four patients who underwent venography of the ipsilateral central veins prior to initial and subsequent venous access device insertion were retrospectively identified. All follow-up venograms were interpreted at the time of catheter placement by one interventional radiologist over a 5-year period and compared to the findings on initial venography. For patients with central vein abnormalities, hospital and home infusion service records and radiology reports were reviewed to determine catheter dwelltime and potential alternative etiologies of central vein stenosis or occlusion. The effect of catheter caliber and dwell time on development of central vein abnormalities was evaluated. Venography performed prior to initial catheter placement showed that 150 patients had normal central veins. Three patients had central vein stenosis, and one had central vein occlusion. Subsequent venograms (n = 154)at the time of additional venous access device placement demonstrated 8 patients with occlusions and 10 with stenoses. Three of the 18 patients with abnormal follow-up venograms were found to have potential alternative causes of central vein abnormalities. Excluding these 3 patients and the 4 patients with abnormal initial venograms, a 7% incidence of central vein stenosis or occlusion was found in patients with prior indwelling catheters and normal initial venograms. Catheter caliber showed no effect on the subsequent development of central vein abnormalities. Patients who developed new or worsened central vein stenosis or occlusion had significantly (p =0.03) longer catheter dwell times than patients without central vein abnormalities. New central vein stenosis or occlusion occurred in 7% of patients following upper arm placement of venous access devices.Patients with longer catheter dwell time were more likely to develop central vein abnormalities. In order to preserve vascular access for dialysis fistulae and grafts and adhere to Dialysis Outcomes Quality Initiative guidelines, alternative venous access sites should be considered for patients with chronic renal insufficiency and end-stage renal disease.

Gonsalves, Carin F., E-mail:; Eschelman, David J.; Sullivan, Kevin L.; DuBois, Nancy; Bonn, Joseph [Jefferson MedicalCollege/Thomas Jefferson University Hospital, Suite 4200 GibbonBuilding, 111 South 11th Street, Philadelphia, PA 19107, Department of Radiology (United States)



The burden of disease of retinal vein occlusion: review of the literature  

Microsoft Academic Search

Retinal vein occlusion (RVO) is the second most common cause of vision loss due to retinal vascular disease. A literature review was undertaken to understand the epidemiology, clinical consequence, current practice patterns, and cost of RVO. Pertinent articles were identified by computerized searches of the English language literature in MEDLINE supplemented with electronic and manual searches of society\\/association proceedings and

M Laouri; E Chen; M Looman; M Gallagher



Inhibition of aldehyde dehydrogenase type 2 attenuates vasodilatory action of nitroglycerin in human veins  

Microsoft Academic Search

Recent studies suggest that the mito- chondrial aldehyde dehydrogenase (ALDH)2 is in- volved in vascular bioactivation of nitroglycerin (GTN). However, neither expression of ALDH2 nor its func- tional role in GTN bioactivation has been reported for the main drug target in humans, namely capacitance vessels. We investigated whether ALDH2 is expressed in human veins and whether inhibition of the enzyme

Martin W. Huellner; Sonja Schrepfer; Michael Weyand; Henry Weiner; Isabella Wimplinger; Thomas Eschenhagen; Thomas Rau



Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application.  


The relative deficiency of the official Terminologia Anatomica with regard to the veins of the lower limbs was responsible for a nonuniform anatomic nomenclature in the clinical literature. In 2001, an International Interdisciplinary Committee updated and refined the official Terminologia Anatomica regarding the veins of the lower limbs. Recommendations for terminology were included in an updating document that appeared in the Journal of Vascular Surgery (2002;36:416-22). To enhance further the use of a common scientific language, the committee worked on the present document, which includes (1) extensions and refinements regarding the veins of the lower limbs; (2) the nomenclature of the venous system of the pelvis; (3) the use of eponyms; and (4) the use of terms and adjectives of particular importance in clinical vascular anatomy. PMID:15874941

Caggiati, Alberto; Bergan, John J; Gloviczki, Peter; Eklof, Bo; Allegra, Claudio; Partsch, Hugo



Recent insights into cerebral cavernous malformations: animal models of CCM and the human phenotype  

PubMed Central

Cerebral cavernous malformations are common vascular lesions of the central nervous system that predispose to seizures, focal neurologic deficits and potentially fatal hemorrhagic stroke. Human genetic studies have identified three genes associated with the disease and biochemical studies of these proteins have identified interaction partners and possible signaling pathways. A variety of animal models of CCM have been described to help translate the cellular and biochemical insights into a better understanding of disease mechanism. In this minireview, we discuss the contributions of animal models to our growing understanding of the biology of cavernous malformations, including the elucidation of the cellular context of CCM protein actions and the in vivo confirmation of abnormal endothelial cell–cell interactions. Challenges and progress towards developing a faithful model of CCM biology are reviewed.

Chan, Aubrey C.; Li, Dean Y.; Berg, Michel J.; Whitehead, Kevin J.



Glossopharyngeal neuralgia in the context of a Chiari type I malformation.  


A 34-year-old woman presented with disabling right-sided glossopharyngeal neuralgia. MRI revealed a Chiari I malformation with an asymmetric herniation of the right tonsil. Surgical inspection of the lower cranial nerves through a suboccipital approach showed no vascular compromise. The patient was pain free for three months before the same symptoms recurred. MRI showed a persisting crowding at the level of the foramen magnum. A second intervention with extension of the suboccipital craniectomy and resection of the right tonsil achieved definitive pain relief. To our knowledge this is the fourth report of a glossopharyngeal neuralgia caused by a Chiari I malformation. Recurrence of the pain after incomplete decompression of the posterior fossa underlines the importance of tonsillectomy in these patients. PMID:22277563

Ruiz-Juretschke, Fernando; García-Leal, Roberto; Garcia-Duque, Sara; Panadero, Teresa; Aracil, Cristina



Ultrasound-guided intralesional laser treatment of venous malformation in the oral cavity.  


An ultrasound-guided intralesional photocoagulation (ILP) technique using a laser is described for treatment of deep venous malformations in the oral cavity. ILP is basically a blind operation and has a risk of unintended destruction of surrounding normal tissue, therefore the authors now routinely use guidance by ultrasonography using a mini-probe to improve the safety and reliability of ILP. This approach enables safe fibre insertion, appropriate laser irradiation, and intraoperative assessment of coagulation. The use of this technique is described in 8 patients. The authors conclude that ultrasound-guided ILP with a laser is a promising technique for less-invasive treatment of a vascular malformation in the oral cavity. PMID:22835683

Miyazaki, H; Ohshiro, T; Watanabe, H; Kakizaki, H; Makiguchi, T; Kim, M; Negishi, A; Yokoo, S



Conus medullaris-cauda arteriovenous malformation and Klippel-Trenaunay syndrome: what is the treatment goal?  


A 29-year-old man with Klippel-Trenaunay syndrome (KTS) presented with a symptomatic conus medullaris-cauda arteriovenous malformation (AVM) manifesting as back and right limb pain, which abruptly worsened with the onset of right limb weakness and urinary retention. He was treated by multisession endovascular embolization resulting in improved neurological status. KTS is a sporadic disease with unknown etiology, but genetic susceptibility may lead to the over-expression of angiogenic factors and increased angiogenesis. KTS may be exceptionally associated with slow-flow spinal AVM, but there is no consensus about the optimal treatment for these symptomatic lesions. Embolization treatment may represent a safe option to minimize complications and possibly improve the neurological status in patients with spinal AVM associated with KTS, if one or both legs are already impaired by hypertrophy or other vascular malformations. Genetic analysis may reveal an underlying angiogenesis change, so closer follow up might be indicated in selected patients. PMID:23438663

Sgubin, Donatella; Kanai, Ryuichi; Di Paola, Francesco; Perin, Alessandro; Longatti, Pierluigi



Vascular Proliferation  

NSDL National Science Digital Library

This FlashTM animation depicts vascularization of the early germ disc. It is shown in the context of a transverse section through a trilaminar germ disc and yolk sac. Clicking shows the cardiogenic field developing into the heart tube, along with vasculogenesis of the major vessels. Clicking again shows angiogenesis of peripheral vessels throughout the developing embryo and yolk sac.

PhD Jack D Thatcher (West Virginia School of Osteopathic Medicine Structural Biology)



Vascular Caliber  

Microsoft Academic Search

Many aspects of vascular caliber can be accounted for on the basis of interactions between the frictional drag generated by the stream, and the sensitivity of the endothelial cells to this force. When the drag force on endothelial cells is at its critical set-point, these lining cells are at rest with respect to factors that affect caliber. An increase in

Simon Rodbard



[Ophthalmologic diagnostic procedures and imaging of retinal vein occlusions].  


Retinal vein occlusions are a common vascular disease of the eye. Ophthalmological diagnostic procedures and imaging are important for the prognosis of the disease, as are the systemic work-up and therapy. Besides routine ophthalmic tests (visual acuity, slit lamp examination, funduscopy) a work-up for glaucoma such as intraocular pressure, visual field or 24 h IOP profile is useful as a diagnostic procedure. Furthermore, new diagnostic and imaging tests such as central corneal thickness and optic nerve head imaging by Heidelberg retina tomography or optical coherence tomography (OCT) should be considered for glaucoma evaluation. Optical coherence tomography also plays a major role in treatment monitoring of macular edema secondary to retinal vein occlusions. Fluorescein angiography is well established and can provide information with regard to size and extent of the occlusion, degree of ischemia, areas of non-perfusion and neovascularization, as well as macular edema. PMID:21331683

Mirshahi, A; Lorenz, K; Kramann, C; Stoffelns, B; Hattenbach, L-O



Branch Retinal Vein Occlusion: Pathogenesis, Visual Prognosis, and Treatment Modalities  

PubMed Central

In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50–60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment for macular edema in a particular group of patients with BRVO, while promising results for this condition are shown by intravitreal application of steroids or new vascular endothelial growth factor inhibitors. Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema which are unresponsive to or ineligible for laser treatment.

Rehak, Jiri; Rehak, Matus



Numerical Modelling of Vein Microstructures  

NASA Astrophysics Data System (ADS)

Mineral veins occur in a variety of forms (syntaxial, antitaxial, etc.), and with various microstructures (fibrous, stretched crystals, vuggy, etc.). These structures can, if correctly interpreted, provide useful insight into the geological and tectonic conditions at which the veins formed (Oliver and Bons 2001). Durney and Ramsay (1973) defined the base for the modern classification and interpretation of vein (micro-) structures. Numerical modelling, not available then, has since been added as a tool to better understand the formation of vein (micro-) structures, focussing on three aspects in particular: 1) What determines the habit of growing vein crystals? In particular, what determines the formation of a fibrous habit? (Bons 2001, Hilgers et al. 2001) 2) The formation of fibrous pressure fringes. The complex internal structures of the fringes appear mostly the result of the relative rotation of object and fringes (Koehn et al. 2001). 3) Competition between growing crystals, which for example explains the development of a conical c-axes CPO in zeolite films (Bons and Bons 2003). References: Bons, P.D. 2001. Development of crystal morphology during unitaxial growth in a progressively widening vein: I. The numerical model. Journal of Structural Geology 23, 865-872. Bons, A.J., Bons, P.D. 2003. The development of oblique preferred orientations in zeolite films and membranes. Microporous and Mesoporous Materials 62, 9-16. Durney DW, Ramsay JG (1973) Incremental strains measured by syntectonic crystal growths. In: Gravity and Tectonics (eds De Jong KA, Scholten K), John Wiley and Sons, New York, pp. 67-96. Hilgers, C., Koehn, D., Bons, P.D., Urai, J.L. 2001. Development of crystal morphology during unitaxial growth in a progressively widening vein: II. Numerical simulations of the evolution of antitaxial fibrous veins. Journal of Structural Geology 23, 873-885. Koehn, D., Aerden, D.G.A.M., Bons, P.D., Passchier, C.W. 2001. Computer experiments to investigate complex fibre patterns in natural antitaxial strain fringes. Journal of Metamorphic Geology 19, 217-232. Oliver, N.H.S., Bons, P.D. 2001. Mechanisms of fluid flow and fluid-rock interaction in fossil metamorphic-hydrothermal systems inferred from vein-wallrock patterns, geometry, and microstructure. Geofluids 1, 137-163.

Bons, P. D.



Commercialization of vein contrast enhancement  

NASA Astrophysics Data System (ADS)

An ongoing clinical study of an experimental infrared (IR) device, the Vein Contrast Enhancer (VCE) that visualizes surface veins for medical access, indicates that a commercial device with the performance of the existing VCE would have significant clinical utility for even a very skilled phlebotomist. A proof-of-principle prototype VCE device has now been designed and constructed that captures IR images of surface veins with a commercial CCD camera, transfers the images to a PC for real-time software image processing to enhance the vein contrast, and projects the enhanced images back onto the skin with a modified commercial LCD projector. The camera and projector are mounted on precision slides allowing for precise mechanical alignment of the two optical axes and for measuring the effects of axes misalignment. Precision alignment of the captured and projected images over the entire field-of-view is accomplished electronically by software adjustments of the translation, scaling, and rotation of the enhanced images before they are projected back onto the skin. This proof-of-principle prototype will be clinically tested and the experience gained will lead to the development of a commercial device, OnTarget!, that is compact, easy to use, and will visualize accessible veins in almost all subjects needing venipuncture.

Lovhoiden, Gunnar; Deshmukh, Harshal; Vrancken, Carlos; Zhang, Yong; Zeman, Herbert D.; Weinberg, Devin



Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases  

PubMed Central

Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism.

Babu, M. R. Ramesh; Ramesh, C.; Thirumurugan, K.; Prasad, G. Arun



Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases.  


Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism. PMID:24015017

Babu, M R Ramesh; Ramesh, C; Thirumurugan, K; Prasad, G Arun



Ventriculovascular shunts via the femoral vein: a temporary feasible alternative in pediatric hydrocephalus.  


Ventriculovascular shunts via the femoral vein have been described as a feasible alternative for cerebrospinal fluid diversion in those complex cases of hydrocephalus in which other accesses are discarded. However, experience is short. To our knowledge, only 4 cases have been reported in the literature to date. We report 2 cases of hydrocephalic children who were developed several complications related to ventriculoperitoneal and ventriculoatrial shunts and who successfully managed by means of ventriculovascular shunts via the femoral vein. Both patients underwent vascular catheter placement through a venotomy performed in the common femoral vein. Catheter advance was controlled under fluoroscopic guidance. Distal catheters were joined by means of a straight connector, and a loop was accommodated in a subcutaneous pocket in the inguinal region to avoid future complications. The femoral vein is a successful alternative approach for distal catheter placement in ventriculovascular shunts when other accesses are ruled out. PMID:21034961

Gutiérrez-González, Raquel; Rivero-Garvía, Mónica; Márquez-Rivas, Javier



The RADICLELESS1 gene is required for vascular pattern formation in rice.  


The molecular mechanisms through which the complex patterns of plant vascular tissues are established are largely unknown. The highly ordered, yet simple, striate array of veins of rice leaves represents an attractive system to study the dynamics underlying pattern formation. Here we show that mutation in the RADICLELESS1 (RAL1) gene results in distinctive vascular pattern defects. In ral1 embryonic scutella, secondary veins are absent and in the prematurely aborted and discontinuous primary veins, cells are misaligned to each other. In ral1 leaves, longitudinal and commissural (transverse) veins display altered spacing and the commissural veins additionally show atypical branching and interruptions in their continuity. The vascular pattern alterations of ral1 occur in the context of normally shaped leaf primordia. Anatomical inspection and analysis of the expression of the procambium specification marker Oshox1-GUS and of the auxin-inducible reporter DR5-GUS demonstrates that all the vascular patterning aberrations of ral1 originate from defects in the procambium, which represents the earliest identifiable stage of vascular development. Furthermore, the ral1 mutant is unique in that procambium formation in leaf primordium development is delayed. Finally, the ral1 vascular patterning distortions are associated with a defective response to auxin and with an enhanced sensitivity to cytokinin. ral1 is the first mutant impaired in both procambium development and vascular patterning to be isolated in a monocot species. PMID:12505996

Scarpella, Enrico; Rueb, Saskia; Meijer, Annemarie H



Decreased Cardiac Glutathione Peroxidase Levels and Enhanced Mandibular Apoptosis in Malformed Embryos of Diabetic Rats  

PubMed Central

OBJECTIVE— To characterize normal and malformed embryos within the same litters from control and diabetic rats for expression of genes related to metabolism of reactive oxygen species (ROS) or glucose as well as developmental genes. RESEARCH DESIGN AND METHODS— Embryos from nondiabetic and streptozotocin-induced diabetic rats were collected on gestational day 11 and evaluated for gene expression (PCR) and distribution of activated caspase-3 and glutathione peroxidase (Gpx)-1 by immunohistochemistry. RESULTS— Maternal diabetes (MD group) caused growth retardation and an increased malformation rate in the embryos of MD group rats compared with those of controls (N group). We found decreased gene expression of Gpx-1 and increased expression of vascular endothelial growth factor-A (Vegf-A) in malformed embryos of diabetic rats (MDm group) compared with nonmalformed littermates (MDn group). Alterations of messenger RNA levels of other genes were similar in MDm and MDn embryos. Thus, expression of copper zinc superoxide dismutase (CuZnSOD), manganese superoxide dismutase (MnSOD), and sonic hedgehog homolog (Shh) were decreased, and bone morphogenetic protein-4 (Bmp-4) was increased, in the MD embryos compared with the N embryos. In MDm embryos, we detected increased activated caspase-3 immunostaining in the first visceral arch and cardiac area and decreased Gpx-1 immunostaining in the cardiac tissue; both findings differed from the caspase/Gpx-1 immunostaining of the MDn and N embryos. CONCLUSIONS— Maternal diabetes causes growth retardation, congenital malformations, and decreased general antioxidative gene expression in the embryo. In particular, enhanced apoptosis of the first visceral arch and heart, together with decreased cardiac Gpx-1 levels, may compromise the mandible and heart and thus cause an increased risk of developing congenital malformation.

Wentzel, Parri; Gareskog, Mattias; Eriksson, Ulf J.



Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia  

PubMed Central

INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty?nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty?nine were female (74.4%) and 10 were male (25.6%), with ages ranging from 11 to 59 years (median of 24 years). All of the lesions affected limbs, and the main symptom reported was pain (97.4%). Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients); medium, between 3 and 15 cm (27 patients); and large, greater than 15 cm (8 patients). RESULTS: The symptoms completely disappeared in 14 patients (35.9%) and improved in 24 (61.5%). The lesion size reduced to zero in 6 patients (15.4%) and decreased in 32 (82%). The median number of sessions was 7. There were no complications in 32 patients (82%), while 3 presented local paresthesia (7.7%), 2 superficial trombophlebites (5.1%), 1 skin ulcer (2.6%), and 1 case of hyperpigmentation (2.6%). CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.

Orlando, Jose Luiz; Caldas, Jose Guilherme Mendes Pereira; do Amaral Campos, Heloisa Galvao; Nishinari, Kenji; Wolosker, Nelson



Venous malformations of the genitals: a therapeutic dilemma.  


Venous malformations may occur anywhere in the body but are rare in the genitourinary tract and external genitalia. The authors report a case of a venous malformation in the glans penis and discuss the controversy over optimal management. PMID:20442077

Kaufman, Daniel; Feber, Kevin M; Palmer, Lane S; Freedman, Alan M



Subfascial endoscopic perforator vein surgery.  


Chronic venous insufficiency is a tremendous health care problem in western societies. Venous disease can affect any combination of the superficial, deep, and perforator venous systems of the lower extremities. Generally the superficial venous deficits are addressed through sclerotherapy, enovenous ablation, stab phlebectomy, and or stripping. Patients with advanced clinical sequelae (lipodermatosclerosis or ulceration) of CVI should also be evaluated for the presence of incompetent perforating veins. Open surgical approached to the calf perforating veins (ie. Linton procedure) were complicated by significant wound complications and have largely been replaced by the less invasive Subfascial Endoscopic Perforator Surgery (SEPS). The use of SEPS in patients with ulceration has been shown to be safe and to reduce the time that patients will have ulcers during follow-up. This chapter will review the pathophysiology, diagnosis, and treatment of incompetent perforating veins of the legs with particular attention to surgical issues. PMID:16387265

Iafrati, Mark D



Diffusion tensor imaging of midline posterior fossa malformations  

Microsoft Academic Search

Background  Diffusion tensor imaging and tractography have been used to evaluate a variety of brain malformations. However, these studies have focused mainly on malformations involving the supratentorial compartments. There is a paucity of data on diffusion tensor imaging of posterior fossa malformations.Objective  To describe the color vector maps and modified or abnormal tracts of midline posterior fossa malformations.Materials and Methods  Diffusion tensor imaging

Elysa Widjaja; Susan Blaser; Charles Raybaud



Hypertension as a presentation of bilateral intrarenal arateriovenous malformation.  


Congenital arteriovenous malformations are rare lesions of the kidneys. The first case of bilateral renal arteriovenous malformations was described in 1987. A case of extensive bilateral intrarenal arterivenous malformations presented to us as a case of hypertension. Renal angiography confirmed the diagnosis. Magnetic resonance angiography ruled out these malformations in cerebral circulation, and enhanced abdominal CT scan was normal. The blood pressure of the patient was controlled by medical therapy only. PMID:18212459

El-Lozi, M S; Hadad, A F


Non-invasive vascular imaging of peripheral vessels  

Microsoft Academic Search

.   The purpose of this review is to describe recent advances in non-invasive vascular imaging techniques and to discuss their\\u000a current clinical applications for imaging of peripheral vessels. Principles for applying ultrasound, CT angiography (CTA),\\u000a and magnetic resonance angiography (MRA) for non-invasive imaging of peripheral arteries and veins are presented. Clinical\\u000a applications are reviewed for different vascular diseases, therapy planning,

P. Reimer; P. Landwehr



The Coronary Vascular System and Associated Medical Devices  

Microsoft Academic Search

\\u000a Even as recent as several hundred years ago, the function of the coronary vascular system was largely unknown. Today, it is\\u000a well established that the coronary system is a highly variable network of both arteries supplying and veins draining the myocardium\\u000a of oxygenated and deoxygenated blood, respectively. Due to recent advances in technology, the coronary vascular system has\\u000a been utilized

Sara E. Anderson; Ryan Lahm; Paul A. Iaizzo


Isolated bilateral external iliac vein aplasia.  


We present a case of 11-year-old girl with a history of prominent superficial veins over abdomen and thorax since birth. A superficial vein extending from either inguinal region joined in umbilical region and extended up to right supraclavicular region. Other features of Klippel-Trenaunay syndrome like nevus, limb edema were absent. On radiological investigations both external iliac veins could not be visualized and venous return from lower limbs was draining into the right subclavian vein via these superficial veins. Both external iliac veins could not be identified during surgery. PMID:22729029

Onkar, Deepali; Onkar, Prashant; Mitra, Kajal



Surgical Treatment of Varicose Veins: Effect of Rationing  

PubMed Central

INTRODUCTION A substantial part of vascular surgical workload is devoted to the treatment of varicose veins. To control demand for cosmetic venous surgery, primary care trusts in Somerset introduced clinical criteria in 2000 for the referral and treatment of varicose veins based on the presence of skin change or ulceration, a history of bleeding, or two or more episodes of thrombophlebitis. PATIENTS AND METHODS A comparison of workload and case mix for the referral and treatment of new patients presenting with varicose veins to the Taunton and Somerset Hospital was carried out over two 6-month periods, before and after the introduction of clinically based assessment criteria. RESULTS A total of 134 operations for varicose veins were carried out in 2000 and 85 such operations in 2002/03 after the introduction of new referral criteria (P = 0.001). Of these, 69% (92/134) were day-case procedures in 2000 compared to only 48% (41/85) in 2002/03 (P = 0.004). There was no significant difference in the type of cases (e.g. single, bilateral or recurrent surgery) performed as a day-case (P = 0.34) or as an in-patient (P = 0.43) over the two periods. There was, however, a significant difference (P = 0.007) in the mean ages of patients in the two periods (48.5 years in period 1; 57.8 years in period 2) and in the average ASA grade (1.15 in period 1; 1.42 in period 2; P = 0.0002). CONCLUSION The introduction of clinical criteria for the referral and treatment of varicose veins reduced workload by 37%.

Re Harris, Mark; Davies, R Justin; Brown, Suki; Jones, Stephen M; Eyers, Paul S; Chester, John F



Congenital malformations by the parental occupation in finland  

Microsoft Academic Search

The Finnish Register of Congenital Malformations, a case-referent register, was used to analyze the associations between the parental occupation and the children born with malformations. The women working in industrial and construction occupations had more children with central nervous system (CNS) and musculoskeletal malformations than the referent mothers. The women employed in transport and communication occupations had more children with

K. Hemminki; P. Mutanen; K. Luoma; I. Saloniemi



Fraser-Cryptophthalmos syndrome with cardiovascular malformations: a rare association.  


Fraser-Cryptophthalmos syndrome is a multiple malformation disorder associated variably with cryptophthalmos (hidden eye), anomalies of the head, nose and ears; syndactyly, renal and genital malformations. In this report, we describe a case of Fraser syndrome with cardiovascular malformations: coarctation of aorta, an association not previously described. PMID:14530551

Hambire, Srinivas D; Bhavsar, Priyanka P; B, Meenakshi; Jayakar, Anagha V



Evaluation of retinal functional loss in branch retinal vein occlusion  

Microsoft Academic Search

  \\u000a \\u000a Purpose: Branch retinal vein occlusion (BRVO) induces variable functional deficits depending on the grade of vascular occlusion and\\u000a its localisation. Theses deficiences are not easily defined by visual acuity measurements. However, microperimetry offers\\u000a topical mapping of retinal function, allowing precise documentation of the intensity and dimension of retinal functional loss\\u000a in BRVO.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Retinal sensitivity was examined using a

Irene A. Barbazetto; Ursula M. Schmidt-Erfurth



Evidence for anti-angiogenic and pro-survival functions of the cerebral cavernous malformation protein 3  

Microsoft Academic Search

Mutations in CCM1, CCM2, or CCM3 lead to cerebral cavernous malformations, one of the most common hereditary vascular diseases of the brain. Endothelial cells\\u000a within these lesions are the main disease compartments. Here, we show that adenoviral CCM3 expression inhibits endothelial\\u000a cell migration, proliferation, and tube formation while downregulation of endogenous CCM3 results in increased formation of\\u000a tube-like structures. Adenoviral

Elisa Schleider; Sonja Stahl; Joycelyn Wüstehube; Ulrich Walter; Andreas Fischer; Ute Felbor



Vascular sarcomas.  


Vascular sarcomas are soft-tissue tumors that arise from the endothelium with a malignant potential. This review discusses the management of epithelioid hemangioendothelioma (EHE) and angiosarcoma. EHE is a vascular tumor of intermediate malignant potential with an indolent course. EHE arising from the liver, lung, or bone tends to be multifocal and the rate of progression is slow and often unpredictable. Treatment should be considered in patients with significant symptomatic deterioration and/or progressive disease on imaging studies. Various cytotoxic and targeted therapies are available for management, with disease stabilization as the most common outcome. Angiosarcoma is an aggressive vascular tumor with a high malignant potential. Multidisciplinary care is critical for the management of localized disease, and the best outcomes are often observed in patients when a combination of systemic and local therapy options is used. Metastatic angiosarcoma is treated primarily with systemic therapy, and several cytotoxic and targeted therapies are available, alone or in combination. The choice of therapy depends on several factors, such as cutaneous location of the tumor, performance status of the patient, toxicity of the treatment, and patient goals. PMID:23852636

Ravi, Vinod; Patel, Shreyaskumar



The surgical anatomy of varicose veins.  


Varicose veins are managed largely in ignorance of important aspects of normal anatomy. In a study of 60 dissected legs the following observations were made: 1. The long saphenous vein--normally lies on the deep fascia enclosed with an envelope of fibrous tissue, which presumably compresses the vein rhythmically on exercise to aid centripetal flow. Thick walled and straight it is never varicose, and, communicating regularly with only one or two of the 60 or so perforating veins in the lower limb, its removal by stripping in operations for varicose veins is unjustifiable. In 18% of legs its femoral part is thin walled, superficial, and sometimes multipartite: in such legs varicose veins are commoner than usual, a point of aetiological interest. 2. The tributaries of the long saphenous vein--below the knee normally drain indirectly into it via an arch vein lying parallel but in a posterior and superficial plane, communicating with it both above and below. To reach it, for instance, the pre-tibial tributaries must cross the long saphenous vein. Varicosities of these tributaries and the arch vein therefore overlie the long saphenous vein and are sometimes attributed to it. Similarly the upper end of the arch vein is often erroneously thought to be the long saphenous vein itself dilated up to an incompetent thigh perforator. 3. Perforating veins--are found all over the limb but mainly at intermuscular septa. Minor ones communicate with small muscle veins, major ones with the main deep veins. The major ones medially above the ankle differ from the rest in running a short (1 cm) and unprotected course from subcutaneous fat to posterior tibial veins through the wide gap between soleus and tibia. They are therefore peculiarly susceptible to damage, and their incompetence is peculiarly direct an its effect, which anatomical weakness may account for the prevalence of medial venous ulceration. PMID:7071165

Thomson, H


Cardiovascular malformations in experimental congenital diaphragmatic hernia  

Microsoft Academic Search

Background\\/Purpose: Newborns with congenital diaphragmatic hernia (CDH) frequently have associated anomalies that have a major impact on survival rate independent of pulmonary hypoplasia and pulmonary hypertension. Cardiovascular malformations (CVM) represent a major group of lethal extrapulmonary abnormalities that often assume greatest prognostic significance in most CDH studies. Animal models resembling human CDH may aid knowledge of the basic embryology that

Paul D Losty; M. Gwen Connell; Ralf Freese; Stefan Laval; Bruce O Okoye; Audrey Smith; Dietrich Kluth; David A Lloyd



Chiari malformation in female monozygotic twins.  


We describe the cases of female monozygotic twins who presented almost synchronously with symptomatic Chiari malformation type I. Both were successfully treated with foramen magnum decompression. We analyse these findings in the context of previously reported cases and discuss the genetic implications. PMID:20649405

Solth, A; Barrett, C; Holliman, D; Mitchell, P



Anatomical progression of the Chiari II malformation  

Microsoft Academic Search

To evaluate whether anatomic change of the relationship of the Chiari II malformation and the cranial base was occurring, 22 children with meningomyelocele had serial MRI scans reviewed. A ratio (B\\/A) was established between the distance from the foramen magnum to the caudalmost portion of herniated cerebellum (B) and the diameter of the foramen magnum (A) and this ratio was

John R. Ruge; Jeff Masciopinto; Bruce B. Storrs; David G. McLone



Angular craniometry in craniocervical junction malformation.  


The craniometric linear dimensions of the posterior fossa have been relatively well studied, but angular craniometry has been poorly studied and may reveal differences in the several types of craniocervical junction malformation. The objectives of this study were to evaluate craniometric angles compared with normal subjects and elucidate the main angular differences among the types of craniocervical junction malformation and the correlation between craniocervical and cervical angles. Angular craniometries were studied using primary cranial angles (basal and Boogard's) and secondary craniocervical angles (clivus canal and cervical spine lordosis). Patients with basilar invagination had significantly wider basal angles, sharper clivus canal angles, larger Boogard's angles, and greater cervical lordosis than the Chiari malformation and control groups. The Chiari malformation group does not show significant differences when compared with normal controls. Platybasia occurred only in basilar invagination and is suggested to be more prevalent in type II than in type I. Platybasic patients have a more acute clivus canal angle and show greater cervical lordosis than non-platybasics. The Chiari group does not show significant differences when compared with the control, but the basilar invagination groups had craniometric variables significantly different from normal controls. Hyperlordosis observed in the basilar inavagination group was associated with craniocervical kyphosis conditioned by acute clivus canal angles. PMID:23640096

Botelho, Ricardo Vieira; Ferreira, Edson Dener Zandonadi



Familial Dandy-Walker malformation and leukodystrophy  

Microsoft Academic Search

We report the first familial cases with two different types of posterior fossa cystic malformation and a leukodystrophic-like aspect on cerebral magnetic resonance imaging (MRI). The girl and her brother had severe encephalopathy, marked hypotonia, absent deep tendon reflexes, macrocrania, gigantism, and dysmorphic face and extremities. The girl had generalized seizures. The boy had unilateral cataract and bilateral optic atrophy.

Véronique T. Humbertclaude; Philippe A. Coubes; Nicolas Leboucq; Bernard B. Echenne



Unilateral regional odontodysplasia with ipsilateral mandibular malformation.  


Regional odontodysplasia is a rare developmental anomaly with an unknown cause. This disorder involves both the ectodermal and mesodermal dental layers. The affected teeth generally cannot be rehabilitated for functional use; therefore, the treatment of choice is extraction with prosthetic replacement. A unique case of unilateral regional odontodysplasia with ipsilateral mandibular malformation is reported. PMID:2356083

Raez, A G



Obstetric complications and congenital malformation in schizophrenia  

Microsoft Academic Search

Recent years have witnessed increasingly intense research activity concerning early life somatic trauma and dysmorphogenesis which are associated with the later development of schizophrenia. The two somatic factors that have received the most extensive scientific attention as antecedents of schizophrenia are obstetric complications (OCs) and the congenital malformations termed `minor physical anomalies' (MPAs). Head circumference (HC) at birth has also

Thomas F McNeil; Elizabeth Cantor-Graae; Baher Ismail



Gastrointestinal malformations in Gorgan, North of Iran: epidemiology and associated malformations  

Microsoft Academic Search

The aim of this prospective study was to evaluate the prevalence and pattern of gastrointestinal malformations (GIM) among\\u000a Iranian newborns in Gorgan, North of Iran. From 1998 through 2003, 37,951 live births in Dezyani hospital in Gorgan, North\\u000a of Iran, were screened for gastrointestinal malformations. Clinical and demographic factors of diagnosed cases were recorded\\u000a in a pre-designed questionnaire for analysis;

Mohammad Jafar Golalipour; Elham Mobasheri; Kaniz-Reza Hoseinpour; Abbas Ali Keshtkar



Mutations in a Gene Encoding a Novel Protein Containing a Phosphotyrosine-Binding Domain Cause Type 2 Cerebral Cavernous Malformations  

PubMed Central

Cerebral cavernous malformations (CCMs) are congenital vascular anomalies of the central nervous system that can result in hemorrhagic stroke, seizures, recurrent headaches, and focal neurologic deficits. Mutations in the gene KRIT1 are responsible for type 1 CCM (CCM1). We report that a novel gene, MGC4607, exhibits eight different mutations in nine families with type 2 CCM (CCM2). MGC4607, similar to the KRIT1 binding partner ICAP1?, encodes a protein with a phosphotyrosine-binding domain. This protein may be part of the complex pathway of integrin signaling that, when perturbed, causes abnormal vascular morphogenesis in the brain, leading to CCM formation.

Liquori, Christina L.; Berg, Michel J.; Siegel, Adrian M.; Huang, Elizabeth; Zawistowski, Jon S.; Stoffer, T'Prien; Verlaan, Dominique; Balogun, Fiyinfolu; Hughes, Lori; Leedom, Tracey P.; Plummer, Nicholas W.; Cannella, Milena; Maglione, Vittorio; Squitieri, Ferdinando; Johnson, Eric W.; Rouleau, Guy A.; Ptacek, Louis; Marchuk, Douglas A.



Mutations within the MGC4607 gene cause cerebral cavernous malformations.  


Cerebral cavernous malformations (CCM) are hamartomatous vascular malformations characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. They cause seizures and focal neurological deficits due to cerebral hemorrhages. CCM loci have already been assigned to chromosomes 7q (CCM1), 7p (CCM2), and 3q (CCM3) and have been identified in 40%, 20%, and 40%, respectively, of families with CCM. Loss-of-function mutations have been identified in CCM1/KRIT1, the sole CCM gene identified to date. We report here the identification of MGC4607 as the CCM2 gene. We first reduced the size of the CCM2 interval from 22 cM to 7.5 cM by genetic linkage analysis. We then hypothesized that large deletions might be involved in the disorder, as already reported in other hamartomatous conditions, such as tuberous sclerosis or neurofibromatosis. We performed a high-density microsatellite genotyping of this 7.5-cM interval to search for putative null alleles in 30 unrelated families, and we identified, in 2 unrelated families, null alleles that were the result of deletions within a 350-kb interval flanked by markers D7S478 and D7S621. Additional microsatellite and single-nucleotide polymorphism genotyping showed that these two distinct deletions overlapped and that both of the two deleted the first exon of MGC4607, a known gene of unknown function. In both families, one of the two MGC4607 transcripts was not detected. We then identified eight additional point mutations within MGC4607 in eight of the remaining families. One of them led to the alteration of the initiation codon and five of them to a premature termination codon, including one nonsense, one frameshift, and three splice-site mutations. All these mutations cosegregated with the disease in the families and were not observed in 192 control chromosomes. MGC4607 is so far unrelated to any known gene family. Its implication in CCMs strongly suggests that it is a new player in vascular morphogenesis. PMID:14740320

Denier, C; Goutagny, S; Labauge, P; Krivosic, V; Arnoult, M; Cousin, A; Benabid, A L; Comoy, J; Frerebeau, P; Gilbert, B; Houtteville, J P; Jan, M; Lapierre, F; Loiseau, H; Menei, P; Mercier, P; Moreau, J J; Nivelon-Chevallier, A; Parker, F; Redondo, A M; Scarabin, J M; Tremoulet, M; Zerah, M; Maciazek, J; Tournier-Lasserve, E



Mutations within the MGC4607 Gene Cause Cerebral Cavernous Malformations  

PubMed Central

Cerebral cavernous malformations (CCM) are hamartomatous vascular malformations characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. They cause seizures and focal neurological deficits due to cerebral hemorrhages. CCM loci have already been assigned to chromosomes 7q (CCM1), 7p (CCM2), and 3q (CCM3) and have been identified in 40%, 20%, and 40%, respectively, of families with CCM. Loss-of-function mutations have been identified in CCM1/KRIT1, the sole CCM gene identified to date. We report here the identification of MGC4607 as the CCM2 gene. We first reduced the size of the CCM2 interval from 22 cM to 7.5 cM by genetic linkage analysis. We then hypothesized that large deletions might be involved in the disorder, as already reported in other hamartomatous conditions, such as tuberous sclerosis or neurofibromatosis. We performed a high-density microsatellite genotyping of this 7.5-cM interval to search for putative null alleles in 30 unrelated families, and we identified, in 2 unrelated families, null alleles that were the result of deletions within a 350-kb interval flanked by markers D7S478 and D7S621. Additional microsatellite and single-nucleotide polymorphism genotyping showed that these two distinct deletions overlapped and that both of the two deleted the first exon of MGC4607, a known gene of unknown function. In both families, one of the two MGC4607 transcripts was not detected. We then identified eight additional point mutations within MGC4607 in eight of the remaining families. One of them led to the alteration of the initiation codon and five of them to a premature termination codon, including one nonsense, one frameshift, and three splice-site mutations. All these mutations cosegregated with the disease in the families and were not observed in 192 control chromosomes. MGC4607 is so far unrelated to any known gene family. Its implication in CCMs strongly suggests that it is a new player in vascular morphogenesis.

Denier, C.; Goutagny, S.; Labauge, P.; Krivosic, V.; Arnoult, M; Cousin, A.; Benabid, A. L.; Comoy, J.; Frerebeau, P.; Gilbert, B.; Houtteville, J. P.; Jan, M.; Lapierre, F.; Loiseau, H.; Menei, P.; Mercier, P.; Moreau, J. J.; Nivelon-Chevallier, A.; Parker, F.; Redondo, A. M.; Scarabin, J. M.; Tremoulet, M.; Zerah, M.; Maciazek, J.; Tournier-Lasserve, E.



Congenital occipitoatlantoaxial malformations in the horse.  


From a clinical, radiological and morphological study of 9 horses with congenital malformations of the occiput, atlas and axis, and from a study of 2 reported cases, 3 diseases were defined: A. Familial occipitalisation of the atlas with atlantalisation of the axis in Arabian horses (7 cases in this report and the case reported by Leipold, et al., 1974). These horses had congenital atlantooccipital fusion, hypoplasia of the atlas and dens, malformation of the axis and modification of the atlantoaxial joint. B. Congenital asymmetrical occipitoatlantoaxial malformation (2 cases in this report). A Standardbred and a Morgan horse had atlantooccipital fusion, a wedge shaped vertebral piece attached to the caudal end of the axis and sigmoid scoliosis of the cervical vertebrae. C. Asymmetrical atlantooccipital fusion (the case reported by Schmaltz, 1915). This horse of an unknown breed had asymmetrical fusion between the atlas and occiput and cervical scoliosis. The clinical syndromes shown by horses with these malformations were variable but were broadly classified as: 1. Foal dead at birth, seen in one foal with A. 2. Tetraparesis at birth, seen in 5 foals with A. These foals were born with signs varying from tetraparesis to tetraplegia. 3. Progressive ataxia, seen in 2 foals with A. Clinical signs were due to a progressive focal cervical compressive myelopathy. 4. Congenital cervical scoliosis/deviated head, seen in the 2 horses with B and the horse with C. These horses had no signs of spinal cord or brain disease. The diagnoses were made clinically by palpation of the occipitoatlantoaxial region and were confirmed radiographically and/or by post mortem examination in all except one case. Pedigree analysis showed the familial nature of the particular occipitoatlantoaxial malformation seen in horses of only the Arabian breed. PMID:565704

Mayhew, I G; Watson, A G; Heissan, J A



Vascular Lesions in Intravascular Drug Abusers in Guilan, North of Iran  

Microsoft Academic Search

Intravenous drug abuse is an increasing social and health problem. Repeated injuries to the veins, injection of some types of insoluble substances, and needle sharing habits result in various complications. Increasing incidence of major vascular complications has been reported worldwide. The objective of this study was to determine the epidemiology of vascular lesions in drug abusers. Medical records of 50

Mohammad-Ali Mohammadzadeh; Manzar Hossain-Akbar; Shahram Ejtemaee-Mehr


Hepatic vein obstruction (Budd-Chiari)  


Hepatic vein obstruction prevents blood from flowing out of the liver and back to the heart. This blockage can cause liver damage. Obstruction of this vein can be caused by a tumor or growth pressing on the vessel, or ...


Retinal Vein Occlusion: Current Treatment  

Microsoft Academic Search

Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is

Rosangela Lattanzio; Ana Torres Gimeno; Maurizio Battaglia Parodi; Francesco Bandello



Extensive Intramuscular Venous Malformation in the Lower Extremity  

PubMed Central

Typical venous malformations are easily diagnosed by skin color changes, focal edema or pain. Venous malformation in the skeletal muscles, however, has the potential to be missed because their involved sites are invisible and the disease is rare. In addition, the symptoms of intramuscular venous malformation overlaps with myofascial pain syndrome or muscle strain. Most venous malformation cases have reported a focal lesion involved in one or adjacent muscles. In contrast, we have experienced a case of intramuscular venous malformation that involved a large number of muscles in a lower extremity extensively.

Chul, Jung Ho; Park, Byung Kyu; Park, Myung Kyu



Congenital pulmonary vein stenosis in an adult patient treated with transcatheter balloon angioplasty.  


Congenital pulmonary vein stenosis (PVS) is a very rare cardiac malformation and commonly associated with cardiac or extracardiac abnormalities. It is usually found during the newborn period and survival to maturity is very rare due to either of progressive pulmonary hypertension or associated cardiac anomalies. In this case report, an adult patient with congenital PVS that was incidentally found during an evaluation for pneumonia, was treated with balloon angioplasty. After balloon angioplasty, the pressure gradient between the stenotic pulmonary vein and left atrium was significantly reduced and this patient had a benign course during the routine follow-up. Although there is no consensus concerning the optimal treatment strategy for this anomaly, balloon angioplasty can be a reasonable therapeutic option for the palliation of adult congenital PVS. PMID:21068023

Kim, Yong-Hyun; Pak, Hui-Nam; Park, Seong-Mi; Shim, Wan-Joo



Leaf Vascular Systems in C3 and C4 Grasses: A Two-dimensional Analysis  

PubMed Central

• Background and Aims It is well documented that C4 grasses have a shorter distance between longitudinal veins in the leaves than C3 grasses. In grass leaves, however, veins with different structures and functions are differentiated: large longitudinal veins, small longitudinal veins and transverse veins. Thus, the densities of the three types of vein in leaves of C3 and C4 grasses were investigated from a two-dimensional perspective. • Methods Vein densities in cleared leaves of 15 C3 and 26 C4 grasses representing different taxonomic groups and photosynthetic subtypes were analysed. • Key Results The C4 grasses had denser transverse veins and denser small longitudinal veins than the C3 grasses (1·9 and 2·1 times in interveinal distance), but there was no significant difference in large longitudinal veins. The total length of the three vein types per unit area in the C4 grasses was 2·1 times that in the C3 grasses. The ratio of transverse vein length to total vein length was 14·3?% in C3 grasses and 9·9?% in C4 grasses. The C3 grasses generally had greater species variation in the vascular distances than the C4 grasses. The bambusoid and panicoid C3 grasses tended to have a denser vascular system than the festucoid C3 grasses. There were no significant differences in the interveinal distances of the three vein types between C4 subtypes, although the NADP-malic enzyme grasses tended to have a shorter distance between small longitudinal veins than the NAD-malic enzyme and phosphoenolpyruvate carboxykinase grasses. • Conclusions It seems that C4 grasses have structurally a superior photosynthate translocation and water distribution system by developing denser networks of small longitudinal and transverse veins, while keeping a constant density of large longitudinal veins. The bambusoid and panicoid C3 grasses have a vascular system that is more similar to that in C4 grasses than to that in the festucoid C3 grasses.




Conservative Therapy for Surgically Untreatable Extensive Arteriovenous Malformation from the Lower Extremity to the Pelvis with Secondary Consumptive Coagulopathy  

PubMed Central

We present a woman with surgically untreatable extended arteriovenous malformations (AVM) and consumptive coagulopathy, which had been controlled by conservative compression and anticoagulation therapies for 17?years. At age 13, she was diagnosed with extended AVM in the entire left leg and pelvis. At age 16, limited surgical resection of the enlarged superficial vein in the left calf was performed for persistent leg pain. One year later, anticoagulation therapy was performed for massive bleeding from hemorrhoids due to AVM and coagulopathy. Despite its intractability, her condition has been favorably controlled with conservative methods, including compression and anticoagulation therapies.

Watanabe, Yoshiko; Iwahashi, Toru; Saiki, Naozumi; Koizumi, Nobusato; Nishibe, Toshiya; Ogino, Hitoshi



Vascular Reconstruction in Limbs Associated with Resection of Tumors  

Microsoft Academic Search

Patients with tumors in limbs who undergo surgical treatment may present involvement of major vessels. The artery must be reconstructed for limb salvage and the vein may be reconstructed to avoid the onset of venous hypertension. The objective of this study was to analyze the results from surgical treatment of tumors associated with vascular reconstruction in limbs. A prospective follow-up

Kenji Nishinari; Nelson Wolosker; Guilherme Yazbek; Luiz Caetano Malavolta; Antônio Eduardo Zerati; Valter Penna; Ademar Lopes



Splenic vein aneurysm: a rare clinical entity.  


A 52-year-old man presented with complaints of generalized malaise along with pain in left hypochondrium and diarrhea. The color Doppler and subsequent contrast enhanced CT scan revealed changes of portal hypertension and saccular dilatation of splenic vein along with partial thrombus in portal vein and superior mesenteric vein. PMID:22733582

Gupta, Amit; Kumar Singhal, Madhu; Maheshwarappa, Ravishanker Pillenahalli; Meena, Mangi Lal



Transient Elastic Support for Vein Grafts Using a Constricting Microfibrillar Polymer Wrap  

PubMed Central

Arterial vein grafts (AVGs) often fail due to intimal hyperplasia, thrombosis, or accelerated atherosclerosis. Various approaches have been proposed to address AVG failure, including delivery of temporary mechanical support, many of which could be facilitated by peri-vascular placement of a biodegradable polymer wrap. The purpose of this work was to demonstrate that a polymer wrap can be applied to vein segments without compromising viability/function, and to demonstrate one potential application; i.e., gradually imposing the mid-wall circumferential wall stress (CWS) in wrapped veins exposed to arterial levels of pressure. Poly(ester urethane)urea, collagen, and elastin were combined in solution, and then electrospun onto freshly-excised porcine internal jugular vein segments. Tissue viability was assessed via Live/Dead™ staining for necrosis, and vasomotor-challenge with epinephrine and sodium nitroprusside for functionality. Wrapped vein segments were also perfused for 24-hrs within an ex vivo vascular perfusion system under arterial conditions (pressure=120/80 mmHg; flow=100 mL/min), and CWS was calculated every hour. Our results showed that the electrospinning process had no deleterious effects on tissue viability, and that the mid-wall CWS vs. time profile could be dictated through the composition and degradation of the electrospun wrap. This may have important clinical applications by enabling the engineering of an improved AVG.

El-Kurdi, Mohammed S.; Hong, Yi; Stankus, John J.; Soletti, Lorenzo; Wagner, William R.; Vorp, David A.



Use of autogenous saphenous vein as a conduit for mesenterico-left portal vein bypass.  


The authors describe a case of extrahepatic portal vein (EHPV) thrombosis and portal hypertension treated with a variant of mesenterico-left portal vein bypass (MLPVB) or Rex shunt. In this case, a segment of autogenous greater saphenous vein was used to bridge the distance between the left gastric vein inflow and the left portal vein. Use of such nontraditional conduit in similar circumstances may expand the application of portal revascularization/decompression procedures in treating these patients. PMID:17560237

Query, Julie A; Sandler, Anthony D; Sharp, William J



Pediatric sciatic neuropathies due to unusual vascular causes.  


Four cases of pediatric sciatic neuropathies due to unusual vascular mechanisms are reported. Pediatric sciatic neuropathies were seen after umbilical artery catheterization, embolization of arteriovenous malformation, meningococcemia, and hypereosinophilic vasculitis. Electrophysiologic studies demonstrated abnormalities in motor studies of peroneal and tibial nerves. Sensory studies demonstrated abnormalities of sural and superficial peroneal nerves. Results of needle electromyography were abnormal in sciatic-innervated muscles. Prognosis was variable and depended on the severity of the initial nerve injury. PMID:18658074

Srinivasan, Jayashri; Escolar, Diane; Ryan, Monique; Darras, Basil; Jones, H Royden



Mutations in 2 distinct genetic pathways result in cerebral cavernous malformations in mice.  


Cerebral cavernous malformations (CCMs) are a common type of vascular malformation in the brain that are a major cause of hemorrhagic stroke. This condition has been independently linked to 3 separate genes: Krev1 interaction trapped (KRIT1), Cerebral cavernous malformation 2 (CCM2), and Programmed cell death 10 (PDCD10). Despite the commonality in disease pathology caused by mutations in these 3 genes, we found that the loss of Pdcd10 results in significantly different developmental, cell biological, and signaling phenotypes from those seen in the absence of Ccm2 and Krit1. PDCD10 bound to germinal center kinase III (GCKIII) family members, a subset of serine-threonine kinases, and facilitated lumen formation by endothelial cells both in vivo and in vitro. These findings suggest that CCM may be a common tissue manifestation of distinct mechanistic pathways. Nevertheless, loss of heterozygosity (LOH) for either Pdcd10 or Ccm2 resulted in CCMs in mice. The murine phenotype induced by loss of either protein reproduced all of the key clinical features observed in human patients with CCM, as determined by direct comparison with genotype-specific human surgical specimens. These results suggest that CCM may be more effectively treated by directing therapies based on the underlying genetic mutation rather than treating the condition as a single clinical entity. PMID:21490399

Chan, Aubrey C; Drakos, Stavros G; Ruiz, Oscar E; Smith, Alexandra C H; Gibson, Christopher C; Ling, Jing; Passi, Samuel F; Stratman, Amber N; Sacharidou, Anastasia; Revelo, M Patricia; Grossmann, Allie H; Diakos, Nikolaos A; Davis, George E; Metzstein, Mark M; Whitehead, Kevin J; Li, Dean Y



Intra-arterial Embolization in the Treatment of Brain Arteriovenous Malformations  

PubMed Central

Summary The crucial question - treat or not a brain arteriovenous malformation - has been the object of many studies, sometimes contradictory. The authors analyse retrospectively, clinically and angiographically, the results of the intra-arterial embolization in the treatment of 106 patients with brain arteriovenous malformation. The endo-vascular therapy was palliative or curative in 46% of the cases, in 30% of the patients the embolization was pre-surgery and in 18% the intra-arterial occlusion was pre-radiosurgery. In 6% the therapeutic protocol included embolization with surgery and radiosurgery. Cyanocrylate was used in 89% of the cases, and in 10% of the patients the embolic material used was Ethylene - vinyl alcohol copolymer - EVOH (Onyx). In this series 11% of total morbidity occurred - transitory in 8% and settled with permanent neurological deficit in 3% of the patients. The mortality post-embolization was 2% and the total mortality post-embolization and surgery was 3%. Total angiographic exclusion immediately post-embolization was confirmed in 24% of the cases. The mean period for clinical and angiographic follow-up was 38 months. 72 patients - 77% of the cases discharged from hospital showed complete exclusion of the lesion after the different combined therapeutic strategy - embolization, surgery and radiosurgery. New retrospective and long-term prospective studies based on the actual therapeutic protocols and new embolic agents are necessary to be able to evaluate accurately a new therapeutic reality in the brain arteriovenous malformations.

Campos, J.; Biscoito, L.; Sequeira, P.; Batista, A.



Intra-arterial Embolization in the Treatment of Brain Arteriovenous Malformations.  


Summary: The crucial question - treat or not a brain arteriovenous malformation - has been the object of many studies, sometimes contradictory. The authors analyse retrospectively, clinically and angiographically, the results of the intra-arterial embolization in the treatment of 106 patients with brain arteriovenous malformation. The endo- vascular therapy was palliative or curative in 46% of the cases, in 30% of the patients the embolization was pre-surgery and in 18% the intra- arterial occlusion was pre-radiosurgery. In 6% the therapeutic protocol included embolization with surgery and radiosurgery. Cyanocrylate was used in 89% of the cases, and in 10% of the patients the embolic material used was Ethylene - vinyl alcohol copolymer - EVOH (Onyx). In this series 11% of total morbidity occurred - transitory in 8% and settled with permanent neurological deficit in 3% of the patients. The mortality post-embolization was 2% and the total mortality post-embolization and surgery was 3%. Total angiographic exclusion immediately post-embolization was confirmed in 24% of the cases. The mean period for clinical and angiographic follow-up was 38 months. 72 patients - 77% of the cases discharged from hospital showed complete exclusion of the lesion after the different combined therapeutic strategy - embolization, surgery and radiosurgery. New retrospective and long-term prospective studies based on the actual therapeutic protocols and new embolic agents are necessary to be able to evaluate accurately a new therapeutic reality in the brain arteriovenous malformations. PMID:20584464

Campos, J; Biscoito, L; Sequeira, P; Batista, A



Renal artery and vein injury following blunt trauma.  

PubMed Central

Blunt injuries of the renal vascular pedicle occur infrequently. The experience with fourteen cases of blunt renal vascular trauma is presented. Most patients were injured in motor vehicle accidents. The diagnosis was made immediately after admission in 6 patients, delayed in 5, and at autopsy in 3. Most patients presented with gross or microscopic hematuria. The diagnosis of renal vascular injury was suggested by IVP in most instances. Surgical management was used in the 6 patients in whom the immediate diagnosis of renal pedicle injury was made; primary vascular repair was carried out in 4 patients and nephrectomy in two. Conservative management was used in 4 of the 5 patients with delayed diagnosis, and nephrectomy was required in the fifth. Three patients received no treatment as two were dead on arrival and one die during laparotomy. Seven patients died (50%). One of the 7 survivors has a functioning kidney following repair of a renal vein laceration. Three patients with devascularized kidneys have been followed long term and have not developed hypertension. An IVP should be mandatory following severe blunt trauma, especially when hematuria is present. Renal arteriography is indicated with distortion of calyces, extravasation or nonfunction seen on IVP and allows a definitive diagnosis of renal vessel injury to be made.

Sturm, J T; Perry, J F; Cass, A S



Inferior Right Hepatic Vein: A Useful Anatomic Variation for Isolated Resection of Segment VIII  

PubMed Central

Anatomical resection of segment VIII (SVIII) is one of the most difficult hepatectomies to perform. Although it is the best choice of surgical treatment for tumors located at SVIII, its feasibility can be compromised when the right hepatic vein (RHV) must be resected en bloc with SVIII. Herein we describe a case of a cirrhotic patient that was submitted to segmentectomy VIII in bloc with the main trunk of the RHV, due to hepatocellular carcinoma. The resection could only be performed because a well developed inferior right hepatic vein (IRHV) was present. Anatomical variations of the liver vascularization should be used by liver surgeons to improve surgical results.

Steinbruck, Klaus; Fernandes, Reinaldo; Bento, Giuliano; Vasconcelos, Rafael; Stoduto, Gustavo; Auel, Thomas; Pacheco-Moreira, Lucio F.



Phleboliths from venous malformations of the head and neck.  


Objectives/HypothesisPhleboliths in venous malformations (VM) of the head and neck are often observed and may cause significant symptoms. Only a few articles refer to the morphology and composition of the phleboliths in VM. The objective of this study was to analyse and to demonstrate their composition and morphology. METHODS: Patients with VM presenting to a vascular anomalies centre during a three-year period were identified. The incidence of phleboliths was analysed followed by morphological and structural analysis with cone beam tomography and X-ray diffraction. RESULTS: Phleboliths were identified in 28/98 patients with VM of the head and neck. Seven patients underwent conventional surgery to reduce the volume of the VM or to remove the phleboliths, which were localized in the cheek (3 cases), submandibular region (2 cases), infrahyoidal neck or upper eyelid (1 case each). The structural analysis showed that more advanced lamination and an increasing radiopacity of the cortex was observed in larger phleboliths. X-ray powder diffraction analysis revealed that the main constituent in the pulverized phleboliths was carbonate-fluorohydroxylapatite. CONCLUSION: This study shows in a vivid way that phleboliths from VM of the head and neck area show a laminar structure and consist of apatite, without any indication of differences in their chemical composition. Treatment of localized intravascular coagulopathy in VM might be able to prevent the formation and the progression of phleboliths. Hypothetically, another option might be lithotripsy. PMID:22302792

Eivazi, B; Fasunla, A J; Güldner, C; Masberg, P; Werner, J A; Teymoortash, A



Temporal lobe arteriovenous malformations: anatomical subtypes, surgical strategy, and outcomes.  


Object Descriptions of temporal lobe arteriovenous malformations (AVMs) are inconsistent. To standardize reporting, the authors blended existing descriptions in the literature into an intuitive classification with 5 anatomical subtypes: lateral, medial, basal, sylvian, and ventricular. The authors' surgical experience with temporal lobe AVMs was reviewed according to these subtypes. Methods Eighty-eight patients with temporal lobe AVMs were treated surgically. Results Lateral temporal lobe AVMs were the most common (58 AVMs, 66%). Thirteen AVMs (15%) were medial, 9 (10%) were basal, and 5 (6%) were sylvian. Ventricular AVMs were least common (3 AVMs, 3%). A temporal craniotomy based over the ear was used in 64%. Complete AVM resection was achieved in 82 patients (93%). Four patients (5%) died in the perioperative period (6 in all were lost to follow-up); 71 (87%) of the remaining 82 patients had good outcomes (modified Rankin Scale scores 0-2); and 68 (83%) were unchanged or improved after surgery. Conclusions Categorization of temporal AVMs into subtypes can assist with surgical planning and also standardize reporting. Lateral AVMs are the easiest to expose surgically, with circumferential access to feeding arteries and draining veins at the AVM margins. Basal AVMs require a subtemporal approach, often with some transcortical dissection through the inferior temporal gyrus. Medial AVMs are exposed tangentially with an orbitozygomatic craniotomy and transsylvian dissection of anterior choroidal artery and posterior cerebral artery feeders in the medial cisterns. Medial AVMs posterior to the cerebral peduncle require transcortical approaches through the temporo-occipital gyrus. Sylvian AVMs require a wide sylvian fissure split and differentiation of normal arteries, terminal feeding arteries, and transit arteries. Ventricular AVMs require a transcortical approach through the inferior temporal gyrus that avoids the Meyer loop. Surgical results with temporal lobe AVMs are generally good, and classifying them does not offer any prediction of surgical risk. PMID:23848823

Gabarrós Canals, Andreu; Rodríguez-Hernández, Ana; Young, William L; Lawton, Michael T



Management of varicose veins and venous insufficiency.  


Chronic venous disease, reviewed herein, is manifested by a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. However, there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins, even when extensive, are not guaranteed. Treatment options range from conservative (eg, medications, compression stockings, lifestyle changes) to minimally invasive (eg, sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ?1 therapies). Ms L, a 68-year-old woman with varicose veins, is presented. She has had vein problems over the course of her life. Her varicose veins recurred after initial treatment, and she is now seeking guidance regarding her current treatment options. PMID:23268520

Hamdan, Allen



The role of MRI in diagnostic algorithm of cervicofacial vascular anomalies in children  

PubMed Central

Summary Background: Vascular anomalies are usually diagnosed through their clinical picture and history. The purpose of this study was to assess the role of MR imaging in initial assessment of cervicofacial vascular anomalies in children. Material/Methods: Twenty pediatric patients with vascular anomalies located in the cervicofacial region underwent MRI examination in our department. Images were evaluated for lesion detectability and its signal characteristics (on T1w, T2w images with fat suppression and contrast enhanced T1w sequences); the extent of the lesions and surrounding tissue involvement were also assessed. Results: In the studied group MR images revealed all anomalies and provided information of their anatomic extent and invasion of surrounding anatomic structures. Nine hemangiomas and six venous malformations were found among studied patients. Two children had multiloculated lesions corresponding to lymphatic malformations. One examination visualized a lesion consisting mainly of dilated vascular channels with an apparent feeding artery, which was consistent with arteriovenous malformation. Two remaining lesions were mixed malformations. Nine patients had lesions limited to subcutaneous tissue. Two masses infiltrated bone structures. There was muscle involvement found in nine cases. Conclusions: MR imaging is a well-established method for detection and monitoring of vascular anomalies in children. With ultrasound used mostly for initial diagnosis and additional flow assessment, angiography viewed as an invasive therapeutic method and computed tomography used only in specific situations due to its high irradiation dose, magnetic resonance is the best imaging method used in differential diagnosis and topographical characterization of vascular malformations and tumors of cervicofacial area in pediatric patients. Noninvasively and without irradiation, it enables evaluation of the extent and characteristics of lesions and planning proper therapeutic strategy.

Wilmanska, Dagmara; Antosik-Biernacka, Aneta; Przewratil, Przemyslaw; Szubert, Wojciech; Stefanczyk, Ludomir; Majos, Agata



Effect of chymase inhibitor on vascular proliferation.  


In vascular tissues, angiotensin II is potentially cleaved from angiotensin I by chymase and angiotensin-converting enzyme (ACE). In the normal state, vascular ACE regulates local angiotensin II formation and plays a crucial role in the regulation of blood pressure, whereas chymase is stored in mast cells and has no enzymatic activity. Chymase is activated immediately upon its release into the extracellular matrix in vascular tissues after mast cells have been activated by stimuli such as vessel injury by grafting or a balloon catheter. In dog grafted veins, chymase activity is increased, and the vascular proliferation is suppressed by either a chymase inhibitor or an angiotensin II receptor blocker. After balloon injury in dog vessels, chymase activity is significantly increased in the injured artery, and a chymase inhibitor is effective in preventing the vascular proliferation, but an ACE inhibitor is ineffective. Chymase plays an important role in the development of vascular proliferation via the induction of local angiotensin II formation in injured vessels. PMID:12499576

Takai, Shinji; Miyazaki, Mizuo



Management of macular edema secondary to central retinal vein occlusion: an evidence-based.  


Retinal vein occlusions are common retinal vascular disorders with the potential for significant vision-related morbidity. Retinal vein occlusions are classified as either branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), or hemiretinal vein occlusion (HRVO) based on the specific occlusion site. Decreased vision in patients afflicted with CRVO may result from retinal ischemia and/or the accumulation of fluid within the center of the retina (macular edema). The Central Vein Occlusion Study (CVOS) Group demonstrated that grid laser photocoagulation is not an effective treatment for decreased vision due to CRVO-related macular edema. Since publication of that report, the standard of care for patients with decreased vision due to CRVO-associated macular edema was observation. However, in the past 5 years, several major randomized controlled clinical trials have investigated new therapeutic modalities for the treatment of macular edema secondary to CRVO. This article aims to provide insight into current evidence-based approaches to the management of macular edema secondary to CRVO. A companion article reviews approaches for the management of macular edema secondary to BRVO. PMID:21153510

Aref, Ahmad A; Scott, Ingrid U



Management of macular edema secondary to branch retinal vein occlusion: an evidence-based update.  


Retinal vein occlusions are common retinal vascular disorders with the potential for significant vision-related morbidity. Retinal vein occlusions are classified as either branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), or hemiretinal vein occlusion (HRVO) based on the specific occlusion site. The most common cause of decreased vision in patients afflicted with BRVO is the accumulation of fluid within the macula (macular edema). The Branch Vein Occlusion Study (BVOS) demonstrated the efficacy of grid laser photocoagulation in the treatment of BRVO-related macular edema. After publication of that report, grid laser became the standard of care for decreased vision due to BRVO-associated macular edema in patients similar to those enrolled in the BVOS. However, several recent major randomized, controlled clinical trials have investigated new therapeutic modalities for the treatment of decreased vision due to macular edema secondary to BRVO. This article aims to provide insight into current evidence-based approaches to management of macular edema secondary to BRVO. A companion article reviews approaches for management of macular edema secondary to CRVO. PMID:21153509

Aref, Ahmad A; Scott, Ingrid U



Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting.  

PubMed Central

We conducted an observational study to evaluate the effectiveness of an endoscopic technique for harvesting the greater saphenous vein for aortocoronary bypass grafting. We hypothesized that the endoscopic technique would minimize the risk of postoperative wound complications. From May 1997 to July 1998, we used an endoscopic technique to harvest the greater saphenous vein in 50 patients who underwent aortocoronary artery bypass grafting. Twenty-five of the patients had an increased risk for wound complications due to preexisting diabetes, obesity, peripheral vascular disease, or lymphedema. The average duration of the procedure was 39 minutes (range, 11 to 70 minutes). The average length of the harvested vein was 58 cm (range, 25 to 85 cm). We made an average of 2.5 incisions per patient (range, 1 to 5 incisions), and the average incision length was 7 cm (range, 3 to 10 cm). Two patients (4%) required conversion to an open technique using 5 small incisions. Postoperative complications included 1 wound infection (2%) and 1 small hematoma (2%). Two patients (4%) had minor erythema at the incision site, and 5 patients (10%) had postoperative lymphedema. The most common problem, ecchymosis, was seen in 6 patients (12%). None required repeat hospitalization or reoperation for wound complications. In our study, the endoscopic approach yielded superior cosmetic results, and reduced wound complications and discomfort, compared with traditional methods of vein harvesting. After gaining expertise with this minimally invasive method of vein harvesting, a surgeon can safely remove the saphenous vein in 20 to 30 minutes. Images

Carrizo, G J; Livesay, J J; Luy, L



Diphallus with anorectal malformation-case report.  


Diphallus is a very rare condition. We report a case of a newborn with absent anal opening and duplication of external genitalia. Examination of the external genitalia showed two well formed penises with fully descended testis within each of the separate hemiscrotums along with soft tissue mass resembling accessory buttock behind the hemiscrotum. Staged reconstruction of duplicated genitalia and anorectal malformation was done. We achieved excellent cosmetic and functional external genitalia. PMID:20223333

Mukunda, Ramachandra; Bendre, Pradnya S; Redkar, Rajeev G; Hambarde, Sandeep



Cerebral Anomalies and Chiari Type 1 Malformation  

Microsoft Academic Search

Objective: To analyze the association of diverse cerebral anomalies in a series of pediatric patients with cerebellar tonsillar ectopia. Methods: We reviewed the medical records of 60 children diagnosed with Chiari type 1 malformation (CM1), of these, 20 patients (11 boys and 9 girls; mean age 7.2 years, range 2–16 years) had an associated cerebral anomaly. Symptoms of tonsillar ectopia

Marcelo Galarza; Juan F. Martínez-Lage; Steven Ham; Sandeep Sood



The spectrum of anorectal malformations in Africa  

Microsoft Academic Search

Anorectal malformations (ARM) remain a significant birth defect with geographic variation in incidence, individual phenotypes\\u000a and regional geographic subtypes. Although early studies indicated a low incidence in Black patients, there is a great paucity\\u000a of knowledge as to the types, frequency and incidence of ARMs encountered in the African continent and their associated anomalies.\\u000a Current evidence suggests a significant clinical

S. W. Moore; A. Alexander; D. Sidler; J. Alves; G. P. Hadley; A. Numanoglu; B. Banieghbal; M. Chitnis; D. Birabwa-Male; B. Mbuwayesango; A. Hesse; K. Lakhoo



Imaging of arteriovenous malformation following stereotactic radiosurgery  

Microsoft Academic Search

Background. Stereotactic radiosurgery allows for a high dose of focused radiation to be delivered to a small lesion such as an arteriovenous\\u000a malformation (AVM). The clinical change and brain response over time to this localized high-dose radiation can be quite striking.\\u000a Objective. The objective of this study to describe and analyse the imaging changes following radiotherapy for AVMs. Materials and

Jeffrey V. Tranchida; Christopher J. Mehall; Thomas L. Slovis; Miguel Lis-Planells



Bronchopulmonary foregut malformations: embryology, radiology and quandary  

Microsoft Academic Search

.  Bronchopulmonary foregut malformations (BPFM) are a heterogeneous group of pulmonary developmental anomalies that present\\u000a at varying ages and with overlapping symptoms, signs and radiology. This article discusses the embryology of these lesions\\u000a with reference to possible common origins and the link between aetiology and radiological appearance. The radiology of each\\u000a lesion, both antenatally and postnatally, is described and illustrated. A

N. A. Barnes; D. W. Pilling



CSF flow study in Chiari I malformation  

Microsoft Academic Search

ObjectiveThe aim of this prospective study was to define the role of cardiac gated phase-contrast ciné magnetic resonance imaging in deciding the therapeutic strategy in patients with Chiari I malformation.Materials and methodsTwenty-one patients operated on between February 2000 and July 2002 were enrolled in the study. All patients underwent a detailed preoperative neurological examination. MRI of the craniovertebral junction and

M. Panigrahi; B. Praveen Reddy; A. K. Reddy; J. J. M. Reddy



The surgical treatment of Chiari I malformation  

Microsoft Academic Search

Summary A retrospective study was undertaken on 133 patients with a Chiari I malformation treated within the last 16 years at the Departments of Neurosurgery at the Nordstadt Hospital Hannover, Germany, and the University of California, Los Angeles, U.S.A. Ninety-seven patients presented with symptoms related to accompanying syringomyelia and 4 with associated syringobulbia. They underwent 149 surgical procedures and were

J. Klekamp; U. Batzdorf; M. Samii; H. W. Bothe



Automatic analysis of the anatomy of arteriovenous malformations using 3D and 4D MRA image sequences.  


The cerebral arteriovenous malformation (AVM) is an abnormal connection between arteries and veins without capillaries in between, leading to increased blood pressure which might result in a rupture and acute bleeding. Exact knowledge about the patient's individual anatomy of the AVM is needed for improved therapy planning. This paper describes a method for automatic extraction of the AVM and automatic recognition of its feeders and draining veins and en passage vessels based on 3D and 4D MRA image sequences. After registration of the MRA datasets the AVM is segmented using a support vector machine based on blood velocity information, a vesselness measure and the bolus arrival time. The extracted hemodynamic information is then used to detect feeders and draining veins of the AVM. The segmentation of the AVM was validated based on manual segmentations for five patient datasets, whereas a mean Dice value of 0.74 was achieved. The presented hemodynamic characterization was able to detect feeders and draining veins with an accuracy of 100%. In summary the presented approach can improve presurgical planning of AVM surgeries. PMID:20841888

Forkert, Nils Daniel; Säring, Dennis; Handels, Heinz



Three-dimensional CT Venography: A Diagnostic Modality for the Preoperative Assessment of Patients with Varicose Veins  

PubMed Central

Objective: We preoperatively assessed varicose veins by means of computed tomography (CT) with contrast injection in the veins of the lower extremity (CT venography). This paper reports the procedures, results and implications of CT venography from the surgical aspect. Methods: A total of 48 legs in 39 patients were examined. Contrast medium was diluted ten-fold and injected into the lower extremity veins, often using a dual route of injection. The images were reconstructed with the volume-rendering method. Results: CT venography clearly visualized the veins with a small amount of contrast medium and facilitated the identification of anatomy that was not suitable for passing the stripper. In addition, CT venography helped identify unusual types of varicose veins or uncommon sites of inflow of small saphenous veins. Such information was helpful for avoiding unexpected vascular injury or for minimizing skin incision. Dual-route injection was beneficial to minimize the blind zones. Doppler ultrasound could be more focused on hemodynamic assessment and determination of incision sites. Conclusions: CT Venography is feasible in all cases of varicose veins. When performed in conjunction with ultrasonography, it appears to facilitate the safe and efficient treatment of various types of varicose veins.

Sato, Katsutoshi; Orihashi, Kazumasa; Takahashi, Shinya; Takasaki, Taiichi; Kurosaki, Tatsuya; Imai, Katsuhiko; Ishifuro, Minoru; Sueda, Taijiro



Septic postpartum ovarian vein thrombosis.  


This report describes the clinical findings and outcome of a patient suffering from septic postpartum ovarian vein thrombosis. Treatment modalities are well described and range from hysterectomy and thrombectomy to the use of vena cava filters in combination with anticoagulation and antibiotics. Defervescence with a combination infusion of tissue plasminogen and heparin were used. This treatment approach has been found particularly successful in cases of ilio-femoral, hepatic, renal and vena caval thromboses. PMID:12370730

Rajab, Khalil E; Malik, Neelam; Skirman, Jonathan H



Current treatment of varicose veins  

Microsoft Academic Search

Opinion statement  Varicose veins (VVs) of the lower limbs are a common complaint that can take many forms, ranging from a nonpathologic condition\\u000a to an invalidating chronic disorder. When they have not been neglected, uncomplicated VVs have often been treated by sclerotherapy\\u000a or surgery, with variably successful results. Currently, the best way of assessing VVs has been to carry out routine

François Becker



Vascular Dementia  

PubMed Central

Cerebrovascular disease is the second leading cause of cognitive impairment in the elderly, either alone or in combination with Alzheimer's disease (AD). Vascular dementia (VaD) is heterogeneous in terms of both clinical phenotype and pathogenetic mechanisms. It may result from multiple cortical infarctions due to cerebral large vessel pathologies or to subcortical ischemic changes such as leukoaraiosis or lacunar infarction due to cerebral small artery disease. Clinical symptoms and signs vary depending on the location and size of the stroke lesion, and no single neuropsychological profile characteristic of VaD has been defined, although dysexecutive function is common. A slightly higher mortality rate and slower progression are reported in VaD compared with AD. VaD is potentially preventable by rigorous identification and treatment of cardiovascular disease risk factors, and modest symptomatic improvement with cholinesterase inhibitors has been reported.



Rhombencephalosynapsis - isolated anomaly or complex malformation?  

PubMed Central

Summary Background: Rhombencephalosynapsis (RES) is a rare malformation of the posterior cranial fossa, characterized by fusion of the cerebellar hemispheres, medial cerebellar peduncles and dentate nuclei. Over the period of 7 years 8 cases of this anomaly have been diagnosed in two pediatric centers in Warsaw including one on the prenatal magnetic resonance imaging (MRI). Material/Methods: Material consists of involves one fetus examined at the gestational age of 27 and 33 weeks and 7 children (5 girls and 2 boys) aged 8 months – 16 years. All of them underwent brain MRI with the use of 1.5T scanners. Results: In 1 case RES was an isolated anomaly, in 1 case it was accompanied by hydrocephalus only, in the remaining 6 cases RES was an element of a complex malformation. The additional anomalies were as follows: callosal hypoplasia in 3 children, abnormalities of gyration in 2, brainstem hypoplasia in 2, isolated fourth ventricle in 1, abnormal white matter signal intensity in 4 (in 2 cases in supratentorial compartment, in 1 in the cerebellum and in 1 in the pons), abnormally dilated extraaxial fluid collections in 2, syringohydromyelia in 2. In 5 cases RES was total, in 3 – partial. Conclusions: Rhombencephalosynapsis has a very characteristic appearance on magnetic resonance imaging which allows diagnosis of this malformation at any age, including prenatal period.

Bekiesinska-Figatowska, Monika; Jurkiewicz, Elzbieta; Szkudlinska-Pawlak, Sylwia; Malczyk, Katarzyna; Nowak, Katarzyna



Malformations of cortical development and epilepsy  

PubMed Central

Malformations of cortical development (MCDs) are macroscopic or microscopic abnormalities of the cerebral cortex that arise as a consequence of an interruption to the normal steps of formation of the cortical plate. The human cortex develops its basic structure during the first two trimesters of pregnancy as a series of overlapping steps, beginning with proliferation and differentiation of neurons, which then migrate before finally organizing themselves in the developing cortex. Abnormalities at any of these stages, be they environmental or genetic in origin, may cause disruption of neuronal circuitry and predispose to a variety of clinical consequences, the most common of which is epileptic seizures, A large number of MCDs have now been described, each with characteristic pathological, clinical, and imaging features. The causes of many of these MCDs have been determined through the study of affected individuals, with many MCDs now established as being secondary to mutations in cortical development genes. This review will highlight the best-known of the human cortical malformations associated with epilepsy. The pathological, clinical, imaging, and etioiogic features of each MCD will be summarized, with representative magnetic resonance imaging (MRI) images shown for each MCD, The malformations tuberous sclerosis, focal cortical dysplasia, hemimegalencephaiy, classical iissencephaly, subcortical band heterotopia, periventricular nodular heterotopia, polymicrogyria, and schizencephaly will be presented.

Leventer, Richard J.; Guerrini, Renzo; Dobyns, William B.


Retrograde Transvenous Ethanol Embolization of High-flow Peripheral Arteriovenous Malformations  

SciTech Connect

Purpose: To report the clinical efficiency and complications in patients treated with retrograde transvenous ethanol embolization of high-flow peripheral arteriovenous malformations (AVMs). Retrograde transvenous ethanol embolization of high-flow AVMs is a technique that can be used to treat AVMs with a dominant outflow vein whenever conventional interventional procedures have proved insufficient. Methods: This is a retrospective study of the clinical effectiveness and complications of retrograde embolization in five patients who had previously undergone multiple arterial embolization procedures without clinical success. Results: Clinical outcomes were good in all patients but were achieved at the cost of serious, although transient, complications in three patients. Conclusion: Retrograde transvenous ethanol embolization is a highly effective therapy for high-flow AVMs. However, because of the high complication rate, it should be reserved as a last resort, to be used after conventional treatment options have failed.

Linden, Edwin van der, E-mail: [Medical Center Haaglanden, Department of Radiology (Netherlands); Baalen, Jary M. van [Leiden University Medical Center, Department of Surgery (Netherlands); Pattynama, Peter M. T. [Erasmus University Medical Center, Department of Radiology (Netherlands)



[Endovascular treatment of pulmonary sequestration with Amplatzer® vascular plugs].  


Pulmonary sequestration is a rare malformation characterised by non-functioning lung tissue, separated from the tracheobronchial tree and with arterial supply from the systemic circulation. The classical therapeutic approach is surgical resection. In recent years, the endovascular embolisation technique is increasingly being used for the treatment of this disease. The embolisation materials used are coils and vascular plugs. The Amplatzer® vascular plug is a self-expandable cylindrical mesh device, particularly useful for the embolisation of large vessels with high flow. Three cases of pulmonary sequestration were treated by embolisation with Amplatzer® vascular plugs. In all cases the procedure was performed without complications, and the aortopulmonary collateral vessels were completely occluded. Our study provides new data on the safety and efficacy of pulmonary embolisation with Amplatzer® vascular plugs, and its preference over coils in the embolisation of large vessels. PMID:22197738

Rodriguez Guerineau, L; Suero Toledano, P; Prada Martínez, F; Mortera Pérez, C; Muchart López, J; Pons Odena, M



Targetoid hemosiderotic hemangioma— a dynamic vascular tumor: Report of 3 cases with episodic and cyclic changes and comparison with solitary angiokeratomas  

Microsoft Academic Search

Background: Both targetoid hemosiderotic hemangiomas (THH) and solitary angiokeratomas (SAK) are acquired vascular malformations formed by superficial vascular ectasias possibly caused by trauma. Objective: We compare the clinicopathologic findings of THHs with those of SAKs and report the clinicopathologic findings of