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Sample records for medullary-anterior pontomesencephalic venous

  1. Upbeat-torsional nystagmus and contralateral fourth nerve palsy due to unilateral dorsal ponto-mesencephalic lesion

    PubMed Central

    Thurtell, Matthew J.; Tomsak, Robert L.; Leigh, R. John

    2010-01-01

    The central projections of the anterior semicircular canals are thought to be conveyed from the vestibular nuclei to the ocular motor nuclei in the midbrain by three distinct brainstem pathways: the medial longitudinal fasciculus, crossing ventral tegmental tract, and brachium conjunctivum. There is controversy as to whether upbeat nystagmus could result from lesions involving each of these pathways. We report a 52-year-old man who presented with a contralesional fourth nerve palsy and primary position upbeat-torsional nystagmus due to a small unilateral dorsal ponto-mesencephalic lymphomatous deposit. We postulate that the upbeat-torsional nystagmus was caused by involvement of the brachium conjunctivum, which lies adjacent to the fourth nerve fascicles at the dorsal ponto-mesencephalic junction, but we cannot exclude involvement of the crossing ventral tegmental tract. Our observations suggest that, in humans, excitatory upward-torsional eye movement signals from the anterior semicircular canals could be partly conveyed to the midbrain by the brachium conjunctivum. PMID:19645952

  2. Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux

    PubMed Central

    Takahashi, S.; Sakuma, I.; Otani, T.; Yasuda, K.; Tomura, N.; Watarai, J.; Kinouchi, H.; Yanagisawa, T.; Mizoi, K.

    2006-01-01

    Summary Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma. We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux. CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and

  3. [Venous ulcer].

    PubMed

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms. PMID:27405863

  4. Venous Ulcers

    PubMed Central

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  5. Venous Ulcers.

    PubMed

    Caprini, J A; Partsch, H; Simman, R

    2012-09-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence.

  6. Discharge Profiles across the Sleep–Waking Cycle of Identified Cholinergic, GABAergic, and Glutamatergic Neurons in the Pontomesencephalic Tegmentum of the Rat

    PubMed Central

    Boucetta, Soufiane; Cissé, Youssouf; Mainville, Lynda; Morales, Marisela

    2014-01-01

    Distributed within the laterodorsal tegmental and pedunculopontine tegmental nuclei (LDT and PPT), cholinergic neurons in the pontomesencephalic tegmentum have long been thought to play a critical role in stimulating cortical activation during waking (W) and paradoxical sleep (PS, also called REM sleep), yet also in promoting PS with muscle atonia. However, the discharge profile and thus precise roles of the cholinergic neurons have remained uncertain because they lie intermingled with GABAergic and glutamatergic neurons, which might also assume these roles. By applying juxtacellular recording and labeling in naturally sleeping–waking, head-fixed rats, we investigated the discharge profiles of histochemically identified cholinergic, GABAergic, and glutamatergic neurons in the LDT, SubLDT, and adjoining medial part of the PPT (MPPT) in relation to sleep–wake states, cortical activity, and muscle tone. We found that all cholinergic neurons were maximally active during W and PS in positive correlation with fast (γ) cortical activity, as “W/PS-max active neurons.” Like cholinergic neurons, many GABAergic and glutamatergic neurons were also “W/PS-max active.” Other GABAergic and glutamatergic neurons were “PS-max active,” being minimally active during W and maximally active during PS in negative correlation with muscle tone. Conversely, some glutamatergic neurons were “W-max active,” being maximally active during W and minimally active during PS in positive correlation with muscle tone. Through different discharge profiles, the cholinergic, GABAergic, and glutamatergic neurons of the LDT, SubLDT, and MPPT thus appear to play distinct roles in promoting W and PS with cortical activation, PS with muscle atonia, or W with muscle tone. PMID:24672016

  7. Discharge profiles across the sleep-waking cycle of identified cholinergic, GABAergic, and glutamatergic neurons in the pontomesencephalic tegmentum of the rat.

    PubMed

    Boucetta, Soufiane; Cissé, Youssouf; Mainville, Lynda; Morales, Marisela; Jones, Barbara E

    2014-03-26

    Distributed within the laterodorsal tegmental and pedunculopontine tegmental nuclei (LDT and PPT), cholinergic neurons in the pontomesencephalic tegmentum have long been thought to play a critical role in stimulating cortical activation during waking (W) and paradoxical sleep (PS, also called REM sleep), yet also in promoting PS with muscle atonia. However, the discharge profile and thus precise roles of the cholinergic neurons have remained uncertain because they lie intermingled with GABAergic and glutamatergic neurons, which might also assume these roles. By applying juxtacellular recording and labeling in naturally sleeping-waking, head-fixed rats, we investigated the discharge profiles of histochemically identified cholinergic, GABAergic, and glutamatergic neurons in the LDT, SubLDT, and adjoining medial part of the PPT (MPPT) in relation to sleep-wake states, cortical activity, and muscle tone. We found that all cholinergic neurons were maximally active during W and PS in positive correlation with fast (γ) cortical activity, as "W/PS-max active neurons." Like cholinergic neurons, many GABAergic and glutamatergic neurons were also "W/PS-max active." Other GABAergic and glutamatergic neurons were "PS-max active," being minimally active during W and maximally active during PS in negative correlation with muscle tone. Conversely, some glutamatergic neurons were "W-max active," being maximally active during W and minimally active during PS in positive correlation with muscle tone. Through different discharge profiles, the cholinergic, GABAergic, and glutamatergic neurons of the LDT, SubLDT, and MPPT thus appear to play distinct roles in promoting W and PS with cortical activation, PS with muscle atonia, or W with muscle tone. PMID:24672016

  8. Discharge profiles across the sleep-waking cycle of identified cholinergic, GABAergic, and glutamatergic neurons in the pontomesencephalic tegmentum of the rat.

    PubMed

    Boucetta, Soufiane; Cissé, Youssouf; Mainville, Lynda; Morales, Marisela; Jones, Barbara E

    2014-03-26

    Distributed within the laterodorsal tegmental and pedunculopontine tegmental nuclei (LDT and PPT), cholinergic neurons in the pontomesencephalic tegmentum have long been thought to play a critical role in stimulating cortical activation during waking (W) and paradoxical sleep (PS, also called REM sleep), yet also in promoting PS with muscle atonia. However, the discharge profile and thus precise roles of the cholinergic neurons have remained uncertain because they lie intermingled with GABAergic and glutamatergic neurons, which might also assume these roles. By applying juxtacellular recording and labeling in naturally sleeping-waking, head-fixed rats, we investigated the discharge profiles of histochemically identified cholinergic, GABAergic, and glutamatergic neurons in the LDT, SubLDT, and adjoining medial part of the PPT (MPPT) in relation to sleep-wake states, cortical activity, and muscle tone. We found that all cholinergic neurons were maximally active during W and PS in positive correlation with fast (γ) cortical activity, as "W/PS-max active neurons." Like cholinergic neurons, many GABAergic and glutamatergic neurons were also "W/PS-max active." Other GABAergic and glutamatergic neurons were "PS-max active," being minimally active during W and maximally active during PS in negative correlation with muscle tone. Conversely, some glutamatergic neurons were "W-max active," being maximally active during W and minimally active during PS in positive correlation with muscle tone. Through different discharge profiles, the cholinergic, GABAergic, and glutamatergic neurons of the LDT, SubLDT, and MPPT thus appear to play distinct roles in promoting W and PS with cortical activation, PS with muscle atonia, or W with muscle tone.

  9. From synapse to gene product: Prolonged expression of c-fos induced by a single microinjection of carbachol in the pontomesencephalic tegmentum

    PubMed Central

    Quattrochi, James J.; Bazalakova, Mihaela; Hobson, J. Allan

    2006-01-01

    It is not known how the brain modifies its regulatory systems in response to the application of a drug, especially over the long term of weeks and months. We have developed a model system approach to this question by manipulating cholinergic cell groups of the laterodorsal and pedunculopontine tegmental (LDT/PPT) nuclei in the pontomesencephalic tegmentum (PMT), which are known to be actively involved in the timing and quantity of rapid eye movement (REM) sleep. In a freely moving feline model, a single microinjection of the cholinergic agonist carbachol conjugated to a latex nanosphere delivery system into the caudolateral PMT elicits a long-term enhancement of one distinguishing phasic event of REM sleep, ponto-geniculo-occipital (PGO) waves, lasting 5 days but without any significant change in REM sleep or other behavioral state. Here, we test the hypothesis that cholinergic activation within the caudolateral PMT alters the postsynaptic excitability of the PGO network, stimulating the prolonged expression of c-fos that underlies this long-term PGO enhancement (LTPE) effect. Using quantitative Fos immunohistochemistry, we found that the number of Fos-immunoreactive (Fos-IR) neurons surrounding the caudolateral PMT injection site decreased sharply by postcarbachol day 03, while the number of Fos-IR neurons in the more rostral LDT/PPT increased >30-fold and remained at a high level following the course of LTPE. These results demonstrate a sustained c-fos expression in response to pharmacological stimulation of the brain and suggest that carbachol's acute effects induce LTPE via cholinergic receptors, with subsequent transsynaptic activation of the LDT/PPT maintaining the LTPE effect. PMID:15893601

  10. From synapse to gene product: prolonged expression of c-fos induced by a single microinjection of carbachol in the pontomesencephalic tegmentum.

    PubMed

    Quattrochi, James J; Bazalakova, Mihaela; Hobson, J Allan

    2005-05-20

    It is not known how the brain modifies its regulatory systems in response to the application of a drug, especially over the long term of weeks and months. We have developed a model system approach to this question by manipulating cholinergic cell groups of the laterodorsal and pedunculopontine tegmental (LDT/PPT) nuclei in the pontomesencephalic tegmentum (PMT), which are known to be actively involved in the timing and quantity of rapid eye movement (REM) sleep. In a freely moving feline model, a single microinjection of the cholinergic agonist carbachol conjugated to a latex nanosphere delivery system into the caudolateral PMT elicits a long-term enhancement of one distinguishing phasic event of REM sleep, ponto-geniculo-occipital (PGO) waves, lasting 5 days but without any significant change in REM sleep or other behavioral state. Here, we test the hypothesis that cholinergic activation within the caudolateral PMT alters the postsynaptic excitability of the PGO network, stimulating the prolonged expression of c-fos that underlies this long-term PGO enhancement (LTPE) effect. Using quantitative Fos immunohistochemistry, we found that the number of Fos-immunoreactive (Fos-IR) neurons surrounding the caudolateral PMT injection site decreased sharply by postcarbachol day 03, while the number of Fos-IR neurons in the more rostral LDT/PPT increased >30-fold and remained at a high level following the course of LTPE. These results demonstrate a sustained c-fos expression in response to pharmacological stimulation of the brain and suggest that carbachol's acute effects induce LTPE via cholinergic receptors, with subsequent transsynaptic activation of the LDT/PPT maintaining the LTPE effect.

  11. Central venous catheters - ports

    MedlinePlus

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... Catheters are used when you need medical treatment over a long period of time. For example, you ...

  12. Epidemiology of venous thromboembolism.

    PubMed Central

    Coon, W W

    1977-01-01

    This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease. PMID:329779

  13. Reoperative venous access.

    PubMed

    Juno, Russell J; Knott, Andrew W; Racadio, John; Warner, Brad W

    2003-05-01

    The maintenance of long-term venous access is critical to the livelihood of children in a variety of clinical situations, especially those who are dependent on parenteral nutrition. Whereas the traditional routes of either peripheral or central venous access are initially adequate, most of these sites eventually succumb to the pitfalls associated with long-term venous access. This review provides a comprehensive and multidisciplinary approach to the management of reoperative venous access with regard to preoperative planning and imaging and specific techniques in interventional radiology and surgery.

  14. Venous insufficiency at work.

    PubMed

    Hobson, J

    1997-07-01

    Chronic venous disease of the lower limbs is one of the most common conditions affecting humankind. It has been postulated that certain workplace conditions may be risk factors for venous insufficiency and varicose veins in particular. This paper examines the evidence for a link between occupation and the prevalence of venous disease. It also reviews recent French research carried out to estimate the prevalence of chronic venous insufficiency in a working population; work and nonwork risk factor and the cost to industry from this condition are also examined. PMID:9242155

  15. [Chronic venous insufficiency (CVI)].

    PubMed

    Renner, R; Simon, J

    2009-10-01

    Chronic venous insufficiency (CVI) is an important and frequent disease for dermatologists, phlebologists and general practitioners. There are various hypotheses for the ethiopathology in CVI, e. g. hormone receptors and impairments concerning the venous contraction or relaxation of the vessel wall and the venous valves might play an important role. At the moment, colour doppler-duplex sonography seems to be the diagnostic method of choice. Modern therapeutic options include compression systems alone or in combination with topical or systemic treatment including minimal invasive methods like endovenous laser or radiofrequency obliteration or foam sclerotherapy. PMID:19826982

  16. Mesenteric venous thrombosis.

    PubMed

    Hmoud, Bashar; Singal, Ashwani K; Kamath, Patrick S

    2014-09-01

    Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival.

  17. Venous thrombosis: an overview

    SciTech Connect

    Peterson, C.W.

    1986-07-01

    Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler, /sup 125/I-radiofibrinogen-uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long-term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by prevention. 61 references.

  18. Etiology of venous ulceration.

    PubMed

    Gourdin, F W; Smith, J G

    1993-10-01

    The etiology of venous ulceration is far more complex than Homans' theory of stagnation and hypo-oxygenation. Indeed, studies have shown that flow in lipodermatosclerotic limbs is actually faster than normal. We suggest, therefore, that the terms "stasis dermatitis" and "stasis ulcer" be dropped from medical parlance. The term "lipodermatosclerosis with ulceration" as used by the British, or simply "venous ulcer," would seem more appropriate. Venous hypertension, produced by incompetence of deep and communicating vein valves and thrombosis of segments of the deep system, is closely correlated with the development of venous ulcers. Precisely how this venous hypertension translates into ulceration is unclear. Burnand et al showed that fibrin cuffs are deposited around the capillaries in lipodermatosclerotic limbs. These cuffs may serve as barriers to the diffusion of oxygen, leading to local ischemia and epidermal necrosis. Others suggest that trapped leukocytes in the microcirculation alter capillary permeability by releasing various inflammatory mediators that hasten the flow of fibrinogen across the capillary membrane and promote the formation of fibrin cuffs. Proof of this hypothesis is still lacking, but may eventually come from using radioactive WBC tagging procedures. A synthesis of these two theories may in fact explain the etiology of venous ulceration. PMID:8211332

  19. Cerebral venous sinus thrombosis

    PubMed Central

    Allroggen, H.; Abbott, R.

    2000-01-01

    Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. It is very often unrecognised at initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Extensive collateral circulation within the cerebral venous system allows for a significant degree of compensation in the early stages of thrombus formation. Systemic inflammatory diseases and inherited as well as acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified. The oral contraceptive pill appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papilloedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. It has now been conclusively shown that intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy, safety and feasability. Local thrombolysis may be indicated in cases of deterioration, despite adequate heparinisation. This should be followed by oral anticoagulation for 3-6 months. The prognosis of cerebral venous sinus thrombosis is generally favourable. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated.


Keywords: cerebral venous sinus thrombosis PMID:10622773

  20. Ileofemoral venous thrombectomy.

    PubMed

    Lindhagen, J; Haglund, M; Haglund, U; Holm, J; Scherstén, T

    1978-01-01

    Twentyeight patients with ileofemoral venous thrombosis were treated surgically. Five of the patients had moderate degree of venous congestion, 18 patients had phlegmasia alba dolens and five patients had phlegmasia coerulea dolens. The mean age was 54 years, range 15-80 years, and 15 were men and 13 were women. In all cases the thrombosis was verified by phlebography. Thrombectomy was performed with a Fogarty venous thrombectomy catheter. Peroperative phlebography was used in most cases to guarantee complete extraction of thrombotic material. No operative pulmonary embolism or mortality was encountered. Postoperative continuous heparin infusion in the thrombectomized segment was used for the first week followed by dicumarol treatment. The patients were followed from 6 months to 4 years postoperatively. In two patients thrombectomy was not possible to perform. One of these patients developed a pronounced postthrombotic syndrome, the other developed venous congestion of more moderate degree. Excellent long-term time results were obtained in 82% of the patients and satisfactory in 14%. Thrombectomy is an efficient treatment of ileofemoral venous thrombosis.

  1. Management of venous trauma.

    PubMed

    Rich, N M

    1988-08-01

    There has been considerable interest in the management of injured extremity veins since the American experience during the Vietnam War. Fortunately, there are an increasing number of reports from civilian experience in the United States that add valuable information. Although the controversy continues, it appears that there is merit in repair of many injured lower-extremity veins, particularly the popliteal vein when it is a single return conduit, assuming that the patient's general condition will permit, in an attempt to prevent acute venous hypertension initially and chronic venous hypertension subsequently. Figure 1 identifies the recovery potential that exists even if the initial venous repair fails. In contrast to thrombosis in the arterial system, recanalization is the rule in venous thrombosis. Patent valves can exist above and below the rather localized area of thrombosis. It appears that recanalization will prevent the problems of chronic venous insufficiency. It is obvious that many patients do well for years; however, the sequelae of acute venous hypertension may be more demonstrable after 10 or 15 years. There has not been similar evidence supporting a more aggressive approach in general in upper-extremity veins. However, it should be appreciated that a return pathway must remain patent, as noted in replantation of extremities. Obviously, there are differences in military and civilian wounds, with the former usually having more extensive soft-tissue destruction and obliteration of collateral veins and lymphatic channels. Unfortunately, many civilian gunshot wounds are being seen in the United States that are similar to the military type. We must not forget the lessons of the past, and we must continue to analyze our experience in the management of injured veins under a variety of conditions.

  2. Chronic venous disease.

    PubMed

    Wolinsky, Claire D; Waldorf, Heidi

    2009-11-01

    Identifying characteristic cutaneous findings is important in determining the appropriate management of certain venous diseases. The health care provider should be familiar with the classic description of patterns and distributions of skin manifestations, such as varicose veins, stasis dermatitis, palpable cord, petechiae, and telangiectasias. In addition to the gross appearance of the skin, a skin biopsy may help elucidate a diagnosis. General treatment and prevention of the underlying venous pathology is essential. Furthermore, specific management of skin findings should include therapy to ameliorate progression of disease and symptomatology when warranted.

  3. Intraoral venous malformation with phleboliths

    PubMed Central

    Mohan, Ravi Prakash S.; Dhillon, Manu; Gill, Navneet

    2011-01-01

    The most common type of vascular malformation is the venous malformation and these are occasionally associated with phleboliths. We report a case of a 45 year old woman with intraoral venous malformation with phleboliths. PMID:24151422

  4. Developmental venous anomalies (DVA): the so-called venous angioma.

    PubMed

    Lasjaunias, P; Burrows, P; Planet, C

    1986-01-01

    Following a review of the literature it is possible to demonstrate the "normality" of the so called venous angiomas. They should be named Developmental Venous Anomaly (DVA). They illustrate in their two extreme types (superficial and deep) the hemodynamic equilibrium of the transcortical venous drainage in the periependymal zones. Venous ectasias and varices which can be encountered, associated with DVA constitute an acquired feature in relation to a venous outlet obstacle. The sinus pericranii represents an extracerebral DVA, but also corresponds to a normal variation. As any extreme anatomical variant, each DVA corresponds to a weak situation which may express itself clinically; only rare situations justify a radical treatment.

  5. Mesenteric venous thrombosis.

    PubMed

    Singal, Ashwani K; Kamath, Patrick S; Tefferi, Ayalew

    2013-03-01

    The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.

  6. Venous thrombosis - series (image)

    MedlinePlus

    Venous thrombosis can cause swelling and pain of the leg in which it forms. Large clots can also break free and travel to the heart and lungs, where they can cause cardiac arrest and sometimes death. This is called pulmonary embolism.

  7. Protected Iliofemoral Venous Thrombectomy

    PubMed Central

    Neri, Eugenio; Civeli, Letizia; Benvenuti, Antonio; Toscano, Thomas; Miraldi, Fabio; Capannini, Gianni; Muzzi, Luigi; Sassi, Carlo

    2002-01-01

    Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. Pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity. The cause was determined to be a severe protein S deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy. When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant. (Tex Heart Inst J 2002;29:130–2) PMID:12075871

  8. Predicted burden of venous disease.

    PubMed

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

    Chronic venous disease is a common condition with clinical signs and symptoms ranging from spider veins, to varicose veins, to active venous ulceration. Both superficial and deep venous dysfunction may be implicated in the development of this disease. Socio-economic factors are shaping our population, with increasing age and body mass index resulting in significant pressure on healthcare systems worldwide. These risk factors also lead to an increased risk of developing superficial and/or deep venous insufficiency, increasing disease prevalence and morbidity. In this chapter, the authors review the current and future burden of chronic venous disease from an epidemiological, quality of life and economic perspective.

  9. Predicted burden of venous disease.

    PubMed

    Onida, Sarah; Davies, Alun Huw

    2016-03-01

    Chronic venous disease is a common condition with clinical signs and symptoms ranging from spider veins, to varicose veins, to active venous ulceration. Both superficial and deep venous dysfunction may be implicated in the development of this disease. Socio-economic factors are shaping our population, with increasing age and body mass index resulting in significant pressure on healthcare systems worldwide. These risk factors also lead to an increased risk of developing superficial and/or deep venous insufficiency, increasing disease prevalence and morbidity. In this chapter, the authors review the current and future burden of chronic venous disease from an epidemiological, quality of life and economic perspective. PMID:26916773

  10. Venous conditions associated with pregnancy.

    PubMed

    Skudder, P A; Farrington, D T

    1993-06-01

    Pregnancy is associated with several changes in venous physiology. These include relaxation of venous wall tone and increased lower extremity venous pressure. As a result of these changes, varicose veins, spider telangiectasias, purpura, and other superficial findings may develop. Treatment of these conditions is conservative during pregnancy. As the changes in venous hemodynamics resolve over several weeks after delivery, partial or complete regression may occur. In cases where persistent abnormality persists well after delivery, more definitive therapy may be considered. Pregnancy is also associated with a mild hypercoagulable state, and there may be trauma to venous endothelium associated with delivery. Coupled with the relative stasis resulting from pelvic venous compression by the uterus and from decreases in venous tone, these changes cause an increased risk of deep vein thrombosis in late pregnancy and the peripartum period. Anticoagulation with heparin is required as coumadin and fibrinolytic agents are considered to be hazardous.

  11. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  12. [Prophylaxis of venous thromboembolism].

    PubMed

    Otero Candelera, Remedios; Grau Segura, Enric; Jiménez Castro, David; Uresandi Romero, Fernando; López Villalobos, José Luis; Calderón Sandubete, Enrique; Medrano Ortega, Francisco Javier; Cayuela Domínguez, Aurelio

    2008-03-01

    The recommendations on venous thromboprophylaxis have been updated on the basis of current evidence reviewed by a multidisciplinary team. The problem has been approached with regard to its relevance in both surgical and nonsurgical patients. It should be noted that these recommendations were drawn up for use in Spain and, therefore, should be implemented with the drugs and therapeutic practices authorized and generally accepted in this country.

  13. Doppler ultrasound study and venous mapping in chronic venous insufficiency.

    PubMed

    García Carriazo, M; Gómez de las Heras, C; Mármol Vázquez, P; Ramos Solís, M F

    2016-01-01

    Chronic venous insufficiency of the lower limbs is very prevalent. In recent decades, Doppler ultrasound has become the method of choice to study this condition, and it is considered essential when surgery is indicated. This article aims to establish a method for the examination, including venous mapping and preoperative marking. To this end, we review the venous anatomy of the lower limbs and the pathophysiology of chronic venous insufficiency and explain the basic hemodynamic concepts and the terminology required to elaborate a radiological report that will enable appropriate treatment planning and communication with other specialists. We briefly explain the CHIVA (the acronym for the French term "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire"=conservative hemodynamic treatment for chronic venous insufficiency) strategy, a minimally invasive surgical strategy that aims to restore correct venous hemodynamics without resecting the saphenous vein.

  14. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration.

  15. Massive superior mesenteric venous aneurysm with portal venous thrombosis.

    PubMed

    Starikov, Anna; Bartolotta, Roger J

    2015-01-01

    Portal venous aneurysm is a rare and sometimes dangerous vascular pathology, which can result in thrombosis or rupture. We present the computed tomography, magnetic resonance, and sonographic imaging of a 27-year-old man with superior mesenteric venous aneurysm and subsequent thrombosis following acute pancreatitis. This multimodality imaging approach can prove useful in the evaluation of these rare aneurysms.

  16. [Endogenous venous thrombolysis].

    PubMed

    Porembskaya, O Ya; Khmelniker, S M; Shaidakov, E V

    2015-01-01

    Widely incorporated into vascular surgery pharmacological thrombolysis in treatment for deep vain thrombosis is fraught with a series of unsolved problems requiring further consideration. In spite of aggressive nature of treatment in a series of cases pharmacological thrombolysis sometimes turns out ineffective. Along with it, the results of experimental studies suggest a possibility of accelerating resorption of thrombotic masses and inhibiting remodelling of the venous wall by means of influencing effector cells of endogenous thrombolysis. A detailed study of the mechanisms of thrombolysis would make it possible to formulate strict criteria for carrying out pharmacological thrombolysis and to increase its efficacy. PMID:26355926

  17. [Travel and venous thromboembolism].

    PubMed

    Hallundbæk Mikkelsen, Kristian; Knudsen, Stine Ulrik; Nannestad Jørgensen, Lars

    2013-10-28

    A literature study on the association between travel and venous thromboembolism (VTE) is conducted. Studies examining the risk of travel-associated VTE, predisposing factors and prophylactic measures are presented. It is concluded that the absolute risk of travel-associated VTE is low and holds a 2-4 fold increase after travel. The risk increases with duration, presence of other risk factors for VTE and extremes of height. Stockings reduces the risk of asymptomatic VTE. Heparin is presumed to constitute protection whereas there is no evidence of a prophylactic effect of acetylsalicylic acid.

  18. Peripheral venous contrast echocardiography.

    PubMed

    Seward, J B; Tajik, A J; Hagler, D J; Ritter, D G

    1977-02-01

    Contrast echocardiography is the technique of injecting various echo-producing agents into the bloodstream and, with standard echocardiographic techniques, observing the blood flow patterns as revealed by the resulting cloud of echoes. These techniques have only recently been utilized to evaluate various cardiac defects. Two physical properties of these agents characterize their usefulness: (1) clouds of echoes can be observed downstream as well as at the injection site, and (2) the echo-producing quality of these agents is completely lost with a single transit through either the pulmonary or the systemic capillary bed. Thus, detection of resultant echoes in both the venous and the arterial blood pool is indicative of abnormal shunting. In 60 patients with a spectrum of cardiac defects and a wide range in age of presentation, studies were made of (1) the feasibility of performing contrast echocardiography with superficial peripheral venous injections, and (2) the clinical usefulness of this relatively noninvasive technique in detecting and localizing intracardiac right ot left shunting. Most superficial peripheral veins could be utilized, and the resultant contrast echograms were reproducible and similar in quality to those obtained more central (caval) injections. Right to left shunts could be localized in the atrial, ventricular or intrapulmonary level. Characteristic flow patterns were also recognized for tricuspid atresia and common ventricle.

  19. Cerebral sinus venous thrombosis

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Milena Castellar-Leones, Sandra; Alcala-Cerra, Gabriel; Rafael Moscote-Salazar, Luis

    2013-01-01

    Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment. PMID:24347950

  20. Venous thrombosis in athletes.

    PubMed

    Grabowski, Gregory; Whiteside, William K; Kanwisher, Michael

    2013-02-01

    Because deep vein thrombosis (DVT) can occur following orthopaedic procedures, knowledge of hereditary and acquired risk factors for DVT is essential. Hereditary forms of thrombophilia include factor V Leiden and prothrombin G20210A mutations, and deficiencies of antithrombin III, protein C, and protein S. Acquired risk factors include but are not limited to trauma, immobilization, and surgical procedures. In general, athletes have a low risk of venous thrombosis; however, this population is exposed to many acquired thrombogenic risk factors, including hemoconcentration, trauma, immobilization, long-distance travel, and the use of oral contraceptives. Thus, orthopaedic surgeons should consider screening athletes for thrombogenic risk factors, including history of venous thrombosis, hypercoagulable disorders, or high altitude exercise, during preparticipation physicals and preoperative examinations. If a patient is determined to be at high risk of DVT, preventive measures such as physical antithrombotic measures and/or low-molecular-weight heparin should be instituted. If an athlete develops a DVT, a risk factor assessment should be conducted along with anticoagulation treatment in accordance with the American College of Chest Physicians guidelines. PMID:23378374

  1. Pathophysiology of chronic venous disease.

    PubMed

    Raffetto, J D; Mannello, F

    2014-06-01

    Chronic venous disease (CVD) is a debilitating condition with a prevalence between 60-70%. The disease pathophysiology is complex and involves genetic susceptibility and environmental factors, with individuals developing visible telengiectasias, reticular veins, and varicose veins. Patient with significant lower extremity symptoms have pain, dermal irritation, swelling, skin changes, and are at risk of developing debilitating venous ulceration. The signature of CVD is an increase in venous pressure referred to as venous hypertension. The various symptoms presenting in CVD and the clinical signs that are observed indicate that there is inflammation, secondary to venous hypertension, and it leads to a number of inflammatory pathways that become activated. The endothelium and glycocalyx via specialized receptors are critical at sensing changes in shear stress, and expression of adhesion molecules allows the activation of leukocytes leading to endothelial attachment, diapedisis, and transmigration into the venous wall/valves resulting in venous wall injury and inflammatory cells in the interstitial tissues. There is a complex of cytokines, chemokines, growth factors, proteases and proteinases, produced by activated leukocytes, that are expressed and unbalanced resulting in an environment of persistent inflammation with the clinical changes that are commonly seen, consisting of varicose veins to more advanced presentations of skin changes and venous ulceration. The structural integrity of protein and the extracellular matrix is altered, enhancing the progressive events of CVD. Work focusing on metabolic changes, miRNA regulation, inflammatory modulation and the glycocalyx will further our knowledge in the pathophysiology of CVD, and provide answers critical to treatment and prevention.

  2. Venous Thromboembolism in Cirrhosis

    PubMed Central

    Yang, ZJ; Costa, KA; Novelli, EM; Smith, RE

    2014-01-01

    The cirrhosis population represents a unique subset of patients who are at risk for both bleeding and developing venous thrombotic embolic events (VTE). It has been commonly misunderstood that these patients are naturally protected from thrombosis by deficiencies in coagulation factors. As a result, the cirrhosis population is often falsely perceived to be ‘autoanticoagulated’. However, the concept of ‘autoanticoagulation’ conferring protection from thrombosis is a misnomer. While patients with cirrhosis may have a bleeding predisposition, not uncommonly they also experience thrombotic events. The concern for this increased bleeding risk often makes anticoagulation a difficult choice. Prophylactic and therapeutic management of VTE in patients with cirrhosis is a difficult clinical problem with the lack of clear established guidelines. The elucidation of laboratory and/or clinical predictors of VTE will be useful in this setting. This review serves to examine VTE, and the use of anticoagulation in the cirrhosis population. PMID:23076776

  3. Overview of venous thromboembolism.

    PubMed

    Abad Rico, José Ignacio; Llau Pitarch, Juan Vicente; Rocha, Eduardo

    2010-12-14

    Thrombosis occurs at sites of injury to the vessel wall, by inflammatory processes leading to activation of platelets, platelet adherence to the vessel wall and the formation of a fibrin network. A thrombus that goes on to occlude a blood vessel is known as a thromboembolism. Venous thromboembolism begins with deep vein thrombosis (DVT), which forms in the deep veins of the leg (calf) or pelvis. In some cases, the DVT becomes detached from the vein and is transported to the right-hand side of the heart, and from there to the pulmonary arteries, giving rise to a pulmonary embolism (PE). Certain factors predispose patients toward the development of venous thromboembolism (VTE), including surgery, trauma, hospitalization, immobilization, cancer, long-haul travel, increased age, obesity, major medical illness and previous VTE; in addition, there may also be a genetic component to VTE. VTE is responsible for a substantial number of deaths per annum in Europe. Anticoagulants are the mainstay of both VTE treatment and VTE prevention, and many professional organizations have published guidelines on the appropriate use of anticoagulant therapies for VTE. Treatment of VTE aims to prevent morbidity and mortality associated with the disease, and any long-term complications such as VTE recurrence or post-thrombotic syndrome. Generally, guidelines recommend the use of low molecular weight heparins (LMWH), unfractionated heparin (UFH) or fondaparinux for the pharmacological prevention and treatment of VTE, with the duration of therapy varying according to the baseline characteristics and risk profile of the individual. Despite evidence showing that the use of anticoagulation prevents VTE, the availability of several convenient, effective anticoagulant therapies and the existence of clear guideline recommendations, thromboprophylaxis is underused, particularly in patients not undergoing surgery. Greater adherence to guideline-recommended therapies, such as LMWH, which can be

  4. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

    de Franciscis, Stefano; De Sarro, Giovambattista; Longo, Paola; Buffone, Gianluca; Molinari, Vincenzo; Stillitano, Domenico M; Gallelli, Luca; Serra, Raffaele

    2015-02-01

    Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty-seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine-lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed.

  5. Thrombophilia and chronic venous ulceration.

    PubMed

    Bradbury, A W; MacKenzie, R K; Burns, P; Fegan, C

    2002-08-01

    It is known that thrombophilia (TP) is a risk factor for deep venous thrombosis (DVT), and that DVT predisposes to chronic venous ulceration (CVU). However, the relationship between TP and CVU has not been well studied. Review of the literature reveals that the prevalence of TP in CVU patients is high--similar to the prevalence found in patients with a history of DVT. This is despite many patients with CVU having no clear history, or duplex evidence of previous DVT. TP may predispose to CVU by leading to macro- or micro-vascular thrombosis. This association raises several issues regarding the investigation, prevention and management of patients with venous disease.

  6. Inflammation in chronic venous ulcers.

    PubMed

    Raffetto, J D

    2013-03-01

    Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age. CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA. Overall, CVD has been estimated to account for 1-3% of the total health-care budgets in countries with developed health-care systems. The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.

  7. Venous Thromboembolism and Marathon Athletes

    MedlinePlus

    ... Heart Association Cardiology Patient Page Venous Thromboembolism and Marathon Athletes Claire M. Hull and Julia A. Harris ... general adult population are indisputable. However, for the marathon athlete who trains intensively and for long periods ...

  8. Understanding Guyton's venous return curves

    PubMed Central

    Feigl, Eric O.

    2011-01-01

    Based on observations that as cardiac output (as determined by an artificial pump) was experimentally increased the right atrial pressure decreased, Arthur Guyton and coworkers proposed an interpretation that right atrial pressure represents a back pressure restricting venous return (equal to cardiac output in steady state). The idea that right atrial pressure is a back pressure limiting cardiac output and the associated idea that “venous recoil” does work to produce flow have confused physiologists and clinicians for decades because Guyton's interpretation interchanges independent and dependent variables. Here Guyton's model and data are reanalyzed to clarify the role of arterial and right atrial pressures and cardiac output and to clearly delineate that cardiac output is the independent (causal) variable in the experiments. Guyton's original mathematical model is used with his data to show that a simultaneous increase in arterial pressure and decrease in right atrial pressure with increasing cardiac output is due to a blood volume shift into the systemic arterial circulation from the systemic venous circulation. This is because Guyton's model assumes a constant blood volume in the systemic circulation. The increase in right atrial pressure observed when cardiac output decreases in a closed circulation with constant resistance and capacitance is due to the redistribution of blood volume and not because right atrial pressure limits venous return. Because Guyton's venous return curves have generated much confusion and little clarity, we suggest that the concept and previous interpretations of venous return be removed from educational materials. PMID:21666119

  9. Systemic venous drainage: can we help Newton?

    PubMed

    Corno, Antonio F

    2007-06-01

    In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton.

  10. Pharmacological prophylaxis of venous thrombo-embolism.

    PubMed

    Flute, P T

    1976-02-01

    The pathogenesis of venous thrombosis is briefly discussed as a basis for the understanding of preventive measures used in this condition. Prophylaxis in venous thrombosis is then reviewed with emphasis on pharmacological treatment, and more particularly on heparin.

  11. [Automatic regulator of venous pressure and venous outflow in the perfusion system].

    PubMed

    Smirnov, L M; Levinskiĭ, M M; Kharnas, S Sh; Cherniak, V A

    1976-01-01

    A scheme for automatic regulation of the venous pressure and venous blood outflow during extracorporeal circulation is proposed. The system consists of a photoelectric sensor placed on a tube led out of the major venous trunkline, a converter and an electromechanical eccentric clamp that compresses the venous trunkline, all of which secures stabilization of the controlled values.

  12. Air travel and venous thromboembolism.

    PubMed Central

    Mendis, Shanthi; Yach, Derek; Alwan, Ala

    2002-01-01

    There has recently been increased publicity on the risk of venous thrombosis after long-haul flights. This paper reviews the evidence base related to the association between air travel and venous thromboembolism. The evidence consists only of case reports, clinical case-control studies and observational studies involving the use of intermediate end-points, or expert opinion. Some studies have suggested that there is no clear association, whereas others have indicated a strong relationship. On the whole it appears that there is probably a link between air travel and venous thrombosis. However, the link is likely to be weak, mainly affecting passengers with additional risk factors for venous thromboembolism. The available evidence is not adequate to allow quantification of the risk. There are insufficient scientific data on which to base specific recommendations for prevention, other than that leg exercise should be taken during travel. Further studies are urgently needed in order to identify prospectively the incidence of the condition and those at risk. PMID:12077617

  13. Venous ulceration, fibrinogen and fibrinolysis.

    PubMed Central

    Leach, R. D.

    1984-01-01

    The effect of long and short-term venous hypertension upon lymph fibrinogen concentrations was studied in an attempt to explain the peri-capillary deposition of fibrin reported in patients with post-phlebitic syndromes. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of rats and human volunteers was also studied. Both long- and short-term venous hypertension were found to increase fibrinogen transport across the interstitial space by more than 600%. Not only was there evidence of fibrinolytic activity in the lymph but after long-term venous hypertension alpha 2 antiplasmin activity was also detectable. Skin biopsies from the venous hypertensive ankles showed deposition of interstitial fibrin. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of the rat was found to be delayed if the rats were given epsilon amino caproic acid but it could not be increased with stanozolol. In human subjects it was found that patients with lipodermatosclerosis had delayed clot clearance and retarded blood fibrinolytic activity when compared with normal volunteers and patients with uncomplicated varicose veins. The principle cause why tall men are more subject to ulcers than short men, Dr Young conceived to be then length of the column of blood in their veins; which by its pressure, renders the legs less able to recover when hurt by any violence. Images Fig. 1 Fig. 2 Fig. 5 PMID:6742738

  14. [THERAPEUTIC GUIDE IN VENOUS ULCERS].

    PubMed

    López Herranz, Marta; Bas Caro, Pedro; García Jábega, Rosa Ma; García Carmona, Francisco Javier; Villalta García, Pedro; Postigo Mota, Salvador

    2014-11-01

    The treatment of venous ulcers and wounds in general, is a complex and important public health problem, with personal effects, family and health, without addressing the economic impact includes assistance, care of patients with ulcerative lesions. The increase in life expectancy, driven by improved socio-sanitary conditions that this aging population, facilitates the emergence of chronic diseases may be complicated by the presence of skin ulcers. There is no doubt that the best way to treat a skin ulcer is avoiding to occur, hence the importance of early diagnosis and risk factors act alone them. In relation to venous ulcers is crucial, provide local treatment, act on the cause, because if not, relapse is the norm in this type of injury. Currently, the moist wound healing, is an important step in solving earlier of these chronic wounds. This has meant that the pharmaceutical industry has been involved in researching and creating different types of dressings, having specific activity at different stages of venous ulcer healing, ie inflammatory phase, proliferative and remodeling. The proliferation of these products has been increasing over the years, not surprisingly, are described therapeutic 12 families that are applied in the management, care of these injuries. The fact of existing therapeutic options highlights the ineffectiveness of these products individually. Therefore, the nurse will not forget that the optimal treatment of venous ulcers, necessarily involves choosing the right product for every type and stage of the lesion. In this decision process, strongly influenced by the specific characteristics of each patient and injury, the nurse will take into account a lot of factors when choosing the product, not forgetting that an ulcer is not cured with a single therapeutic element, several products being used throughout the process to evolutionary venous ulcer until complete resolution.

  15. Case of Cerebral Venous Thrombosis with Unusual Venous Infarcts

    PubMed Central

    Kamaraju, Susheel Kumar; Pasupaleti, Bhimeswarao; Juluri, Naganarasimharaju

    2015-01-01

    Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed. PMID:26023623

  16. Clinical aspects of venous thrombophilia.

    PubMed

    Girolami, Antonio; Fabris, Fabrizio; Girolami, Bruno

    2002-01-01

    Venous thrombophilia is the result of clotting changes namely of a hypercoagulable state together with blood flow and vessel wall changes. There is no need for all these components to be present in order for thrombosis to occur. As the matter of fact, thrombosis may occur even if only one of these conditions is present. In clinical practice a combination of factors is usualy seen. In comparison with arterial thrombophilia, clotting changes and blood flow seen to play a major role in venous thrombosis. Venous thrombophilia may remain asynptomatic or may result in a series of clinical syndromes. The commonest of these are: 1. Superficial vein thrombosis, 2. Deep vein thrombosis of legs, 3. Deep vein thrombosis of arms, 4. Caval veins thrombosis, 5. Portal vein thrombosis, 6. Hepatic veins thrombosis, 7. Renal vein thrombosis, 8. Cerebral sinuses thrombosis, 9. Right heart thrombosis, 10. Miscellaneous (ovarian, adrenal veins thrombosis, etc.). Since the first two are widely and easily recognized, these is no need for an extensive discussion. Deep vein thromboses of upper limbs are not as frequent as those of lower limbs or of superficial phlebitis but they can still be recognized on clinical grounds and non invasive techniques. The remaining 7 syndromes are less common and therefore less frequently suspected and recognized. Of particular interest, among these less common manifestations of venous thrombophilia are hepatic vein and renal vein thrombosis. Hepatic veins thrombosis, sometimes part of inferior vena cava thrombosis is most frequently due to an isolated occlusion of hepatic veins thereby causing a form of venocclusive disease. Occasionally diagnosis may be difficult because of slow onset of symptoms (hepatomegaly, right flank pain, fever, ascites etc.). The same is true for renal vein thrombosis which may also be of difficult diagnosis since it causes proteinuria and flank pain. The proteinuria is often interpreted as due to a nephrotic syndrome which

  17. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  18. Hydrocephalus in cerebral venous thrombosis.

    PubMed

    Zuurbier, Susanna M; van den Berg, René; Troost, Dirk; Majoie, Charles B; Stam, Jan; Coutinho, Jonathan M

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and 2010 (prospectively since July 2006). Hydrocephalus was defined as a bicaudate index larger than the 95th percentile for age, and/or a radial width of the temporal horn of ≥ 5 mm. We excluded patients in whom hydrocephalus was caused by a disease other than CVT or if it was iatrogenic. 20 out of 99 patients with CVT had hydrocephalus. 6 patients with hydrocephalus were excluded from the analysis. Patients with hydrocephalus more often had focal neurological deficits (86 vs. 49%, p = 0.02) and were more frequently comatose (43 vs. 16%, p = 0.06), as compared to patients without hydrocephalus. Deep cerebral venous thrombosis (64 vs. 9%, p < 0.001) and edema of the basal ganglia and thalami (64 vs. 4%, p < 0.001) were more common in patients with hydrocephalus. Intraventricular hemorrhage was present in 1 patient with hydrocephalus, compared to none among patients without hydrocephalus (7 vs. 0%, p = 0.15). Outcome at follow-up was worse in patients with hydrocephalus (mRS 0-1, 36 vs. 68%, p = 0.02; mortality 29 vs. 9%, p = 0.07). Hydrocephalus occurs more frequently in cerebral venous thrombosis than previously believed, especially in patients with deep cerebral venous thrombosis and edema of the basal ganglia. The presence of hydrocephalus is associated with a worse clinical outcome, but a direct causal relation is unlikely. Routine shunting procedures are not advisable.

  19. Starling curves and central venous pressure.

    PubMed

    Berlin, David A; Bakker, Jan

    2015-01-01

    Recent studies challenge the utility of central venous pressure monitoring as a surrogate for cardiac preload. Starting with Starling's original studies on the regulation of cardiac output, this review traces the history of the experiments that elucidated the role of central venous pressure in circulatory physiology. Central venous pressure is an important physiologic parameter, but it is not an independent variable that determines cardiac output. PMID:25880040

  20. Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access

    SciTech Connect

    Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio

    2011-12-15

    Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

  1. Septic cerebral venous sinus thrombosis.

    PubMed

    Khatri, Ismail A; Wasay, Mohammad

    2016-03-15

    Septic cerebral venous sinus thrombosis, once a common and deadly disease, has fortunately become rare now. Not only that the incidence has fallen significantly after the antibiotic era, the morbidity and mortality has also decreased substantially. Cavernous sinus thrombosis is by far the commonest form of septic cerebral venous sinus thrombosis. Due to its rare occurrence, a lot of current generation clinicians have not encountered the entity in person. Despite all the advances in diagnostic modalities, a high index of clinical suspicion remains the mainstay in prompt diagnosis and management of this potentially lethal condition. Keeping this in view, the authors have reviewed the subject including the old literature and have summarized the current approach to diagnosis and management. Septic cavernous thrombosis is a fulminant disease with dramatic presentation in most cases comprised of fever, periorbital pain and swelling, associated with systemic symptoms and signs. The preceding infection is usually in the central face or paranasal sinuses. The disease rapidly spreads to contralateral side and if remains undiagnosed and untreated can result in severe complications or even death. Prompt diagnosis using radiological imaging in suspected patient, early use of broad spectrum antibiotics, and judicial use of anticoagulation may save the life and prevent disability. Surgery is used only to treat the nidus of infection. PMID:26944152

  2. Acroangiodermatitis secondary to chronic venous insufficiency.

    PubMed

    Palmer, Benjamin; Xia, Yang; Cho, Sunghun; Lewis, Felisa S; Lewis, Felicia S

    2010-11-01

    Acroangiodermatitis (AAD) is a benign uncommon vasoproliferative disorder that affects the lower extremities. It appears to be a reactive phenomenon related to severe chronic Venous insufficiency and stasis of the lower extremities. The clinical presentation of this condition often is similar to Kaposi sarcoma. We report a case of AAD in a patient with severe hypertension and chronic venous insufficiency. PMID:21214123

  3. Developmental Venous Anomaly: Benign or Not Benign

    PubMed Central

    AOKI, Rie; SRIVATANAKUL, Kittipong

    2016-01-01

    Developmental venous anomalies (DVAs), previously called venous angiomas, are the most frequently encountered cerebral vascular malformations. However, DVA is considered to be rather an extreme developmental anatomical variation of medullary veins than true malformation. DVAs are composed of dilated medullary veins converging centripetally into a large collecting venous system that drains into the superficial or deep venous system. Their etiology and mechanism are generally accepted that DVAs result from the focal arrest of the normal parenchymal vein development or occlusion of the medullary veins as a compensatory venous system. DVAs per se are benign and asymptomatic except for under certain unusual conditions. The pathomechanisms of symptomatic DVAs are divided into mechanical, flow-related causes, and idiopathic. However, in cases of DVAs associated with hemorrhage, cavernous malformations (CMs) are most often the cause rather than DVAs themselves. The coexistence of CM and DVA is common. There are some possibilities that DVA affects the formation and clinical course of CM because CM related to DVA is generally located within the drainage territory of DVA and is more aggressive than isolated CM in the literature. Brain parenchymal abnormalities surrounding DVA and cerebral varix have also been reported. These phenomena are considered to be the result of venous hypertension associated with DVAs. With the advance of diagnostic imagings, perfusion study supports this hypothesis demonstrating that some DVAs have venous congestion pattern. Although DVAs should be considered benign and clinically silent, they can have potential venous hypertension and can be vulnerable to hemodynamic changes. PMID:27250700

  4. Stent Placement on Fresh Venous Thrombosis

    SciTech Connect

    Vorwerk, Dierk; Guenther, Rolf W.; Schuermann, Karl

    1997-09-15

    Purpose: To report on the efficacy of fixing fresh venous thrombus to the venous wall by stent placement. Methods: Seven patients underwent stenting to treat acute venous thrombosis. In two patients, the hemodialysis fistula was thrombosed with the thrombus extending into the brachial veins. In three patients, the hemodialysis fistula was patent but massive swelling of the ipsilateral arm was caused by proximal venous thrombosis. Two patients presented with iliac venous thrombosis within stented pelvic veins. Stent placement was preceded by other mechanical thrombectomy methods in all cases. Results: Attachment of thrombus to the venous wall was successful in all cases treated. Acute rethrombosis did not occur. Follow-up patency in dialysis patients was 7.2 {+-} 2.1 months. One patient had rethrombosis of the dialysis graft 3 months after primary treatment. Three patients developed restenosis within a mean period of 7.7 months. One shunt remained patent for 10 months with no event of reobstruction during follow-up. In both patients with iliac stent placement, the vein remained patent over a follow-up period of 8 and 12 months respectively. Conclusion: Stenting fresh venous thrombus can achieve immediate venous patency. It may be used as an alternative approach when all other percutaneous methods fail. Frequent restenosis within stented veins limits its use to very selected cases.

  5. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  6. Venous Thromboembolism in Patients with Membranous Nephropathy

    PubMed Central

    Lionaki, Sophia; Derebail, Vimal K.; Hogan, Susan L.; Barbour, Sean; Lee, Taewoo; Hladunewich, Michelle; Greenwald, Allen; Hu, Yichun; Jennette, Caroline E.; Jennette, J. Charles; Falk, Ronald J.; Cattran, Daniel C.; Nachman, Patrick H.; Reich, Heather N.

    2012-01-01

    Summary Background and objectives The aims of this study were to determine the frequency of venous thromboembolic events in a large cohort of patients with idiopathic membranous nephropathy and to identify predisposing risk factors. Design, setting, participants, & measurements We studied patients with biopsy-proven membranous nephropathy from the Glomerular Disease Collaborative Network (n=412) and the Toronto Glomerulonephritis Registry (n=486) inception cohorts. The cohorts were pooled after establishing similar baseline characteristics (total n=898). Clinically apparent and radiologically confirmed venous thromboembolic events were identified. Potential risk factors were evaluated using multivariable logistic regression models. Results Sixty-five (7.2%) subjects had at least one venous thromboembolic event, and this rate did not differ significantly between registries. Most venous thromboembolic events occurred within 2 years of first clinical assessment (median time to VTE = 3.8 months). After adjusting for age, sex, proteinuria, and immunosuppressive therapy, hypoalbuminemia at diagnosis was the only independent predictor of a venous thromboembolic event. Each 1.0 g/dl reduction in serum albumin was associated with a 2.13-fold increased risk of VTE. An albumin level <2.8 g/dl was the threshold below which risk for a venous thromboembolic event was greatest. Conclusions We conclude that clinically apparent venous thromboembolic events occur in about 7% of patients with membranous nephropathy. Hypoalbuminemia, particularly <2.8 g/dl, is the most significant independent predictor of venous thrombotic risk. PMID:22076873

  7. Venous pressure in man during weightlessness

    NASA Technical Reports Server (NTRS)

    Kirsch, K. A.; Roecker, L.; Gauer, O. H.; Krause, R.; Wicke, H. J.; Leach, C.; Landry, R.

    1984-01-01

    To determine whether the body fluid shift from the lower limbs toward the head that occurs during spaceflight leads to lasting increases of venous pressure in the upper body, venous pressure and hematocrit measurements were made on four astronauts before flight and 1 and 12 hours after recovery and compared with measurements in space. During the mission the hematocrit was elevated and the venous pressure lowered by 1 to 8 centimeters of water as compared with the preflight data. One hour after landing the hematocrit decreased, indicating a hemodilution, venous pressures were unexpectedly high, and a body weight loss of 4 to 5 percent was observed. Twelve hours later the venous pressures were the lowest recorded during the study. The fluid shift apparently takes place during the first several hours of spaceflight. Thereafter, the pressure in the peripheral veins and the central circulation is lower than that measured before flight.

  8. [News on venous thromboembolic disease].

    PubMed

    Arcelus, J I; García-Bragado, F; Jiménez, D; Lozano Sánchez, F S; Lecumberri, R; Román Sánchez, P

    2012-09-01

    This paper brings together the latest developments that have occurred in different aspects of venous thromboembolism (VTE): VTE prophylaxis in high-risk orthopedic surgery and acutely ill hospitalized medical patients; therapeutic advances in pulmonary embolism and superficial vein thrombosis and VTE future prospects. It summarizes the reviews that five speakers made in-depth for the Second Day in New Anticoagulant Treatment, held in Madrid on November 18, 2011, organized by the Foundation for the Study of Thromboembolic Disease in Spain and endorsed by the Spanish Society of Internal Medicine, Spanish Society of Pneumology and Thoracic Surgery, Spanish Society of Cardiology, Spanish Society of Thrombosis and Haemostasis and the Spanish Society of Angiology and Vascular Surgery.

  9. The impact of obesity on venous insufficiency.

    PubMed

    Seidel, A C; Belczak, C E Q; Campos, M B; Campos, R B; Harada, D S

    2015-08-01

    Association between chronic venous disease and obesity has recently been studied, with indications that it may worsen in obese patients. The aim of study was to correlate clinical classes of chronic venous disease according to Clinical Etiology Anatomy Pathophysiology (CEAP) classification and body mass index, as well as to compare the severity of chronic venous disease in obese and nonobese patients. This retrospective cross-sectional prevalence study was conducted at the Maringá State University and Belczak Vascular Center along a period of 2 years, consisting of a random sample of 482 patients with complaints compatible with chronic venous disease. Data obtained from patient's files included gender, age, weight and height (for calculating body mass index), and clinical class (C) of chronic venous disease according to CEAP classification. Statistical analysis included Spearman's correlation coefficient, Chi-square test (for comparing frequencies), and Student's t-test (for comparing means). Significant positive correlation between body mass index and clinical classes was established for women (0.43), but not for men (0.07). Obesity (body mass index  : ≥  : 30.0) was significantly more frequent in patients with chronic venous disease in clinical classes 3 (p < 0.001) and 4 (p = 0.002) and less frequent in patients with chronic venous disease in clinical class 1 (p < 0.001). This study evidenced significant correlation between body mass index and clinical classes of chronic venous disease in women, but not in men. It also corroborated the negative impact of obesity on the clinical severity of chronic venous disease.

  10. Upper Body Venous Compliance Exceeds Lower Body Venous Compliance in Humans

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.

    1996-01-01

    Human venous compliance hypothetically decreases from upper to lower body as a mechanism for maintenance of the hydrostatic indifference level 'headward' in the body, near the heart. This maintains cardiac filling pressure, and thus cardiac output and cerebral perfusion, during orthostasis. This project entailed four steps. First, acute whole-body tilting was employed to alter human calf and neck venous volumes. Subjects were tilted on a tilt table equipped with a footplate as follows: 90 deg, 53 deg, 30 deg, 12 deg, O deg, -6 deg, -12 deg, -6 deg, O deg, 12 deg, 30 deg, 53 deg, and 90 deg. Tilt angles were held for 30 sec each, with 10 sec transitions between angles. Neck volume increased and calf volume decreased during head-down tilting, and the opposite occurred during head-up tilt. Second, I sought to cross-validate Katkov and Chestukhin's (1980) measurements of human leg and neck venous pressures during whole-body tilting, so that those data could be used with volume data from the present study to calculate calf and neck venous compliance (compliance = (Delta)volume/(Delta)pressure). Direct measurements of venous pressures during postural chances and whole-body tilting confirmed that the local changes in venous pressures seen by Katkov and Chestukhin (1980) are valid. The present data also confirmed that gravitational changes in calf venous pressure substantially exceed those changes in upper body venous pressure. Third, the volume and pressure data above were used to find that human neck venous compliance exceeds calf venous compliance by a factor of 6, thereby upholding the primary hypothesis. Also, calf and neck venous compliance correlated significantly with each other (r(exp 2) = 0.56). Fourth, I wished to determine whether human calf muscle activation during head-up tilt reduces calf venous compliance. Findings from tilting and from supine assessments of relaxed calf venous compliance were similar, indicating that tilt-induced muscle activation is

  11. Current opinion on iliofemoral venous thrombectomy.

    PubMed

    Stephens, G L

    1976-02-01

    Iliofemoral venous thrombosis is discussed and a technique of iliofemoral venous thrombectomy is presented. Operative phlebography is recommended. The personal recommendations of leading American vascular surgeons in treating the patient with acute iliofemoral venous thrombosis are presented. I recommend thrombectomy for phlegmasia cerulea dolens, and in previously healthy, young ambulatory patients with phlegmasia alba dolens who are seen within 48 hours following thrombosis and have failed to show clinical improvement after a trial of bed rest, elevation of the lower extremities, and intravenous heparin. The majority of patients seen with phlegmasia alba dolens will best be served with nonoperative treatment.

  12. Measurement of venous compliance (8-IML-1)

    NASA Technical Reports Server (NTRS)

    Thirsk, R. B.

    1992-01-01

    The prime objective of this International Microgravity Laboratory (IML-1) investigation is to measure the bulk compliance (distensibility) of the veins in the lower leg before, during, and after spaceflight. It is of particular interest whether venous compliance over the range of both positive and negative transmural pressures (various states of venous distention and collapse) changes throughout the duration of spaceflight. Information concerning the occurrence and character of compliance changes could have implications for the design of improved antigravity suits and further the understanding of inflight and postflight venous hemodynamics.

  13. [Ultrasound-guided peripheral venous access].

    PubMed

    Fuzier, Régis; Rougé, Pierre; Pierre, Sébastien

    2016-02-01

    International guidelines advocate the use of first-line ultrasound for central venous catheter, particularly for the internal jugular vein. The role of ultrasound in peripheral venous access remains questionable. In some specific situations, such as pediatrics, obesity and patients with poor venous network, problems to cannulate peripheral vein may occur. Success rate of peripheral intravenous access increases with the diameter of the vein and for a depth of the vein between 0.3 and 1.5 cm. The type of puncture (long-axis or short-axis) and the type of catheters have little influence on the success rate. Specific considerations have to be taken concerning infection control.

  14. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  15. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  16. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Venous blood pressure manometer. 870.1140 Section... pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a venous catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class...

  17. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.

    PubMed

    Tracz, Edyta; Zamojska, Ewa; Modrzejewski, Andrzej; Zaborski, Daniel; Grzesiak, Wilhelm

    2015-01-01

    The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

  18. Venous disease: the missing link in cardiovascular medicine.

    PubMed

    Madyoon, Hooman; Lepor, Norman E

    2013-01-01

    Until recently, medical literature and the practice of vascular medicine focused on the cosmetic aspects of venous disease and the advanced stages of venous insufficiency such as painful varicose veins and venous ulcers. The systemic effects of venous insufficiency resulting from a reduction of venous return and increased transit time of blood from the lower extremities that can mimic heart failure are only recently being recognized. This article reviews the diagnosis and treatment options for the patients with venous insufficiency, and increases awareness about the systemic effects of venous disease and its role in the practice of cardiovascular medicine. PMID:23651983

  19. The possibility for use of venous flaps in plastic surgery

    NASA Astrophysics Data System (ADS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  20. The possibility for use of venous flaps in plastic surgery

    SciTech Connect

    Baytinger, V. F. Kurochkina, O. S. Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  1. Upper-extremity deep venous thrombosis: a review.

    PubMed

    Mai, Cuc; Hunt, Daniel

    2011-05-01

    Upper-extremity deep venous thrombosis is less common than lower-extremity deep venous thrombosis. However, upper-extremity deep venous thrombosis is associated with similar adverse consequences and is becoming more common in patients with complex medical conditions requiring central venous catheters or wires. Although guidelines suggest that this disorder be managed using approaches similar to those for lower-extremity deep venous thrombosis, studies are refining the prognosis and management of upper-extremity deep venous thrombosis. Physicians should be familiar with the diagnostic and treatment considerations for this disease. This review will differentiate between primary and secondary upper-extremity deep venous thromboses; assess the risk factors and clinical sequelae associated with upper-extremity deep venous thrombosis, comparing these with lower-extremity deep venous thrombosis; and describe an approach to treatment and prevention of secondary upper-extremity deep venous thrombosis based on clinical evidence.

  2. Anatomy of the foot venous pump: physiology and influence on chronic venous disease.

    PubMed

    Uhl, J-F; Gillot, C

    2012-08-01

    The aim of this paper is to demonstrate the location of the venous foot pump using an anatomical study. Four hundred cadaveric feet were injected with green neoprene latex followed by a dissection. A coloured segmentation of the venous system was achieved. The Lejars' concept of the venous sole of the foot is incorrect: the true blood venous reservoir of the foot is located deeply in the plantar veins, between the plantar muscles. The medial and mostly lateral plantar veins converge into the plexus shaped calcaneal crossroad, where the blood is ejected upwards into the two posterior tibial veins. In addition, the several medial perforators of the foot directly connect the deep system (medial plantar veins) to the superficial venous system (medial marginal vein). This forms a true 'medial functional unit' which is unique in the limb given its directional flow is from deep to superficial. In conclusion, the plantar veins play an important role in the physiology of the venous return since a venous reservoir of 25 mL of blood is mobilized upwards with each step during walking. Therefore, the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency.

  3. [Venous thromboembolic disease: presentation of a case].

    PubMed

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion.

  4. Circulating venous bubbles in children after diving.

    PubMed

    Lemaitre, Frederic; Carturan, Daniel; Tourney-Chollet, Claire; Gardette, Bernard

    2009-02-01

    Doppler ultrasonic detection of circulating venous bubbles after a scuba dive is a useful index of decompression safety in adults, since a relationship between bubbles and the risk of decompression sickness has been documented. No study, however, has investigated circulating venous bubbles in young recreational divers after their usual dives. The aim of this study was to determine whether these bubbles would be detected in children who performed a single dive without any modification in their diving habits. Ten young recreational divers (13.1 +/- 2.3 years) performed their usual air dive. They were Doppler-monitored 20 min before the dive (12 +/- 3 m for 26 +/- 7 min) and for 60 min after surfacing, at 20-min intervals. No circulating venous bubbles were detected after the children surfaced. The results showed that during a usual shallow diving session, venous bubbles were not detected in children.

  5. Intraneural Venous Malformations of the Median Nerve

    PubMed Central

    González Rodríguez, Alba; Midón Míguez, José

    2016-01-01

    Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation. PMID:27462571

  6. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  7. Venous air embolism during radical perineal prostatectomy.

    PubMed

    Jolliffe, M P; Lyew, M A; Berger, I H; Grimaldi, T

    1996-12-01

    An abrupt decrease in end-tidal carbon dioxide (CO2) occurred in an anesthetized male who was placed in the head down position during radical perineal prostatectomy. The end-tidal CO2 was restored after insertion of a wet pack into the operative site, which strongly indicated venous air embolism as the cause. Predisposing factors, detection, and treatment of venous air embolism in this setting are discussed.

  8. The chronic cerebrospinal venous insufficiency syndrome.

    PubMed

    Zamboni, P; Galeotti, R

    2010-12-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenosies of the internal jugular and/or azygous veins (IJVs-AZ) with opening of collaterals and insufficient drainage proved by reduced cerebral blood flow and increased mean transit time in cerebral MRI perfusional study. The present review is aimed to give a comprehensive overview of the actual status of the art of the diagnosis and treatment of this condition. As far as the origin of venous narrowing is concerned, phlebographic studies of the IJVs and AZ systems demonstrated that venous stenoses were likely to be truncular venous malformations; mostly, they are intraluminal defects such as malformed valve, septa webs. CCSVI condition has been found to be strongly associated with multiple sclerosis (MS), a disabling neurodegenerative and demyelinating disease considered autoimmune in nature. In several epidemiological observations performed at different latitudes on patients with different genetic backgrounds, the prevalence of CCSVI in MS ranges from 56% to 100%. To the contrary, by using venous MR and/or different Doppler protocols, CCSVI was not detected with the same prevalence. Two pilot studies demonstrated the safety and feasibility in Day Surgery of the endovascular treatment of CCSVI by means of balloon angioplasty (PTA). It determines a significant reduction of postoperative venous pressure. Restenosis rate was found out elevated in the IJVs, but negligible in the AZ. However, PTA seems to positively influence clinical and QoL parameters of the associated MS and warrants further randomized control trials.

  9. Venous catheterization with ultrasound navigation

    SciTech Connect

    Kasatkin, A. A. Nigmatullina, A. R.; Urakov, A. L.

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  10. Venous catheterization with ultrasound navigation

    NASA Astrophysics Data System (ADS)

    Kasatkin, A. A.; Urakov, A. L.; Nigmatullina, A. R.

    2015-11-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient's exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  11. Quality of life in venous disease.

    PubMed

    van Korlaar, Inez; Vossen, Carla; Rosendaal, Frits; Cameron, Linda; Bovill, Edwin; Kaptein, Adrian

    2003-07-01

    Quality of life (QOL) can be defined as the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient. Studies on the impact of chronic venous disease on quality of life are scarce compared to quality of life research in other diseases. The purpose of this paper was to describe instruments that assess the quality of life in patients with chronic venous disease and to review the literature on this topic. A computer search of the MedLine database was performed to identify papers; the bibliographies of relevant articles were reviewed to obtain additional papers. Papers were included if they described the development or use of a quality of life instrument for patients with chronic venous disease. A total of 25 papers were identified that fit the inclusion criteria. The studies described in the papers used six different generic instruments and ten disease-specific instruments. Quality of life in chronic venous disease was assessed in 12 studies. Six studies compared different types of treatment for chronic venous disease where QOL was an outcome measure. Despite the wide variety of measures used, results indicate that the quality of life of patients with chronic venous disease is affected in the physical domain mostly with regard to pain, physical functioning and mobility, and that they suffer from negative emotional reactions and social isolation. We feel that QOL should be a standard measure in future studies in patients with chronic venous disease, preferably with a combination of generic and disease-specific measures.

  12. Quality of life in venous disease.

    PubMed

    van Korlaar, Inez; Vossen, Carla; Rosendaal, Frits; Cameron, Linda; Bovill, Edwin; Kaptein, Adrian

    2003-07-01

    Quality of life (QOL) can be defined as the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient. Studies on the impact of chronic venous disease on quality of life are scarce compared to quality of life research in other diseases. The purpose of this paper was to describe instruments that assess the quality of life in patients with chronic venous disease and to review the literature on this topic. A computer search of the MedLine database was performed to identify papers; the bibliographies of relevant articles were reviewed to obtain additional papers. Papers were included if they described the development or use of a quality of life instrument for patients with chronic venous disease. A total of 25 papers were identified that fit the inclusion criteria. The studies described in the papers used six different generic instruments and ten disease-specific instruments. Quality of life in chronic venous disease was assessed in 12 studies. Six studies compared different types of treatment for chronic venous disease where QOL was an outcome measure. Despite the wide variety of measures used, results indicate that the quality of life of patients with chronic venous disease is affected in the physical domain mostly with regard to pain, physical functioning and mobility, and that they suffer from negative emotional reactions and social isolation. We feel that QOL should be a standard measure in future studies in patients with chronic venous disease, preferably with a combination of generic and disease-specific measures. PMID:12876622

  13. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

    Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance. PMID:2062096

  14. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

    Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance.

  15. Venous thromboembolism (VTE) and glioblastoma.

    PubMed

    Yust-Katz, Shlomit; Mandel, Jacob J; Wu, Jimin; Yuan, Ying; Webre, Courtney; Pawar, Tushar A; Lhadha, Harshad S; Gilbert, Mark R; Armstrong, Terri S

    2015-08-01

    The risk of venous thromboembolism (VTE) is high for patients with brain tumors (11-20 %). Glioblastoma (GBM) patients, in particular, have the highest risk of VTE (24-30 %). The Khorana scale is the most commonly used clinical scale to evaluate the risk of VTE in cancer patients but its efficacy in patients with GBM remains unclear. The aim of this study is to estimate the frequency of VTE in GBM patients and identify potential risk factors for the development of VTE during adjuvant chemotherapy. Furthermore, we intend to examine whether the Khorana scale accurately predicts the risk of VTE in GBM patients. We retrospectively reviewed the medical records of GBM patients treated at MD Anderson during the years 2005-2011. The study cohort included 440 patients of which 64 (14.5 %) developed VTE after the start of adjuvant treatment. The median time to develop VTE was 6.5 months from the start of adjuvant treatment. On multivariate analysis male sex, BMI ≥ 35, KPS ≤ 80, history of VTE and steroid therapy were significantly associated with the development of VTE. The Khorana scale was found to be an invalid VTE predictive model in GBM patients due to poor specificity. Of the 64 patients who developed a VTE, 36 were treated with anticoagulation, 2 with an IVC filter, and 21 with both. Complications (intracranial hemorrhage, bleeding in other organs and thrombocytopenia) secondary to anticoagulation were reported in 16 % (n = 10). VTE is common in patients with GBM. Our results did not validate the Khorana scale in GBM patients. Additional studies identifying which GBM patients are at highest risk for VTE are needed to enable further evaluation of VTE preventive measures in this selected group.

  16. Risk factors for peripheral venous disease resemble those for venous thrombosis: the San Diego Population Study

    PubMed Central

    Cushman, M; Callas, PW; Denenberg, JO; Bovill, EG; Criqui, MH

    2010-01-01

    Background Clinically silent deep vein thrombosis (DVT) is common and may cause chronic venous disease that resembles post-thrombotic syndrome. Objective We evaluated whether peripheral venous disease in a general population shares risk factors with DVT. Methods In an established cohort of 2,404 men and women, the San Diego Population Study, peripheral venous disease was evaluated using physical exam, symptom assessment, and venous ultrasound. We performed a case control study including 308 cases in 4 hierarchical groups by severity, and 346 controls without venous abnormalities, frequency matched to cases by 10-year age group, race and sex. Cases and controls had no prior history of venous thrombosis. Hemostatic risk factors were measured in cases and controls. Results Accounting for age, obesity and family history of leg ulcer, ORs for elevated factor VIII, von Willebrand factor, D-dimer, and for factor V Leiden were 1.4 (95% CI 0.9–2.1), 1.5 (CI 1.0–2.3), 1.7 (CI 1.1–2.8), and 1.1 (CI 0.5–2.4), respectively. These associations were larger in the two most severe case groups; ORs 2.0 (CI 1.0–3.8), 1.7 (CI 0.9–3.3), 2.7 (CI 1.2–6.1) and 2.3 (CI 0.8–7.1). Each hemostatic factor was also associated with severity of venous disease, for example elevated D-dimer was associated with a 2.2-fold increased odds of being in one higher severity group. Prothrombin 20210A was not associated with venous disease. Conclusions DVT risk factors are associated with presence and severity of peripheral venous disease. Results support a hypothesis that peripheral venous disease may sometimes be post-thrombotic syndrome due to previous unrecognized DVT. PMID:20492466

  17. Venous gangrene of the upper extremity.

    PubMed Central

    Smith, B M; Shield, G W; Riddell, D H; Snell, J D

    1985-01-01

    Gangrene of the hand associated with acute upper extremity venous insufficiency has been seen in four limbs in three patients treated at Vanderbilt University Medical Center. All three patients had life-threatening illnesses associated with diminished tissue perfusion, hypercoagulability, and venous injury. One patient progressed to above-elbow amputation, but venous thrombectomy in one limb and thrombolytic therapy in two others were successful in preventing major tissue loss. All three patients eventually died from their underlying illness. Thirteen previously reported patients with "venous gangrene" of the upper extremity have been analyzed. An underlying life-threatening illness was present in the majority of these patients (7/13, 54%) and, like the Vanderbilt series, amputations were frequent (7/13, 54%) and mortality (5/13, 38%) was high. This unusual form of ischemia appears to be produced by permutations of global circulatory stasis, subclavian or axillary vein occlusion, and peripheral venous thrombosis. Early, aggressive restoration of adequate cardiac output and thrombectomy and/or thrombolytic therapy may provide the best chance for tissue salvage and survival in this group of patients. Images FIG. 1. FIG. 2. FIG. 3. FIG. 4. FIG. 5. FIGS. 6A and B. FIGS. 7A and B. FIG. 8. PMID:3977453

  18. Venous Malformation: update on etiopathogenesis, diagnosis & management

    PubMed Central

    Dompmartin, Anne; Vikkula, Miikka; Boon, Laurence M

    2011-01-01

    The aim of this review was to discuss the current knowledge on etiopathogenesis, diagnosis and therapeutic management of venous malformations. Venous malformations (VMs) are slow-flow vascular anomalies. They are simple, sporadic or familial (cutaneo-mucosal venous malformation or glomuvenous malformations), combined (e.g. capillaro-venous, capillaro-lymphaticovenous malformations) or syndromic (Klippel-Trenaunay, Blue Rubber Bleb Naevus and Maffucci). Genetic studies have identified causes of familial forms and of 40% of sporadic VMs. Another diagnostic advancement is the identification of elevated D-dimer level as the first biomarker of venous malformations within vascular anomalies. Those associated with pain are often responsive to Low Molecular Weight Heparin which should also be used to avoid disseminated intravascular coagulopathy secondary to intervention, especially if fibrinogen level is low. Finally, development of a modified sclerosing agent, ethylcellulose–ethanol, has improved therapy. It is efficient and safe, and widens indications for sclerotherapy to sensitive and dangerous areas such as hands, feet and periocular area. PMID:20870869

  19. Comparison of Oseltamivir and Oseltamivir Carboxylate Concentrations in Venous Plasma, Venous Blood, and Capillary Blood in Healthy Volunteers

    PubMed Central

    Instiaty, Insti; Lindegardh, Niklas; Jittmala, Podjanee; Hanpithakpong, Warunee; Blessborn, Daniel; Pukrittayakamee, Sasithon; White, Nicholas J.

    2013-01-01

    Oseltamivir and oseltamivir carboxylate concentrations were measured in venous plasma, venous blood, and capillary blood taken simultaneously from 24 healthy volunteers. Median (range) venous-blood-to-plasma ratios were 1.42 (0.920 to 1.97) for oseltamivir and 0.673 (0.564 to 0.814) for oseltamivir carboxylate. Capillary blood/venous plasma ratios were 1.32 (0.737 to 3.16) for oseltamivir and 0.685 (0.502 to 1.34) for oseltamivir carboxylate. Oseltamivir concentrations in venous and capillary blood were similar. Oseltamivir carboxylate showed a time-dependent distribution between venous and capillary blood. PMID:23507284

  20. [Cerebral venous thrombosis during tuberculous meningoencephalitis].

    PubMed

    Guenifi, W; Boukhrissa, H; Gasmi, A; Rais, M; Ouyahia, A; Hachani, A; Diab, N; Mechakra, S; Lacheheb, A

    2016-05-01

    Cerebral venous thrombosis is a rare disease characterized by its clinical polymorphism and multiplicity of risk factors. Infections represent less than 10% of etiologies. Tuberculosis is not a common etiology, only a few observations are published in the literature. Between January 2005 and March 2015, 61 patients were hospitalized for neuro-meningeal tuberculosis. Among them, three young women had presented one or more cerebral venous sinus thromboses. No clinical feature was observed in these patients; vascular localizations were varied: sagittal sinus (2 cases), lateral sinus (2 cases) and transverse sinus (1 case). With anticoagulant and antituberculosis drugs, the outcome was favorable in all cases. During neuro-meningeal tuberculosis, the existence of consciousness disorders or neurological focal signs is not always the translation of encephalitis, hydrocephalus, tuberculoma or ischemic stroke; cerebral venous sinus thrombosis may be the cause and therefore should be sought. PMID:27090100

  1. Infections associated with the central venous catheters.

    PubMed

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  2. Noninvasive measurement of central venous pressure

    NASA Technical Reports Server (NTRS)

    Webster, J. G.; Mastenbrook, S. M., Jr.

    1972-01-01

    A technique for the noninvasive measurement of CVP in man was developed. The method involves monitoring venous velocity at a point in the periphery with a transcutaneous Doppler ultrasonic velocity meter while the patient performs a forced expiratory maneuver. The idea is the CVP is related to the value of pressure measured at the mouth which just stops the flow in the vein. Two improvements were made over the original procedure. First, the site of venous velocity measurement was shifted from a vein at the antecubital fossa (elbow) to the right external jugular vein in the neck. This allows for sensing more readily events occurring in the central veins. Secondly, and perhaps most significantly, a procedure for obtaining a curve of relative mean venous velocity vs mouth pressure was developed.

  3. Prevalence of detectable venous pressure drops expected with venous needle dislodgement.

    PubMed

    Ribitsch, Werner; Schilcher, Gernot; Hafner-Giessauf, Hildegard; Krisper, Peter; Horina, Jörg H; Rosenkranz, Alexander R; Schneditz, Daniel

    2014-01-01

    Venous needle dislodgement (VND) is a potentially fatal complication during hemodialysis (HD) treatment and the venous pressure monitor is the most widely used device for its detection. VND can only be detected by the venous sensor if the resulting pressure drop exceeds the difference between the actual venous pressure and the lower alarm limit. In clinical practice, the lower alarm limit is usually set 30-40 mmHg below the actual venous pressure to avoid a disproportionate high number of nuisance alarms. The aim of this study was to quantify the number of fistulas and grafts in a group of HD patients where venous pressure monitoring can be expected to detect VND. We determined intra-access pressures in 99 chronic HD patients. Sixty-five (65.7%) had a fistula and 34 (34.3%) had a prosthetic graft as a vascular access. Mean intra-access pressure (Pa ) in fistulas was 32.6 ± 23.5 mmHg, whereas in grafts mean Pa was 60.9 ± 19.5 mmHg. Nineteen (29.2%) of the fistulas and 32 (94.1%) of the grafts exhibited an intra-access pressure above 40 mmHg. Therefore, in our study nearly all grafts but only 29% of fistulas would fulfill the requirement for venous pressure monitoring to detect VND. PMID:24341865

  4. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  5. ASSESSMENT OF VENOUS THROMBOSIS IN ANIMAL MODELS

    PubMed Central

    SP, Grover; CE, Evans; AS, Patel; B, Modarai; P, Saha; A, Smith

    2016-01-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro computed tomography and high frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition. PMID:26681755

  6. Assessment of Venous Thrombosis in Animal Models.

    PubMed

    Grover, Steven P; Evans, Colin E; Patel, Ashish S; Modarai, Bijan; Saha, Prakash; Smith, Alberto

    2016-02-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition.

  7. [A case of retroperitoneal venous aneurysm].

    PubMed

    Maeda, S; Tamaki, M; Yamamoto, N; Takeda, A; Kuriyama, M; Kawada, Y; Mizoguchi, Y; Kasahara, M

    1991-01-01

    Venous aneurysm is a rare entity and the disease occurring in the retroperitoneal space has been reported in only 4 cases. Therefore, the fifth case of retroperitoneal venous aneurysm on the literature was described. A 59-year-old male was referred to our clinic because of painless large mass in the left abdomen. Computed tomography, ultrasonography, and magnetic resonance imaging revealed a cystic mass at the perinephric space. The resected cyst contained yellow-grayish fluid. The cyst wall was microscopically formed of 4 layers; blood and cholesterin, hyaline, muscle and collagen from the inner to outer side. He is well without any trouble after the operation.

  8. Detection of deep venous thrombophlebitis by gallium 67 scintigraphy

    SciTech Connect

    Miller, J.H.

    1981-07-01

    Deep venous thrombophlebitis may escape clinical detection. Three cases are reported in which whole-body gallium 67 scintigraphy was used to detect unsuspected deep venous thrombophlebitis related to indwelling catheters in three children who were being evaluated for fevers of unknown origin. Two of these children had septicemia from Candida organisms secondary to these venous lines. Gallium 67 scintigraphy may be useful in the detection of complications of indwelling venous catheters.

  9. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... catheter to indicate manometrically the central or peripheral venous pressure. (b) Classification. Class II... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous...

  10. 21 CFR 870.1140 - Venous blood pressure manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Venous blood pressure manometer. 870.1140 Section... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1140 Venous blood pressure manometer. (a) Identification. A venous blood pressure manometer is a device attached to a...

  11. Nonclinical aspects of venous thrombosis in pregnancy.

    PubMed

    Struble, Evi; Harrouk, Wafa; DeFelice, Albert; Tesfamariam, Belay

    2015-09-01

    Pregnancy is a hypercoagulable state which carries an excess risk of maternal venous thrombosis. Endothelial injury, alterations in blood flow and activation of the coagulation pathway are proposed to contribute to the hypercoagulability. The risk for thrombosis may be accentuated by certain drugs and device implants that directly or indirectly affect the coagulation pathway. To help ensure that these interventions do not result in adverse maternal or fetal outcomes during pregnancy, gravid experimental animals can be exposed to such treatments at various stages of gestation and over a dosage range that would identify hazards and inform risk assessment. Circulating soluble biomarkers can also be evaluated for enhancing the assessment of any increased risk of venous thrombosis during pregnancy. In addition to traditional in vivo animal testing, efforts are under way to incorporate reliable non-animal methods in the assessment of embryofetal toxicity and thrombogenic effects. This review summarizes hemostatic balance during pregnancy in animal species, embryofetal development, biomarkers of venous thrombosis, and alterations caused by drug-induced venous thrombosis.

  12. Arterial and Venous Thrombosis in Cancer Patients

    PubMed Central

    Blann, Andrew D.; Dunmore, Simon

    2011-01-01

    The most frequent ultimate cause of death is myocardial arrest. In many cases this is due to myocardial hypoxia, generally arising from failure of the coronary macro- and microcirculation to deliver enough oxygenated red cells to the cardiomyocytes. The principle reason for this is occlusive thrombosis, either by isolated circulating thrombi, or by rupture of upstream plaque. However, an additionally serious pathology causing potentially fatal stress to the heart is extra-cardiac disease, such as pulmonary hypertension. A primary cause of the latter is pulmonary embolus, considered to be a venous thromboembolism. Whilst the thrombotic scenario has for decades been the dominating paradigm in cardiovascular disease, these issues have, until recently, been infrequently considered in cancer. However, there is now a developing view that cancer is also a thrombotic disease, and notably a disease predominantly of the venous circulation, manifesting as deep vein thrombosis and pulmonary embolism. Indeed, for many, a venous thromboembolism is one of the first symptoms of a developing cancer. Furthermore, many of the standard chemotherapies in cancer are prothrombotic. Accordingly, thromboprophylaxis in cancer with heparins or oral anticoagulation (such as Warfarin), especially in high risk groups (such as those who are immobile and on high dose chemotherapy), may be an important therapy. The objective of this communication is to summarise current views on the epidemiology and pathophysiology of arterial and venous thrombosis in cancer. PMID:21403876

  13. [Arterial and venous microanastomoses in the rat].

    PubMed

    Gianaroli, L; Bufferli, M; Livani, M F

    1980-11-15

    Arterial and venous microvascular surgery for diameters smaller than 2 mm are shown with particular care. Some technical devices are put in evidence. Besides their statistical data the Authors present immediate and long term post-operative controls which are usually applied. The most frequent causes of failure are discussed. PMID:7213480

  14. [Prevention of venous thromboembolism in psychiatry].

    PubMed

    Malý, R; Masopust, J; Konupcíková, K

    2006-03-01

    The hospitalized patients of the psychiatric wards represent a risk group for the development of venous thromboembolism. Apart from sedative administration, total movement reduction, bad life style and daily routine and increased body weight, there is negative impact of dehydration, prolonged hospitalization and sometimes immobilisation in consequence of mechanical restraints. A large amount of patients are treated with antipsychotics that have a series of adverse effects. Depending of the drug used, the most frequent of them are somnolence, fatigue, extrapyramidal syndrome, hypotension, hepatotoxicity, increased body weight, prolongation of the QT interval of the ECG with a risk of ventricular arrhythmias, hematopoietic disorders, lipid or glycide metabolism disorders or hyperprolactinemia. Another potential adverse effect of these drugs is the heightened risk of venous thromboembolism development (deep vein thrombosis and/or pulmonary embolism). There is the risk of a pathological blood clotting event in psychiatric patients, especially those treated with antipsychotics. Although it is not high, it can have fatal consequences when combined with a relatively frequent pulmonary embolism and difficult diagnostics of thromboembolism. An algorithm for thromboembolism prevention has been developed. It involves important general risk factors of venous thrombosis (VTE history, immobilisation, malignancy, age over 75 years etc.) and also markers (physical restraints, dehydration, obesity, antipsychotics use) that can participate in the pathogenesis of venous thrombosis in the hospitalized psychiatric patients with limited motility. The authors believe that this prophylaxis is indicated, safe, effective and that it improves the quality of life at relatively low costs.

  15. Mesenteric venous thrombosis: clinical and therapeutical approach.

    PubMed

    Hotoleanu, C; Andercou, O; Andercou, A

    2008-12-01

    Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis of venous thrombosis. Leukocytosis and metabolic acidosis are considered to be the most specific laboratory findings in patients with mesenteric ischemia. Abdominal computed tomography is the test of choice for the diagnosis. However, most of the cases are diagnosed during laparotomy or autopsy. Anticoagulant therapy administrated early increases the survival rate. Surgery is indicated in cases with bowel infarction or peritonitis.

  16. [Venous vascularization of the lentiform nucleus].

    PubMed

    Wolfram-Gabel, R; Maillot, C

    The venous vascularization of the nucleus lentiformis in man is studied in 30 brains by injecting the vascular system with gelatinous Indian ink. The venous vascularization of the nucleus lentiformis is drained towards the deep venous system of the brain by two ways, one ascending, the other descending. The first one is formed by superior lenticular veins which drain into the thalamo-striate vein, principal tributary of the internal cerebral vein. The second one is formed by inferior lenticular veins which depend from the deep middle cerebral vein, another tributary of the internal cerebral vein. The veins of the nucleus lentiformis, especially the veins of the putamen, present many similarities with these one of the cerebral cortex. They form the center of venous units surrounded by an arterial ring formed by the branches of ramification of the central arteries. The principal vein of the unit is surrounded by a capillary-free space. This similarities may be explained by the common origin of the cerebral cortex and of the putamen, both belong to the neocortical system.

  17. PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ORTHOPAEDIC SURGERY

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sguizzatto, Guilherme Turolla

    2015-01-01

    The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presentation and critique of prophylaxis currently available in our environment. PMID:27047885

  18. Transplantation of cryopreserved canine venous allografts.

    PubMed

    Bank, H L; Schmehl, M K; Warner, R; Pratt, M F; Albernaz, M S; Metcalf, J S; Darcy, M

    1991-01-01

    Local vascular reconstructions frequently require the use of vein grafts to bridge arterial or venous defects. Most previous studies on the use of cryopreserved veins have used relatively large caliber vessels. There have been few studies on the effectiveness of cryopreserved micro- or small-venous allografts. Here, we tested two types of cryopreserved venous allografts: (1) 1.5- to 1.9-mm diameter microvenous grafts (MVG); and (2) 4- to 5-mm diameter small venous grafts (SVG). Cryopreserved MVG allografts were placed into saphenous arteries of six experimental dogs and SVG cryopreserved allografts were placed into femoral arteries of six experimental dogs for 3 to 6 weeks. Two fresh MVG autografts were also transplanted into experimental dogs as controls and autografts were transferred to the contralateral side in SVG dogs as controls. None of the six cryopreserved MVG grafts retained patency but three/six cryopreserved SVG allografts were patent at harvest. Histological examination of grfts revealed control autografts were undergoing arterialization with an intact intima. Experimental cryopreserved allografts showed extensive medial fibrosis, significant lymphocytic infiltrates, and sporadic areas of intact intima for both patent and nonpatent grafts.

  19. [A case of retroperitoneal venous aneurysm].

    PubMed

    Tsujimura, A; Nishimura, K; Matsumiya, K; Oka, T; Takaha, M; Arima, R; Kurata, A

    1992-09-01

    A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.

  20. Arterialized Venous Bone Flaps: An Experimental Investigation

    PubMed Central

    Borumandi, Farzad; Higgins, James P.; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander

    2016-01-01

    In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705

  1. The aetiology of deep venous thrombosis.

    PubMed

    Malone, P C; Agutter, P S

    2006-09-01

    Most ideas about the pathogenesis of deep venous thrombosis (DVT) are dominated by a 'consensus model' first articulated around 1962. This model invokes 'Virchow's triad' and attributes thrombogenesis in veins to some combination of 'hypercoagulability', 'stasis' and 'intimal injury'. This arose as a by-product of studies on the mechanisms of haemostasis and bleeding diatheses that were at best only indirectly relevant to thrombosis, and there are reasons for doubting the causal significance of 'hypercoagulability' and 'stasis' in the aetiology of DVT. Proponents of the consensus model make little reference to a substantial literature, mostly historical, that: (a) emphasizes the significance of the venous valve pockets (VVP) and blood rheology in DVT pathogenesis; and (b) describes morphological features specific to venous thrombi that a valid aetiological model must explain. This literature provides the basis for an alternative hypothesis of DVT aetiology, published some 30 years ago, which has been experimentally corroborated and is compatible with recent cell and molecular biological studies of the venous endothelium. We review this alternative hypothesis, considering its potential value for future research on DVT and embolism, and its significance for clinical practice.

  2. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    PubMed

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration. PMID:19648868

  3. [Venous thrombosis associated with central venous catheter use in patients with cancer].

    PubMed

    Iglesias Rey, Leticia; Fernández Pérez, Isaura; Barbagelata López, Cristina; Rivera Gallego, Alberto

    2015-01-01

    The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment.

  4. To what extent might deep venous thrombosis and chronic venous insufficiency share a common etiology?

    PubMed

    Malone, P Colm; Agutter, P S

    2009-08-01

    According to the valve cusp hypoxia hypothesis (VCHH), deep venous thrombosis is caused by sustained non-pulsatile (streamline) venous blood flow. This leads to hypoxemia in the valve pockets; hypoxic injury to the inner (parietalis) endothelium of the cusp leaflets activates the elk-1/egr-1 pathway, leading to leukocyte and platelet swarming at the site of injury and, potentially, blood coagulation. Here, we propose an extension of the VCHH to account for chronic venous insufficiency. First, should the foregoing events not proceed to frank thrombogenesis, the valves may nevertheless be chronically injured and become incompetent. Serial incompetence in lower limb valves may then generate ''passive'' venous hypertension. Second, should ostial valve thrombosis obstruct venous return from muscles via tributaries draining into the femoral vein, as Virchow illustrated, ''active'' venous hypertension may supervene: muscle contraction would force the blood in the vessels behind the blocked ostial valves to re-route. Passive or active venous hypertension opposes return flow, leading to luminal hypoxemia and vein wall distension, which in turn may impair vasa venarum perfusion; the resulting mural endothelial hypoxia would lead to leukocyte invasion of the wall and remodelling of the media. We propose that varicose veins result if gross active hypertension stretches the valve ''rings'', rendering attached valves incompetent caudad to obstructed sites, replacing normal centripetal flow in perforating veins with centrifugal flow and over-distending those vessels. We also discuss how hypoxemia-related venous/capillary wall lesions may lead to accumulation of leukocytes, progressive blockage of capillary blood flow, lipodermosclerosis and skin ulceration.

  5. Partial Aortic Occlusion and Cerebral Venous Steal: Venous Effects of Arterial Manipulation in Acute Stroke

    PubMed Central

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S.

    2011-01-01

    Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and “luxury perfusion” in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifest by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution, analogous to positive end expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs. PMID:21441149

  6. Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

    PubMed Central

    Prasad, Deepa; Strainic, James P.; Pandya, Khyati; Kouretas, Peter C.

    2016-01-01

    We report a rare causal association between obstructed supracardiac totally anomalous pulmonary venous drainage and coronary sinus ostial atresia. Our 12-week-old patient developed venous myocardial infarction secondary to coronary venous hypertension because her sole route of coronary venous drainage was obstructed. She recovered after the obstruction was relieved by balloon dilation. Surgical repair then included anastomosis of the pulmonary venous confluence to the left atrium, ligation of the vertical vein, and unroofing of the coronary sinus. Coronary sinus ostial atresia is rarely diagnosed before autopsy. PMID:27777530

  7. Navigating venous access: a guide for hospitalists.

    PubMed

    Simonov, Michael; Pittiruti, Mauro; Rickard, Claire M; Chopra, Vineet

    2015-07-01

    Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However, such knowledge is difficult to come by and usually only gleaned through years of clinical experience. To bridge this gap, we provide an in-depth summary of the relevant anatomical considerations, physical characteristics, advantages, and disadvantages of VADs commonly used in the hospital setting. In doing so, we seek to improve the safety and share the science of vascular access with frontline clinicians. To aid decision-making, we conclude by operationalizing the available data through algorithms that outline appropriate vascular access for the hospitalized patient. PMID:25755150

  8. Venous thromboembolism in women taking hormonal contraceptives.

    PubMed

    Blanco-Molina, Angeles; Monreal, Manuel

    2010-02-01

    Hormonal contraceptives are a popular method of contraception, but their use has been associated with an increased risk for venous thromboembolism. In order to reduce such risk, these compounds have been changed in their dosage, chemical composition and route of administration. The absolute risk of death from pulmonary embolism in contraceptive users has been estimated to be 10.5 (95% CI: 6.2-16.6) per million woman-years. The safest option is an oral contraceptive containing levonorgestrel combined with a low dose of estrogen. Identifying women at increased risk for venous thromboembolism is difficult, and greater use of thromboprophylaxis during immobility or minor surgery should be warranted. Several authors have called for all women to be screened for thrombophilia before prescription of hormonal contraceptives, but its cost-effectiveness remains uncertain.

  9. Reduction of venous thrombosis complicating phlebography

    SciTech Connect

    Bettmann, M.A.; Salzman, E.W.; Rosenthal, D.; Clagett, P.; Davies, G.; Nebesar, R.; Rabinov, K.; Ploetz, J.; Skillman, J.

    1980-06-01

    Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive /sup 125/I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reuction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.

  10. Deep venous thrombophlebitis following aortoiliac reconstructive surgery

    SciTech Connect

    Reilly, M.K.; McCabe, C.J.; Abbott, W.M.; Brewster, D.C.; Moncure, A.C.; Reidy, N.C.; Darling, R.C.

    1982-09-01

    One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption.

  11. [Paraspinal arteriovenous malformations with perimedullary venous drainage].

    PubMed

    Schmidt, C; Lonjon, J; Costalat, V; Menjot De Champfleur, N; Seris, C; Brunel, H; Bourbotte, G; Bouillot, P; Teissier, J-M; Martinat, P; Bonafe, A

    2008-07-01

    Symptoms of chronic myelopathy in cases of paraspinal arteriovenous malformations are most often related to perimedullary venous drainage. Here, we report on three cases of such malformations that have unique epidural venous drainage. These thoracolumbar lesions manifested as isolated back pain (in two cases) and S1 lumboradicular pain (in one case). MRI presented evidence to suggest a diagnosis of these rare conditions, based on signs of vertebral erosion, signal loss (flow void) on T1- and T2-weighted imaging, and partial enhancement after gadolinium injection, with no signs of congestive myelopathy. Spinal angiography confirmed the presence of a paraspinal fistula and, at the same time, allowed treatment by intra-arterial onyx injection.

  12. Aneurysmal portosystemic venous shunt: a case report.

    PubMed

    Bodner, G; Glück, A; Springer, P; König, P; Perkmann, R

    1999-10-01

    A case of an aneurysmal portosystemic venous shunt detected by colour Doppler ultrasound (CDUS) is presented. A young female patient complained of postprandial fatigue and had paroxysmal tachycardia. A direct vascular communication between right portal vein and right hepatic vein was found at CDUS and confirmed by direct portal angiogram. Using detachable coils a complete occlusion of the intrahepatic shunt was obtained. Reports from the literature regarding portovenous aneurysms are reviewed.

  13. [Venous drainage of Littler's neurovascular pedicle flap].

    PubMed

    Lebreton, E; Assouline, A

    1988-01-01

    The antegrade transosseous injection of the digital veins, followed by dissection enables the authors to analyse the role of various networks in drainage of the pulp. The satellite veins of the digital artery in the finger are probably not involved. The venous return of the pulp is constituted by an anatomical continuity between the superficial palmar network and the common digital veins. A narrow anastomotic channel is demonstrated in the commissure between these two systems.

  14. [Implantable venous access ports, nursing practices].

    PubMed

    Ourliac, Maryse; Dijols-Lécuyer, Isabelle

    2016-05-01

    Following the publication of national recommendations regarding the handling of implantable venous access ports, an observation audit was carried out in a hospital in 2013. This enabled an assessment of the existing system to be performed, current practices to be compared with the hospital's protocol and adapted corrective measures to be put in place. A further audit carried out in 2015 was particularly encouraging. PMID:27157553

  15. What's new: Management of venous leg ulcers: Approach to venous leg ulcers.

    PubMed

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.

  16. Transpulmonary passage of venous air emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Hills, B. A.

    1985-01-01

    Twenty-seven paralyzed anesthetized dogs were embolized with venous air to determine the effectiveness of the pulmonary vasculature for bubble filtration or trapping. Air doses ranged from 0.05 to 0.40 ml/kg min in 0.05-ml increments with ultrasonic Doppler monitors placed over arterial vessels to detect any microbubbles that crossed the lungs. Pulmonary vascular filtration of the venous air infusions was complete for the lower air doses ranging from 0.05 to 0.30 ml/kg min. When the air doses were increased to 0.35 ml/kg min, the filtration threshold was exceeded with arterial spillover of bubbles occurring in 50 percent of the animals and reaching 71 percent for 0.40 ml/kg min. Significant elevations were observed in pulmonary arterial pressure and pulmonary vascular resistance. Systemic blood pressure and cardiac output decreased, whereas left ventricular end-diastolic pressure remained unchanged. The results indicate that the filtration of venous bubbles by the pulmonary vasculature was complete when the air infusion rates were kept below a threshold value of 0.30 ml/kg min.

  17. Fluid dynamics of venous valve closure.

    PubMed

    Qui, Y; Quijano, R C; Wang, S K; Hwang, N H

    1995-01-01

    In vitro experiment was performed on a stented bovine jugular vein valve (VV, 14 mm I.D. x 2 cm long) and a stentless bovine jugular vein valve conduit (10 mm I.D. x 6 cm long) in a hydraulic flow loop with a downstream oscillatory pressure source to mimic respiratory changes. Simultaneous measurements were made on the valve opening area, conduit and sinus diameter changes using a specially designed laser optic system. Visualization of flow fields both proximal and distal to the venous valve, and the valve opening area were simultaneously recorded by using two video cameras. Laser Doppler anemometer surveys were made at three cross sections: the valve inlet, the valve exist, and 2 cm downstream of the venous valve to quantity flow reflux at valve closure. The experiment confirmed that the VV is a pressure-operated rather than a flow-driven device and that little or no reflux is needed to close the valve completely. The experiment further demonstrated that the VV sinus expands rapidly against back pressure, a critical character to consider in venous prosthesis design. PMID:8572425

  18. Porto-spleno-mesenteric venous thrombosis.

    PubMed

    Battistelli, S; Coratti, F; Gori, T

    2011-02-01

    Porto-spleno-mesenteric (PSM) venous thrombosis is a rare clinical condition that, while being mostly unrecognized, is nonetheless often severe with a high morbidity and mortality. PSM venous thrombosis is the cause of as many as 5-10% of all abdominal ischemic events, and it presents with a highly variable and non-specific pattern of abdominal symptoms. Such complex and non-specific presentation can delay diagnosis, determining the poor clinical outcome of this condition. This review article discusses the information available on the pathogenesis, clinical presentation, diagnosis and general management of PSM venous thrombosis, with a focus on a number of some clinical issues that remain unaddressed. In particular, the current understanding of the predisposing factors and the heterogeneous clinical manifestations of this condition are described in detail. The recent advances in imaging techniques, which are leading to an improved diagnostic accuracy and facilitate an early diagnosis are also presented. Further, the indications and limits of both pharmacological and surgical treatment options are discussed.

  19. [Outpatient treatment of venous thromboembolic disease].

    PubMed

    Malý, Radovan; Malý, Jaroslav

    2015-05-01

    Venous thromboembolic disease which includes both venous thrombosis and pulmonary embolism, is a frequent and potentially fatal disease. Based on the introduction of low-molecular-weight heparins (LMWH) into practice it has been proved that outpatient treatment of venous thrombosis is effective and safe for a large number of patients with VTE. The growing volume of data on LMWH outpatient treatment in recent years shows that up to 50 % of patients with clinically stable pulmonary embolism can be treated at home. In spite of these facts home treatment of pulmonary embolism has not been established as part of common practice as yet. If we were to summarize the conditions for home treatment, we would consider outpatient care for patients at low risk based on auxiliary criteria, free from hemodynamic instability (primarily without a shock state), free from right ventricular failure, prior chronic heart or lung disease, serious comorbidities (gastrointestinal tract disease, kidney disease, blood diseases, advanced cancers), at low risk of early thromboembolism recurrence, free from other indications for hospitalization (pain requiring parenteral analgesics, infections etc.), at low risk of bleeding and with guaranteed patients cooperation and well-organized home care. PMID:26075852

  20. Mesenteric venous thrombosis: diagnosis and noninvasive imaging.

    PubMed

    Bradbury, Michelle S; Kavanagh, Peter V; Bechtold, Robert E; Chen, Michael Y; Ott, David J; Regan, John D; Weber, Therese M

    2002-01-01

    Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. Doppler ultrasonography allows direct evaluation of the mesenteric and portal veins, provides semiquantitative flow information, and allows Doppler waveform analysis of the visceral vessels; however, it is operator dependent and is often limited by overlying bowel gas. Conventional contrast material-enhanced computed tomography (CT) allows sensitive detection of venous thrombosis within the central large vessels of the portomesenteric circulation and any associated secondary findings; however, it is limited by respiratory misregistration, motion artifact, and substantially decreased longitudinal spatial resolution. Helical CT and CT angiography, especially when performed with multi-detector row scanners, and magnetic resonance (MR) imaging, particularly gadolinium-enhanced MR angiography, enable volumetric acquisitions in a single breath hold, eliminating motion artifact and suppressing respiratory misregistration. Helical CT angiography and three-dimensional gadolinium-enhanced MR angiography should be considered the primary diagnostic modalities for patients with a high clinical suspicion of mesenteric ischemia. Conventional angiography is reserved for equivocal cases at noninvasive imaging and is also used in conjunction with transcatheter therapeutic techniques in management of symptomatic portal and mesenteric venous thrombosis.

  1. Clinical significance of intracranial developmental venous anomalies

    PubMed Central

    Topper, R.; Jurgens, E.; Reul, J.; Thron, A.

    1999-01-01

    OBJECTIVES—Venous angiomas, or developmental venous anomalies (DVAs), represent the most often occurring cerebral vascular malformation. The clinical significance of a DVA is, however, at present unclear.
METHODS—A retrospective analysis was carried out on two series of consecutive cranial MRIs performed between January 1990 and August 1996 in a university department of neuroradiology and in a large radiological private practice. The medical records of all patients in whom a DVA was diagnosed were screened to identify the specific complaint which necessitated the imaging procedure.
RESULTS—A total of 67 patients with DVA could be identified. In 12 patients an associated cavernoma was found. The main reason for performing the MRI was the evaluation of seizures or of headaches. In all patients with DVA in whom an intracerebral haemorrhage was diagnosed an associated cavernoma was present at the site of the haemorrhage. None of the 67 patients showed an association between the complaints that led to the MRI and the location of the DVA.
CONCLUSIONS—DVAs do not seem to be associated with a specific clinical presentation. In a significant percentage of cases, however, coexisting cavernomas are found which have a defined bleeding potential and should be treated independently of the DVA. This study supports the hypothesis that DVAs are a congenital abnormality of venous drainage without clinical significance.

 PMID:10407000

  2. [Management of venous thromboembolism: A 2015 update].

    PubMed

    Galanaud, J-P; Messas, E; Blanchet-Deverly, A; Quéré, I; Wahl, D; Pernod, G

    2015-11-01

    Deep venous thrombosis (DVT) and pulmonary embolism (PE) constitute venous thromboembolic disease (VTE). Venous thromboembolic disease is a common, serious, and multifactorial disease, the incidence of which increases with age. Risk factors, whether transient (surgery, plaster immobilization, bed rest/hospitalization) or chronic/persistent (age, cancer, clinical or biological thrombophilia, etc.), modulate the duration of treatment. In the absence of pathognomonic clinical sign or symptom, diagnostic management relies in the evaluation of the clinical pre-test probability followed by a laboratory or an imaging testing. So far, compression ultrasound and multidetector computed tomography angiography are the best diagnostic tests to make a positive diagnosis of DVT or PE, respectively. Anticoagulants at therapeutic dose for at least 3months constitute the cornerstone of VTE management. Availability of new direct oral anticoagulants, which have recently been shown to be as effective and as safe as vitamin K antagonist in clinical trials, should facilitate ambulatory management of VTE and favour extended treatments for individuals with unprovoked VTE or VTE provoked by a chronic/persistent risk factor.

  3. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

    PubMed

    Lee, Byung B; Nicolaides, Andrew N; Myers, Kenneth; Meissner, Mark; Kalodiki, Evi; Allegra, Claudio; Antignani, Pier L; Bækgaard, Niels; Beach, Kirk; Belcaro, Giovanni; Black, Stephen; Blomgren, Lena; Bouskela, Eliete; Cappelli, Massimo; Caprini, Joseph; Carpentier, Patrick; Cavezzi, Attilio; Chastanet, Sylvain; Christenson, Jan T; Christopoulos, Demetris; Clarke, Heather; Davies, Alun; Demaeseneer, Marianne; Eklöf, Bo; Ermini, Stefano; Fernández, Fidel; Franceschi, Claude; Gasparis, Antonios; Geroulakos, George; Sergio, Gianesini; Giannoukas, Athanasios; Gloviczki, Peter; Huang, Ying; Ibegbuna, Veronica; Kakkos, Stavros K; Kistner, Robert; Kölbel, Tilo; Kurstjens, Ralph L; Labropoulos, Nicos; Laredo, James; Lattimer, Christopher R; Lugli, Marzia; Lurie, Fedor; Maleti, Oscar; Markovic, Jovan; Mendoza, Erika; Monedero, Javier L; Moneta, Gregory; Moore, Hayley; Morrison, Nick; Mosti, Giovanni; Nelzén, Olle; Obermayer, Alfred; Ogawa, Tomohiro; Parsi, Kurosh; Partsch, Hugo; Passariello, Fausto; Perrin, Michel L; Pittaluga, Paul; Raju, Seshadri; Ricci, Stefano; Rosales, Antonio; Scuderi, Angelo; Slagsvold, Carl E; Thurin, Anders; Urbanek, Tomasz; M VAN Rij, Andre; Vasquez, Michael; Wittens, Cees H; Zamboni, Paolo; Zimmet, Steven; Ezpeleta, Santiago Z

    2016-06-01

    There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein

  4. Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens.

    PubMed

    Lal, Brajesh K

    2015-03-01

    Venous ulcer is a common vascular condition affecting 1% of the population, and a prevalence that increases with age. Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." The economic and social burden of this condition is significant to both the affected individual and the health care system. The recurrent nature of venous ulcers underscore the need for treatment of the underlying pathophysiology, that is, ambulatory venous hypertension produced by venous valve reflux alone or in conjunction with venous obstruction.

  5. Clinical features of venous insufficiency and the risk of venous thrombosis in older people.

    PubMed

    Engbers, Marissa J; Karasu, Alev; Blom, Jeanet W; Cushman, Mary; Rosendaal, Frits R; van Hylckama Vlieg, Astrid

    2015-11-01

    Venous thrombosis is common in older age, with an incidence of 0·5-1% per year in those aged >70 years. Stasis of blood flow is an important contributor to the development of thrombosis and may be due to venous insufficiency in the legs. The risk of thrombosis associated with clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, obtained with a standardized interview was assessed in the Age and Thrombosis Acquired and Genetic risk factors in the Elderly (AT-AGE) study. The AT-AGE study is a case-control study in individuals aged 70 years and older (401 cases with a first-time venous thrombosis and 431 control subjects). We calculated odds ratios (ORs) and corresponding 95% confidence intervals (CI) adjusted for age, sex and study centre. Varicose veins and leg ulcer were associated with a 1·6-fold (95% CI 1·2-2·3) and 3·3-fold increased risk of thrombosis (95% CI 1·6-6·7), respectively, while the risk was increased 3·0-fold (95% CI 2·1-4·5) in the presence of leg oedema. The risk of thrombosis was highest when all three risk factors occurred simultaneously (OR: 10·5; 95% CI 1·3-86·1). In conclusion, clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, are risk factors for venous thrombosis in older people.

  6. Core content for training in venous and lymphatic medicine

    PubMed Central

    Min, Robert J; Comerota, Anthony J; Meissner, Mark H; Carman, Teresa L; Rathbun, Suman W; Jaff, Michael R; Wakefield, Thomas W; Feied, Craig F

    2014-01-01

    The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content. PMID:25059735

  7. [Myelopathies in impairment of extravertebral venous blood circulation].

    PubMed

    Tsuladze, I I; Dreval', O N; Kornienko, V N

    2009-01-01

    Development of myelopathies of venous genesis is based on venous hypertension inside vertebral canal which was initially described by J. Aboulker. According to anatomical and functional features of epidural venous system, two factors contribute in development of venous congestion: decreased outflow and increased inflow. Clinical manifestation is presented by spastic movement disorders. Morphological study performed in 18 cadavers allowed to discover so called 'narrow areas' which cause impaired circulation through large feeders of caval veins, which can be discovered by selective phlebography. Main phlebographic features include stenosis, compression, atresia, thrombosis and retrograde flow towards epidural venous plexus. We examined 58 patients with spastic para- and tetraparesis of unknown nature. Phlebographic signs of venous dyscirculation were revealed in 34 cases. 28 surgical operations were performed: 24 on feeders of vena cava superior and 4 on feeders of vena cava inferior. In 18 cases we obtained satisfactory results. This investigation should be continued.

  8. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    ERIC Educational Resources Information Center

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  9. [Venous thrombosis associated with central venous catheter use in patients with cancer].

    PubMed

    Iglesias Rey, Leticia; Fernández Pérez, Isaura; Barbagelata López, Cristina; Rivera Gallego, Alberto

    2015-01-01

    The use of central venous catheters for various applications (administration of chemotherapy, blood products and others) in patients with cancer is increasingly frequent. The association between thrombosis and catheter use has been fully established but aspects such as its causes, diagnosis, prophylaxis and treatment have not. We describe a case of thrombosis in a patient with cancer treated with chemotherapy who carried a central venous catheter. We also perform a review of the risk factors, the role of the prophylaxis and the treatment. PMID:25771092

  10. The relationship of intracranial venous pressure to hydrocephalus.

    PubMed

    Portnoy, H D; Branch, C; Castro, M E

    1994-01-01

    Little is known about intracranial venous pressure in hydrocephalus. Recently, we reported that naturally occurring hydrocephalus in Beagle dogs was associated with an elevation in cortical venous pressure. We proposed that the normal pathway for cerebrospinal fluid (CSF) absorption includes transcapillary or transvenular absorption of CSF from the interstitial space and that the increase in cortical venous pressure is an initial event resulting in decreased absorption and subsequent hydrocephalus. Further analysis, however, suggests that increased cortical venous pressure reflects the effect of the failure of transvillus absorption with increase in CSF pressure on the venous pressure gradient between ventricle and cortex. Normally, the cortical venous pressure is maintained above CSF pressure by the Starling resistor effect of the lateral lacunae. A similar mechanism is absent in the deep venous system, and thus the pressure in the deep veins is similar to that in the dural sinuses. Decreased CSF absorption causes an increase in CSF pressure followed by an increase in cortical venous pressure without a similar increase in periventricular venous pressure. The periventricular CSF to venous (transparenchymal) pressure (TPP) gradient increases. In contrast, cortical vein pressure remains greater than CSF pressure (negative TPP). The elevated periventricular TPP gradient causes ventricular dilatation and decreased periventricular cerebral blood flow (CBF), a condition that persists even if the CSF pressure returns to normal, particularly if tissue elastance is lessened by tissue damage. If deep CBF is to be maintained, periventricular venous pressure must increase. Since the veins are in a continuum, cortical venous pressure will further increase above the CSF pressure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8194060

  11. Neoplastic zebras of venous thrombosis: Diagnostic challenges in vascular medicine.

    PubMed

    Cornejo, A; Lekah, A; Kurklinsky, A K

    2015-12-01

    Venous thrombosis is a common medical problem. Imaging differentiation of neoplasms and venous clots may prove challenging. We report three cases of "mistaken identities" of venous thrombi and neoplasms on the basis of clinical findings and different imaging modalities: ultrasound, computed tomography, and magnetic resonance imaging. Imaging studies are not always reliable and consideration of clinical features, including pretest probability, is necessary for correct diagnosis. A combination of imaging modalities and biopsies is needed for correct diagnosis in some cases.

  12. Venous ulcers of the lower limb: Where do we stand?

    PubMed Central

    Chatterjee, Sasanka S.

    2012-01-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  13. Cerebral Venous Air Embolism Secondary to Mesenteric Infarction.

    PubMed

    Spanuchart, Ittikorn; Tamura, Aileen; Matsuda, Brent; Leo, Qi Jie Nicholas; Sung, Hiro

    2016-05-01

    Cerebral air embolism is a rare, yet potentially fatal condition. We present a case of retrograde cerebral venous air emboli arising from the hepatic portal venous system, secondary to a mesenteric infarction. A 69-year-old man with a history of gastrointestinal amyloidosis presented with fever and lethargy. Computed tomography of the brain detected multiple foci of air in the right frontal, fronto-parietal, and left lateral frontal sulci consistent with cerebral venous air emboli. Computed tomography of the abdomen and pelvis revealed moderate thickening and dilatation of the small bowel with diffuse scattered intestinal pneumatosis suggestive of mesenteric infarction with resultant extensive intrahepatic portal venous air. The patient was deemed a poor candidate for surgical intervention and died as a result of septic shock. We believe the cerebral venous air emboli was a result of retrograde flow of air arising from the hepatic venous air ascending via the inferior and superior vena cava to the cerebral venous system. To our knowledge, there have been no reported cases of retrograde cerebral venous air embolism arising from hepatic portal venous system secondary to mesenteric infarction. The clinical significance and prognosis in this setting requires further investigation. PMID:27239392

  14. Diagnosis and Management of Spontaneous Lumbar Venous Retroperitoneal Hematoma in Setting of Deep Venous Thrombosis: A Case Report and Algorithm

    PubMed Central

    Tseng, Joseph; Chapman, Todd; Scott, Ryan; Kalinkin, Olga

    2016-01-01

    Retroperitoneal hematoma is rare and benefits from a systematic approach to prevent morbidity and mortality. Management of such bleeds is based upon patient stability, the cause (spontaneous or posttraumatic), and source (arterial or venous). Herein, the authors describe a diagnostic and management algorithm for retroperitoneal hemorrhage with an example of a rare lumbar venous bleed under the complicated clinical setting of deep venous thrombosis. PMID:27795865

  15. Direct oral anticoagulants and venous thromboembolism.

    PubMed

    Franchini, Massimo; Mannucci, Pier Mannuccio

    2016-09-01

    Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE. PMID:27581829

  16. [Pain in venous thrombosis of the leg].

    PubMed

    Henriet, J P

    1992-01-01

    According to D. Reinharez, pain and edema are the commonest presenting symptoms in phlebology. Pain is one of the most classical symptoms of an ordinary deep venous thrombosis, a valuable feature when present, in the form of deep tension, heaviness, swelling and a feeling of dead weight. It is often absent or slight. It may consist merely of a dull cramp, or of an "undefinable" (C. Bourde) odd, heavy leg. It generally affects the calf but may involve the sole of the foot, the heel, the thigh, the groin or even the true pelvis. This feeling, although "imprecise and variable" (P. Wallois, P. Griton) is highly suggestive. It increases on standing and walking in the form of unilateral uncomfortable tension, heaviness or painful swelling, which maybe a source of worry or even anxiety to the patient. Tenderness on palpation of venous tracts and their stretching is more suggestive. In the opinion of M. Duruble, Neuhof's sign (feeling of tender fullness of the calf) is more reliable than Homans' sign (pain in the calf caused by passive dorsiflexion of the foot, with the lower limb in extension) which essentially stretches only the posterior tibial venous system. The value of Sigg's sign (pain in the popliteal fossa on passive extension of the knee) is controversial. Far more rare is phlegmasia coerulea dolens or Grégoire's blue leg, complicating phlegmasia alba dolens or of sudden onset, with initial very severe or even "intolerable" pain (J.J. Pinot) in Scarpa's triangle, rapidly spreading to the limb. In varicose phlebitis (M. Perrin) or superficial thrombophlebitis or varico-phlebitis (A.A. Ramelet) or superficial venitis (J.P. Henriet), pain most often consists of moderate burning tension overlying the thrombosed vein(s), increased by palpation and mobilisation. Sometimes severe initially, it is exacerbated by the slightest touch. In total, pain, regardless of its characteristics, its site and/or its severity, is one of the most constant clinical features of venous

  17. Treating venous thromboembolism in patients with cancer

    PubMed Central

    Piatek, Caroline; O’Connell, Casey L; Liebman, Howard A

    2015-01-01

    Venous thromboembolism (VTE) is a major cause of morbidity and mortality among patients with cancer. Although much is known about the factors that contribute to VTE risk, pre-emptive therapy in high-risk populations is clearly indicated in only a few clinical situations. Low-molecular-weight heparin is still the recommended class of anticoagulants for cancer-associated VTE. Management of VTE in patients with renal failure, hemorrhagic brain metastases, thrombocytopenia and coagulopathy remains challenging with few safe and effective alternatives. Novel oral agents are currently being investigated and may play a role in the future in the treatment of cancer-associated VTE. PMID:22475288

  18. Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria

    PubMed Central

    Meppiel, Elodie; Crassard, Isabelle; de Latour, Régis Peffault; de Guibert, Sophie; Terriou, Louis; Chabriat, Hugues; Socié, Gérard; Bousser, Marie-Germaine

    2015-01-01

    Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of hematopoietic stem cells characterized by hemolytic anemia, marrow failure, and a high incidence of life-threatening venous thrombosis. Cerebral venous system is the second most frequent location of thrombosis after hepatic veins. However, data about PNH-related cerebral venous thrombosis (CVT) are very scarce because of the rarity of both the disorders. We report a French study about PNH patients with CVT. Patients were recruited retrospectively, from the Société Française d’Hématologie (SFH) registry of 465 patients with PNH; the Lariboisière registry of 399 patients with CVT; and a direct contact with 26 French Hematology Units. We review cases reported since 1938 in the English and French language literature. We then compared patients of our series with cases from the literature, with non-PNH-related CVT cases from Lariboisière registry, and with PNH patients without CVT from SFH registry. Fifteen patients were included between 1990 and 2012. Most patients were women (12/15) and half of them presented associated hormonal venous thrombosis risk factors. Three patients had concomitant hepatic vein thrombosis. CVT was the first manifestation of PNH in 4 patients. No major difference in CVT characteristics was found compared with non-PNH-related CVT cases, except for a younger age at diagnosis in PNH patients (P < 0.001). All patients were treated with anticoagulation therapy. One death occurred in acute stage. All surviving patients were independent 1 year after. Median survival time was 9 years. Recurrent thrombosis rate was 50% at 6 years, occurring in patients that did not have bone marrow transplantation or eculizumab therapy. Cases of death were mainly related to hepatic vein thrombosis. Prognosis of CVT was good in our series. However, these patients have a poor long-term prognosis due to PNH disease by itself. PNH treatment should be proposed as soon as possible to

  19. STUDIES OF OXYGEN IN THE VENOUS BLOOD

    PubMed Central

    Lundsgaard, Christen

    1918-01-01

    1. Thirty-one determinations of the total oxygen-combining power and the oxygen in the venous blood from vena mediana cubiti of sixteen resting patients are reported. 2. The difference between the total oxygen capacity of the hemoglobin and the oxygen in the venous blood, the oxygen unsaturation, is calculated. 3. In twelve patients with compensated heart lesions the unsaturation was found within normal limits, between 2.5 and 8 volume per cent. 4. In four patients with incompensated heart disease the values for the unsaturation were all above the normal limit, from 9.7 to 15.2 volume per cent. 5. A general discussion of the problem of interpreting the results is given. 6. A comparison is drawn between the oxygen consumption calculated from direct determination of the blood flow on a normal subject (the writer) and the oxygen unsaturation determined 4 years later on the same subject. A close agreement between the two series of values exists. PMID:19868200

  20. Immunological aspects of chronic venous disease pathogenesis

    PubMed Central

    Grudzińska, Ewa

    2014-01-01

    Chronic venous disease (CVD) is a very common health problem concerning up to 1/3 of the society. Although venous hypertension and valvular incompetence have been long known to be crucial for development of the illness, its exact aetiology remains unclear. Recent findings indicate that inflammatory processes may be crucial for development of incompetent valves and vein wall remodelling. One of the most interesting theories describes “leucocyte trapping” as the mechanism responsible for elevated vein wall permeability and oxidative stress in the veins. At the same time, the cytokine profile of the blood in incompetent veins has not been thoroughly examined. Popular anti-inflammatory drugs relieve some symptoms but do not have much proved effects in prevention and treatment. We intend to summarize the existing knowledge of the immunological aspects of CVD in order to emphasize its importance for understanding the aetiology of this illness. We also wish to indicate some aspects that remain to be studied in more detail. PMID:26155174

  1. Menopausal hormone therapy and venous thromboembolism

    PubMed Central

    2014-01-01

    Menopausal hormone therapy (MHT) is the most effective method of treating vasomotor symptoms and other climacteric symptoms related to estrogen deficiency in peri- and postmenopausal period. In addition to estrogen replacement, women with preserved uterus require the addition of progestagen in order to ensure endometrial safety. One of rare but severe complications of MHT is venous thromboembolism (VTE). The incidence of VTE rises in parallel to women's age and body weight. The condition is also linked to hereditary and acquired risk factors. Oral estrogens increase the risk of venous thromboembolic complications to varying extents, probably depending on their type and dose used. Observational studies have not found an association between an increased risk of VTE and transdermal estrogen treatment regardless of women's age and body mass index (BMI). Micronized progesterone and pregnanes, including dydrogesterone, have no effect on the risk of VTE, whereas norpregnane progestagens cause an additional increase in risk. Among hormonal preparations which are commercially available in Poland, the combination of transdermal estradiol with oral dydrogesterone appears to be the optimum choice, as it does not elevate the risk of VTE (compared to patients not using MHT), and dydrogesterone seems to be the progestagen of choice. PMID:26327865

  2. [Drug Treatment of Chronic Venous Diesease].

    PubMed

    Pavlović, Miloš D

    2016-06-01

    Chronic venous disease (CVD) affects at least 15-25 % of the general population incurring not only high morbidity but also considerable economical burden. The mainstay of modern treatment of CVD are endovenous therapeutic procedures and compression therapy. As far as the pathogenesis of CVD is being gradually unraveled the interest in drugs able to impact the process is growing. Here we have presented an overview of a majority of oral preparations used so far to treat CVD including venous leg ulcers. After several decades of clinical use a few flavonoid preparations, in the first place micronized purified flavonoid fraction, collected enough evidence to recommend them as a short-term adjunct treatment of CVD. However, other compounds are also promising in this regards. Yet, we need more larger and longer-term clinical trials to more precisely define effects, cost-effectiveness and, above all, capacity for prophylactic application of the drugs. Learning more about basis of CVD will help design new drugs directed at specific aspects of the disease process. PMID:27379855

  3. The cerebral venous system and hypoxia.

    PubMed

    Wilson, Mark H; Imray, Christopher H E

    2016-01-15

    Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure.

  4. Aged venous thrombi: radioimmunoimaging with fibrin-specific monoclonal antibody

    SciTech Connect

    Rosebrough, S.F.; Grossman, Z.D.; McAfee, J.G.; Kudryk, B.J.; Subramanian, G.; Ritter-Hrncirik, C.A.; Witanowski, L.S.; Tillapaugh-Fay, G.; Urrutia, E.

    1987-02-01

    Radioimmunoimaging of fresh canine venous thrombi with a murine monoclonal antibody specific for human and dog fibrin has been reported. Successful imaging of canine deep venous thrombi 1, 3, and 5 days old at the time of antibody injection is reported. Images were positive in all dogs, and the uptake of fibrin-specific antibody was equivalent to that of fresh thrombi.

  5. Increased risk of venous thromboembolism in patients with acute leukaemia

    PubMed Central

    Mohren, M; Markmann, I; Jentsch-Ullrich, K; Koenigsmann, M; Lutze, G; Franke, A

    2006-01-01

    Patients with malignancies have an increased risk for venous thromboembolisms (VTE), but data on patients with acute leukaemia are very limited so far. We found VTE in 12% of 455 patients with acute leukaemia, half of which occurred in association with central venous catheters, with equal risk of ALL and AML. PMID:16421591

  6. Venous disease: investigation and treatment, fact or fiction?

    PubMed Central

    Scott, H. J.; McMullin, G. M.; Coleridge Smith, P. D.; Scurr, J. H.

    1990-01-01

    This review looks at some clinical and experimental methods and treatments used in venous disease, and attempts to dispel some myths which have been associated with it. Over the last century numerous techniques have been introduced to aid the understanding of the physiology of normal legs and the pathophysiology of those with venous disease. Tourniquet testing along with clinical examination remains the only method of venous assessment in most hospitals. Venous ulceration in the past has been associated with deep vein incompetence, but the newer, non-invasive techniques of Doppler ultrasound and duplex examination are now identifying patients with leg ulceration who have superficial venous insufficiency and therefore a surgically correctable condition. Perforating veins and their possible role in the aetiology of venous ulceration along with invasive and non-invasive methods for their detection is reviewed. Some of the conservative compression treatments and dressings available for the treatment of venous ulceration are discussed. It is concluded that adherence to sound surgical principles remains the mainstay of the successful management of patients with venous disease. PMID:2192676

  7. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt....

  8. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt....

  9. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt....

  10. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Peritoneo-venous shunt. 876.5955 Section 876.5955 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5955 Peritoneo-venous shunt....

  11. CEREBRAL VENOUS THROMBOSIS AND TURNER SYNDROME: A RARE REPORTED ASSOCIATION.

    PubMed

    Guler, A; Alpaydin, S; Bademkiran, F; Sirin, H; Celebisoy, N

    2015-01-01

    Turner Syndrome is the only known viable chromosomal monosomy, characterised by the complete or partial absence of an X chromosome. It's the most common chromosomal abnormality in females. Apart from the well known dysmorphic features of the syndrome, it has been associated with a number of vascular pathologies; mainly involving the cardiovascular, renovascular, peripheral vascular and cerebrovascular system. It seems striking that thromboembolism is not considered as a feature of the syndrome. Most of the thromboembolism cases are related to the arterial vascular system; except for some rare reported portal venous thrombosis cases, peripheral venous thrombosis cases and to the best of our knowledge a single case of cerebral venous thrombosis with Dandy Walker malformation and polymicrogyria. We herein report a cerebral venous thrombosis case with Turner Syndrome. With no other found underlying etiology, we want to highlight that Turner Syndrome, itself, may have a relationship not only with the cerebral arterial vascular system pathologies but also with the cerebral venous thrombosis.

  12. Venous return curves obtained from graded series of valsalva maneuvers

    NASA Technical Reports Server (NTRS)

    Mastenbrook, S. M., Jr.

    1974-01-01

    The effects were studied of a graded series of valsalva-like maneuvers on the venous return, which was measured transcutaneously in the jugular vein of an anesthetized dog, with the animal serving as its own control. At each of five different levels of central venous pressure, the airway pressure which just stopped venous return during each series of maneuvers was determined. It was found that this end-point airway pressure is not a good estimator of the animal's resting central venous pressure prior to the simulated valsalva maneuver. It was further found that the measured change in right atrial pressure during a valsalva maneuver is less than the change in airway pressure during the same maneuver, instead of being equal, as had been expected. Relative venous return curves were constructed from the data obtained during the graded series of valsalva maneuvers.

  13. Unilateral Loss of Spontaneous Venous Pulsations in an Astronaut

    NASA Technical Reports Server (NTRS)

    Mader, Thomas H.; Gibson, C. Robert; Lee, Andrew G.; Patel, Nimesh; Hart, Steven; Pettit, Donald R.

    2014-01-01

    Spontaneous venous pulsations seen on the optic nerve head (optic disc) are presumed to be caused by fluctuations in the pressure gradient between the intraocular and retrolaminar venous systems. The disappearance of previously documented spontaneous venous pulsations is a well-recognized clinical sign usually associated with a rise in intracranial pressure and a concomitant bilateral elevation of pressure in the subarachnoid space surrounding the optic nerves. In this correspondence we report the unilateral loss of spontaneous venous pulsations in an astronaut 5 months into a long duration space flight. We documented a normal lumbar puncture opening pressure 8 days post mission. The spontaneous venous pulsations were also documented to be absent 21 months following return to Earth.. We hypothesize that these changes may have resulted from a chronic unilateral rise in optic nerve sheath pressure caused by a microgravity-induced optic nerve sheath compartment syndrome.

  14. [Cerebral venous thrombosis and hereditary protein C deficiency].

    PubMed

    Massons, J; Arboix, A; Oliveres, M; Besses, C; Muñoz, C; Titus, F

    1992-01-01

    Protein C together with its plasmatic cofactor protein S and antithrombin III probably represent the most important plasmatic inhibitor in coagulation. Protein C deficiency constitutes a high risk factor for venous thrombosis. Cerebral venous thrombosis is a manifestation which is scarcely referred to in protein C deficiency. The case of a 32 year old patient with protein C deficiency is presented. The patient was admitted for an endocraneal hypertension syndrome. CT and MR demonstrated multiple hemorrhagic cerebral infarctions. Arteriography confirmed vertebral venous thrombosis. Only six cases sufficiently documenting cerebral venous thrombosis due to protein C deficiency were found in the literature. In most cases coadjuvant factors exist predisposing thromboembolic disease. The present clinical case demonstrates the importance of considering protein C deficiency in the diagnosis of cerebral venous thrombosis in young adults.

  15. Occult pulmonary embolism: a common occurrence in deep venous thrombosis

    SciTech Connect

    Dorfman, G.S.; Cronan, J.J.; Tupper, T.B.; Messersmith, R.N.; Denny, D.F.; Lee, C.H.

    1987-02-01

    Ventilation-perfusion scans were used in a prospective study to determine the prevalence of occult pulmonary embolus in proven deep venous thrombosis. Fifty-eight patients without symptoms of pulmonary embolism, but with venographically proven deep venous thrombosis, were subjected to chest radiographs, /sup 99m/Tc macroaggregated-albumin perfusion scans, and /sup 133/Xe ventilation scans. Of the 49 patients with deep venous thrombosis proximal to the calf veins, 17 (35%) had high-probability scans. Of all 58 patients, only 12 (21%) had normal scans. When the study population was compared with a group of 430 patients described in reports of pulmonary perfusion in asymptomatic persons, a significantly higher percentage of high-probability scans was found in the study population with deep venous thrombosis. Baseline ventilation-perfusion lung scanning is valuable for patients with proven above-knee deep venous thrombosis.

  16. Vegetables intake and venous thromboembolism: a systematic review.

    PubMed

    Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo

    2016-04-01

    A higher intake of vegetables has been convincingly associated with a decreased risk of arterial thrombotic disorders, so that a similar association may be expected with venous thromboembolism. An electronic search was conducted in Medline, Web of Science and Scopus to identify epidemiological studies that investigated the independent association between intake of vegetables and risk of venous thrombosis. Our systematic literature search allowed to identify four prospective and one case-control studies. Although a lower risk of venous thromboembolism was reported in one prospective and one case-control studies, no significant association was found between larger intake of vegetables and risk of venous thrombosis in the remaining three large prospective studies. Taken together, the epidemiological data available in the current scientific literature do not support the notion that higher consumption of vegetables may have a significant impact on the risk of venous thrombosis. PMID:27023878

  17. An anatomical study of the laterotrigeminal venous system.

    PubMed

    Simões, S

    1993-04-01

    The middle cranial fossa of 100 cadavers were dissected under stereoscopic loupe in order to identify and systematize the venous vessels located along the lateral margin of the trigeminal cave. The author found that at the sensitive root and trigeminal ganglion level a dural venous canal was present in most individuals examined and that the upper side of this canal communicated with the superior petrosal sinus. However, at the level of the lateral border of the intracranial segment of the mandibular nerve, venous lacunae were found to prevail, and these lacunae communicated with several other venous formations in the peritrigeminal region. The author concludes that the venous vascularization of this area constitutes a major risk in surgical interventions made in the middle cranial fossa. In addition, it is a relevant factor in the hemodynamics of the intracranial circulation.

  18. Outcome of venous stenting following catheter directed thrombolysis for acute proximal lower limb venous thrombosis: a prospective study with venous Doppler follow-up at 1-year.

    PubMed

    Srinivas, B C; Patra, Soumya; Reddy, Babu; Nagesh, C M; Agarwal, Naveen; Manjunath, C N

    2015-10-01

    Functional outcome of venous stent placement for the management of acute iliofemoral deep vein thrombosis (DVT) following catheter-directed thrombolysis (CDT), remain undefined. The purpose of this study was to assess immediate and intermediate term outcomes among patients treated with venous stenting following CDT in patients with proximal lower limb DVT. Thirty consecutive patients aged between 20-70 years with proximal lower limb DVT formed the study group. The mean duration of CDT done with streptokinase was 4.5 ± 1.3 days. Patients with residual venous obstruction and/or large clot burden were treated further with venous angioplasty and/or stenting. Primary endpoint was to evaluate the safety, efficacy and patency of venous stenting in the management of incomplete result following CDT. After 12 months, post-thrombotic syndrome (PTS) was assessed clinically using Villalta scale and deep venous patency was assessed through duplex ultrasound. We studied 8 (5 female and 3 male) patients with 9 (3 left and 6 right) limb involvement and 13 stent (4 balloon expandable and 9 self expandable) placement. All patients improved clinically immediately following venous stenting. Technical success was achieved in all patients. One patient developed pulmonary embolism during course of hospital stay. One patient had stent thrombosis and PTS and another patient died due to carcinoma breast during follow-up. Deep venous stenting is an effective mode of treatment in proximal acute lower limb DVT with high late patency rate up to 1-year.

  19. Improvements of venous tone with pycnogenol in chronic venous insufficiency: an ex vivo study on venous segments.

    PubMed

    Belcaro, Gianni; Dugall, Mark; Luzzi, Roberta; Hosoi, M; Corsi, Marcello

    2014-03-01

    This study evaluated the stretching and dilatation of venous segments ex vivo in subjects with primary varicose veins in comparison with comparable segments from subjects that used the supplement Pycnogenol (150 mg/d) for 3 months before surgery. Subjects with varicose veins and chronic venous insufficiency voluntarily used Pycnogenol for a period of at least 3 months. The segments of veins removed with surgery (in 30 subjects that had used Pycnogenol and in 10 comparable control subjects that had not used the supplement) were compared with normal, unused vein segments harvested for bypass grafting. The segments were suspended and a weight was attached to the distal part of the veins for 3 minutes and dilated with pressurized water. Digital images were recorded; the veins were measured before and after stretching to evaluate elongation. The manipulation of the vein segment was minimal. Tests were completed within 20 minutes after harvesting the veins. All segments were 4 cm long. The stretching test indicated a significantly higher level of passive elongation in control, varicose segments (2.29; 0.65 mm) in comparison with 1.39; 0.2 mm in vein segments from Pycnogenol-using patients. The dilation test showed an average higher dilation (2.19; 0.3 mm) in control varicose veins in comparison with varicose veins from Pycnogenol-using patients (1.32; 0.7 mm) (p < 0.05). Stretching and dilatation were lower in veins from Pycnogenol-using subjects (p < 0.05). The measurement of destretching and the recovery after dilatation indicated a better tone and recovery of the original size/shape in varicose segments from patients using Pycnogenol. Varicose segments had a more significant persistent dilatation and elongation in comparison with normal vein segments. Pycnogenol seems to decrease passive dilatation and stretching and gives vein walls a greater tonic recovery and elasticity that allows the vein to recover its original shape after dynamic stresses.

  20. Venous outflow reconstruction in living donor liver transplantation: Dealing with venous anomalies

    PubMed Central

    Jeng, Long-Bin; Thorat, Ashok; Yang, Horng-Ren; Li, Ping-Chun

    2015-01-01

    The reconstruction of the vascular outflow tract of partial liver grafts has received considerable attention in the past, especially in the setting of right liver grafts with undrained segments. Hepatic venous outflow reconstruction is an important factor for successful living donor liver transplantation outcome. However, in presence of undrained anterior sector and presence of multiple short hepatic veins that drain substantial portions of liver, outflow reconstruction without backtable venoplasty may lead to severe graft congestion and subsequent graft dysfunction. Various backtable venoplasty techniques in presence of multiple hepatic veins that can be used in either right- or left-lobe liver transplantation are devised to ensure a single, wide outflow channel. In this overview, various techniques to overcome the hepatic venous variations of liver allograft and outflow reconstruction are discussed. PMID:26722643

  1. [Central venous infusion of dopamine. Changes in dose during central venous pressure measurement].

    PubMed

    Guiglio, C; Haro, D; Muchada, R

    1993-01-01

    The changes in the doses of dopamine administered at a steady rate which occur during central venous pressure (CVP) measurement were studied. A workbench model with a single lumen central venous catheter was devised with which a mathematical model was constructed to calculate the alterations due to changes in different variables: central venous pressure, dopamine dose, collateral infusions. The average time for CVP measurement was 2 min. The volume of 5% glucose solution filling the manometer was 2.3 ml. The dopamine bolus generated by CVP measurement was equivalent to a dose of 85 micrograms.kg-1 x min-1. The delay required for a return to the initial dose was 2 h 42 min. Changes in CVP led to inversely proportional changes in dopamine dose. These also depended on the level to which the measuring tube was filled before carrying out the measurement. High initial rates of dopamine infusion required shorter times for a return to initial dopamine doses. The bolus and time for recovery were also inversely proportional to the volume of infusion fluids given at a steady rate on the same venous line. This model was tested in a patient suffering from bacterial pneumonia and septic shock (60 years, 55 kg). CVP measurement resulted in a bolus dose of 17 micrograms.kg-1 x min-1, leading to a 43% decrease in aortic flow rate and 60% in the ejection volume. After about 25 min, heart rate and mean arterial blood pressure had returned to their initial values, although aortic flow rate remained 30% below initial values. This problem is also met with other drugs, such as heparin.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8338258

  2. Dabigatran for the treatment of venous thromboembolism.

    PubMed

    Schellong, Sebastian M

    2015-08-01

    Venous thromboembolism (VTE) is a major cause of morbidity and mortality, and individuals with a first VTE are at risk of recurrent VTE. VTE treatment is divided into three phases: a first short phase of acute (traditionally parenteral) anticoagulation, followed by a second maintenance phase with an oral anticoagulant, which may be continued into a third extended maintenance phase in patients considered to be at increased risk of recurrent VTE. Vitamin K antagonists are effective oral anticoagulants but have well-known limitations; non-vitamin K oral anticoagulants including dabigatran etexilate (DE) were therefore developed. DE was approved for VTE treatment on the basis of an extensive clinical trial program that evaluated DE during both the maintenance phase and the extended maintenance phase of VTE treatment. This article provides a comprehensive overview of DE in VTE treatment, from its preclinical characteristics and pharmacokinetic properties to its efficacy and safety in major clinical trials.

  3. Role of surgery in iliofemoral venous thrombosis.

    PubMed

    Rutherford, R B

    1986-05-01

    Thrombectomy has a limited but definite role in the clinical management of patients with iliofemoral venous thrombosis. It is best applied selectively to achieve specific goals in two different groups of patients at either end of the disease spectrum. In relatively active healthy young patients with phlegmasia alba dolens operated on relatively soon after thrombosis, better protection against the late postthrombotic sequelae can be achieved. Patients with malignancy, underlying coagulopathy, or those who are inactive or have a limited life expectancy due to age or concurrent disease should not be operated on for bland thrombosis. At the other extreme, when phlegmasia cerulea dolens causes painful tense swelling, increases compartmental or decreases ankle pressures, and threatens limb viability in spite of heparinization and leg elevation, thrombectomy should be performed.

  4. Management of varicose veins and venous insufficiency.

    PubMed

    Hamdan, Allen

    2012-12-26

    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.

  5. Hepatic portal venous gas in Crohn's disease

    PubMed Central

    Cunningham, Georgina; Cameron, Georgina; De Cruz, Peter

    2014-01-01

    Hepatic portal venous gas (HPVG) is a rare finding that has only been reported previously among 25 patients with Crohn's disease in the English literature. We present a case of a 27-year-old woman with Crohn's disease who presented with fever, abdominal pain and per rectal bleeding and was found to have HPVG at the time of presentation most likely due to an enterovenous fistula. She was managed with intravenous antibiotics, corticosteroids and infliximab and subsequently made a full recovery. HPVG is most likely a manifestation of penetrating Crohn's disease, is overall associated with a low mortality rate and can be managed conservatively in the majority of cases associated with Crohn's disease. Although surgery has been suggested for cases of enterovenous fistulae in the past, this is the first case to suggest that use of antitumour necrosis factor therapy may arrest associated gastrointestinal bleeding and avoid the need for surgery. PMID:25260428

  6. Endovascular Treatment of Venous Occlusive Disease

    PubMed Central

    2008-01-01

    Endovascular treatment of acute and chronic iliac vein occlusions has proven to be safe and effective. Recanalization of chronic occlusions with balloon angioplasty and stenting can re-establish normal venous flow in the iliac veins and the IVC and relieve symptoms in the majority of treated patients. CDT with recanalization and stenting of underlying chronically obstructed iliofemoral segments is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as anticoagulation and compression therapy alone are not satisfactory in preventing PTS. The new treatment modalities offer stimulating options for a patient group that is not adequately treated, neither by medical nor open surgical therapy. The substantial effort and additional costs of endovascular treatment appear to be justified by the encouraging mid-term results both for patients with acute and chronic occlusive iliofemoral disease. However, multi-center randomized prospective studies are required to further validate the role of these techniques. PMID:23555345

  7. [Ambulatory treatment of deep venous thrombosis].

    PubMed

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  8. Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis.

    PubMed

    Lupascu, Cristian; Darius, Tom; Goffette, Pierre; Lerut, Jan

    2015-01-01

    Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental) portal hypertension. PMID:26539214

  9. Provisional Matrix Deposition in Hemostasis and Venous Insufficiency: Tissue Preconditioning for Nonhealing Venous Ulcers

    PubMed Central

    Parker, Tony J.; Broadbent, James A.; McGovern, Jacqui A.; Broszczak, Daniel A.; Parker, Christina N.; Upton, Zee

    2015-01-01

    Significance: Chronic wounds represent a major burden on global healthcare systems and reduce the quality of life of those affected. Significant advances have been made in our understanding of the biochemistry of wound healing progression. However, knowledge regarding the specific molecular processes influencing chronic wound formation and persistence remains limited. Recent Advances: Generally, healing of acute wounds begins with hemostasis and the deposition of a plasma-derived provisional matrix into the wound. The deposition of plasma matrix proteins is known to occur around the microvasculature of the lower limb as a result of venous insufficiency. This appears to alter limb cutaneous tissue physiology and consequently drives the tissue into a ‘preconditioned’ state that negatively influences the response to wounding. Critical Issues: Processes, such as oxygen and nutrient suppression, edema, inflammatory cell trapping/extravasation, diffuse inflammation, and tissue necrosis are thought to contribute to the advent of a chronic wound. Healing of the wound then becomes difficult in the context of an internally injured limb. Thus, interventions and therapies for promoting healing of the limb is a growing area of interest. For venous ulcers, treatment using compression bandaging encourages venous return and improves healing processes within the limb, critically however, once treatment concludes ulcers often reoccur. Future Directions: Improved understanding of the composition and role of pericapillary matrix deposits in facilitating internal limb injury and subsequent development of chronic wounds will be critical for informing and enhancing current best practice therapies and preventative action in the wound care field. PMID:25785239

  10. Retinal venous pressure: the role of endothelin.

    PubMed

    Flammer, Josef; Konieczka, Katarzyna

    2015-01-01

    The retinal venous pressure (RVP) can be measured non-invasively. While RVP is equal to or slightly above intraocular pressure (IOP) in healthy people, it is often markedly increased in patients with eye or systemic diseases. Beside a mechanical obstruction, the main cause of such an elevation is a local dysregulation of a retinal vein, particularly a constriction induced by endothelin-1 (ET-1). A local increase of ET-1 can result from a high plasma level, as ET-1 can diffuse from the fenestrated capillaries of the choroid into the optic nerve head (ONH), bypassing the blood retinal barrier. A local increase can also result from increased local production either by a sick neighboring artery or retinal tissue. Generally, the main factors increasing ET-1 are inflammations and hypoxia, either locally or in a remote organ. RVP is known to be increased in patients with glaucoma, retinal vein occlusion (RVO), diabetic retinopathy, high mountain disease, and primary vascular dysregulation (PVD). PVD is the major vascular component of Flammer syndrome (FS). An increase of RVP decreases perfusion pressure, which heightens the risk for hypoxia. An increase of RVP also elevates transmural pressure, which in turn heightens the risk for retinal edema. In patients with RVO, a high level of RVP may not only be a consequence but also a potential cause of the occlusion; therefore, it risks causing a vicious circle. Narrow retinal arteries and particularly dilated retinal veins are known risk indicators for future cardiovascular events. As the major cause for such a retinal venous dilatation is an increased RVP, RVP may likely turn out to be an even stronger predictor. PMID:26504500

  11. Deep venous thrombosis and occult malignancy: an epidemiological study.

    PubMed Central

    Nordström, M.; Lindblad, B.; Anderson, H.; Bergqvist, D.; Kjellström, T.

    1994-01-01

    OBJECTIVE--To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. DESIGN--Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. SUBJECTS--4399 patients who had phlebography in one hospital. SETTING--General hospital in Malmö, Sweden, serving a population of 230,000. MAIN OUTCOME MEASURE--Number of cancers recorded. RESULTS--4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. CONCLUSION--Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required. PMID:8173368

  12. Adverse pacemaker hemodynamics evaluated by pulmonary venous flow monitoring.

    PubMed

    Stierle, U; Krüger, D; Mitusch, R; Potratz, J; Taubert, G; Sheikhzadeh, A

    1995-11-01

    The pacemaker syndrome refers to symptoms and signs in the pacemaker patient caused by an inadequate timing of atrial and ventricular contractions. The lack of normal atrioventricular synchrony may result in a decreased cardiac output and venous cannon A waves. The objective of this study was to define the left atrial and pulmonary venous flow response to ventricular pacing in a group of 14 unselected consecutive patients with total heart block and sinus rhythm. Pulmonary venous flow was assessed by transesophageal pulsed Doppler echocardiography in the VVI and DDD pacing modes. An inappropriate atrial timing caused a marked augmentation of the normally small pulmonary venous z wave in all patients ("negative atrial kick," peak z wave in DDD pacing 14.5 +/- 4.6 cm/s, VVI pacing 51.8 +/- 15.0 cm/s). Restoration of AV synchrony (DDD pacing, AV interval 100 ms) abolished these "cannon z waves" in all patients, and a normal pattern of pulmonary venous flow was achieved. Abnormal pulmonary venous flow characteristics were observed in 2 of 14 patients during DDD pacing with short AV intervals (100 ms). The Doppler pattern was similar to the findings seen in VVI pacing. Assessment of pulmonary venous flow by transesophageal pulsed Doppler echocardiography may provide a simple, sensitive, and relatively noninvasive technique to evaluate patients with suspected pacing induced adverse hemodynamics.

  13. Cardiovascular Pressures with Venous Gas Embolism and Decompression

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.

    1995-01-01

    Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

  14. Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis

    SciTech Connect

    Inada, K.; Shirai, N.; Hayashi, M.; Matsumoto, K.; Hirose, M.

    1983-06-01

    The incidence of postoperative deep venous thrombosis was investigated using the iodine-125-fibrinogen method in 256 patients undergoing major surgery. Deep venous thrombosis was found in 49 patients (15.3 percent), and nonfatal pulmonary embolism developed in one of seven patients in whom the thrombus extended to the popliteal vein. The same investigation was performed in 110 patients who wore a graduated compression stocking on one leg, with the other leg serving as a control. Deep venous thrombosis was found in 4 of 110 stockinged legs (3.6 percent) and in 16 of 110 control legs (14.5 percent). The incidence of deep venous thrombosis decreased significantly in patients who wore the stocking. An increase in femoral venous flow velocity was found in the stockinged legs by the Doppler method. The mean velocity of venous return by xenon-133 clearance was significantly greater in the stockinged legs than in the control legs. These findings were considered to support the efficacy of graduated compression stockings for the prevention of deep venous thrombosis.

  15. Absence of venous valves in mice lacking Connexin37.

    PubMed

    Munger, Stephanie J; Kanady, John D; Simon, Alexander M

    2013-01-15

    Venous valves play a crucial role in blood circulation, promoting the one-way movement of blood from superficial and deep veins towards the heart. By preventing retrograde flow, venous valves spare capillaries and venules from being subjected to damaging elevations in pressure, especially during skeletal muscle contraction. Pathologically, valvular incompetence or absence of valves are common features of venous disorders such as chronic venous insufficiency and varicose veins. The underlying causes of these conditions are not well understood, but congenital venous valve aplasia or agenesis may play a role in some cases. Despite progress in the study of cardiac and lymphatic valve morphogenesis, the molecular mechanisms controlling the development and maintenance of venous valves remain poorly understood. Here, we show that in valved veins of the mouse, three gap junction proteins (Connexins, Cxs), Cx37, Cx43, and Cx47, are expressed exclusively in the valves in a highly polarized fashion, with Cx43 on the upstream side of the valve leaflet and Cx37 on the downstream side. Surprisingly, Cx43 expression is strongly induced in the non-valve venous endothelium in superficial veins following wounding of the overlying skin. Moreover, we show that in Cx37-deficient mice, venous valves are entirely absent. Thus, Cx37, a protein involved in cell-cell communication, is one of only a few proteins identified so far as critical for the development or maintenance of venous valves. Because Cxs are necessary for the development of valves in lymphatic vessels as well, our results support the notion of common molecular pathways controlling valve development in veins and lymphatic vessels.

  16. Mechanism of action of isoproterenol on venous return.

    PubMed

    Green, J F

    1977-02-01

    The systemic vascular effects of isoproterenol infused in a dose of 1 mug-kg-1-min-1 was studied in 10 anesthetized dogs. A right heart bypass preparation allowed the separation of venous return into splanchnic and extrasplanchnic flows. Each channel was drained by gravity into an external reservoir. Venous return was then pumped into the pulmonary artery. During the infusion of isoproterenol, the pump was set at sufficient speed to maintain a constant level of blood in the external reservoir. Venous resistances and compliances of both channels were calculated from transient and steady-state volume shifts that occurred after rapid drops in splanchnic and then extrasplanchnic venous pressures. Isoproterenol affected both arterial and venous systems. Venous return increased from 1.62+/-0.11 to 2.40+/-0.19 liter/min (P less than 0.001) while arterial pressure fell from 97.5+/-3.8 to 70.2+/-5.9 mmHg (P less than 0.01). The compliances of the splanchnic and extrasplanchnic channels did not change significantly from their control values of 0.025+/-0.004 and 0.024+/-0.002 liter/mmHg. The venous resistance of the extrasplanchnic channel also did not change from its control value of 5.0 mmHg-liter-1-min-1; however, the splanchnic venous resistance decreased from 16.3+/-3.2 to 9.4+/-2.8 mmHg-liter-1-min-1 (P less than 0.001). The effective splanchnic back pressure, estimated by measuring the level to which hepatic venous pressure had to be raised to cause a change in portal pressure, decreased from 3.9 to 3.0 mmHg (P less than 0.01).

  17. Total Anomalous Pulmonary Venous Connection to the Portal Vein

    SciTech Connect

    Wyttenbach, Marina; Carrel, Thierry; Schuepbach, Peter; Tschaeppeler, Heinz; Triller, Juergen

    1996-03-15

    Anomalous pulmonary venous return represents a rare congenital anomaly with wide anatomic and physiologic variability. We report a case of a newborn with a rare form of total infracardiac anomalous pulmonary venous connection (TAPVC). The pulmonary veins draining both lungs formed two vertical veins, which joined to a common pulmonary trunk below the diaphragm. This venous channel connected to the portal vein through the esophageal hiatus. The diagnosis was suggested by color Doppler sonography and confirmed by intravenous digital subtraction angiography, which allowed definition of the anatomy.

  18. Vertebral venous channels: CT appearance and differential considerations

    SciTech Connect

    Sartoris, D.J.; Resnick, D.; Guerra, J. Jr.

    1985-06-01

    A comprehensive study of the anatomy, radiologic images, and pathology of venous channels in the thoracic and lumbar vertebral bodies was performed using cadavers and patients. These structures may be mistaken for fractures, lytic lesions, or other abnormalities on high-resolution axial computed tomographic (CT) scans of the spine. A distinct osseous wall, absence of extension over multiple contiguous levels, lack of displacement, and predominant localization in the mid-axial plane of the vertebral body are characteristic features of venous channels. An understanding of the normal intraosseous venous anatomy should prevent misinterpretation of clinical CT studies in most instances.

  19. Acute mesenteric venous thrombosis with a vaginal contraceptive ring.

    PubMed

    Eilbert, Wesley; Hecht, Benjamin; Zuiderveld, Loren

    2014-07-01

    Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.

  20. Double connections in total anomalous pulmonary venous connection.

    PubMed

    Arciprete, P; McKay, R; Watson, G H; Hamilton, D I; Wilkinson, J L; Arnold, R M

    1986-07-01

    Three infants who underwent operation for total anomalous pulmonary venous connection had unobstructed drainage of all the pulmonary veins to both the coronary sinus and left vertical vein. In one patient the anatomy was demonstrated preoperatively and complete correction accomplished without difficulty, but in two patients the second connection was discovered only at postoperative reinvestigation. Arbitrary classification of total anomalous pulmonary venous connection into cardiac, supracardiac, infracardiac, and mixed types does not lend itself to description of such lesions and may obscure their clinical importance. For these less common variants of total anomalous pulmonary venous connection, a more detailed and precise definition of morphology facilitates accurate surgical repair.

  1. Submandibular venous hemangioma: Case report and review of the literature.

    PubMed

    Wallace, Adam N; Vyhmeister, Ross; Kamran, Mudassar; Teefey, Sharlene A

    2015-10-01

    Hemangiomas of the submandibular space are very rare. Only 11 cases have been reported in the English literature, all of which were cavernous hemangiomas. In this report, we describe the case of a venous hemangioma in a 70-year-old woman. Ultrasound examination revealed a lobulated, homogeneous, hypoechoic mass, and minimal flow was detected on power Doppler evaluation. The mass and the submandibular gland were surgically excised, and the endothelium was found to be positive for CD31 and D2-40 markers, consistent with venous hemangioma. To our knowledge, this is the first reported case of a venous hemangioma in the submandibular space.

  2. Extensive portal venous gas: Unlikely etiology and outcome.

    PubMed

    Schatz, Tiffany P; Nassif, Mohammed O; Farma, Jeffrey M

    2015-01-01

    Portal venous gas or hepatic portal venous gas (HPVG) found on imaging portends grave outcomes for patients suffering from ischemic bowel disease or mesenteric ischemia. HPVG is more rarely seen with severe but treatable abdominal infection as well as multiple benign conditions, and therefore must be aggressively evaluated. We report a 70-year old female who developed extensive intra- and extra-hepatic portal venous gas, pneumatosis intestinalis and free air associated with a perforation of the jejunojejunostomy after a gastrectomy for gastric carcinoma.

  3. Venous ulcer: late complication of a traumatic arteriovenous fistula.

    PubMed

    Young, Calvin J; Dardik, Alan; Sumpio, Bauer; Indes, Jeff; Muhs, Bart; Ochoa Chaar, Cassius I

    2015-01-01

    Arteriovenous fistula (AVF) formation after penetrating trauma is a well-described phenomenon. However, diagnosis of traumatic AVF is frequently delayed as patients often do not have hard signs of vascular injury at the initial presentation. Late complications of traumatic AVF include arterial and venous dilatation, distal ischemia, venous congestion, and congestive heart failure. This case report describes a traumatic femoral AVF causing distal venous ulceration 3 years after the injury. The AVF was treated with open repair. In the operating room, the Nicoladoni-Branham sign was elicited. The ulcer healed at 1 month and has not recurred at 1-year follow-up.

  4. Venous gas embolism - Time course of residual pulmonary intravascular bubbles

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Luehr, S.; Katz, J.

    1989-01-01

    A study was carried out to determine the time course of residual pulmonary intravascular bubbles after embolization with known amounts of venous air, using an N2O challenge technique. Attention was also given to the length of time that the venous gas emboli remained as discrete bubbles in the lungs with 100 percent oxygen ventilation. The data indicate that venous gas emboli can remain in the pulmonary vasculature as discrete bubbles for periods lasting up to 43 + or - 10.8 min in dogs ventilated with oxygen and nitrogen. With 100 percent oxygen ventilation, these values are reduced significantly to 19 + or - 2.5 min.

  5. [Treatment by danaparoid sodium for portal venous thrombosis].

    PubMed

    Shudo, Ryushi; Yazaki, Yasuyuki; Sugawara, Kenji; Honda, Mitsunori

    2007-02-01

    We report a case of hepatitis B type liver cirrhosis with portal venous thrombosis in which danaparoid sodium was very effective. The portal venous thrombosis in this case disappeared 2 weeks commencing after administration of danaparoid sodium. The patient had not adverse effects or complications such as hemorrhage, and the clinical course was good. We consider that danaparoid sodium is an anticoagulant unlikely to cause adverse effects such as hemorrhage, and that it might be effective for treatment of portal venous thrombosis. We intend to examine the indications of treatment with danaparoid sodium, clarify the best administration method, and establishment of maintenance therapy by investigating more cases. PMID:17283415

  6. [Current status of the management of venous thromboembolism in Japan].

    PubMed

    Nakamura, Mashio

    2014-07-01

    In the past, unfractionated heparin and warfarin have been used as anticoagulants for treatment of venous thromboembolism in Japan. Although it has been effective anticoagulants, these uses are accompanied by several pitfalls, which have led to research and the discovery of new additional groups of anticoagulants: parenteral factor Xa inhibitors, such as fondaparinux, and oral direct factor Xa inhibitors, such as rivaroxaban, apixaban and edoxaban. These new anticoagulants are fast-acting, noninferior to heparin and warfarin in preventing recurrence of venous thromboembolism, and do not require monitoring. These new anticoagulants show promise for improvement of long-term outcome for venous thromboembolism.

  7. Assisted venous drainage, venous air, and gaseous microemboli transmission into the arterial line: an in-vitro study.

    PubMed

    Rider, S P; Simon, L V; Rice, B J; Poulton, C C

    1998-12-01

    The objective of this study was to examine the interaction of cardiopulmonary bypass venous air with assisted venous drainage, focusing on its production of gaseous microemboli in the arterial line. An in-vitro recirculating cardiopulmonary bypass circuit containing fresh whole bovine blood was monitored with a pulsed-doppler microbubble detector. Air of specific amounts was injected into the venous line and gaseous microemboli counts were obtained distal to the arterial filter. Data was recorded for unassisted drainage, vacuum-assisted drainage, and centrifugal pump-assisted drainage. Centrifugal pump-assisted drainage produced over 300 microbubbles in one minute distal to the arterial filter when venous air was introduced into the circuit. Of these, 220 were greater than 80 microns in size. Vacuum-assisted drainage produced no microbubbles when the same amount of venous air was introduced into the circuit. However, vacuum-assisted drainage did produce some microbubbles in the arterial line when a stopcock was left open on the venous line for 30 seconds. Unassisted drainage produced no microbubbles at all levels of venous air entrainment. Air becomes entrained in the venous line from a variety of sources. In a typical gravity-drained situation, the air remains whole and is dissipated in the venous reservoir by buoyancy and filtration. In an assisted-drainage situation, the air is subjected to additional forces. The air is subjected to a greater degree of negative pressure and, with centrifugal pump assisted drainage, is subjected to kinetic energy imparted by the cones or vanes of the pump. The kinetic energy from the centrifugal pump appears to break the air into small bubbles which become suspended in the blood, passing through the reservoir, oxygenator, and arterial filter. In a clinical setting, these bubbles would be passed into a patient's arterial system.

  8. Venous outflow of the brain after bilateral complete jugular ligation.

    PubMed

    Ensari, Serdar; Kaptanoğlu, Erkan; Tun, Kağan; Gün, Taylan; Beşkonakli, Etem; Celikkanat, Serdar; Dere, Hüseyin; Cekirge, Saruhan

    2008-01-01

    A case of a patient with bilateral internal, external, posterior external and anterior jugular vein ligations and excisions performed in the neck due to a larynx tumor is presented. Radical neck dissection is a standard otorhinolaryngological procedure in the management of head and neck cancer patients with bilateral lymph node metastasis to the neck. Sacrifice of both internal and external jugular veins bilaterally has been recognized as a dangerous approach leading to intracranial hypertension with subsequent neurological sequela and death. In this report, we aimed to demonstrate how venous outflow from the brain diverts after jugular venous system obliteration. After bilateral jugular vein ligations, digital subtraction angiography (DSA) showed that the venous drainage route of the brain had been diverted from the jugular veins to the vertebral venous plexus. PMID:18382980

  9. 21 CFR 876.5955 - Peritoneo-venous shunt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... activated one-way valve. The catheter is implanted with one end in the peritoneal cavity and the other in a large vein. This device enables ascitic fluid in the peritoneal cavity to flow into the venous...

  10. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms

    PubMed Central

    Wattanakit, Keattiyoat; Cushman, Mary

    2010-01-01

    Purpose of review An estimated 13% of Americans have kidney disease. We sought to describe the association of kidney disease with risk of venous thromboembolism and discuss possible mechanisms explaining this association. Recent findings All severities of kidney disease appear to increase the risk of venous thromboembolism. In the general population the risk associated with mild to moderate kidney disease is 1.3–2-fold increased, and present even for microalbuminuria, although stage 1 chronic kidney disease itself has not been studied. End-stage renal disease is also associated with a 2.3-fold increased risk, compared to the general population. Although data are limited, risk increases after kidney transplant and with nephrotic syndrome as well. Summary Rates of kidney disease are increasing rapidly in the population and kidney disease is a risk factor for venous thromboembolism. An improved understanding of mechanisms linking kidney disease with venous thromboembolism will allow further study of best prevention efforts. PMID:19561505

  11. [Venous thrombosis of atypical location in patients with cancer].

    PubMed

    Campos Balea, Begoña; Sáenz de Miera Rodríguez, Andrea; Antolín Novoa, Silvia; Quindós Varela, María; Barón Duarte, Francisco; López López, Rafael

    2015-01-01

    Venous thromboembolism (VTE) is a complication that frequently occurs in patients with neoplastic diseases. Several models have therefore been developed to identify patient subgroups diagnosed with cancer who are at increased risk of developing VTE. The most common forms of thromboembolic episodes are deep vein thrombosis in the lower limbs and pulmonary thromboembolism. However, venous thrombosis is also diagnosed in atypical locations. There are few revisions of unusual cases of venous thrombosis. In most cases, VTE occurs in the upper limbs and in the presence of central venous catheters, pacemakers and defibrillators. We present the case of a patient diagnosed with breast cancer and treated with surgery, chemotherapy and radiation therapy who developed a thrombosis in the upper limbs (brachial and axillary).

  12. Deep venous thrombosis and postthrombotic syndrome: invasive management.

    PubMed

    Comerota, A J

    2015-03-01

    Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava.

  13. Incidence of Venous Thromboembolic Events Among Nursing Home Residents

    PubMed Central

    Gomes, Josephine P; Shaheen, Wassim H; Truong, Son V; Brown, Edward F; Beasley, Brent W; Gajewski, Byron J

    2003-01-01

    Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint—development of a venous thromboembolic event (VTE)—were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation. PMID:14687280

  14. Facts and fiction surrounding the discovery of the venous valves.

    PubMed

    Scultetus, A H; Villavicencio, J L; Rich, N M

    2001-02-01

    Venous valves are delicate structures, the integrity of which is crucial for the normal function of the venous system. Their abnormalities lead to widespread disorders, ranging from chronic venous insufficiency to life-threatening thromboembolic phenomena. The discovery of the venous valves, however, has been the subject of hot controversy. Even though Fabricius ab Aquapendente is credited with the discovery by most historians, we demonstrate in this paper that other anatomists described them many years before Fabricius ab Aquapendente publicly demonstrated them in Padua in 1579. A thorough review of the historical literature surrounding the discovery of the venous valves was carried out from 1545 to the present under the supervision of the Medical History Department of our institution. Research was performed at the History of Medicine Division of the National Library of Medicine and through MEDLINE access to the medical literature. The Parisian Charles Estienne first mentioned the venous valves in his 1545 publication when he described "apophyses membranarum" in the veins of the liver. Lusitanus and Canano publicly demonstrated them in the azygos vein during cadaver dissections performed in Ferrera, Italy. The Parisian Jacques Sylvius described valves in the veins of the extremities in 1555. The work of these anatomists, however, could not achieve full recognition, because Andreas Vesalius, the leading anatomist at that time, was unable to confirm their findings and strongly denied the existence of venous valves. Vesalius's influence was so powerful that research on the subject was idle until 1579, when Fabricius ab Aquapendente "discovered" the venous valves. About the same time, the German Salomon Alberti published the first drawings of a venous valve (in 1585). William Harvey, a disciple of Fabricius ab Aquapendente, finally postulated the function of the venous valves, providing anatomical support for one of the greatest discoveries in medicine: the blood

  15. Prophylaxis against venous thromboembolism in orthopedic surgery.

    PubMed

    Liu, Lin-tao; Ma, Bao-tong

    2006-08-01

    Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic

  16. The up-to-date management of venous thromboembolism.

    PubMed

    Chakrabarti, Anob M

    2015-08-01

    There have been a number of developments in the management of venous thromboembolism over the past few years. Old questions, such as thrombolysis, have been revisited in recent trials. New initiatives, such as ambulatory care pathways, are being established across the country. This conference brought together doctors from the UK, USA, Spain and Australia to review the up-to-date management of venous thromboembolism.

  17. Multiple medullary venous malformations decreasing cerebral blood flow: Case report

    SciTech Connect

    Tomura, N.; Inugami, A.; Uemura, K.; Hadeishi, H.; Yasui, N. )

    1991-02-01

    A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere. Single-photon emission computed tomography using N-isopropyl-p-({sup 123}I) iodoamphetamine demonstrated decreased cerebral blood flow in the right cerebral hemisphere.

  18. Venous obstruction in permanent pacemaker patients: an isotopic study

    SciTech Connect

    Pauletti, M.; Di Ricco, G.; Solfanelli, S.; Marini, C.; Contini, C.; Giuntini, C.

    1981-01-01

    Isotope venography was used to study the venous circulation proximal to the superior vena cava in two groups of pacemaker patients, one with a single endocavitary electrode and the other with multiple pacing catheters. A control group of patients without pacemakers was also studied. Numerous abnormalities were found, especially in the group with multiple electrodes. These findings suggest that venous obstruction is a common complication of endocardial pacing.

  19. Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps

    PubMed Central

    Nguyen, Gerard K.; Monahan, John F. W.; Davis, Gabrielle B.; Lee, Yong Suk; Ragina, Neli P.; Wang, Charles; Zhou, Zhao Y.; Hong, Young Kwon; Spivak, Ryan M.; Wong, Alex K.

    2013-01-01

    The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and allow clinicians to

  20. Simple handling of venous air embolism during abdominal myomectomy.

    PubMed

    Basaran, Betül; Basaran, Ahmet; Kozanhan, Betül; Özmen, Sadık; Basaran, Mustafa

    2016-01-01

    We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment. PMID:27591473

  1. Development and structures of the venous pole of the heart.

    PubMed

    Anderson, Robert H; Brown, Nigel A; Moorman, Antoon F M

    2006-01-01

    In the past, our interpretations of cardiac development depended on analysis of serially sectioned embryos, supported by three-dimensional reconstructions. It was not possible, using these techniques, to trace the fate of the various embryonic building blocks. This has all changed with the advent of the new techniques in molecular biology. Combining our experience with these new techniques and our previous studies using the classic approach, we have reviewed how the recent advances clarify controversies that still exist concerning the development of the venous pole. The arguments devolve on whether the pulmonary vein is itself a new development or whether its primordium is derived from the systemic venous tributaries, the so-called sinus venosus. The new techniques show that, rather than developing in the form of a segmented tube, the heart is built up by addition of material to both its arterial and venous poles. At no stage is it possible to recognize a discrete part of the tube that can be identified as the sinus venosus. The confluence of the systemic venous tributaries does not become recognizable as a discrete anatomic entity until compartmented into the newly formed right atrium concomitant with formation of the venous valves. The new molecular techniques show that the pulmonary vein is a new structure, anatomically and developmentally, that is derived from mediastinal myocardium. It gains its connection to the morphologically left atrium between the right- and left-sided systemic venous tributaries. PMID:16193508

  2. Glycosaminoglycan sulodexide modulates inflammatory pathways in chronic venous disease.

    PubMed

    Mannello, F; Ligi, D; Raffetto, J D

    2014-06-01

    Inflammation represents an important epiphenomenon in the etiopathogenesis of chronic venous disease, a worldwide debilitating condition affecting millions of subjects. The pathophysiology of chronic venous disease (CVD) is based on the hemodynamic abnormalities in conjunction to alterations in cellular and extracellular matrix biocompounds. The endothelial dysfunction results from early perturbation in the endothelium linked to glycocalyx injury and promoted by inflammatory cells and mediators (such as matrix metalloproteinases and interleukins), which lead to progressive dilation of the vein resulting in chronic venous insufficiency. Activated leukocytes during the inflammatory process release enzymes, free radicals, chemokines and inflammatory cytokines in the vessel microenvironment, which are responsible for the changes of the venous wall and venous valve, reflux and venous hypertension, and the development/progression of tissue destruction and skin changes. Sulodexide, a highly purified mixture of glycosaminoglycans composed by 80% fast moving heparin and 20% of dermatan sulphate, exhibits anti-thrombotic and profibrinolytic properties, restoring also the essential endothelial glycocalyx. Glycosaminoglycan sulodexide has been also characterized to reduce the release of inflammatory cytokines/chemokines and to inhibit the matrix metalloproteinases-related proteolytic cascades, counteracting endothelial dysfunctions. The pleiotropic effects of sulodexide set the basis for a very promising agent in treating the spectrum of CVD.

  3. Atrial natriuretic peptide increases resistance to venous return in rats

    SciTech Connect

    Chien, Y.W.; Frohlich, E.D.; Trippodo, N.C.

    1987-05-01

    To examine mechanisms by which administration of atrial natriuretic peptide (ANP) decreases venous return, the authors compared the hemodynamic effects of ANP furosemide (FU), and hexamethonium (HEX) with those of vehicle (VE) in anesthetized rats. Compared with VE, ANP reduced mean arterial pressure, central venous pressure, and cardiac index and increased calculated resistance to venous return. /sup 141/Ce-labeled microspheres were used to determine cardiac output. Mean circulatory filling pressure, distribution of blood flow between splanchnic organs and skeletal muscles, and total peripheral resistance remained unchanged. FU increased urine output similar to that of ANP, yet produced no hemodynamic changes, dissociating diuresis, and decreased cardiac output. HEX lowered arterial pressure through a reduction in total peripheral resistance without altering cardiac output or resistance to venous return. The results confirm previous findings that ANP decreases cardiac output through a reduction in venous return and suggest that this results partly from increased resistance to venous return and not from venodilation or distribution of blood flow.

  4. Development of venous-venous extracorporeal blood purification circuits in rodents for sepsis

    PubMed Central

    Peng, Zhi-Yong; Rimmelé, Thomas; Zhou, Feihu; Chuasuwan, Anan; Kellum, John A.

    2013-01-01

    BACKGROUND Unlike pharmacological interventions in sepsis, extracorporeal blood purification which is widely used in septic patients is not typically studied in experimental rodents. Most of the previous studies have performed extracorporeal blood purification in larger animals and typically use artery-venous (AV) vascular access. We developed a venous-venous (VV) purification model in the rat as a treatment for sepsis. METHODS Using adult male Sprague Dawley rats we cannulated the femoral artery or vein and the jugular vein with P50 tubing and created a VV or AV circuit. Blood flow was determined by arterial pressure in the AV circuit while in the VV circuit the blood flow was regulated using a rotary pump. The safety of this circuit was evaluated using the changes of blood interleukin-6 (IL-6), rectal temperature and seven-day survival with sham extracorporeal circulation (circuit connection without treatment) to the control (without circuit). The main side effects of this V-V circuit with A–V circuit were compared. RESULTS The difference of IL-6, body temperature and cumulative survival were no statistically significant after extracorporeal circulation. The main side effects of extracorporeal circulation occurred less often with VV compared to AV therapy: massive bleeding (2.5% vs. 15%, p=0.04), clot formation (2.5% vs. 15%, p=0.04). This VV circuit has been successfully used in different septic rodent models with different techniques (hemoadsorption and hemofiltration). CONCLUSIONS VV blood purification in a rodent model appears to be effective and is safer than AV circuit. PMID:23953896

  5. Imaging Diagnosis of Splanchnic Venous Thrombosis

    PubMed Central

    Rajesh, S.; Mukund, Amar; Arora, Ankur

    2015-01-01

    Splanchnic vein thrombosis (SVT) is a broad term that includes Budd-Chiari syndrome and occlusion of veins that constitute the portal venous system. Due to the common risk factors involved in the pathogenesis of these clinically distinct disorders, concurrent involvement of two different regions is quite common. In acute and subacute SVT, the symptoms may overlap with a variety of other abdominal emergencies while in chronic SVT, the extent of portal hypertension and its attendant complications determine the clinical course. As a result, clinical diagnosis is often difficult and is frequently reliant on imaging. Tremendous improvements in vascular imaging in recent years have ensured that this once rare entity is being increasingly detected. Treatment of acute SVT requires immediate anticoagulation. Transcatheter thrombolysis or transjugular intrahepatic portosystemic shunt is used in the event of clinical deterioration. In cases with peritonitis, immediate laparotomy and bowel resection may be required for irreversible bowel ischemia. In chronic SVT, the underlying cause should be identified and treated. The imaging manifestations of the clinical syndromes resulting from SVT are comprehensively discussed here along with a brief review of the relevant clinical features and therapeutic approach. PMID:26600801

  6. Serum albumin and risk of venous thromboembolism

    PubMed Central

    Folsom, Aaron. R.; Lutsey, Pamela L.; Heckbert, Susan R.; Cushman, Mary

    2010-01-01

    Summary The incidence of venous thromboembolism (VTE) is increased in patients with albuminuria. However, whether a low serum albumin concentration is associated with increased risk of VTE has been a matter of controversy. We determined the association of serum albumin with VTE incidence in two large, prospective, population-based cohorts: the Atherosclerosis Risk in Communities (ARIC) Study (n = 15,300) and the Cardiovascular Health Study (CHS) (n = 5,400). Validated VTE occurrence (n=462 in ARIC and n=174 in CHS) was ascertained during follow-up. In both studies, after adjustment for age, sex, race, use of hormone replacement therapy, estimated GFR, history of cancer, and diabetes, serum albumin tended to be associated inversely with VTE. The adjusted hazard ratio per standard deviation lower albumin was 1.18 (95% CI = 1.08, 1.31) in ARIC and 1.10 (95% CI = 0.94, 1.29) in CHS. The hazard ratio for albumin below (versus above) the fifth percentile was 1.28 (95% CI = 0.90, 1.84) in ARIC and 1.80 (95% CI = 1.11, 2.93) in CHS. In conclusion, low serum albumin was a modest marker of increased VTE risk. The observed association likely does not reflect cause and effect, but rather that low serum albumin reflects a hyperinflammatory or hypercoagulable state. Whether this association has clinical relevance warrants further study. PMID:20390234

  7. Venous thrombosis. Lifting the clouds of misunderstanding.

    PubMed

    Stephen, J M; Feied, C F

    1995-01-01

    Deep venous thrombosis (DVT) is often occult and difficult to recognize clinically. The diagnostic approach should begin with color-flow (duplex) ultrasound, noninvasive functional tests such as plethysmography, or both. Because these tests are not 100% sensitive, contrast venography or magnetic resonance imaging may be necessary in a patient with unexplained symptoms. A baseline ventilation-perfusion scan should be considered for any patient with DVT, because there is a high incidence of clinically inapparent pulmonary embolism. In the absence of contraindications, systemic or regional thrombolytic therapy should be considered for every patient with acute DVT. Surgical thrombectomy may be indicated for patients with a large, obstructive proximal thrombus. At a minimum, routine treatment should start with heparin and proceed to oral warfarin (Coumadin, Panwarfin, Sofarin), which should be continued for 3 months. Recurrent DVT after cessation of therapy warrants lifetime use of anticoagulants. A filter should be placed in the inferior vena cava whenever a large, poorly adherent thrombus is identified or when there is progression of thrombosis despite an anticoagulant regimen.

  8. Venous Drainage Patterns in Carotid Cavernous Fistulas

    PubMed Central

    Aralasmak, Ayse; Karaali, Kamil; Senol, Utku; Ozdemir, Huseyin; Alkan, Alpay

    2014-01-01

    Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298

  9. Forty-five-degree two-stage venous cannula: advantages over standard two-stage venous cannulation.

    PubMed

    Lawrence, D R; Desai, J B

    1997-01-01

    We present a 45-degree two-stage venous cannula that confers advantage to the surgeon using cardiopulmonary bypass. This cannula exits the mediastinum under the transverse bar of the sternal retractor, leaving the rostral end of the sternal incision free of apparatus. It allows for lifting of the heart with minimal effect on venous return and does not interfere with the radially laid out sutures of an aortic valve replacement using an interrupted suture technique.

  10. Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

    PubMed Central

    MITSUHASHI, Yutaka; HAYASAKI, Koji; KAWAKAMI, Taichiro; NAGATA, Takashi; KANESHIRO, Yuta; UMABA, Ryoko; OHATA, Kenji

    2016-01-01

    The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage. PMID:27063146

  11. Living-Engineered Valves for Transcatheter Venous Valve Repair

    PubMed Central

    Weber, Benedikt; Robert, Jérôme; Ksiazek, Agnieszka; Wyss, Yves; Frese, Laura; Slamecka, Jaroslav; Kehl, Debora; Modregger, Peter; Peter, Silvia; Stampanoni, Marco; Proulx, Steven; Falk, Volkmar

    2014-01-01

    Background: Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno- and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. Methods: Tri- and bicuspid venous valves (n=27) based on polyglycolic acid–poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bone-marrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n=18) and experimentally delivered (n=7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. Results: The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. Conclusions: Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of

  12. Computer-assisted venous thrombosis volume quantification.

    PubMed

    Puentes, John; Dhibi, Mounir; Bressollette, Luc; Guias, Bruno; Solaiman, Basel

    2009-03-01

    Venous thrombosis (VT) volume assessment, by verifying its risk of progression when anticoagulant or thrombolytic therapies are prescribed, is often necessary to screen life-threatening complications. Commonly, VT volume estimation is done by manual delineation of few contours in the ultrasound (US) image sequence, assuming that the VT has a regular shape and constant radius, thus producing significant errors. This paper presents and evaluates a comprehensive functional approach based on the combination of robust anisotropic diffusion and deformable contours to calculate VT volume in a more accurate manner when applied to freehand 2-D US image sequences. Robust anisotropic filtering reduces image speckle noise without generating incoherent edge discontinuities. Prior knowledge of the VT shape allows initializing the deformable contour, which is then guided by the noise-filtering outcome. Segmented contours are subsequently used to calculate VT volume. The proposed approach is integrated into a system prototype compatible with existing clinical US machines that additionally tracks the acquired images 3-D position and provides a dense Delaunay triangulation required for volume calculation. A predefined robust anisotropic diffusion and deformable contour parameter set enhances the system usability. Experimental results pertinence is assessed by comparison with manual and tetrahedron-based volume computations, using images acquired by two medical experts of eight plastic phantoms and eight in vitro VTs, whose independently measured volume is the reference ground truth. Results show a mean difference between 16 and 35 mm(3) for volumes that vary from 655 to 2826 mm(3). Two in vivo VT volumes are also calculated to illustrate how this approach could be applied in clinical conditions when the real value is unknown. Comparative results for the two experts differ from 1.2% to 10.08% of the smallest estimated value when the image acquisition cadences are similar.

  13. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    SciTech Connect

    Graaf, Rick de; Wolf, Mark de; Sailer, Anna M.; Laanen, Jorinde van Wittens, Cees; Jalaie, Houman

    2015-10-15

    PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.

  14. The pathogenesis of thrombosis in venous prostheses.

    PubMed

    Itoh, T; Shiba, E; Kambayashi, J; Watase, M; Kawasaki, T; Sakon, M; Mori, T

    1990-12-01

    To evaluate the pathogenesis of thrombosis formation in synthetic venous grafts, the inferior vena cava of rabbits were replaced by woven Tetron (polyethylene terephtalate) grafts. Six animals were assigned as controls without medication (Group A), and 48 animals were randomly assigned to experimental groups as follows: ticlopidine hydrochloride (100 mg/kg/day) was administered orally from 5 days prior to operation to the end of the experiment (Group B); warfarin sodium (0.33 mg/kg/day) was given orally for the same period (Group C); and a combination of ticlopidine hydrochloride (50 mg/kg/day) and warfarin sodium (0.16 mg/kg/day) was administered for the same period (Group D). All the grafts in group A occluded within 3 h. All grafts harvested from groups B and D remained patent at least until the twenty-eighth day after grafting but the lumen was narrowed by intimal hyperplasia. Although the grafts from group C were patent at the seventh day, all grafts occluded with intimal hyperplasia on day 14 and day 28. The dry weight of thrombus in the graft in group B and group D was 39 +/- 3 mg and 30 +/- 2 mg, respectively on day 28. These figures were significantly lower than that of the control group 59 +/- 9 mg at 5 h after the initial heparinisation. Ultrastructural studies with scanning electron microscopy showed that the thrombus in the graft of the control group was composed of platelet aggregates anchored to synthetic fibres and of erythrocytes entrapped in the fibrin network. By day 7, in the groups modified with drugs, sheets of endothelial-like cells extended across both suture lines from the host stumps and extended to the middle of the graft thereafter. Light microscopy revealed that the initimal hyperplasia in groups B, C and D on day 28 were mainly composed of fibroblasts, myoblasts, collagenous fibres and micro-capillaries.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2279573

  15. SP-05VENOUS THROMBOEMBOLISM AND GLIOBLASTOMA

    PubMed Central

    Yust-Katz, Shlomit; Mandel, Jacob; Ying, Yuan; Wu, Jimin; Courtney, C.; Ladha, Harshad; Pawar, Tushar; Gilbert, Mark; Armstrong, Terri

    2014-01-01

    The risk of venous thromboembolism (VTE) is very high for patients with brain tumors; Glioblastoma (GB) specifically is one of the most at risk cancers. The aim of this study is to estimate the frequency and identify potential risk factors of GB patients developing VTE during adjuvant chemotherapy and to test if the Khorana scale accurately predicts the risk of VTE among this patient population. We retrospectively reviewed patients with GB treated at MD Anderson during the years 2005-2011. The target population of our study was patients who developed VTE after starting adjuvant chemotherapy. Patients were excluded if they did not start treatment with the established standard of care, had less than 6 months follow up or if they developed VTE before starting adjuvant treatment. The study sample included 440 patients. 64 (14.5%) of them developed VTE. The median time to develop VTE was 6.5 months. On multivariate analysis male sex, BMI≥ 35, KPS ≤80, history of VTE and steroid therapy were significantly associated with the development of VTE. We also found that in this patient sample, the Khorana scale was not a valid predictive model in GB patients due to very poor specificity. Of the 64 patients who developed a VTE, 36 were treated with anticoagulation, 2 with an IVC filter, and 21 with both. Complications secondary to anticoagulation were reported in 16% (n = 10) of patients. The complications included intracranial hemorrhage, bleeding to other organs and thrombocytopenia. VTE is very common in patients with GB. Currently, we are lacking a scale that accurately predicts the risk of VTE among GB patients. Predictive scales used for other cancers do not seem valid for GB due to the unique nature of the disease. Future studies are needed to create an accurate predictive model for VTE in GB patients.

  16. The Current Role of Venous Sampling in the Localization of Endocrine Disease

    SciTech Connect

    Lau, Jeshen H. G. Drake, William; Matson, Matthew

    2007-07-15

    Endocrine venous sampling plays a specific role in the diagnosis of endocrine disorders. In this article, we cover inferior petrosal sinus sampling, selective parathyroid venous sampling, hepatic venous sampling with arterial stimulation, adrenal venous sampling, and ovarian venous sampling. We review their indications and the scientific evidence justifying these indications in the diagnosis and management of Cushing's syndrome, hyperparathyroidism, pancreatic endocrine tumors, Conn's syndrome, primary hyperaldosteronism, pheochromocytomas, and androgen-secreting ovarian tumors. For each sampling technique, we compare its diagnostic accuracy with that of other imaging techniques and, where possible, look at how it impacts patient management. Finally, we incorporate venous sampling into diagnostic algorithms used at our institution.

  17. Squamous cell carcinoma developed on chronic venous leg ulcer.

    PubMed

    Sîrbi, Adelina Gabriela; Florea, Marius; Pătraşcu, Virgil; Rotaru, Maria; Mogoş, Dan Gabriel; Georgescu, Claudia Valentina; Mărgăritescu, Nicolae Dragoş

    2015-01-01

    Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34βE12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.

  18. Air pollution and venous thrombosis: a meta-analysis

    PubMed Central

    Tang, Liang; Wang, Qing-Yun; Cheng, Zhi-Peng; Hu, Bei; Liu, Jing-Di; Hu, Yu

    2016-01-01

    Exposure to air pollution has been linked to cardiovascular and respiratory disorders. However, the effect of air pollution on venous thrombotic disorders is uncertain. We performed a meta-analysis to assess the association between air pollution and venous thrombosis. PubMed, Embase, EBM Reviews, Healthstar, Global Health, Nursing Database, and Web of Science were searched for citations on air pollutants (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and particulate matters) and venous thrombosis. Using a random-effects model, overall risk estimates were derived for each increment of 10 μg/m3 of pollutant concentration. Of the 485 in-depth reviewed studies, 8 citations, involving approximately 700,000 events, fulfilled the inclusion criteria. All the main air pollutants analyzed were not associated with an increased risk of venous thrombosis (OR = 1.005, 95% CI = 0.998–1.012 for PM2.5; OR = 0.995, 95% CI = 0.984–1.007 for PM10; OR = 1.006, 95% CI = 0.994–1.019 for NO2). Based on exposure period and thrombosis location, additional subgroup analyses provided results comparable with those of the overall analyses. There was no evidence of publication bias. Therefore, this meta analysis does not suggest the possible role of air pollution as risk factor for venous thrombosis in general population. PMID:27600652

  19. Preliminary clinical investigations of a new noninvasive venous pulse oximeter

    NASA Astrophysics Data System (ADS)

    Chan, Daniel; Smith, Peter R.; Caine, Michael P.; Spyt, Tomasz; Boehm, Maria; Machin, David

    2003-10-01

    For decades, the monitoring of mixed venous oxygen saturation, SvO2 has been performed invasively using fibre-optic catheters. This procedure is not without risk as complications may arise from catheterisation. The group has devised a new non-invasive venous oximetry method which involves inducing regular modulations of the venous blood volume and associated measurement of those modulations using optical means. A clinical investigation was conducted in Glenfield Hospital, UK to evaluate the sensitivity of the new technique to haemodynamic changes such as Cardiac Output (CO) in intraoperative and postoperative cardiac patients. Preliminary trials on patients recovering from cardiac surgery yielded an average correlation of r = 0.72 between CO at different Intra Aortic Balloon Pump (IABP) augmentation levels and SvO2 measured by the new venous oximeter. In intraoperative patients undergoing off-pump cardiac surgery, SvO2 recorded by the new technique responded to unplanned events such as a cardiac arrest. CONCLUSION: The new venous oximetry technique is a promising technique which responds to haemodynamic changes such as CO and with further development might offer an alternative means of monitoring SvO2 non-invasively.

  20. Communication between lymphatic and venous systems in mice.

    PubMed

    Shao, Lenan; Takeda, Kazu; Kato, Shigeki; Mori, Shiro; Kodama, Tetsuya

    2015-09-01

    The lymphatic system in mice consists of lymphatic vessels and 22 types of lymph nodes. Metastatic tumor cells in the lymphatic system spread to distant organs through the venous system. However, the communication routes between the lymphatic and venous systems have not been fully elucidated. Here, we identify the communication routes between the lymphatic and venous systems in the axillary and subiliac regions of MXH10/Mo-lpr/lpr inbred mice, which develop systemic swelling of lymph nodes up to 10mm in diameter, allowing investigation of the topography of the lymph nodes and lymphatic vessels. Using a gross anatomy dissection approach, the efferent lymphatic vessels of the proper axillary lymph node were shown to communicate with the subclavian vein. Furthermore, we found that the thoracoepigastric vein, which connects the subclavian vein and inferior vena cava, runs adjacent to the subiliac and proper axillary lymph nodes, and receives venous blood from these lymph nodes routed through small branches. The direction of blood flow in the thoracoepigastric vein occurred in two directions in the intermediate region between the proper axillary lymph node and subiliac lymph node; one to the subclavian vein, the other to the inferior vena cava. This paper reveals the anatomy of the communication between the lymphatic and venous systems in the axillary and subiliac regions of the mouse, and provides new insights relevant to the investigation of the mechanisms of lymph node metastasis and cancer immunology, and the development of diagnostic and treatment methods for lymph node metastasis, including drug delivery systems.

  1. Risk factors for venous thromboembolism in immunoglobulin light chain amyloidosis

    PubMed Central

    Bever, Katherine M.; Masha, Luke I.; Sun, Fangui; Stern, Lauren; Havasi, Andrea; Berk, John L.; Sanchorawala, Vaishali; Seldin, David C.; Sloan, J. Mark

    2016-01-01

    Patients with immunoglobulin light chain amyloidosis are at risk for both thrombotic and bleeding complications. While the hemostatic defects have been extensively studied, less is known about thrombotic complications in this disease. This retrospective study examined the frequency of venous thromboembolism in 929 patients with immunoglobulin light chain amyloidosis presenting to a single referral center, correlated risk of venous thromboembolism with clinical and laboratory factors, and examined complications of anticoagulation in this population. Sixty-five patients (7%) were documented as having at least one venous thromboembolic event. Eighty percent of these patients had events within one year prior to or following diagnosis. Lower serum albumin was associated with increased risk of VTE, with a hazard ratio of 4.30 (CI 1.60–11.55; P=0.0038) for serum albumin less than 3 g/dL compared to serum albumin greater than 4 g/dL. Severe bleeding complications were observed in 5 out of 57 patients with venous thromboembolism undergoing treatment with anticoagulation. Prospective investigation should be undertaken to better risk stratify these patients and to determine the optimal strategies for prophylaxis against and management of venous thromboembolism. PMID:26452981

  2. Air pollution and venous thrombosis: a meta-analysis

    NASA Astrophysics Data System (ADS)

    Tang, Liang; Wang, Qing-Yun; Cheng, Zhi-Peng; Hu, Bei; Liu, Jing-Di; Hu, Yu

    2016-09-01

    Exposure to air pollution has been linked to cardiovascular and respiratory disorders. However, the effect of air pollution on venous thrombotic disorders is uncertain. We performed a meta-analysis to assess the association between air pollution and venous thrombosis. PubMed, Embase, EBM Reviews, Healthstar, Global Health, Nursing Database, and Web of Science were searched for citations on air pollutants (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and particulate matters) and venous thrombosis. Using a random-effects model, overall risk estimates were derived for each increment of 10 μg/m3 of pollutant concentration. Of the 485 in-depth reviewed studies, 8 citations, involving approximately 700,000 events, fulfilled the inclusion criteria. All the main air pollutants analyzed were not associated with an increased risk of venous thrombosis (OR = 1.005, 95% CI = 0.998–1.012 for PM2.5; OR = 0.995, 95% CI = 0.984–1.007 for PM10; OR = 1.006, 95% CI = 0.994–1.019 for NO2). Based on exposure period and thrombosis location, additional subgroup analyses provided results comparable with those of the overall analyses. There was no evidence of publication bias. Therefore, this meta analysis does not suggest the possible role of air pollution as risk factor for venous thrombosis in general population.

  3. Calf pump activity influencing venous hemodynamics in the lower extremity.

    PubMed

    Recek, Cestmir

    2013-03-01

    Calf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of the previous pathological situation; this chain of events has been called hemodynamic paradox. PMID:24436580

  4. Air pollution and venous thrombosis: a meta-analysis.

    PubMed

    Tang, Liang; Wang, Qing-Yun; Cheng, Zhi-Peng; Hu, Bei; Liu, Jing-Di; Hu, Yu

    2016-01-01

    Exposure to air pollution has been linked to cardiovascular and respiratory disorders. However, the effect of air pollution on venous thrombotic disorders is uncertain. We performed a meta-analysis to assess the association between air pollution and venous thrombosis. PubMed, Embase, EBM Reviews, Healthstar, Global Health, Nursing Database, and Web of Science were searched for citations on air pollutants (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and particulate matters) and venous thrombosis. Using a random-effects model, overall risk estimates were derived for each increment of 10 μg/m(3) of pollutant concentration. Of the 485 in-depth reviewed studies, 8 citations, involving approximately 700,000 events, fulfilled the inclusion criteria. All the main air pollutants analyzed were not associated with an increased risk of venous thrombosis (OR = 1.005, 95% CI = 0.998-1.012 for PM2.5; OR = 0.995, 95% CI = 0.984-1.007 for PM10; OR = 1.006, 95% CI = 0.994-1.019 for NO2). Based on exposure period and thrombosis location, additional subgroup analyses provided results comparable with those of the overall analyses. There was no evidence of publication bias. Therefore, this meta analysis does not suggest the possible role of air pollution as risk factor for venous thrombosis in general population. PMID:27600652

  5. Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

    PubMed Central

    Januário, Virginia; de Ávila, Dione Augusto; Penetra, Maria Alice; Sampaio, Ana Luisa Bittencourt; Noronha Neta, Maria Isabel; Cassia, Flavia de Freire; Carneiro, Sueli

    2016-01-01

    BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy. PMID:26982773

  6. Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis

    PubMed Central

    Faraji, Fardin; Didgar, Farshid; Talaie-Zanjani, Afsoon; Mohammadbeigi, Abolfazl

    2013-01-01

    Cerebral venous sinus thrombosis is a rare form of stroke caused by thrombosis in venous sinuses of the brain. In this study, we reported on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure despite being treated with anti-epileptic drugs at high doses. The case was a 33-year-old woman with a history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month. She was febrile and a brain CT scan indicated hemorrhagic focus in the left posterior parietal and the temporal lobe. Magnetic resonance imaging and magnetic resonance venography also proved venous sinus thrombosis in the left transverse sinus. Besides [In addition], a laboratory assessment confirmed brucellosis. Following the treatment with anti-coagulant, anti-brucellosis, and anti-epileptic agents, the patient was discharged in good condition with medical orders. Clinical suspicion and accurate evaluation of a patient's history is the most important clue in diagnosis and treatment of brucellosis and cerebral venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control. PMID:24250168

  7. Pulmonary venous waterfall and perivenous pressure in the living dog.

    PubMed

    Smith, H C; Butler, J

    1975-02-01

    Evidence has been obtained that a waterfall effect occurs in the pulmonary veins of the living dog. Anesthetized open-chest dogs were used. Small catheters were passed from the left atrium retrogradely up the pulmonary veins and venous tributaries until they finally pierced the venous walls. They were then pulled out through the surface of the lung until their bellshaped inner ends wedged in small side branches of the vein. They were used to measure upstream venous pressures via the occluded tributary without occlusion of the vein. The pulmonary lymphatics and bronchial circulation were untouched. Alveolar pressure (transpulmonary pressure, Ptp) was held constant during the periods of measurement. We found that intrapulmonary (upstream) venous pressures did not rise with elevation of left atrial (downstream) pressures at any Ptp until a pressure of at least 7 cmH2O above the base of the lung was exceeded. This left atrial pressure (below which a venous waterfall or flow-limiting segment effect was present) increased with Ptp when Ptp exceeded about 15 cmH2O. The waterfall occurs in the larger veins at the lung surface. Its presence and location suggest that intrapulmonary veins in the living animal are held open by the surrounding lung tissue and that neither the flow through them nor their contained volume is influenced by left atrial pressure when this is low.

  8. Clinical considerations concerning detection of venous air embolism.

    PubMed

    Albin, M S; Carroll, R G; Maroon, J C

    1978-01-01

    Venous air embolism during neurosurgical procedures (detected by Doppler Ultrasound and aspiration via a right atrial catheter) was noted in 100 of 400 patients in the sitting position, 5 of 60 patients in the lateral position, 7 of 48 patients in the supine position, and 1 of 10 individuals monitored in the prone position. We confirmed venous air embolism in many of these cases by using serial technetium-macroaggregated albumin lung scans. Gravitational gradients from the venous portal of entrance to the right side of the heart were as small as 5.0 cm, with aspiration of 200 ml of air occurring. Doppler ultrasonic air bubble detection and aspiration through a previously inserted right atrial catheter are critical factors in the diagnosis and treatment of this condition.

  9. Medical and surgical treatment of chronic venous ulcers.

    PubMed

    Cooper, Michol A; Qazi, Umair; Bass, Eric; Zenilman, Jonathan; Lazarus, Gerald; Valle, M Frances; Malas, Mahmoud B

    2015-01-01

    Venous ulcer of the lower extremity is a common vascular condition and is associated with decreased quality of life, reduced mobility, and social isolation. Treatment of chronic venous ulcer (CVU) includes compression therapy, debridement of the ulcer when necessary, and wound care. Collagen and antimicrobial dressings can improve the proportion of ulcers healed compared with compression alone. Acellular skin equivalents are not superior to compression, but cellular human skin equivalents can promote more rapid healing, particularly in patients with longstanding ulcers. Current vascular surgical practice is to eliminate documented reflux or obstruction in patients with CVU that have failed a 3-month period of compression dressing, debridement, and local wound care. We found that surgical treatment of the superficial venous system can decrease the time to healing of CVUs compared with compression therapy alone, but does not increase the proportion of ulcers healed. PMID:27113282

  10. Medical and surgical treatment of chronic venous ulcers.

    PubMed

    Cooper, Michol A; Qazi, Umair; Bass, Eric; Zenilman, Jonathan; Lazarus, Gerald; Valle, M Frances; Malas, Mahmoud B

    2015-01-01

    Venous ulcer of the lower extremity is a common vascular condition and is associated with decreased quality of life, reduced mobility, and social isolation. Treatment of chronic venous ulcer (CVU) includes compression therapy, debridement of the ulcer when necessary, and wound care. Collagen and antimicrobial dressings can improve the proportion of ulcers healed compared with compression alone. Acellular skin equivalents are not superior to compression, but cellular human skin equivalents can promote more rapid healing, particularly in patients with longstanding ulcers. Current vascular surgical practice is to eliminate documented reflux or obstruction in patients with CVU that have failed a 3-month period of compression dressing, debridement, and local wound care. We found that surgical treatment of the superficial venous system can decrease the time to healing of CVUs compared with compression therapy alone, but does not increase the proportion of ulcers healed.

  11. Cortical venous thrombosis following exogenous androgen use for bodybuilding

    PubMed Central

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic–clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

  12. Cortical venous thrombosis following exogenous androgen use for bodybuilding.

    PubMed

    Sveinsson, Olafur; Herrman, Lars

    2013-01-01

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

  13. Varicose Veins: Role of Mechanotransduction of Venous Hypertension

    PubMed Central

    Atta, Hussein M.

    2012-01-01

    Varicose veins affect approximately one-third of the adult population and result in significant psychological, physical, and financial burden. Nevertheless, the molecular pathogenesis of varicose vein formation remains unidentified. Venous hypertension exerted on veins of the lower extremity is considered the principal factor in varicose vein formation. The role of mechanotransduction of the high venous pressure in the pathogenesis of varicose vein formation has not been adequately investigated despite a good progress in understanding the mechanomolecular mechanisms involved in transduction of high blood pressure in the arterial wall. Understanding the nature of the mechanical forces, the mechanosensors and mechanotransducers in the vein wall, and the downstream signaling pathways will provide new molecular targets for the prevention and treatment of varicose veins. This paper summarized the current understanding of mechano-molecular pathways involved in transduction of hemodynamic forces induced by blood pressure and tries to relate this information to setting of venous hypertension in varicose veins. PMID:22489273

  14. Allergic contact dermatitis in venous leg ulcer patients.

    PubMed

    Tavadia, S; Bianchi, J; Dawe, R S; McEvoy, M; Wiggins, E; Hamill, E; Urcelay, M; Strong, A M M; Douglas, W S

    2003-05-01

    Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.

  15. Cortical venous thrombosis following exogenous androgen use for bodybuilding.

    PubMed

    Sveinsson, Olafur; Herrman, Lars

    2013-02-05

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully.

  16. Primary hyperaldosteronism: comparison of CT, adrenal venography, and venous sampling

    SciTech Connect

    Geisinger, M.A.; Zelch, M.G.; Bravo, E.L.; Risius, B.F.; O'Donovan, P.B.; Borkowski, G.P.

    1983-08-01

    Twenty-nine patients with primary hyperaldosteronism were evaluated with computed tomography (CT), adrenal venous sampling, and adrenal venography. Twenty-three patients had aldosteronomas and six had bilateral adrenocortical hyperplasia. Sixteen (70%) of the adenomas were accurately located by CT. All nodules of 1.5 cm or larger diameter and 50% of nodules 1.0 to 1.4 cm in diameter were demonstrated. Nodules of less than 1.0 cm in diameter generally were not detected. High-resolution CT appeared more sensitive than standard CT (75% vs 58%). Adrenal venous sampling for aldosterone assay was the most sensitive of the three methods, localizing 22 (96%) of the 23 adenomas. Eighteen (78%) of the adenomas were identified by adrenal venography, although two patients with bilateral cortical hyperplasia were mistakenly diagnosed as having a small adenoma. No such false-positive studies were encountered with CT or adrenal venous sampling.

  17. Cerebral venous hemodynamic abnormalities in episodic and chronic migraine

    PubMed Central

    Petolicchio, Barbara; Viganò, Alessandro; di Biase, Lazzaro; Tatulli, Doriana; Toscano, Massimiliano; Vicenzini, Edoardo; Passarelli, Francesco; Di Piero, Vittorio

    2016-01-01

    Summary Alterations of cerebral venous drainage have been demonstrated in chronic migraine (CM), suggesting that cerebral venous hemodynamic abnormalities (CVHAs) play a role in this condition. The aim of the present study was to look for a correlation between CM and CVHAs. We recruited 33 subjects suffering from CM with or without analgesic overuse, 29 episodic migraine (EM) patients with or without aura, and 21 healthy subjects as controls (HCs). CVHAs were evaluated by transcranial and extracranial echo-color Doppler evaluation of five venous hemodynamic parameters. CVHAs were significantly more frequent in the CM and EM patients than in the HCs. In the migraine patients, CVHAs were not correlated with clinical features. The significantly greater frequency of CVHAs observed in the migraineurs may reflect a possible relationship between migraine and these abnormalities. Prospective longitudinal studies are needed to investigate whether CVHAs have a role in the processes of migraine chronification. PMID:27358220

  18. The maternal venous system: the ugly duckling of obstetrics

    PubMed Central

    Tomsin, K.

    2013-01-01

    In pregnancy, both maternal vascular tone and cardiac function are considered key players to reach a normal outcome for both mother and child. This complex story of maternal hemodynamics is intensely discussed in current scientific literature, however the role of the maternal veins has been strongly underestimated. We developed and evaluated a set of measurable objective parameters which give an indication of venous function, i.e. the venous impedance index and the venous pulse transit time. These parameters turned out to be subject to changes throughout normal pregnancy and in preeclampsia enabling their use in gestational hemodynamic studies. From our studies, we concluded that the venous system is a crucial determinant of cardiac output, which can be estimated by impedance cardiography. The introduction of these non-invasive techniques in obstetrics enables profiling the maternal cardiovascular system, integrating both arteries and veins, as well as maternal cardiac function. Studying the cascade of cardiovascular changes throughout pregnancy using such non-invasive, easily applicable, and highly accessible methods opens perspectives to introduce this maternal cardiovascular profile in several clinical settings. The early discrimination between low and high risk patients, together with the classification of different pregnancy disorders may help guiding the clinical work-up of the pregnant population regarding both prevention and treatment, as well as follow-up. We illustrate that the venous system, being an “ugly duckling” at first neglected by the medical world, transforms and matures into a beautiful swan, accepted by the obstetric world. We are confident that this is the beginning of many other studies regarding the maternal venous system, an important piece of the gestational physiology puzzle. PMID:24753937

  19. Sulodexide for the Prevention of Recurrent Venous Thromboembolism

    PubMed Central

    Bignamini, Angelo A.; Davì, Giovanni; Palareti, Gualtiero; Matuška, Jiří; Holý, Martin; Pawlaczyk-Gabriel, Katarzyna; Džupina, Andrej; Sokurenko, German Y.; Didenko, Yury P.; Andrei, Laurentia D.; Lessiani, Gianfranco; Visonà, Adriana

    2015-01-01

    Background— Patients with a first episode of unprovoked venous thromboembolism have a high risk of recurrence after discontinuation of anticoagulant therapy. Extending anticoagulation reduces the risk of recurrence but is associated with increased bleeding. Sulodexide, a glycosaminoglycan, exerts antithrombotic and profibrinolytic actions with a low bleeding risk when administered orally, but its benefit for preventing recurrent venous thromboembolism is not well known. Methods and Results— In this multicenter, double-blind study, 615 patients with first-ever unprovoked venous thromboembolism who had completed 3 to 12 months of oral anticoagulant treatment were randomly assigned to sulodexide 500 lipasemic units twice daily or placebo for 2 years, in addition to elastic stockings. The primary efficacy outcome was recurrence of venous thromboembolism. Major or clinically relevant bleeding was the primary safety outcome. Venous thromboembolism recurred in 15 of the 307 patients who received sulodexide and in 30 of the 308 patients who received placebo (hazard ratio, 0.49; 95% confidence interval [CI], 0.27–0.92; P=0.02). The analysis in which lost to follow-up was assigned to failure yielded a risk ratio among treated versus control subjects of 0.54 (95% confidence interval, 0.35–0.85; P=0.009). No major bleeding episodes occurred; 2 patients in each treatment group had a clinically relevant bleeding episode. Adverse events were similar in the 2 groups. Conclusion— Sulodexide given after discontinuation of anticoagulant treatment reduced the risk of recurrence in patients with unprovoked venous thromboembolism, with no apparent increase of bleeding risk. Clinical Trial Registration— URL: https://www.clinicaltrialsregister.eu/. Identifier: EudraCT number 2009-016923-77. PMID:26408273

  20. A rare cause of cerebral venous thrombosis: cryptococcal meningoencephalitis.

    PubMed

    Senadim, Songul; Alpaydin Baslo, Sezin; Tekin Güveli, Betül; Dedei Daryan, Metin; Kantaroglu, Elif; Ozturk, Oya; Atakli, Dilek

    2016-07-01

    Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a non-endemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis. PMID:27025504

  1. Cerebral venous sinus stenting for pseudotumor cerebri: A review

    PubMed Central

    Kanagalingam, Sivashakthi; Subramanian, Prem S.

    2014-01-01

    Pseudotumor cerebri is characterized by headaches, visual field changes, papilledema and an elevated cerebrospinal fluid opening pressure without evidence of an intracranial mass. In the setting of failed medical therapy, surgical options such as ventriculoperitoneal shunts and optic nerve sheath fenestrations are considered. Recently, venous sinus stenting has emerged as a new treatment option for patients with pseudotumor cerebri. We review the role of cerebral venous sinus stenting in the management of patients with medically refractory pseudotumor cerebri. Although long- term studies are needed in this field, the current reports indicate a favorable outcome for preventing vision loss and symptom control. PMID:25859134

  2. New Anticoagulants for the Prevention and Treatment of Venous Thromboembolism

    PubMed Central

    McRae, Simon J; Ginsberg, Jeffrey S

    2005-01-01

    Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety), ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism. PMID:17319097

  3. [Neonatal cerebral venous thrombosis: diagnosis by magnetic resonance angiography].

    PubMed

    Puig, J; Pedraza, S; Méndez, J; Trujillo, A

    2006-01-01

    Neonatal cerebral venous thrombosis (NCVT) is a rare, severe neuropathology of multiple etiology and variable clinical presentation. We describe the case of a 25-day-old infant that presented with a tonic convulsion. Ultrasound examination showed tetraventricular hemorrhage. Magnetic resonance imaging (MRI) showed the presence of acute thrombosis of the deep and superficial venous systems associated to a hemorrhagic infarct of the left thalamus. Coagulation study revealed a deficit of protein C. Thrombosis of deep cerebral veins must be ruled out as a cause of a neonatal convulsive crisis. The presence of a hemorrhagic thalamic lesion supports the diagnosis of NCVT, which must in turn be confirmed by magnetic resonance angiography (MRA).

  4. Central Venous Disease in Hemodialysis Patients: An Update

    SciTech Connect

    Modabber, Milad; Kundu, Sanjoy

    2013-08-01

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.

  5. [Widespread mesenteric venous thrombosis and cirrhosis diagnosed with autopsy].

    PubMed

    Kömür, İlhami; Özdemirel, Rifat Özgür; Başpınar, Bünyamin; Şam, Bülent; Anık Karayel, Ferah

    2015-09-01

    Mesenteric venous thrombosis is a rare disorder with a high mortality rate. Since patients remain asymptomatic, diagnosis of the disease is difficult. Diagnosis can be mainly made with either laparotomy or autopsy. Many factors are considered in the etiology of mesenteric venous thrombosis. Liver cirrhosis and chronic pyelonephritis, which we detected in the autopsy and histologic examination of our case, are considered as two of the factors. In our study, it was aimed to present a case with near-total intestinal necrosis caused by portal vein thrombosis which spread to the lineal vein, pancreatic vein and to the branches of superior mesenteric veins.

  6. Adrenal venous sampling in a patient with adrenal Cushing syndrome

    PubMed Central

    Villa-Franco, Carlos Andrés; Román-Gonzalez, Alejandro; Velez-Hoyos, Alejandro; Echeverri-Isaza, Santiago

    2015-01-01

    The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia. PMID:26309345

  7. Adrenal venous sampling in a patient with adrenal Cushing syndrome.

    PubMed

    Builes-Montaño, Carlos Esteban; Villa-Franco, Carlos Andrés; Román-Gonzalez, Alejandro; Velez-Hoyos, Alejandro; Echeverri-Isaza, Santiago

    2015-01-01

    The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

  8. Venous thromboembolic events in minimally invasive gynecologic surgery.

    PubMed

    Ramirez, Pedro T; Nick, Alpa M; Frumovitz, Michael; Schmeler, Kathleen M

    2013-01-01

    The rate of venous thromboembolic events (VTEs) including deep venous thrombosis and pulmonary embolism among women undergoing gynecologic surgery is high, particularly for women with a gynecologic malignancy. Current guidelines recommend VTE thrombopropylaxis in the immediate postoperative period for patients undergoing open surgery. However, the VTE prophylaxis recommendations for women undergoing minimally invasive gynecologic surgery are not as well established. The risk of VTEs in patients undergoing minimally invasive surgery appears to be low based on retrospective analyses. To date, there are no established guidelines that specifically provide a standard of care for patients undergoing minimally invasive gynecologic surgery for benign or malignant disease.

  9. Air embolism in central venous catheterization: diagnosis, treatment, and prevention.

    PubMed

    Lambert, M J

    1982-10-01

    Air embolism associated with central venous catheterization carries with it a significant morbidity and mortality. The diagnosis should be suggested by sudden alterations in cardiovascular, respiratory, or central nervous system function in a patient with a central venous catheter. A "mill wheel" cardiac murmur is characteristic. Placing the patient in the left lateral decubitus with the head down allows displacement of the air from the pulmonary outflow tract. Prevention of the complication involves thorough patient and physician preparation before subclavian catheterization, use of a Luer lock between catheter and tubing, meticulous catheter care, and employment of a pump with an in-line air detector.

  10. Management of catheter-associated upper extremity deep venous thrombosis.

    PubMed

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  11. Cerebral venous thrombosis after immune thrombocytopenic purpura and anti-D immune globulin therapy.

    PubMed

    Kayyali, Husam R; Abdelmoity, Ahmed T; Morriss, M Craig; Graf, William D

    2008-03-01

    Cerebral venous thrombosis has multiple etiologies and a wide variety of clinical manifestations. This article reports on a young girl who developed cerebral venous thrombosis after intravenous anti-D immune globulin therapy for immune thrombocytopenic purpura. In this case, venous infarction was manifested by an unusual pattern of restricted diffusion limited to the corpus callosum. The cause of cerebral venous thrombosis in this patient may be related to both immune thrombocytopenia and immunoglobulin therapy.

  12. Modification of the trap door technique to treat venous aneurysms in arteriovenous fistulae.

    PubMed

    Kapoulas, Konstantinos C; Georgakarakos, Efstratios I; Georgiadis, George S; Lazarides, Miltos K

    2012-01-01

    We present a modification of the "trap door" technique to treat true venous aneurysms which complicate vascular access arteriovenous fistula. The technique provides wide exposure of the aneurysm, facilitating aneurysmoraphy and permitting the exploitation of any adequate venous length for autologous reconstruction of the venous outflow. Furthermore, by precluding the proximity of the newly-reconstructed venous segments to the incised skin, their level of compromise from tissue scarring or infection is prevented. PMID:22020527

  13. Abducens Palsy Due to Cerebral Venous Sinus Thrombosis in a Patient with Heart Failure

    PubMed Central

    Özgönül, Cem; Ceylan, Osman Melih; Mutlu, Fatih Mehmet; Altınsoy, Halil İbrahim; Aparcı, Mustafa

    2015-01-01

    Cerebral venous sinus thrombosis has a wide spectrum of presentation. The clinical manifestation depends on the location of the thrombus, its rate of progression, and the extent of venous collateralization. In this case report, we present the findings of cerebral venous sinus thrombosis presenting with abducens palsy and papilloedema in a patient with heart failure, an unusual etiology for cerebral venous sinus thrombosis. PMID:27800228

  14. Use of single-cannula venous-venous extracorporeal life support in the management of life-threatening airway obstruction.

    PubMed

    Ko, Michael; dos Santos, Pedro R; Machuca, Tiago N; Marseu, Katherine; Waddell, Thomas K; Keshavjee, Shaf; Cypel, Marcelo

    2015-03-01

    The use of venous-venous extracorporeal life support (VV ECLS) for the endoscopic management of airway obstruction has been rarely reported. In most instances, ECLS has been used in the setting of cardiopulmonary resuscitation in which venoarterial ECLS was initiated as part of resuscitation. We report a patient with a bulky primary tumor of the tracheal carina presenting with airway obstruction who was managed with intraoperative single-cannula VV ECLS to facilitate endoscopic interventions leading to more definitive airway security. PMID:25742860

  15. A Fatal Case of Hepatic Portal Venous Gas Associated With Hemodialysis

    PubMed Central

    Begum, Tahmina

    2016-01-01

    Hepatic portal venous gas is a rare cause of acute abdomen caused by leakage of air from the gastrointestinal tract to the portal venous system. The mortality is high, particularly when associated with intestinal ischemia or necrosis. We describe a fatal case of hepatic portal venous gas and pneumatosis intestinalis due to hemodialysis-related hypotension and severe atherosclerotic disease. PMID:27800516

  16. Calibrated BOLD using direct measurement of changes in venous oxygenation.

    PubMed

    Driver, Ian D; Hall, Emma L; Wharton, Samuel J; Pritchard, Susan E; Francis, Susan T; Gowland, Penny A

    2012-11-15

    Calibration of the BOLD signal is potentially of great value in providing a closer measure of the underlying changes in brain function related to neuronal activity than the BOLD signal alone, but current approaches rely on an assumed relationship between cerebral blood volume (CBV) and cerebral blood flow (CBF). This is poorly characterised in humans and does not reflect the predominantly venous nature of BOLD contrast, whilst this relationship may vary across brain regions and depend on the structure of the local vascular bed. This work demonstrates a new approach to BOLD calibration which does not require an assumption about the relationship between cerebral blood volume and cerebral blood flow. This method involves repeating the same stimulus both at normoxia and hyperoxia, using hyperoxic BOLD contrast to estimate the relative changes in venous blood oxygenation and venous CBV. To do this the effect of hyperoxia on venous blood oxygenation has to be calculated, which requires an estimate of basal oxygen extraction fraction, and this can be estimated from the phase as an alternative to using a literature estimate. Additional measurement of the relative change in CBF, combined with the blood oxygenation change can be used to calculate the relative change in CMRO(2) due to the stimulus. CMRO(2) changes of 18 ± 8% in response to a motor task were measured without requiring the assumption of a CBV/CBF coupling relationship, and are in agreement with previous approaches.

  17. Diploic venous anatomy studied in-vivo by MRI.

    PubMed

    Jivraj, Khalil; Bhargava, Ravi; Aronyk, Keith; Quateen, Ahmed; Walji, Anil

    2009-04-01

    Calvarial diploic venous anatomy has been studied post-mortem, but few studies have addressed these venous structures in-vivo. Previous work in our laboratory has shown that intraosseous infusion through the skull diploic space near the diploic veins in animals and humans does access the superior sagittal sinus and the systemic venous system. We developed a volumetric method of imaging the diploic veins in-vivo using MRI, intravenous gadolinium, and digital subtraction to provide for three-dimensional depiction and exact localization of these veins. We hypothesized that this technique would allow for an assessment of the probability of existence, distribution, and concentration of diploic veins in the skull. We scanned 31 neurosurgical patients, and were able to create 3D diploic venous maps in 74% of them. These maps were processed using Adobe Photoshop CS2. Mathworks MatLab 6.5, once customized, counted the number of pixels occupied by the diploic veins in the processed image. The probability of veins was highest in the occipital regions (100%). The inferior occipital (4.1%) and posterior parietal (4.1%) regions had the highest concentrations of diploic veins. Digital subtraction venography using a volumetric MRI sequence can demonstrate the diploic veins in-vivo. The inferior occipital region may be the best area for an intraosseous infusion device because it has the greatest likelihood of containing a vein and also has the highest concentration of veins. PMID:19173254

  18. The Organization of the Venous Spaces of the Cavernous Sinus

    PubMed Central

    de Alencastro, Luiz Carlos

    1992-01-01

    The study of the venous channels in the cavernous sinus in 48 sphenoid bones was performed. Thirty-eight bones were electrolyticly decalcified, subsequently embedded in gelatin, and cut in 1 mm thick slices. Microdissection of the other ten specimens complemented the analysis. Every specimen had the venous structure arranged as a plexus, however, although the channels were variable in number, form, and diameter, the two sides were quite symmetrical. Channels of smaller diameter predominated anteriorly. There was no demonstrable muscular layer in these vessels; the endothelial lining was easily visualized. Fatty tissue separated the venous channels from each other and from arteries and nerves. The distance from the carotid artery and the lateral wall increased anteriorly, but there were significant veins between these two structures in only 35% of the cases. In about one third of specimens the oculomotor nerve was placed over the carotid artery. The abducens nerve was found to be intimately related to the lateral wall without any venous channels between them in 92% of the specimens. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7 PMID:17170875

  19. Development of Needle Insertion Manipulator for Central Venous Catheterization

    NASA Astrophysics Data System (ADS)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  20. A familial venous malformation locus is on chromosome 9p

    SciTech Connect

    Boon, L.M.; Mulliken, J.B.; Vikkula, M.

    1994-09-01

    Venous malformation is the most common vascular malformation affecting 0.2% of the population. Depending upon size and location, these slow-flow lesions may cause pain, anatomic distortion and threaten life. Most venous malformations occur sporadically and present as solitary lesions. For this reason, determining their pathogenic bases has proven elusive. However, venous malformations also occur in several rare syndromes, some of which demonstrate Mendelian inheritance. As a first step towards identifying the pathogenic bases for these lesions, we have mapped a locus for an autosomal dominant disorder in a three generation family that manifests as multiple cutaneous and mucosal venous malformations. This locus lies within a 24.5 cM interval on chromosome 9p, defined by the markers D9S157 and D9S163. A maximum LOD score of 4.11 at {theta} = 0.05 is obtained with several markers within the interval. The interferon gene cluster, which has previously been implicated in angiogenesis, and the multiple tumor suppressor gene, responsible for several types of malignant tumors, also lie within this interval and are potential candidates.

  1. Capillary-venous malformation in the upper limb.

    PubMed

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

    2015-01-01

    We present a group of patients with regional capillary malformations of the upper limbs and few additional findings other than prominent veins. We believe that this entity is the upper extremity equivalent of capillary-venous malformation of the lower limb and, likewise, belongs at the minor end of the spectrum of vascular disorders with overgrowth. PMID:25557931

  2. A rare localization of cerebral venous sinus thrombosis. Case report.

    PubMed

    Carangelo, B; Lavalle, L; Tiezzi, G; Branco, D; Lippa, L; Mileo, E; Costantino, G; Mariottini, A; Muscas, G; Maturo, A

    2015-01-01

    In this work the Authors report their experience on the treatment of a case of cavernous venous sinus thrombosis. The diagnosis is clinical and neuroradiological, CT, MRN, cerebral angiography and orbital venography have aided in establishing the diagnosis during life. Very interesting is the therapeutic approach. PMID:26017108

  3. Managing venous leg ulcers and oedema using compression hosiery.

    PubMed

    Tickle, Joy

    2015-10-21

    Increasing demand for services and rising costs in the NHS have resulted in reduced consultation times and resources for clinicians when treating patients with compression therapy. This article emphasises the importance of considering alternative treatment approaches, while encouraging patient choice, independence and self-care. One alternative treatment is the use of compression hosiery kits for the management of venous leg ulceration and oedema.

  4. Cerebral venous sinus thrombosis in children with nephrotic syndrome

    PubMed Central

    Gera, D. N.; Yadav, D. K.; Kute, V. B.; Patil, S. B.; Trivedi, H. L.

    2012-01-01

    Nephrotic syndrome in infancy and childhood can be associated with thromboembolic complications. We describe two cases of nephrotic syndrome who presented with non-specific findings. Magnetic resonance imaging brain with magnetic resonance venography showed thrombosis of multiple venous sinuses. Patients were successfully treated with anticoagulants and there was complete resolution of thrombosis on repeat imaging. PMID:23439670

  5. Infant death due to air embolism from peripheral venous infusion.

    PubMed

    Sowell, Matthew W; Lovelady, Cari L; Brogdon, B G; Wecht, Cyril H

    2007-01-01

    An otherwise healthy male infant was brought to the hospital because the mother suspected superficial infection at the operative site 5 days after an inguinal hernia repair. He was admitted to the pediatric unit overnight to be evaluated by his surgeon the next morning. When a venous infusion of maintenance fluids was started, the patient immediately went into cardio-respiratory arrest and was pronounced dead after resuscitation efforts failed. Subsequently, air collections were found in both venous and arterial circulations, including the splenoportal system. Detailed review of the clinical presentation and course, laboratory results, radiological, and pathological findings, along with a review of pertinent literature provides an explanation for the death by air embolism. Apparent inconsistent findings both radiographically and at autopsy are resolved. The mechanism of distribution of air to both systemic and splenoportal circulation is discussed. We believe this to be only the eighth case reported in English-language literature of infantile death from peripheral venous infusion. In all age groups, we find only six other cases in the English-language literature of gas found concomitantly in both the systemic and portal venous systems. PMID:17209934

  6. Scintigraphic demonstration of lower extremity periostitis secondary to venous insufficiency

    SciTech Connect

    Gensburg, R.S.; Kawashima, A.; Sandler, C.M.

    1988-07-01

    The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of (/sup 67/Ga)citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

  7. [Syndromes of venous mesenteric ischemia: infarction and transient ischemia].

    PubMed

    Cardot, F; Borg, J Y; Guédon, C; Lerebours, E; Colin, R

    1992-01-01

    The reports of 8 patients with acute or subacute abdominal pain related to venous mesenteric ischemia were reviewed. None of the patients presented local or regional predisposing factors for venous thrombosis. In 4 patients, a localized segment of ischemic small bowel (median length 125 cm; range: 30-350) was resected without immediate anastomosis and postoperative anticoagulation therapy was given. Two of these patients developed recurrent ischemia involving the bowel adjacent to the stoma, treated successfully in 1 case by a repeat resection. The 4 other patients hospitalized with intestinal obstructive symptoms (1 case) or abdominal angina (3 cases) were treated by long term anticoagulation in 3 cases and artificial nutrition in 2 cases. None of them developed mesenteric infarction with a median follow up of 34 months. In 7 of the 8 patients, a coagulopathy was found: primary myeloproliferative disorder (1 case), hypercoagulation state (5 cases), autoimmune hemolytic anemia (1 case). These observations suggest that venous mesenteric ischemia included two different entities on the basis of clinical and morphological criteria: mesenteric infarction and subacute transient ischemia without bowel infarction. Most of apparently idiopathic cases of acute or subacute venous mesenteric ischemia are related to hypercoagulation states requiring a long term anticoagulation.

  8. [Hemostatic status in subjects with deep venous thrombosis].

    PubMed

    Ferlito, S; Bonomo, T; Pitari, G; Puleo, R; Condorelli, M; Mazzone, D

    1996-12-01

    The authors report a study on the hemostatic status of a group of patients with deep venous thrombosis in order to highlight the possible pathogenetic responsibility of blood coagulative disorders in the genesis of thrombosis. The group consisted of 27 patients (14 males, 13 females, mean age 48 +/- 4 years) with deep venous thrombosis of the lower limbs (clinical symptoms were primary in 21 cases, secondary in 6 cases) diagnosed on the basis of clinical data and ultrasonographic instrumental findings. Fourteen normal subjects were also examined as a control group (12 males, 2 females, mean age 28 +/- 5 years). Venous blood was collected on fasting from patients and controls to examine the following parameters: fibrinogen (F), factor VII (F VII), antithrombin III (AT III), protein C (PC), protein S (PS) using coagulometric methods (IL), and tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), fibrinopeptide A (FPA), betathromboglobulin (BTG) and dimer-D (D-D) using ELISA methods (Boehringer). Patients with deep venous thrombosis showed a significant increase in F, FVII, tPA and D-D levels compared to controls, whereas a significant reduction was observed in PAI-1. Nonsignificant variations were found for AT III, PC, PS and BTG. In the light of these results the authors affirm that: high fibrinogen and factor VII levels are highly prognostic for thrombosis in patients with deep venous thrombosis; the importance of the lack of inhibitory factors (AT III, PC, PS) is confined to individual genetically predisposed cases; there is an efficacious hyperfibrinolytic reactive response to the presence of thrombus (increase in tPA and D-D, reduction of PAI-1).

  9. The Critical Importance of Hepatic Venous Blood Flow Doppler Assessment for Patients in Shock.

    PubMed

    Hulin, Jonathan; Aslanian, Pierre; Desjardins, Georges; Belaïdi, Mustapha; Denault, André

    2016-03-01

    Hepatic venous blood flow can be easily obtained using bedside ultrasound with either transthoracic or transesophageal echocardiography. Six critically ill patients with shock associated with absent or significantly reduced hepatic venous blood flow in the presence of normal or increased pulmonary venous flow are presented. In all these patients, the etiology of shock was secondary to increased resistance to venous return from either an intraabdominal process or through extrinsic or intrinsic occlusion of the proximal inferior vena cava or right atrium. These shock situations are secondary to increased resistance to venous return. Their treatment is highly specific and typically involves a surgical intervention. PMID:26556108

  10. Severe Juxtahepatic Venous Injury: Survival after Prolonged Hepatic Vascular Isolation Without Shunting

    PubMed Central

    Worthley, C. S.; Terblanche, J.

    1990-01-01

    Survival following major juxtahepatic venous injury is rare in blunt liver trauma despite the use of intracaval shunting. Prolonged liver arterial inflow control, total hepatic venous isolation and lobectomy without shunting was used in a patient to repair a combined vena caval and hepatic venous injury after blunt liver injury. An extended period of normothermic hepatic ischemia was tolerated. Early recognition of retrohepatic venous injury and temporary liver packing to control bleeding and correct hypovolemia are essential before caval occlusion. Hepatic vascular isolation without shunting is an effective simple alternative technique allowing major venous repair in complex liver trauma. PMID:2090188

  11. Deep venous thromboses in patients with hematological malignancies after peripherally inserted central venous catheters.

    PubMed

    Tran, Ha; Arellano, Martha; Chamsuddin, Abbas; Flowers, Christopher; Heffner, Leonard T; Langston, Amelia; Lechowicz, Mary Jo; Tindol, Allen; Waller, Edmund; Winton, Elliott F; Khoury, Hanna J

    2010-08-01

    The incidence of deep venous thromboses (DVTs) associated with peripherally inserted central catheters (PICCs) in patients with hematological malignancies is not well described. We sought to determine the incidence, characteristics, and outcomes of PICC-related DVTs in this patient population. Retrospective, single center cohort analysis of patients with hematological malignancies with upper extremity PICCs and symptomatic upper extremity DVTs were identified by electronic medical record databases search. Between April 2001 and February 2006, 899 PICCs were placed in 498 patients, and ultrasound documented DVTs were observed in 39 (7.8%) a median of 26 days after PICC placement. Twenty-three (59%) had a new diagnosis of hematological malignancy at the time of PICC placement. DVT management included PICC removal (71%), thrombectomy/thrombolysis (13%), and 3-month anticoagulation. No pulmonary emboli or hemorrhages were observed. A change to centrally inserted tunneled internal jugular (IJ) catheters was instituted February 2006, and the incidence of DVTs was 0.4% among 843 tunneled IJ catheters placed in a subsequent cohort of 667 patients with hematological malignancies. Patients with hematological malignancies have a high incidence of PICC-associated DVTs. Internal jugular vein tunneled PICCs are associated with a very low incidence of DVTs in this patient population.

  12. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia

    PubMed Central

    Chakraborty, Arunangshu; Agrawal, Sanjit; Datta, Taniya; Mitra, Suparna; Khemka, Rakhi

    2016-01-01

    Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.

  13. JUGULAR CENTRAL VENOUS CATHETER PLACEMENT THROUGH A MODIFIED SELDINGER TECHNIQUE FOR LONG-TERM VENOUS ACCESS IN CHELONIANS.

    PubMed

    Pardo, Mariana A; Divers, Stephen

    2016-03-01

    Long-term or repeated venous access in chelonians is difficult to obtain and manage, but can be critically important for administration of medications and blood sampling in hospitalized patients. Jugular catheterization provides the most rapid and secure route for vascular access, but catheters can be difficult to place, and maintaining catheter patency may be challenging. Long multilumen polyurethane catheters provide flexibility and sampling access, and minimize difficulties, such as catheter displacement, that have been encountered with traditional over-the-needle catheters. We describe placement of 4 Fr. 13-cm polyurethane catheters in three chelonians with the use of a modified Seldinger technique. Venous access was obtained with the use of an over-the-needle catheter, which allowed placement of a 0.018-in.-diameter wire, over which the polyurethane catheter was placed. Indwelling time has ranged between 1 and 4 mo currently. All tortoises were sedated for this procedure. Polyurethane central catheters provide safe, long-term venous access that allows clinicians to perform serial blood sampling as well as intravenous administration of medications, anesthetic agents, and fluids. A jugular catheter can also allow central venous pressure measurement. Utilization of central line catheters was associated with improvements in diagnostic efficiency and therapeutic case management, with minimal risks and complications.

  14. Hickman to central venous catheter: A case of difficult venous access in a child suffering from acute lymphoblastic leukemia

    PubMed Central

    Chakraborty, Arunangshu; Agrawal, Sanjit; Datta, Taniya; Mitra, Suparna; Khemka, Rakhi

    2016-01-01

    Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed. PMID:27695218

  15. The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients

    SciTech Connect

    Clarke-Pearson, D.L.; Synan, I.S.; Colemen, R.E.; Hinshaw, W.; Creasman, W.T.

    1984-04-15

    Three hundred eighty-two patients who underwent major operations for gynecologic malignancy were studied prospectively to determine the natural history of postoperative venous thromboemboli. Iodine 125-labeled fibrinogen leg counting, to diagnose deep venous thrombosis, was performed daily. Sixty-three patients (17%) developed postoperative venous thromboembolic complications. Deep venous thrombosis initially arose in the calf veins in 52 patients. Twenty-seven percent of these thrombi lysed spontaneously. Four percent of thrombi in the calf veins progressed to deep venous thrombosis in the femoral vein, and 4% resulted in pulmonary emboli. Nine other patients developed proximal deep venous thrombosis without prior thrombosis in the calf veins. One patient with proximal deep venous thrombosis also had a pulmonary embolus. Two patients with no evidence of deep venous thrombosis on prospective /sup 125/I-labeled fibrinogen leg counting developed pulmonary emboli, including one fatal pulmonary embolus that was found at autopsy to have arisen from the internal iliac veins. Fifty percent of all venous thromboemboli were detected within 48 hours of operation, although two patients developed significant deep venous thrombosis and pulmonary emboli after discharge from the hospital. These results add important information to our understanding of this disease process, and raise issues related to appropriate treatment and prophylaxis of venous thromboembolism in patients after gynecologic operations.

  16. Pdgfrb‐Cre targets lymphatic endothelial cells of both venous and non‐venous origins

    PubMed Central

    Ulvmar, Maria H.; Martinez‐Corral, Ines; Stanczuk, Lukas

    2016-01-01

    Abstract The Pdgfrb‐Cre line has been used as a tool to specifically target pericytes and vascular smooth muscle cells. Recent studies showed additional targeting of cardiac and mesenteric lymphatic endothelial cells (LECs) by the Pdgfrb‐Cre transgene. In the heart, this was suggested to provide evidence for a previously unknown nonvenous source of LECs originating from yolk sac (YS) hemogenic endothelium (HemEC). Here we show that Pdgfrb‐Cre does not, however, target YS HemEC or YS‐derived erythro‐myeloid progenitors (EMPs). Instead, a high proportion of ECs in embryonic blood vessels of multiple organs, as well as venous‐derived LECs were targeted. Assessment of temporal Cre activity using the R26‐mTmG double reporter suggested recent occurrence of Pdgfrb‐Cre recombination in both blood and lymphatic ECs. It thus cannot be excluded that Pdgfrb‐Cre mediated targeting of LECs is due to de novo expression of the Pdgfrb‐Cre transgene or their previously established venous endothelial origin. Importantly, Pdgfrb‐Cre targeting of LECs does not provide evidence for YS HemEC origin of the lymphatic vasculature. Our results highlight the need for careful interpretation of lineage tracing using constitutive Cre lines that cannot discriminate active from historical expression. The early vascular targeting by the Pdgfrb‐Cre also warrants consideration for its use in studies of mural cells. genesis 54:350–358, 2016. © 2016 The Authors. Genesis Published by Wiley Periodicals, Inc. PMID:27060598

  17. Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.

    PubMed

    Hernandez, Sergio; Valdes, Jorge; Salama, Moises

    2016-06-01

    Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively. Venous thromboembolism creates an economic burden on both the patient and the healthcare system. The intent of this literature review is to determine existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings.

  18. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis

    PubMed Central

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-01-01

    Abstract Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  19. Radiotherapy for intraarticular venous malformations of the knee.

    PubMed

    Fujita, Takeshi; Okimoto, Tomoaki; Ito, Katsuyoshi; Tanabe, Masahiro; Matsunaga, Naofumi

    2014-11-01

    Intraarticular venous malformation (IAVM) of the knee is a rare vascular disease that manifests with pain, swelling, and hemarthrosis. A young man with left knee pain and swelling was admitted to our institution for the treatment of the IAVM of the left knee which was diagnosed by a local orthopedic doctor via arthroscopy. A total dose of 40 Gy of radiotherapy was delivered with a daily dose of 2.0 Gy using 6 MV X-ray beams and a linear accelerator through anteroposterior portals. Fifteen months after radiotherapy, follow-up examination using radiologic imaging showed distinct shrinkage of the venous malformations. Swelling and pain of the left knee had decreased, and range of motion of the left knee was maintained. This report describes a case involving a 38-year-old man with IAVM of the left knee in whom favorable outcomes were obtained in response to radiotherapy. PMID:25017778

  20. Hokusai-VTE: Edoxaban for the treatment of venous thromboembolism

    PubMed Central

    Said, Karim

    2013-01-01

    Venous thromboembolism is associated with a high morbidity and, if left untreated, may progress to fatal outcome. The standard treatment of venous thromboembolism consists of heparin followed by long-term treatment with a vitamin K antagonist. However, the use of vitamin K antagonist has several inherent problems and practical challenges. These challenges have prompted the search for new oral anticoagulant drugs including direct factor Xa inhibitors (e.g., rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g., dabigatran). To date, results for dabigatran, rivaroxaban, apixaban, for the treatment of VTE have been published. Recently, results of the 4th new oral anticoagulant agent, edoxaban, have been published in the Hokusai-VTE study. This review discusses the Hokusai-VTE study with special emphasis on its salient features (compared to other new oral anticoagulant studies) in addition to an overview on some key lessons learnt. PMID:24749116

  1. Lymphatic vessels arise from specialized angioblasts within a venous niche.

    PubMed

    Nicenboim, J; Malkinson, G; Lupo, T; Asaf, L; Sela, Y; Mayseless, O; Gibbs-Bar, L; Senderovich, N; Hashimshony, T; Shin, M; Jerafi-Vider, A; Avraham-Davidi, I; Krupalnik, V; Hofi, R; Almog, G; Astin, J W; Golani, O; Ben-Dor, S; Crosier, P S; Herzog, W; Lawson, N D; Hanna, J H; Yanai, I; Yaniv, K

    2015-06-01

    How cells acquire their fate is a fundamental question in developmental and regenerative biology. Multipotent progenitors undergo cell-fate restriction in response to cues from the microenvironment, the nature of which is poorly understood. In the case of the lymphatic system, venous cells from the cardinal vein are thought to generate lymphatic vessels through trans-differentiation. Here we show that in zebrafish, lymphatic progenitors arise from a previously uncharacterized niche of specialized angioblasts within the cardinal vein, which also generates arterial and venous fates. We further identify Wnt5b as a novel lymphatic inductive signal and show that it also promotes the ‘angioblast-to-lymphatic’ transition in human embryonic stem cells, suggesting that this process is evolutionarily conserved. Our results uncover a novel mechanism of lymphatic specification, and provide the first characterization of the lymphatic inductive niche. More broadly, our findings highlight the cardinal vein as a heterogeneous structure, analogous to the haematopoietic niche in the aortic floor.

  2. Venous Thromboembolism – Current Diagnostic and Treatment Modalities

    PubMed Central

    Bosevski, Marijan; Srbinovska-Kostovska, Elizabeta

    2016-01-01

    BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality. AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE. RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE. Novel oral anticoagulants seem to have some advantages in the treatment of this disorder. Rivaroxaban has been approved widespread, for use as a single-drug approach of VTE. CONCLUSION: Both guidelines are almost similar and good basis for evidence-based treatment of this disorder. PMID:27703586

  3. Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.

    PubMed

    Hernandez, Sergio; Valdes, Jorge; Salama, Moises

    2016-06-01

    Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively. Venous thromboembolism creates an economic burden on both the patient and the healthcare system. The intent of this literature review is to determine existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings. PMID:27501651

  4. Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis.

    PubMed

    Ennaifer, R; Moussa, A; Mouelhi, L; Salem, M; Bouzaidi, S; Debbeche, R; Trabelsi, S; Najjar, T

    2009-01-01

    Thrombosis is a well recognized complication of inflammatory bowel disease that occurs in 1.3 to 6.4% of patients, however, cerebral vascular involvement is unusual. We present the case of a 16-year-old female in whom cerebral venous thrombosis was the presenting symptom of an active ulcerative pancolitis. Thrombophilia screen (plasma levels of proteins C and S, antithrombin, antibeta2-glycoprotein, lupus anticoagulant and anticardiolipin antibodies, activated protein C resistance, homocystein level antinuclear antibodies) was negative. The patient was successfully treated with anticoagulant therapy, phenobarbital and sulfasalazine. Cerebral venous thrombosis is an exceptional presenting feature of ulcerative colitis. Disease activity may play a major role in the occurrence of thrombosis. PMID:19902870

  5. A Rare Central Venous Catheter Malposition: A Case Report

    PubMed Central

    Moeinipour, Ali Asghar; Amouzeshi, Ahmad; Joudi, Marjan; Fathi, Mehdi; Jahanbakhsh, Saeed; Hafez, Saeed; Izanloo, Azra; Khorsand, Mahmood

    2014-01-01

    Introduction: Central venous catheter placement is a routine procedure for the management of critically ill patients; however, it is important to ensure its proper placement. A central venous catheter malposition may cause various complications, some of which can be fatal. Case Presentation: We report an unexpected malposition of a catheter in the left internal jugular vein, where it entered into the left internal mammary vein. Conclusions: We think one of the influential factors for leading a guidewire and catheter into a nominated vein may be the left sided bevel of the needle at the time of internal jugular vein needle and catheter insertion. We were required to continue going towards the subclavian vein and accidentally turned into the left internal mammary vein. PMID:24660160

  6. How I manage venous thromboembolism risk in hospitalized medical patients.

    PubMed

    Dobromirski, Mark; Cohen, Alexander T

    2012-08-23

    Venous thromboembolism is a significant cause of illness and death worldwide. Large bodies of evidence support the heightened risk status of hospitalized medical patients, and that prophylactic measures significantly reduce the risk of thrombosis, yet these patients often fail to receive adequate prophylactic therapy. This failure may be accounted for by a lack of awareness of the relevant indications, poorly designed implementation systems, and clinical concerns over the side effects of anticoagulant medications. This article briefly summarizes our understanding of the clinical factors relevant to the evaluation of venous thromboembolism risk in hospitalized medical patients. We describe our approach to the use of thromboprophylaxis, through which we aim to minimize the disease burden of this under-recognized and preventable pathology.

  7. Cryotherapy and ankle motion in chronic venous disorders

    PubMed Central

    Kelechi, Teresa J.; Mueller, Martina; Zapka, Jane G.; King, Dana E.

    2013-01-01

    This study compared ankle range of motion (AROM) including dorsiflexion, plantar flexion, inversion and eversion, and venous refill time (VRT) in leg skin inflamed by venous disorders, before and after a new cryotherapy ulcer prevention treatment. Fifty-seven-individuals participated in the randomized clinical trial; 28 in the experimental group and 29 received usual care only. Results revealed no statistically significant differences between the experimental and usual care groups although AROM measures in the experimental group showed a consistent, non-clinically relevant decrease compared to the usual care group except for dorsiflexion. Within treatment group comparisons of VRT results showed a statistically significant increase in both dorsiflexion and plantar flexion for patients with severe VRT in the experimental group (6.9 ± 6.8; p = 0.002 and 5.8 ± 12.6; p = 0.02, respectively). Cryotherapy did not further restrict already compromised AROM, and in some cases, there were minor improvements. PMID:23516043

  8. [Venous insufficiency in the pregnant woman. Rheological correction by troxerutin].

    PubMed

    Lefebvre, G; Lacombe, C

    1991-02-25

    We realized a double-blind randomized study in 26 pregnant with clinical symptoms of lower limbs venous insufficiency. Both groups were similar and received either (n = 12) troxerutine (4 g/day) or placebo (n = 14), during 30 days. Evaluation at J0 and J30 was both clinical and rheological by mean of Myrenne aggregometer. After blood shear rate of 600 s-1, two parameters were determined: M after roughly stopping shear rate, M1 after diminishing to shear rate of 3 s-1. Results exhibited steady values in patients receiving troxerutine while a significant increasing values in patients receiving placebo for the two parameters M and M1. That result in erythrocyte antiaggregating action of troxerutine, hence lowering viscosity action, in venous insufficiency during pregnancy.

  9. Automated noninvasive determination of mixed venous pCO2.

    PubMed

    Leavell, K; Finkelstein, S M; Warwick, W J; Budd, J R

    1986-01-01

    The determination of mixed venous pCO2 is desirable for assessing the metabolic and respiratory status of a patient. A totally automated, laboratory computer-controlled noninvasive system has been developed to determine mixed venous pCO2 by an equilibrium rebreathing method or by an exponential compartmental analysis for cases in which equilibrium is not achieved. A gas mixture is charged to a 2-liter anesthesia bag contained in a thermostatically controlled chamber used to maintain the temperature at 37 degrees C. This feature improves upon past rebreathing methods and eliminates water vapor as a variable in gas composition measurement. This bag is connected to a rebreathing circuit controlled by a minicomputer. The subject breathes from a mouthpiece attached to a two-way valve and rebreathes the gas mixture for a period of 30 seconds. Inspirate and expirate hoses are placed in the rebreathing bag to ensure a more uniform gas distribution than is generally found in rebreathing systems. Exchange of CO2 takes place between lungs and rebreathing bag, and the concentration of CO2 is continuously monitored by a mass spectrometer. After a period of time, the concentration of CO2 in the rebreathing bag, the alveoli, and the mixed venous blood come into equilibrium, demonstrated by a plateau on the record of CO2 concentration vs. time. Compartmental analysis predicts the mixed venous pCO2 even if an equilibrium is not established. This feature is a significant benefit of this new method, eliminating problems associated with establishing an equilibrium, such as gas mixture volume adjustment, recirculation, and poor ventilation. The predicted value agrees with the equilibrium valve for cases in which equilibrium is reached.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Cerebral venous thrombosis in a patient with acute postinfectious glomerulonephritis

    PubMed Central

    Morkhandikar, S.; Priyamvada, P. S.; Srinivas, B. H.; Parameswaran, S.

    2016-01-01

    Thrombosis of the cerebral venous sinuses (CVT) is described in nephrotic syndrome. A 13-year-old girl was admitted with acute post-infectious glomerulonephritis (APIGN). Subsequently she developed recurrent seizures with focal neurological deficits. On evaluation, she was found to have CVT. To the best of our knowledge, this is the first report of CVT in APIGN. Identifying this complication is imperative, as timely diagnosis and treatment could be lifesaving. PMID:27194837

  11. Cerebral Venous Thrombosis in the Mediterranean Area in Children

    PubMed Central

    Menascu, S.; Lotan, A.; Ben Zeev, B.; Nowak-Gottl, U:; Kenet, G.

    2011-01-01

    Cerebral Venous Sinus (sinovenous) Thrombosis (CSVT) is a serious and rare disorder, increasingly recognized and diagnosed in pediatric patients. The etiology and pathophisiology has not yet been completely clarified, and unlike adults with CSVT, management in children and neonates remains controversial. However, morbidity and mortality are significant, highlighting the continued need for high-quality studies within this field. The following review will highlight aspects of CSVT in the mediteranian area in children. PMID:21869915

  12. Cross-sectional echocardiographic diagnosis of systemic venous return.

    PubMed Central

    Huhta, J C; Smallhorn, J F; Macartney, F J; Anderson, R H; de Leval, M

    1982-01-01

    To determine the sensitivity and specificity of cross-sectional echocardiography in diagnosing anomalous systemic venous return we used the technique in 800 consecutive children with congenital heart disease and whom the diagnosis was ultimately confirmed by angiography. Cross-sectional echocardiography was performed without prior knowledge of the diagnosis in all but 11 patients, who were recalled because of a known abnormality of atrial situs. The sensitivity of cross-sectional echocardiographic detection of various structures was as follows: right superior vena cava 792/792 (100%); left superior vena cava 46/48 (96%); bilateral superior vena cava 38/40 (95%); bridging innominate vein with bilateral superior vena cava 13/18 (72%); connection of superior caval segment to heart (coronary sinus or either atrium) (100%); absence of suprarenal inferior vena cava 23/23 (100%); azygos continuation of the inferior vena cava 31/33 (91%); downstream connection of azygos continuation, once seen, 21/21 (100%); partial anomalous hepatic venous connection (one hepatic vein not connected to the inferior vena cava) 1/1 (100%); total anomalous hepatic venous connection (invariably associated with left isomerism) 23/23 (100%). The specificity of each above diagnoses was 100% except in one infant with exomphalos in whom absence of the suprarenal inferior vena cava was incorrectly diagnosed. Thus cross-sectional echocardiography is an extremely specific and highly sensitive method of recognizing anomalous systemic venous return. It is therefore of great value of planning both cardiac catheterisation and cannulation for open heart surgery. Images PMID:6751361

  13. Embryologicalic collateral venous channel on radionuclide liver/spleen study

    SciTech Connect

    Wilkinson, R.H. Jr.; Johnson, D.G.

    1983-07-01

    Obstruction of normal venous portal blood flow generally results in collateral circulation. The obstruction may be intrinsic t the vasculature (e.g., hepatic vein thrombosis, vascular anomalies) or it may be extravascular (e.g., cirrhosis, hepatic masses) and may effect blood flow by deforming and compressing the intrahepatic or splenoportal axis vessels. A technetium-99m sulfur colloid liver/spleen study demonstrates what is thought to be a functional paraumbilical or umbilical vein in a cirrhotic patient with portal hypertension.

  14. A unique case of venous air embolus with survival.

    PubMed

    Davare, Dafney L; Chaudry, Zishan; Sanchez, Rafael; Lee, Seong K; Kiffin, Chauniqua; Rosenthal, Andrew A; Carrillo, Eddy H

    2016-01-01

    Venous air embolus (VAE) occurs when gas, specifically atmospheric air, enters into the vascular system. Although rare, they can be fatal due to risk of cardiovascular collapse. In this report, we present a unique case of a 66-year-old female trauma patient with an inferior vena cava air embolism. An overview of the potential cause is presented, along with a review of the management of VAE. PMID:27587307

  15. A unique case of venous air embolus with survival

    PubMed Central

    Davare, Dafney L.; Chaudry, Zishan; Sanchez, Rafael; Lee, Seong K.; Kiffin, Chauniqua; Rosenthal, Andrew A.; Carrillo, Eddy H.

    2016-01-01

    Venous air embolus (VAE) occurs when gas, specifically atmospheric air, enters into the vascular system. Although rare, they can be fatal due to risk of cardiovascular collapse. In this report, we present a unique case of a 66-year-old female trauma patient with an inferior vena cava air embolism. An overview of the potential cause is presented, along with a review of the management of VAE. PMID:27587307

  16. Assessment of anomalous systemic and pulmonary venous connections by transoesophageal echocardiography in infants and children.

    PubMed Central

    Stümper, O; Vargas-Barron, J; Rijlaarsdam, M; Romero, A; Roelandt, J R; Hess, J; Sutherland, G R

    1991-01-01

    OBJECTIVE--To assess the value of transoesophageal echocardiography in the preoperative definition of systemic and pulmonary venous connections. DESIGN--Transoesophageal echocardiographic studies were performed prospectively under general anaesthesia in 76 consecutive unoperated children. Results were compared with those obtained by earlier transthoracic ultrasound studies (n = 76), cardiac catheterisation (n = 62), and subsequent surgical inspection (n = 58). SETTING--Two tertiary referral centres. PATIENTS--76 unoperated infants and children (age 0.2-14.8 years, mean age 4.1 years) with congenital heart disease. MAIN OUTCOME MEASURE--Identification of anomalous systemic and pulmonary venous connections. RESULTS--Transoesophageal studies showed anomalous venous connections in 14 patients. Two had both anomalous systemic and pulmonary venous connections. Transoesophageal studies showed 12 anomalous systemic venous connections in nine patients. In eight patients these were confirmed at operation or catheterisation: one patient is awaiting operation. Six anomalous systemic venous connections were missed during earlier transthoracic studies. Anomalous pulmonary venous connections (one mixed total, six partial) were shown in seven patients. These were confirmed at operation in six and by cardiac catheterisation in one. Four of these patients were missed during earlier transthoracic ultrasound studies. No patient defined as having normal venous connections by the transoesophageal study was subsequently shown to have anomalous venous connections at operation or angiography. CONCLUSIONS--Transoesophageal echocardiography is a highly sensitive tool for the preoperative definition of systemic and pulmonary venous connections. In this series it was better than transthoracic ultrasound and complemented cardiac catheterisation and angiocardiography. Images PMID:1772706

  17. Potential involvement of the extracranial venous system in central nervous system disorders and aging

    PubMed Central

    2013-01-01

    Background The role of the extracranial venous system in the pathology of central nervous system (CNS) disorders and aging is largely unknown. It is acknowledged that the development of the venous system is subject to many variations and that these variations do not necessarily represent pathological findings. The idea has been changing with regards to the extracranial venous system. Discussion A range of extracranial venous abnormalities have recently been reported, which could be classified as structural/morphological, hemodynamic/functional and those determined only by the composite criteria and use of multimodal imaging. The presence of these abnormalities usually disrupts normal blood flow and is associated with the development of prominent collateral circulation. The etiology of these abnormalities may be related to embryologic developmental arrest, aging or other comorbidities. Several CNS disorders have been linked to the presence and severity of jugular venous reflux. Another composite criteria-based vascular condition named chronic cerebrospinal venous insufficiency (CCSVI) was recently introduced. CCSVI is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes that may interfere with normal venous outflow. Summary Additional research is needed to better define the role of the extracranial venous system in relation to CNS disorders and aging. The use of endovascular treatment for the correction of these extracranial venous abnormalities should be discouraged, until potential benefit is demonstrated in properly-designed, blinded, randomized and controlled clinical trials. Please see related editorial: http://www.biomedcentral.com/1741-7015/11/259. PMID:24344742

  18. Venous arterialization for the treatment of large-area foot skin retrograde avulsion.

    PubMed

    Xiao, Wan-an; Jiang, Jia-xi; Tian, Feng; Li, Xiao-chuan; Tian, Li-jie

    2013-08-01

    Between 2009 and 2011, three patients with large-area foot skin retrograde avulsion (more than 1% of the body surface area) underwent venous arterialization. Anastomosis of the artery in the wound surface with the vein in the skin flap and an appropriate number of venous end-to-end anastomoses were performed. The skin flaps survived in all 3 patients. Six months postoperatively, the flap elasticity and appearance were close to that of normal skin, and foot function was better without scar contracture. When venous arterialization is used to treat foot avulsion, the following points should be noted. Surgical indications include no fresh bleeding from the wound edge of the avulsed skin after debridement, more complete avulsed skin, and superficial veins that do not completely separate from the avulsed skin. Venous arterialization is not suitable to avulsion with fresh bleeding, avulsed skin in small fragments, and avulsion with a subcutaneous venous network embolism. During debridement, the subcutaneous venous network should be protected to avoid exposing the vein stems outside the fat layer. If the avulsion is less than 1% of the body surface area, arterial-venous anastomosis can provide adequate blood supply. Venous-venous anastomosis is performed as much as possible to enhance venous return and decrease microcirculatory pressure, which is conducive to the establishment of effective blood circulation.

  19. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    PubMed

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  20. Transesophageal Echocardiographic Study of Decompression-Induced Venous Gas Emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Morris, W. P.

    1995-01-01

    Transesophageal echo-cardiography was used to evaluate venous bubbles produced in nine anesthetized dogs following decompression from 2.84 bar after 120 min at pressure. In five dogs a pulsed Doppler cuff probe was placed around the inferior vena cava for bubble grade determination. The transesophageal echo images demonstrated several novel or less defined events. In each case where the pulmonary artery was clearly visualized, the venous bubbles were seen to oscillate back and forth several times, bringing into question the effect of coincidental counting in routine bubble grade analysis using precordial Doppler. A second finding was that in all cases, extensive bubbling occurred in the portal veins with complete extraction by the liver sinusoids, with one exception where a portal-to-hepatic venous anastomosis was observed. Compression of the bowel released copious numbers of bubbles into the portal veins, sometimes more than were released into the inferior vena cava. Finally, large masses of foam were routinely observed in the non-dependent regions of the inferior vena cava that not only delayed the appearance of bubbles in the pulmonary artery but also allowed additional opportunity for further reaction with blood products and for coalescence to occur before reaching the pulmonary microcirculation. These novel observations are discussed in relation to the decompression process.

  1. Enhanced global mathematical model for studying cerebral venous blood flow.

    PubMed

    Müller, Lucas O; Toro, Eleuterio F

    2014-10-17

    Here we extend the global, closed-loop, mathematical model for the cardiovascular system in Müller and Toro (2014) to account for fundamental mechanisms affecting cerebral venous haemodynamics: the interaction between intracranial pressure and cerebral vasculature and the Starling-resistor like behaviour of intracranial veins. Computational results are compared with flow measurements obtained from Magnetic Resonance Imaging (MRI), showing overall satisfactory agreement. The role played by each model component in shaping cerebral venous flow waveforms is investigated. Our results are discussed in light of current physiological concepts and model-driven considerations, indicating that the Starling-resistor like behaviour of intracranial veins at the point where they join dural sinuses is the leading mechanism. Moreover, we present preliminary results on the impact of neck vein strictures on cerebral venous hemodynamics. These results show that such anomalies cause a pressure increment in intracranial cerebral veins, even if the shielding effect of the Starling-resistor like behaviour of cerebral veins is taken into account. PMID:25169660

  2. Occupational effect on the occurrence of idiopathic venous thromboembolism.

    PubMed

    Freeman, Randall J; Jankosky, Christopher; Olsen, Cara H; Mallon, Timothy

    2012-10-01

    Few studies have explored the effects of various occupations on venous thromboembolism occurrence. We examined idiopathic venous thromboembolism (IVTE) occurrence by occupation, body size, and age in the U.S. military. To capture idiopathic cases, exclusion criteria included recognized venous thromboembolism risk factors. Each case was matched to three controls on branch of service, sex, rank/grade, race, and education level. Body mass index, age, and occupation were analyzed with chi2 and logistic regression. Of 2,167 cases, most were male (87%), white (69%), enlisted (78%), averaging 36 years old. IVTE odds increased with age (p < 0.001). Every occupation showed greater odds than pilots/aircrew (p < 0.001), especially infantry/artillery/combat arms, which showed twice the odds, followed by health care workers. Normal weight was protective, especially in pilots/aircrew (OR 0.52, p = 0.03) and repair/engineering (OR 0.72, p < 0.001). Our analysis found a lower risk of IVTE among pilots and aircrew compared to other military occupations. Body size had less impact than expected in aircraft and vehicle operators. Greater odds in health care workers and infantry/artillery/combat arms than in pilots/aircrew and armor/motor transport occupational groups may reflect prolonged standing. Limitations include potential miscoding of health records and potential misclassification. Future IVTE research should explore job functions and worker characteristics.

  3. Cosmetic leg veins: evaluation using duplex venous imaging.

    PubMed

    Thibault, P; Bray, A; Wlodarczyk, J; Lewis, W

    1990-07-01

    The records of 305 consecutive patients who had presented with cosmetic symptoms related to varicose and/or spider veins over a 12-month period were studied. Following clinical assessment, 250 (82%) patients were referred for duplex venous imaging. A total of 500 lower limbs were evaluated; 236 (47%) were documented to have incompetence in the superficial venous system (long or short saphenous veins). Only 6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found to have perforator incompetence. Short saphenous vein incompetence was found in 59 (12%) limbs. In the long saphenous vein there was a consistent pattern of an increasing incidence of incompetence from the saphenofemoral junction down to the below-knee segment. The duplex imaging findings were applied to determine the optimal treatment, ie, whether surgery, sclerotherapy, or a combination of both would provide the best short- and long-term results. The possible etiology and pathophysiology of spider and varicose veins are discussed in relation to these results.

  4. [Cerebral venous thrombosis in minimal change nephrotic syndrome].

    PubMed

    Hirata, M; Kuroda, M; Koni, I

    1999-06-01

    A 46-year old man presented with an eight-day history of edema and was found to be nephrotic, with a plasma albumin level of 1.1 g/dl and urine protein excretion of 13.3 g/24 hrs. The level of plasma creatinine was normal at 1.0 mg/dl. A finding of renal biopsy was consistent with minimal change glomerulopathy. On the 6th hospital day, he suddenly developed a severe headache and was noted to have bilateral papilledema. Lumbar puncture revealed an opening pressure of 250 mm of water. Magnetic resonance venography showed an irregular flow in the superior sagittal sinus and right transverse sinus, a finding consistent with thrombus. The diagnosis of cerebral venous thrombosis was made, and the patient was given both Warfarin 2 mg/day and prednisolone 60 mg/day. A complete recovery from nephrotic syndrome was achieved within eight weeks. Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The most common clinical features are renal vein thrombosis, femoral vein thrombosis, and pulmonary embolism, however, cerebral venous sinus thrombosis is rare in patients with nephrotic syndrome. It is important to be aware of this complication, since prompt treatment with anticoagulation and control of nephrotic syndrome can lead to a successful outcome.

  5. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae.

  6. Variability in the Cardiac Venous System of Wistar Rats

    PubMed Central

    Krešáková, Lenka; Purzyc, Halina; Schusterová, Ingrid; Fulton, Benjamin; Maloveská, Marcela; Vdoviaková, Katarina; Kravcová, Zuzanna; Boldižár, Martin

    2015-01-01

    Rats are often used as animal models in experimental cardiology for studying myocardial infarctions and various cardiologic procedures. Currently the cardiac venous system is a target for the delivery of drugs, gene vectors, angiogenetic growth factors, stem cells, and cardioprotective reagents. The purpose of this study was to describe the anatomic configuration and variability of the cardiac venous system in Wistar rats, by using the corrosion cast method and perfusion of colored latex. The distribution of veins in the rat heart disagrees with prior descriptions for other mammals, except mice, which have a similar pattern. Coronary venous drainage in the 36 rats examined consistently involved the left cardiac, left conal, major caudal, right cardiac, and right conal veins. Other veins involved inconsistently included the cranial cardiac vein (58.3% of cases), minor caudal veins (16.7%), conoanastomotic vein (66.7%), and left atrial vein (75%). In 4 cases (11.1%), the collateral veins were located between the left conal and left cardiac veins. In this study, high morphologic variability between cases was manifested by differences in the arrangement, size, mode of opening, and formation of the common root and affected all regions of the heart but primarily the right ventricle. PMID:25651085

  7. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

    SciTech Connect

    Solar, Miroslav; Ceral, Jiri; Krajina, Antonin; Ballon, Marek; Malirova, Eva; Brodak, Milos; Cap, Jan

    2010-08-15

    Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.

  8. Alcohol consumption and venous thromboembolism: friend or foe?

    PubMed

    Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo

    2015-12-01

    A light to moderate consumption of certain types of alcoholic beverages may exert a favorable effect on cardiovascular risk, but no conclusive information is available on the putative relationship between alcohol intake and the risk of venous thromboembolism (VTE). We performed an electronic search on Medline and Scopus, using the keywords "venous thromboembolism", "venous thrombosis" and "alcohol", to identify clinical studies linking alcohol intake and VTE risk. The literature search generated 16 studies, 4 of which are case-control, 1 cross-sectional and 11 prospective. Significant reduction of VTE associated with alcohol intake is observed in only 4/16 studies, and in all these the association is only meaningful for a moderate amount of alcohol (i.e., 2-4 glasses). Unlike these trials, two other studies observe that alcohol intake is associated with an increased risk of VTE, whereas the association is insignificant in the remainder. Binge drinking increases the VTE risk in one study but not in another. The consumption of beer is associated with a decreased VTE risk in one study but not in two others. We hence conclude that the relationship between intake of alcoholic beverages and increased or decreased risk of VTE is largely elusive. PMID:26446524

  9. Guidelines for the treatment of head and neck venous malformations

    PubMed Central

    Zheng, Jia Wei; Mai, Hua Ming; Zhang, Ling; Wang, Yan An; Fan, Xin Dong; Su, Li Xin; Qin, Zhong Ping; Yang, Yao Wu; Jiang, Yin Hua; Zhao, Yi Fang; Suen, James Y

    2013-01-01

    Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient’s appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient’s condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients. PMID:23724158

  10. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis.

    PubMed

    Minet, Clémence; Potton, Leila; Bonadona, Agnès; Hamidfar-Roy, Rébecca; Somohano, Claire Ara; Lugosi, Maxime; Cartier, Jean-Charles; Ferretti, Gilbert; Schwebel, Carole; Timsit, Jean-François

    2015-08-18

    Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and severe complication of critical illness. Although well documented in the general population, the prevalence of PE is less known in the ICU, where it is more difficult to diagnose and to treat. Critically ill patients are at high risk of VTE because they combine both general risk factors together with specific ICU risk factors of VTE, like sedation, immobilization, vasopressors or central venous catheter. Compression ultrasonography and computed tomography (CT) scan are the primary tools to diagnose DVT and PE, respectively, in the ICU. CT scan, as well as transesophageal echography, are good for evaluating the severity of PE. Thromboprophylaxis is needed in all ICU patients, mainly with low molecular weight heparin, such as fragmine, which can be used even in cases of non-severe renal failure. Mechanical thromboprophylaxis has to be used if anticoagulation is not possible. Nevertheless, VTE can occur despite well-conducted thromboprophylaxis.

  11. The venous drainage of the heart in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Dinç, G; Ozdemir, D

    2004-08-01

    The venous drainage of the heart in porcupines (Hystrix cristata) was investigated. Each of the five adult porcupines (three males, two females) was injected with a coloured latex mixture via the V. cava caudalis for the demonstration of the cardiac veins. The dissection of the specimens revealed that the venous drainage of the heart in porcupines was made by the V. cordis magna, V. distalis ventriculi sinistri, V. proximalis ventriculi sinistri, V. cordis caudalis (the left marginal vein), V. cordis media and Vv. cordis dextrae. The cardiac veins were observed in a subepicardial course on the heart except for the R. interventricularis paraconalis. The R. interventricularis paraconalis showed an intramyocardial course until the middle of the sulcus interventricularis paraconalis, and a subepicardial course after this point. The V. cordis magna and V. distalis ventriculi sinistri opened to the sinus coronarius. The V. cordis caudalis and the V. cordis media drained into the V. cava caudalis. The venous drainage of the conus arteriosus was made by the left V. coni arteriosi opening to the R. interventricularis paraconalis, and by the right V. coni arteriosi which continued to the Vv. cordis dextrae. PMID:15239815

  12. Exercise-Induced Systemic Venous Hypertension in the Fontan Circulation.

    PubMed

    Navaratnam, Devaraj; Fitzsimmons, Samantha; Grocott, Michael; Rossiter, Harry B; Emmanuel, Yaso; Diller, Gerard-Paul; Gordon-Walker, Timothy; Jack, Sandy; Sheron, Nick; Pappachan, John; Pratap, Jayant Nick; Vettukattil, Joseph J; Veldtman, Gruschen

    2016-05-15

    Increasingly end-organ injury is being demonstrated late after institution of the Fontan circulation, particularly liver fibrosis and cirrhosis. The exact mechanisms for these late phenomena remain largely elusive. Hypothesizing that exercise induces precipitous systemic venous hypertension and insufficient cardiac output for the exercise demand, that is, a possible mechanism for end-organ injury, we sought to demonstrate the dynamic exercise responses in systemic venous perfusion (SVP) and concurrent end-organ perfusion. Ten stable Fontan patients and 9 control subjects underwent incremental cycle ergometry-based cardiopulmonary exercise testing. SVP was monitored in the right upper limb, and regional tissue oxygen saturation was monitored in the brain and kidney using near-infrared spectroscopy. SVP rose profoundly in concert with workload in the Fontan group, described by the regression equation 15.97 + 0.073 watts per mm Hg. In contrast, SVP did not change in healthy controls. Regional renal (p <0.01) and cerebral tissue saturations (p <0.001) were significantly lower and decrease more rapidly in Fontan patients. We conclude that in a stable group of adult patients with Fontan circulation, high-intensity exercise was associated with systemic venous hypertension and reduced systemic oxygen delivery. This physiological substrate has the potential to contribute to end-organ injury.

  13. Fate of venous repair after shock and trauma

    SciTech Connect

    Barkun, J.S.; Terazza, O.; Daignault, P.; Chiu, R.C.; Mulder, D.S.

    1988-09-01

    To assess the role of shock and trauma in the subsequent thrombosis of a venous repair, the following experiments were performed. Two groups of unsplenectomized dogs were studied: control dogs (Gr.C) underwent replacement of a segment of superficial femoral vein by an autogenous vein graft. Trauma group (Gr.T) dogs were subjected to hypovolemic shock using a modified Wiggers' technique and received standardized hindleg trauma. After resuscitation, venous repairs identical to Gr.C dogs were performed. Gr.T dogs exhibited a 78% thrombosis rate as opposed to 12% in Gr.C animals. To elucidate possible mechanisms, platelets were drawn from another ten animals, divided into similar groups, and labelled with Indium-111-oxine. In Gr.T animals, graft activity increased over time and platelet distribution along the graft was homogeneous. These results contrasted markedly with those of Gr.C animals. We conclude that shock and trauma predispose venous repairs to failure and that altered platelet-endothelium interactions may be implicated.

  14. Pacemaker wire central venous stenosis and one more reason to not run central venous catheters for dialysis in reverse flow.

    PubMed

    Ash, Stephen R; Ugianskis, Erika J

    2013-01-01

    A 75-year-old man on chronic peritoneal dialysis had unrecognized stenosis of the superior vena cava (SVC) due to pacemaker wires placed 5 years earlier. The patient was placed on hemodialysis after hernia surgery. When a tunneled central venous catheter for dialysis was placed from the right internal jugular (IJ) vein, the venous lumen extended through the stenotic area but not the arterial lumen. Probably due to a subsequent clot at the arterial lumen port the patient developed SVC syndrome and when the catheter was run in the reversed flow direction he developed hypovolemic shock. The stenosis and SVC syndrome resolved with angioplasty of the SVC stenosis, removal of the IJ catheter and use of a femoral vein catheter. The patient eventually returned to peritoneal dialysis and the femoral catheter was removed. PMID:22860886

  15. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Janssen, Rob Paulus Augustinus; Reijman, Max; Janssen, Daan Martijn; van Mourik, Jan Bernardus Antonius

    2016-01-01

    AIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined. RESULTS Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism. CONCLUSION After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.

  16. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

    PubMed Central

    Janssen, Rob Paulus Augustinus; Reijman, Max; Janssen, Daan Martijn; van Mourik, Jan Bernardus Antonius

    2016-01-01

    AIM To summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined. RESULTS Fourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism. CONCLUSION After ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction. PMID:27672574

  17. Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

    PubMed Central

    2016-01-01

    Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders. PMID:27006525

  18. A novel approach for assessing the progression of deep venous thrombosis by area of venous thrombus in ultrasonic elastography.

    PubMed

    Wang, Chao; Wang, Lei; Zhang, Yuhui; Chen, Ming

    2014-04-01

    Exact age determination of deep venous thrombosis (DVT) is important for an appropriate treatment. The purpose of this present study is to assess the age of acute DVT with the area of venous thrombi in elasticity imaging during the thrombosis procession. The thrombus area is obtained from a specially designed program. It was applied to clot specimens induced in human great saphenous (n = 15) at selected time points following the initiation of thrombosis. The relative mean proportion of blood clots was 50.01% ± 12.44% at day 1; 69.94% ± 8.19% at day 3; 81.93% ± 6.15% at day 6; and 92.37% ± 4.06% at day 9. The results indicated that the thrombus area increased significantly over time, while the normalized strain values inside the thrombus changed only a little. The pathological analyses also showed the same results. Therefore, we conclude that the area of venous thrombi in elasticity imaging may be a novel function for acute DVT staging.

  19. Discrepant ratios of arterial versus venous thrombosis in hemophilia A as compared with hemophilia B.

    PubMed

    Girolami, Antonio; Bertozzi, Irene; de Marinis, Giulia Berti; Tasinato, Valentina; Sambado, Luisa

    2014-04-01

    The occurrence of thrombosis in patients with congenital bleeding disorders represents an exceptional event. Hemophilia A and hemophilia B patients have been showed to present both arterial and venous thrombosis (85 cases of arterial thrombosis and 34 cases of venous thrombosis). The great majority of arterial thrombosis are myocardial infarction or other acute coronary syndromes, whereas the majority of venous thrombosis are deep vein thrombosis and/or pulmonary embolisms. However there are discrepancies in the proportion of arterial and venous thrombosis seen in hemophilia A versus hemophilia B. The ratio of arterial versus venous thrombosis in hemophilia A is 3.72 whereas that for hemophilia B is 1.12. This indicates that arterial thrombosis is more frequent in hemophilia A as compared to hemophilia B and the opposite is true for venous thrombosis. The potential significance of this discrepancy is discussed.

  20. Venous Sac Embolization of Pulmonary Arteriovenous Malformation: Preliminary Experience Using Interlocking Detachable Coils

    SciTech Connect

    Takahashi, Koji; Tanimura, Keiichi; Honda, Masanori; Kikuno, Motoyuki; Toei, Hisao; Hyodoh, Hideki; Furuse, Makoto; Yamada, Tomonori; Aburano, Tamio

    1999-05-15

    Purpose: To evaluate the indication and advantages of venous sac embolization of pulmonary arteriovenous malformations (PAVMs) using interlocking detachable coils (IDCs). Methods: We performed percutaneous embolization in 12 PAVMs in four patients using IDCs, initially placed in the venous sac or at the feeding artery to prevent systemic migration of additional coils. We placed the IDCs in the venous sac in PAVMs with the following vascular architecture: the draining vein was larger than the feeding arteries and both vessels were interposed with the venous sac or there were short feeding arteries. Results: Complete occlusion was achieved in all 12 PAVMs without significant complications. We deployed IDCs in the venous sac in eight PAVMs and in the feeding artery in four. Conclusion: Venous sac embolization may be beneficial in PAVMs with large out-flow vessels or short feeding arteries. IDCs are suitable for this procedure.

  1. The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment.

    PubMed

    Pesta, Wiesław; Kurpiewski, Waldemar; Kowalczyk, Marek; Szynkarczuk, Rafał; Luba, Magdalena; Zurada, Anna; Grabysa, Radosław

    2011-12-01

    In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5(th) and 6(th) degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency.

  2. A review of the current management and treatment options for superficial venous insufficiency.

    PubMed

    Zhan, Henry T; Bush, Ruth L

    2014-10-01

    The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency.

  3. Iliofemoral venous thrombosis following fascial excision of a deep burn of the lower extremity: case report.

    PubMed

    Gibran, N S; Heimbach, D M; Nicholls, S C

    1992-12-01

    Burned patients with deep venous thrombosis present a particularly perplexing challenge. They frequently require central venous catheters. Their altered skin integrity does not permit correlation with the typical changes described by the classic terminology for thrombophlebitis or its most severe forms, phlegmasia cerulea dolens or phlegmasia alba dolens. They are at risk of exsanguination or massive graft loss with lytic therapy or anticoagulation. Venous thrombectomy may be a necessary limb-saving surgical option.

  4. Reduction of erosion risk in adult patients with implanted venous access ports.

    PubMed

    Burris, Jennifer; Weis, Mary

    2014-08-01

    One of the most common venous access devices used in patients with cancer is the implanted venous access port. Although incidences of infection and thrombosis are the most commonly reported complications, erosion rates of venous access ports are estimated at almost 1%. This article describes how evidence-based interdisciplinary interventions decreased port erosions for a regional health center from 3.2% to less than 1%.

  5. A new approach to non-invasive oxygenated mixed venous PCO(sub)2

    NASA Technical Reports Server (NTRS)

    Fisher, Joseph A.; Ansel, Clifford A.

    1986-01-01

    A clinically practical technique was developed to calculate mixed venous CO2 partial pressure for the calculation of cardiac output by the Fick technique. The Fick principle states that the cardiac output is equal to the CO2 production divided by the arterio-venous CO2 content difference of the pulmonary vessels. A review of the principles involved in the various techniques used to estimate venous CO2 partial pressure is presented.

  6. Venous thromboembolism and antithrombotic therapy in pregnancy.

    PubMed

    Chan, Wee-Shian; Rey, Evelyne; Kent, Nancy E; Chan, Wee-Shian; Kent, Nancy E; Rey, Evelyne; Corbett, Thomas; David, Michèle; Douglas, M Joanne; Gibson, Paul S; Magee, Laura; Rodger, Marc; Smith, Reginald E

    2014-06-01

    Objectif : Présenter une approche, fondée sur les données actuelles, envers le diagnostic, la prise en charge et la thromboprophylaxie de la thromboembolie veineuse pendant la grossesse et la période postpartum. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed, Medline, CINAHL et The Cochrane Library entre novembre 2011 et juillet 2013 au moyen d’un vocabulaire contrôlé (p. ex. « pregnancy », « venous thromboembolism », « deep vein thrombosis », « pulmonary embolism », « pulmonary thrombosis ») et de mots clés (p. ex. « maternal morbidity », « pregnancy complications », « thromboprophylaxis », « antithrombotic therapy ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles publiés en anglais ou en français. Aucune restriction n’a été imposée en matière de dates. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins de santé préventifs (Tableau). Recommandations 1. La tenue d’un examen objectif s’avère requise lorsque la présence d’une thrombose veineuse profonde ou d’une embolie pulmonaire est soupçonnée sur le plan clinique. (II-2A) 2. Pour diagnostiquer la présence d’une thrombose veineuse profonde, il est recommandé d’avoir recours à une échographie; lorsque l’examen initial donne des résultats n

  7. Malposition of a Peripherally Inserted Central Venous Catheter in the Graft Hepatic Vein.

    PubMed

    Ersoy, Zeynep; Araz, Coşkun; Taşkın, Duygu; Moray, Gökhan; Torgay, Adnan

    2015-11-01

    Central venous catheters are used for delivering medications and parenteral nutrition, measuring hemodynamic variations, and providing long-term intravenous access. In our clinic, during liver transection using a living-liver donor, peripherally inserted central venous catheters are generally preferred because they involve a less invasive technique with a lower risk of complications. In this report, we present the case of a 36-year-old male liver donor into whom we peripherally inserted a central venous catheter from his left basilic vein. After transecting the hepatic vein, the surgeon found foreign material inside the venous lumen, which turned out to be the distal segment of the catheter.

  8. Squamous cell carcinoma lung: Presented with bilateral lower limb deep venous thrombosis with gangrene formation

    PubMed Central

    Saha, Kaushik; Sengupta, Amitabha; Patra, Anupam; Jash, Debraj

    2013-01-01

    Bilateral venous thrombosis due to underlying malignancy is a rare entity. It is worthy to search for malignancy in patients of bilateral venous gangrene. Our patient presented with severe bilateral leg pain as a result of venous gangrene. There was associated left sided massive pleural effusion with scalp nodule. Fine needle aspiration cytology of scalp nodule revealed metastatic squamous cell carcinoma and fiber optic bronchoscopy guided biopsy from growth at left upper lobe bronchus confirmed the case as squamous cell carcinoma lung. It was rare for squamous cell carcinoma lung to present as bilateral venous gangrene with anticardiolipin antibody negative. PMID:24455526

  9. Heterotopic bone formation (myositis ossificans) and lower-extremity swelling mimicking deep-venous disease

    SciTech Connect

    Orzel, J.A.; Rudd, T.G.; Nelp, W.B.

    1984-10-01

    A quadriplegic patient with a swollen leg was suspected of having deep-venous thrombosis, and was studied with radionuclide venography (RNV) and contrast venography. Focal narrowing of the femoral vein, seen on RNV, was due to extrinsic compression. Although soft-tissue radiographs were normal, Tc-99m diphosphonate imaging established the diagnosis of early heterotopic bone formation (myositis ossificans), which was responsible for the venous compression. Clinically this inflammatory process can mimic deep-venous thrombosis, and should be considered in evaluating patients at risk for both heterotopic bone formation and deep-venous thrombosis.

  10. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

    PubMed Central

    Roldan, Carlos J.; Paniagua, Linda

    2015-01-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for “Central line malposition” and then for “Central venous catheters intravascular malposition,” we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient’s body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition. PMID:26587087

  11. Role of matrix metalloproteinases in non-healing venous ulcers.

    PubMed

    Amato, Bruno; Coretti, Guido; Compagna, Rita; Amato, Maurizio; Buffone, Gianluca; Gigliotti, Diego; Grande, Raffaele; Serra, Raffaele; de Franciscis, Stefano

    2015-12-01

    Chronic venous ulceration (CVU) of the lower limbs is a common condition affecting 1% of the adult population in Western countries, which is burdened with a high complication rate and a marked reduction in the quality of life often due to prolonged healing time. Several metalloproteinases (MMPs) such as MMP-9 together with neutrophil gelatinase-associated lipocalin (NGAL) appear to be involved in the onset and healing phases of venous ulcer, but it is still unclear how many biochemical components are responsible for prolonged healing time in those ulcers. In this study, we evaluate the role of MMP-1 and MMP-8 in long lasting and refractory venous ulcers. In a 2-year period we enroled 45 patients (28 female and 17 male, median age 65) with CVU. The enroled population was divided into two groups: group I were patients with non-healing ulcers (ulcers that had failed to heal for more than 2 months despite appropriate treatments) and group II were patients with healing ulcers (ulcers in healing phases). MMP-1 and MMP-8 were measured in fluids and tissues of healing and non-healing ulcers by means of enzyme-linked immunosorbent assay (ELISA) and Western blot analysis, respectively. In particular the patterns of the collagenases MMP-1 and MMP-8 in healing wounds were distinct, with MMP-8 appearing in significantly greater amounts especially in the non-healing group. Our findings suggest that MMP-1, and MMP-8 are overexpressed in long lasting CVU. Therefore, this dysregulation may represent the main cause of the pathogenesis of non-healing CVU.

  12. Segmentation and separation of venous vasculatures in liver CT images

    NASA Astrophysics Data System (ADS)

    Wang, Lei; Hansen, Christian; Zidowitz, Stephan; Hahn, Horst K.

    2014-03-01

    Computer-aided analysis of venous vasculatures including hepatic veins and portal veins is important in liver surgery planning. The analysis normally consists of two important pre-processing tasks: segmenting both vasculatures and separating them from each other by assigning different labels. During the acquisition of multi-phase CT images, both of the venous vessels are enhanced by injected contrast agent and acquired either in a common phase or in two individual phases. The enhanced signals established by contrast agent are often not stably acquired due to non-optimal acquisition time. Inadequate contrast and the presence of large lesions in oncological patients, make the segmentation task quite challenging. To overcome these diffculties, we propose a framework with minimal user interactions to analyze venous vasculatures in multi-phase CT images. Firstly, presented vasculatures are automatically segmented adopting an efficient multi-scale Hessian-based vesselness filter. The initially segmented vessel trees are then converted to a graph representation, on which a series of graph filters are applied in post-processing steps to rule out irrelevant structures. Eventually, we develop a semi-automatic workow to refine the segmentation in the areas of inferior vena cava and entrance of portal veins, and to simultaneously separate hepatic veins from portal veins. Segmentation quality was evaluated with intensive tests enclosing 60 CT images from both healthy liver donors and oncological patients. To quantitatively measure the similarities between segmented and reference vessel trees, we propose three additional metrics: skeleton distance, branch coverage, and boundary surface distance, which are dedicated to quantifying the misalignment induced by both branching patterns and radii of two vessel trees.

  13. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.

    PubMed

    Roldan, Carlos J; Paniagua, Linda

    2015-09-01

    Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.

  14. [Transport and localization of troxerutin in the venous wall].

    PubMed

    Carlsson, K; Patwardhan, A; Poullain, J C; Gerentes, I

    1996-01-01

    The vein wall is nourished by diffusion of blood nutrients from the lumen and from the vasa vasorum. It is likely that drugs take the same ways to reach and diffuse through the vessel wall. Thus the uptake of a drug with affinity for the vein wall should give information on its transport to the tissue. This study aimed to explore troxerutin uptake by the long saphenous vein. Troxerutin is a naturally fluorescent flavonoid which has been known to improve subjective signs of patients with chronic venous insufficiency. Nine patients undergoing surgical treatment of varicosis were enrolled in the study. They received for the last 4 days before surgery either 3,500 mg of troxerutin (n = 4) or 1,000 mg twice daily (n = 2). Three patients as controls did not receive any drug. Two samples from thigh and calf long saphenous vein were harvested in each patients and investigated with a confocal laser scanning microscope developed by our institute measuring the fluorescence emitted by troxerutin after excitation by a 458 nm wavelength laser-beam. The intensity of the overall fluorescence was significantly higher in the treated groups (p < 0,001) and slightly higher in the patient who received 3,500 mg of troxerutin than with the lower dosage. The outer wall region provided the highest fluorescence in the treated group while a significant difference was observed in the fluorescence of the medial region between treated and control group. These results showed a marked affinity of troxerutin for the venous wall. The highest uptake in the outer wall region is likely to result from transport through vasa vasorum, owing to the rheologic properties of the drug. The significant medial fluorescence may account for the venous tone improvement with the drug.

  15. Detection of deep venous thrombosis by indium-111 leukocyte scintigraphy

    SciTech Connect

    D'Alonzo, W.A. Jr.; Alavi, A.

    1986-05-01

    Indium-111-labeled leukocyte ((/sup 111/In)WBC) scintigraphy has been used successfully for detection of inflammation. Occasionally, noninflammatory collections of white blood cells such as hematomas or hemorrhage have been localized. We report a case in which unsuspected femoral deep venous thrombosis was diagnosed on an (/sup 111/In)WBC leukocyte scan performed for detection of osteomyelitis. Readers are advised to avoid interpreting all vascular (/sup 111/In)WBC localization as necessarily infectious. This may be of particular significance in patients with vascular grafts.

  16. Prevention and treatment of venous thromboembolism during HRT: current perspectives

    PubMed Central

    Rott, Hannelore

    2014-01-01

    Many large trials in the past 15 years have proven an increased risk of vascular complications in women using oral, mostly non-bioidentical, hormone therapy. The risk of vascular complications depends on the route of administration (oral versus transdermal), age, duration of administration, and type of hormones (bioidentical versus non-bioidentical). Acquired and/or hereditary thrombophilias (eg, factor V Leiden, prothrombin mutation G20210A, and others) lead to a further increase of risk for venous thromboembolism, stroke, or myocardial infarction. Therefore, bioidentical hormone therapy via the transdermal route seems to be the safest opportunity for hormone replacement therapy, although large trials for bioidentical hormone therapy are needed. PMID:25210472

  17. Postorthopedic Surgery Joint Replacement Surgery Venous Thromboembolism Prophylaxis.

    PubMed

    Kwong, Louis M; Kimball, Jon A

    2016-10-01

    Elective total hip or knee arthroplasty places patients at risk for venous thromboembolism (VTE). As our understanding of the pathophysiology of VTE after joint arthroplasty has increased, pharmacologic strategies have been developed to target different aspects of the coagulation cascade. Various approaches have been used as risk reduction strategies. In 2011 and 2014 the Food and Drug Administration approved rivaroxaban and apixaban as new oral antithrombotic agents. Although controversies remain with regard to the ideal VTE pharmacoprophylactic agent, this class of novel oral anticoagulants has been demonstrated to be safe and to be more effective than enoxaparin. PMID:27637304

  18. Caring for cerebral venous sinus thrombosis in children

    PubMed Central

    Hashmi, Mubashira; Wasay, Mohammad

    2011-01-01

    Cerebral venous sinus thrombosis in children is increasingly recognized as diagnostic tools and clinical awareness has improved. It is a multifactorial disease where prothrombotic risk factors and predisposing clinical conditions usually in combination constitute the underlying etiology. Clinical features range from headache, seizures to comatose state. Although symptomatic treatment involving control of infections, seizures and intracranial hypertension is uniform, use of anticoagulation and local thrombolytic therapy is still controversial. Morbidity and mortality can be significant and long-term neurological sequelae include developmental delay, sensorimotor and visual deficits and epilepsy. PMID:21887032

  19. Echocardiographic definition of right pulmonary venous connection at catheterization.

    PubMed

    Harris, J P; Nanda, N; Stewart, S; Alexson, C G; Manning, J A

    1983-01-01

    Traditional methods of identifying partial anomalous pulmonary venous connection to the right atrium in the presence of an atrial defect are not always reliable. Twenty patients were studied with a new technique in which the catheter is introduced into the right superior pulmonary vein followed by echocardiographic assessment of the catheter position in relation to the left atrium and atrial septum. The insertion site of the right pulmonary veins was detected in every patient and in ten patients has been verified at operation. This approach can be performed rapidly and appears to be accurate as well as reliable.

  20. Cerebral Venous Congestion as Indication for Thrombolytic Treatment

    SciTech Connect

    Tsai, Fong Y. Kostanian, Varoujan; Rivera, Monica; Lee, Kwo-Whie; Chen, Clayton C.; Nguyen, Thong H.

    2007-07-15

    Purpose. To carry out a retrospective analysis of patients with acute dural sinus thrombosis, and the role of cerebral venous congestion in patient management. Methods. Twenty-five patients were identified with the clinical and imaging diagnosis of acute dural sinus thrombosis. The imaging diagnosis was by magnetic resonance (MR) and/or computed tomography (CT) venography. There was a female predominance with a female to male ratio of 1.5 to 1 (16 women, 9 men). The age range was from 19 to 64 years old with an average age of 37 years. The first 10 patients, who ranged in age from 21 to 64 years old (average 37 years), received only anticoagulation therapy with heparin and warfarin for periods ranging from 5 days to 2 months. The remaining 15 patients ranged in age from 19 to 57 years old (average 38 years). They either underwent subsequent thrombectomy after a trial of anticoagulation therapy, or went straight to thrombectomy. These latter 15 patients had initial evidence of cerebral venous congestion, either clinically by severe or worsening symptoms despite anticoagulation therapy, or on initial or subsequent CT or MR imaging. In our experience, the cerebral venous congestion imaging findings included intracranial hemorrhage, a hematoma, or edema. The thrombolytic treatment technique consisted of the advancement of a 6 Fr guiding catheter to the jugular bulb or sigmoid sinus from a transfemoral approach. A microcatheter was then advanced to the proximal portion of the thrombus and then either tissue plasminogen activator (tPA) or urokinase was injected to prevent clot propagation. A balloon catheter was used to perform thrombectomy since the thrombolytic agents can be injected via the inner lumen with an inflated balloon. The inflated balloon helped to keep the venous flow from washing out the thrombolytic agent, thus facilitating the agent's effect. Results. The first 10 patients received only anticoagulation therapy with heparin and warfarin for periods

  1. Intracranial venous sinus thrombosis complicating AIDS-associated nephropathy.

    PubMed

    Afsari, Khosrow; Frank, Jeffrey; Vaksman, Yulia; Nguyen, Thanhan V

    2003-03-01

    An alert and oriented 27-year-old African American woman with AIDS presented with a 10-day history of fever, cough productive of yellow sputum, nausea, and vomiting and a 1-day history of excruciating headache and photophobia. Her condition rapidly deteriorated into a coma with decorticate and then decerebrate posture, and she died 3 weeks later. There was evidence of extensive intracranial venous sinus thrombosis (ICVST), renal vein thrombosis (RVT), and multiple cerebral hemorrhagic infarcts due to a hypercoagulable state complicating AIDS-associated nephrotic syndrome. This is the first reported case of fatal ICVST and RVT with extensive cerebral hemorrhagic infarcts complicating nephrotic syndrome in a patient with AIDS.

  2. Venous pattern of polymicrogyria detected by susceptibility weighted imaging (SWI)

    PubMed Central

    Wagner, Franca; Weisstanner, Christian; Strozzi, Susi; Lang, Matthias F

    2015-01-01

    We report a case of a 9-year-old boy presenting with spastic-dystonic movement disorder of the right arm. MRI showed vast unilateral left-sided polymicrogyria (PMG) with perisylvian, temporal, frontal, and parietal location. Corresponding to the distinctly reduced gyration, the focal pattern of cortical veins in susceptibility weighted imaging (SWI) was absent due to missing sulcal depth. In contrast, adjacent regions with sufficient sulcal depth revealed a pattern with numerically increased and finer cortical veins. Therefore, with its atypical venous pattern SWI indicates an abnormal parenchymal anatomy and might be an additional helpful tool for diagnosing PMG. PMID:26668757

  3. Mesenteric venous thrombosis associated with oral contraceptives: a case report.

    PubMed

    Milne, P Y; Thomas, R J

    1976-05-01

    Small-bowel infarction resulting from mesenteric venous thrombosis is a rare but life-threatening complication to which young women taking oral contraceptives are liable. The patient characteristically presents with an "acute abdomen" after a variable prodromal period of vague abdominal pain. The correct diagnosis can be made from the macroscopic appearance at laparotomy, provided the surgeon is alert to the condition. An accurate diagnosis is important, as anticoagulation measures must be instituted early to counter the commonly associated thromboembolic phenomena. PMID:1067070

  4. Neurobrucellosis and venous sinus thrombosis: an uncommon association.

    PubMed

    Lima, Joana Isabel da Silva; Canelas, Cátia Filipa Gomes; Veiga, Andreia Sofia de Sousa Botelho Trindade; Carvalho, Dina Maria Mota

    2016-01-01

    Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis. PMID:27384841

  5. Primary leiomyosarcoma of saphenous vein presenting as deep venous thrombosis.

    PubMed

    Fremed, Daniel I; Faries, Peter L; Schanzer, Harry R; Marin, Michael L; Ting, Windsor

    2014-12-01

    Only a small number of venous leiomyosarcomas have been previously reported. Of these tumors, those of saphenous origin comprise a minority of cases. A 59-year-old man presented with symptoms of deep vein thrombosis and was eventually diagnosed with primary leiomyosarcoma of great saphenous vein origin. The tumor was treated with primary resection and femoral vein reconstruction with autologous patch. Although extremely rare, saphenous leiomyosarcoma can present as deep vein thrombosis. Vascular tumors should be included in the differential diagnosis of atypical extremity swelling refractory to conventional deep vein thrombosis management.

  6. Prophylaxis of venous thromboembolism: analysis of cost effectiveness.

    PubMed Central

    Salzman, E W; Davies, G C

    1980-01-01

    The rapidly expanding literature regarding prevention of venous thromboembolism is confusing and contradictory, but, when analysed in the aggregate, the collective experience permits a judgment about the relative efficacy of different prophylactic regimens in specific patient populations, who vary in the risk factors predisposing them to thromboembolism. The dollar cost of the several approaches to prevention and their consequences should also be a matter of concern. Efficacy and dollar cost together determine cost effectiveness, which provides a practical guide to selection of the prophylactic approach appropriate to an individual patient. PMID:6767449

  7. Edoxaban in venous thromboembolism and stroke prevention: an appraisal.

    PubMed

    Proietti, Marco; Lip, Gregory Y H

    2016-01-01

    Oral anticoagulation is the therapeutic cornerstone in preventing thromboembolic risk in both atrial fibrillation (AF) and venous thromboembolism (VTE). After decades of the sole therapeutic oral anticoagulation option being warfarin, the introduction of non-vitamin K antagonist oral anticoagulants has heralded a new era. Edoxaban is the latest addition to these available for clinical use. Edoxaban was as effective and safer than warfarin in preventing thromboembolic risk in AF patients. Similarly, edoxaban effectiveness and safety was evident when treating VTE patients to prevent recurrent VTE or VTE-related death. Therefore, edoxaban represents a valuable alternative in treating thromboembolic risk for AF and VTE patients. PMID:27013883

  8. TRANSITION TO COLLATERAL FLOW AFTER ARTERIAL OCCLUSION PREDISPOSES TO CEREBRAL VENOUS STEAL

    PubMed Central

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Pranevicius, Henrikas; Liebeskind, David S.

    2011-01-01

    Introduction Stroke related tissue pressure increase in the core (Pcore) and penumbra (Ppen) determines regional cerebral perfusion pressure (rCPP) defined as a difference between local inflow pressure (Pi) and venous (Pv) or tissue pressure, whichever is higher. We previously showed that venous pressure reduction below the Pcore causes blood flow diversion - cerebral venous steal. Now we investigated how transition to collateral circulation after complete arterial occlusion affects rCPP distribution. Methods We modified two parallel Starling resistor model to simulate transition to collateral inflow after complete main stem occlusion. We decreased Pv from the arterial pressure (Pa) to zero, and investigated how arterial and venous pressure elevation augments rCPP. Results When core pressure exceeded venous (Pcore>Pv), rCPP=Pi−Pcore. Venous pressure (Pv) decrease from Pa to Pcore caused smaller Pi to drop augmenting rCPP. Further drop of Pv to Ppen decreased rCPP in the core but augmented rCPP in penumbra. After transition to collateral circulation, lowering Pv below Ppen further decreased rCPP and collaterals themselves became pathway for steal. Venous pressure level at which rCPP in the core becomes zero we termed the “point of no reflow” (PONR). Transition from direct to collateral circulation resulted in decreased Pi, decreased rCPP, and a shift of PONR to higher venous loading values. Arterial pressure augmentation increased rCPP, but only after venous pressure exceeded PONR. Conclusion In the presence of tissue pressure gradients, transition to collateral flow predisposes to venous steal (collateral failure) which may be reversed by venous pressure augmentation. PMID:22246692

  9. Multiple sclerosis, an unlikely cause of chronic cerebrospinal venous insufficiency: retrospective analysis of catheter venography

    PubMed Central

    Simka, Marian; Ludyga, Tomasz; Kazibudzki, Marek; Latacz, Paweł; Świerad, Marcin

    2012-01-01

    Objectives It is unknown if a relationship exists between multiple sclerosis and chronic cerebrospinal venous insufficiency and if this venous pathology is a causal factor for multiple sclerosis or is a product of a neurological disease. Even so, one should expect that if multiple sclerosis were the cause for venous lesions, then patients with an extended history of the disease would present with a more severe venous pathology. Design Retrospective analysis of catheter venography of the azygous and internal jugular veins, and duration of clinical history of the disease in multiple sclerosis patients. Setting Mono-profile specialist hospital. Participants 353 multiple sclerosis patients, with duration of the disease: 0.5-41 years (median: 10 years). Main outcome measures We performed statistical analysis of the correlations between the duration of multiple sclerosis and the degree and number of venous lesions revealed using catheter venography. Results We observed weak, statistically insignificant correlations between the severity of chronic cerebrospinal venous insufficiency and the duration of multiple sclerosis. For the cumulated scores of venous lesions, Spearman and Kendall's tau correlation coefficients were 0.03 and 0.02, respectively; for maximal scores of venous lesions, coefficients were 0.06 and 0.05, while for the number of diseased veins they were 0.007 and 0.006, respectively. Consequently, this analysis did not yield any data supporting the idea that MS is the cause of venous lesions. Conclusion The results of our survey indicated that venous malformations are most likely congenital, and multiple sclerosis had no significant impact on the development of venous pathology. PMID:23301144

  10. Factor V Leiden Is Associated with Higher Risk of Deep Venous Thrombosis of Large Blood Vessels

    PubMed Central

    Arsov, Todor; Miladinova, Daniela; Spiroski, Mirko

    2006-01-01

    Aim To determine the prevalence of factor V Leiden mutation in patients with different presentation of venous thromboembolic disease and healthy individuals in the Republic of Macedonia. Methods The retrospective case-control study involved 190 patients with venous thromboembolic disease and 200 healthy individuals, who were screened for the presence of factor V Leiden mutation, using a polymerase chain reaction-restriction fragment length polymorphism method. The prevalence of factor V Leiden was analyzed according to the localization of thrombosis, presence of risk factors, and family history of thrombosis. The odds of deep venous thrombosis were calculated with respect to the presence of factor V Leiden mutation. Results The prevalence of factor V Leiden mutation among patients with venous thromboembolic disease was 21.1%, compared with 5.5% in the healthy individuals. Factor V Leiden positive patients had the first episode of deep venous thrombosis at a younger age, and the prevalence of the mutation was the highest among patients with a positive family history of thrombosis (33.9%, P = 0.003) and in patients with deep venous thrombosis affecting a large blood vessel (37.7%, P = 0.001). The prevalence of factor V Leiden mutation was lower in patients with calf deep venous thrombosis and primary thromboembolism (13.3% and 13.1%, respectively; P>0.05). The odds ratio for iliofemoral or femoral deep venous thrombosis in factor V Leiden carriers was 10.4 (95% confidence interval, 4.7-23.1). Conclusion The prevalence of factor V Leiden mutation was high in patients with venous thromboembolic disease and healthy individuals in the Republic of Macedonia. Factor V Leiden carriers have the highest odds of developing deep venous thrombosis affecting a large venous blood vessel. PMID:16758522

  11. Distance of the internal central venous catheter tip from the right atrium is positively correlated with central venous thrombosis.

    PubMed

    Ballard, David H; Samra, Navdeep S; Gifford, Karen Mathiesen; Roller, Robert; Wolfe, Bruce M; Owings, John T

    2016-06-01

    Central venous catheters (CVCs) are associated with occlusive, infectious, and thrombotic complications. The aim of this study was to determine if internal CVC tip position was correlated with subsequent complications. This was an institutional review board approved single-center retrospective review of 169 consecutive patients who underwent placement of 203 semipermanent CVCs. Using post-placement chest X-rays, a de novo scale of internal catheter tip position was developed. Major complications were recorded. A logistic regression analysis was used to determine if catheter tip position predicted subsequent complications. There were 78 men and 91 women with a mean age of 48 ± 11 years. There were 21 catheter tips placed in the subclavian/innominate veins, 32 in the upper superior vena cava, 113 in the atriocaval junction, and 37 in the right atrium. There were 83 complications occurring in 61 (36.1 %) patients, including sepsis in 40 (23.7 %), venous thrombosis in 18 (10.7 %), catheter occlusion in 16 (9.5 %), internal catheter repositioning in 6 (3.6 %), pneumothorax in 2 (1.2 %), and death in 1 (0.6 %). An internal catheter tip position peripheral to the atriocaval junction resulted in a catheter that was more likely to undergo internal repositioning (p < 0.001) and venous thrombosis (p < 0.001). Patients with femoral catheters were more likely to develop sepsis (45 %) than patients whose catheters were inserted through the upper extremity veins (18 %) (p < 0.01). In conclusion, to reduce catheter-associated morbidity and potentially mortality, the internal catheter tip should be positioned at the atriocaval junction or within the right atrium and femoral insertion sites should be avoided whenever possible.

  12. Positional Relationship Between the Pulmonary Venous Confluence-Vertical Vein and Atria in Infracardiac Total Anomalous Pulmonary Venous Connection.

    PubMed

    Peng, Yongxuan; Ge, Yang; Zhang, Haibo; Liu, Jinfen; Hong, Haifa; Lu, Yanan

    2016-02-01

    To explore the positional relationship between the pulmonary venous confluence-venous vein (PVC-VV) and both the atria in infracardiac total anomalous pulmonary venous connection (iTAPVC), using two-dimensional (2D) computerized tomography (CT) reconstruction. Through the 2D reconstruction of enhanced cardiac CT images of patients with iTAPVC, the projection of PVC-VV on coronal axial images was acquired and its location on the bilateral atrial splice was analyzed. Sagittal axial reconstruction was used to identify which atrium had a precise anterior-posterior positional relationship with PVC-VV. The type of iTAPVC, where the projection of PVC-VV was lying on the left atrium, and the left atrium had a precise anterior-posterior positional relationship with PVC-VV, was classified as the left atrial type. If the projection of PVC-VV was lying on the right atrium and the right atrium had a precise anterior-posterior positional relationship with PVC-VV, it was classified as the right atrial type. Finally, if the projection of PVC-VV was lying in the middle of the bilateral atria, and both the atria had precise anterior-posterior positional relationship with PVC-VV, it was referred to as the bilateral atrial type. Upon analysis of the 22 enhanced cardiac CT images, 6 were the left atrial type (27.27 %), 9 were right atrial type (40.91 %), while 7 were of the bilateral atrial type (31.82 %). The positional relationship between PVC-VV and the bilateral atria are variable, and iTAPVC classification using 2D CT reconstruction is an invaluable tool in designing the surgical approaches in iTAPVC.

  13. A Rare Occurrence of Simultaneous Venous and Arterial Thromboembolic Events – Lower Limb Deep Venous Thrombosis and Pulmonary Thromboembolism as Initial Presentation in Acute Promyelocytic Leukemia

    PubMed Central

    Kutiyal, Aditya S.; Dharmshaktu, Pramila; Kataria, Babita; Garg, Abhilasha

    2016-01-01

    The development of acute myeloid leukemia has been attributed to various factors, including hereditary, radiation, drugs, and certain occupational exposures. The association between malignancy and venous thromboembolism events is well established. Here, we present a case of a 70-year-old Indian man who had presented with arterial and venous thrombosis, and the patient was later diagnosed with acute promyelocytic leukemia (APL). In our case, the patient presented with right lower limb deep venous thrombosis and pulmonary thromboembolism four months prior to the diagnosis of APL. Although thromboembolic event subsequent to the diagnosis of malignancy, and especially during the chemotherapy has been widely reported, this prior presentation with simultaneous occurrence of both venous and arterial thromboembolism has rarely been reported. We take this opportunity to state the significance of a complete medical evaluation in cases of recurrent or unusual thrombotic events. PMID:26949347

  14. [Femoral venous catheterization. Does it really need to be avoided?].

    PubMed

    Lorente, L; León, C

    2009-12-01

    The guidelines to prevent central venous catheter related bloodstream infections (CVCBSI) of the Centers for Disease Control and Prevention (CDC) of 2002, Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias/ Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEMICYUC/SEIMC) of 2004, and the recently published guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA(IDSA) of 2008 have recommended using the subclavian vein and avoiding the use of the femoral vein. They also recommend considering the use of antiseptic- or antimicrobial-impregnated CVCs for hospital units or groups of patients with a high incidence of CVCBSI. When implementing these guidelines, two questions could be asked: 1) Could the abuse of the subclavian vein and avoiding the use of the femoral vein imply a decrease in the incidence of CVCBSI, but an increase in the rate of mechanical complications as pneumothorax and/or hemothorax? 2) Couldn't antimicrobial-impregnated CVCs be used to prevent CVCBSI when the femoral venous access is used?

  15. Inadvertent arterial injury secondary to treatment of venous insufficiency.

    PubMed

    Nitecki, Samy S; Bass, Arie

    2007-01-01

    Arterial injury during treatment of varicose veins is a rare but devastating complication that can lead to leg amputation. Approximately 6,000 patients were treated by either surgery (4,800 patients treated by ligation, stripping, and stub avulsion) or ultrasound-guided foam sclerotherapy (USGS) (1,200 patients) in the last 7 years for venous insufficiency at three medical centers. Six patients (0.1%) sustained inadvertent arterial injury. The incidence of arterial injury during surgery was 0.06% (3 of 4,800) and was of a mechanical nature amenable to repair. None of these patients had tissue loss. The injury during USGS (0.25%, 3 of 1,200) was of a chemical and irreversible nature. All three patients suffered tissue loss. In our experience, the incidence of arterial injuries during USGS is four times higher than during traditional surgery and carries a much higher risk of tissue loss. Although experience, technical skill, and awareness of this complication help reduce the incidence of arterial injury during surgery, they seem to offer no protection during USGS. Careful mapping of the arterial venous communications and avoidance of high-risk zones will help prevent this complication.

  16. New bench test for venous cannula performance assessment.

    PubMed

    Abdel-Sayed, S; Favre, J; Horisberger, J; Taub, S; Hayoz, D; von Segesser, L K

    2007-11-01

    Cannula design is of prime importance for venous drainage during cardiopulmonary bypass (CPB). To evaluate cannulas intended for CPB, an in vitro circuit was set up with silicone tubing between the test cannula encased in a movable preload reservoir and another static reservoir. The pressure-drop (DeltaP) value (P-drainage - P-preload) was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasound flowmeter. Data display and data recording were controlled using a LabView application, custom made particularly for our experiments. Our results demonstrated that DeltaP, Q, and cannula resistance (DeltaP/Q) values were significantly decreased when the cannula diameter was increased for Smart and Medtronic cannulas. Smartcanula showed 36% and 43% less resistance compared to Medtronic venous and Medtronic femoral cannulas, respectively. The cannula shape (straight- or curved-tips) did not affect the DLP cannula resistance. Out of five cannulas tested, the Smartcanula outperforms the other commercially available cannulas. The mean (DeltaP/Q) values were 3.3 +/- 0.08, 4.07 +/- 0.08, 5.58 +/- 0.10, 5.74 +/- 0.15, and 6.45 +/- 0.15 for Smart, Medtronic, Edwards, Sarns, and Gambro cannulas, respectively (two-way ANOVA, p < 0.0001). In conclusion, the present assay allows discrimination between different forms of cannula with high or low lumen resistance. PMID:18666745

  17. Intraosseous hypertension and venous congestion in osteonecrosis of the knee.

    PubMed

    Uchio, Y; Ochi, M; Adachi, N; Nishikori, T; Kawasaki, K

    2001-03-01

    To determine whether an angiogenic factor affects the pathogenesis of the idiopathic osteonecrosis of the medial femoral condyle, intraosseous pressure and venogram in 11 knees with osteonecrosis were compared with intraosseous pressure and venogram in 11 knees with the medial type of osteoarthritis. Patients were matched by age, gender, obesity index, blood pressure, tibiofemoral angle, and clinical evaluation. The intraosseous pressure of the medial condyle of the knees with osteonecrosis (62.8 +/- 27.3 mm Hg) was significantly higher than that in the lateral condyle of the knees with osteonecrosis (25.4 +/- 18.9 mm Hg) and those of both condyles of the knees with osteoarthritis (medial, 31.6 +/- 17.4 mm Hg; lateral, 29.5 +/- 11.0 mm Hg). In contrast, there was no significant difference in the pressure between the medial and lateral condyles of the knees with osteoarthritis. Venography showed a marked disturbance of venous drainage in all patients with osteonecrosis. In addition, the average clearance time of the medium in the medial femoral condyle was significantly more prolonged in patients with osteonecrosis (17.7 +/- 6.1 minutes) than in patients with osteoarthritis (5.5 +/- 1.6 minutes). These data support the hypothesis that venous stasis within the medullar canal in the condyle increases intraosseous pressure and decreases arteriovenous pressure difference, leading to osteonecrosis. PMID:11249168

  18. Notch signaling regulates venous arterialization during zebrafish fin regeneration

    PubMed Central

    Kametani, Yoshiko; Chi, Neil C.; Stainier, Didier Y.R.; Takada, Shinji

    2015-01-01

    In order to protect against blood pressure, a mature artery is supported by mural cells which include vascular smooth muscle cells and pericytes. To regenerate a functional vascular system, arteries should be properly reconstructed with mural cells although the mechanisms underlying artery reconstruction remain unclear. In this study, we examined the process of artery reconstruction during regeneration of the zebrafish caudal fin as a model to study arterial formation in an adult setting. During fin regeneration, the arteries and veins form a net-like vasculature called the vascular plexus, and this plexus undergoes remodeling to form a new artery and 2 flanking veins. We found that the new vascular plexus originates mainly from venous cells in the stump but very rarely from the arterial cells. Interestingly, these vein-derived cells contributed to the reconstructed arteries. This arterialization was dependent on Notch signaling, and further analysis revealed that Notch signaling was required for the initiation of arterial gene expression. In contrast, venous remodeling did not require Notch signaling. These results provide new insights towards understanding mechanisms of vascular regeneration and illustrate the utility of the adult zebrafish fin to study this process. PMID:25810153

  19. Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

    SciTech Connect

    Semiz-Oysu, Aslihan Keussen, Inger; Cwikiel, Wojciech

    2007-07-15

    Purpose. The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins. Material and Methods. Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation. Results. Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%). Conclusion. We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.

  20. Sharp Central Venous Recanalization by Means of a TIPS Needle

    SciTech Connect

    Honnef, Dagmar Wingen, Markus; Guenther, Rolf W.; Haage, Patrick

    2005-06-15

    The purpose of this study was to perform an alternative technique for recanalization of a chronic occlusion of the left brachiocephalic vein that could not be traversed with a guidewire. Restoration of a completely thrombosed left brachiocephalic vein was attempted in a 76-year-old male hemodialysis patient with massive upper inflow obstruction, massive edema of the face, neck, shoulder, and arm, and occlusion of the stented right brachiocephalic vein/superior vena cava. Vessel negotiation with several guidewires and multipurpose catheters proved unsuccessful. The procedure was also non-viable using a long, 21G puncture needle. Puncture of the superior vena cava (SVC) at the distal circumference of the stent in the right brachiocephalic vein/superior vena cava, however, was feasible with a transjugular intrahepatic portosystemic shunt (TIPS) set under biplanar fluoroscopy using the distal end of the right brachiocephalic vein as a target, followed by balloon dilatation and partial extraction of thrombotic material of the left brachiocephalic vein with a wire basket. Finally, two overlapping stents were deployed to avoid early re-occlusion. Venography demonstrated complete vessel patency with free contrast media flow via the stents into the SVC, which was reconfirmed in follow-up examinations. Immediate clinical improvement was observed. Venous vascular recanalization of chronic venous occlusion by means of a TIPS needle is feasible as a last resort under certain precautions.

  1. Venous compliance and fluid shift measurements on Spacelab IML-1

    NASA Technical Reports Server (NTRS)

    Leiski, D.; Thirsk, R. B.; Charles, J. B.; Bennett, B.

    1992-01-01

    During the first few hours of a human spaceflight mission, a headward fluid shift out of the abdomen, pelvis, and legs initiates a number of adaptive cardiovascular responses, including a loss of intravascular and extravascular fluid volume. On return to earth, these cardiovascular changes may lead to debilitating symptoms of orthostatic intolerance in an unprotected astronaut. To test the hypothesis that an inflight increase in compliance of the leg veins may contribute to this condition, measurements of lower leg fluid shift and bulk venous compliance were collected from crew members during the eight-day First International Microgravity Laboratory shuttle mission. An ultrasonic limb plethysmograph, in conjunction with two compression cuffs encircling the calf and thigh, was used to determine bulk compliance of the underlying veins over a range of negative and positive transmural pressures. The data from inflight experiment sessions were compared to preflight and postflight sessions. The preliminary results indicate that the volume of the lower leg decreased by over 10 percent by the sixth day of flight, but there was no apparent change in venous compliance.

  2. Cancer-Associated Venous Thromboembolic Disease, Version 1.2015.

    PubMed

    Streiff, Michael B; Holmstrom, Bjorn; Ashrani, Aneel; Bockenstedt, Paula L; Chesney, Carolyn; Eby, Charles; Fanikos, John; Fenninger, Randolph B; Fogerty, Annemarie E; Gao, Shuwei; Goldhaber, Samuel Z; Hendrie, Paul; Kuderer, Nicole; Lee, Alfred; Lee, Jason T; Lovrincevic, Mirjana; Millenson, Michael M; Neff, Anne T; Ortel, Thomas L; Paschal, Rita; Shattil, Sanford; Siddiqi, Tanya; Smock, Kristi J; Soff, Gerald; Wang, Tzu-Fei; Yee, Gary C; Zakarija, Anaadriana; McMillian, Nicole; Engh, Anita M

    2015-09-01

    The NCCN Guidelines for Cancer-Associated Venous Thromboembolic Disease outline strategies for treatment and prevention of venous thromboembolism (VTE) in adult patients with a diagnosis of cancer or for whom cancer is clinically suspected. VTE is a common complication in patients with cancer, which places them at greater risk for morbidity and mortality. Therefore, risk-appropriate prophylaxis is an essential component for the optimal care of inpatients and outpatients with cancer. Critical to meeting this goal is ensuring that patients get the most effective medication in the correct dose. Body weight has a significant impact on blood volume and drug clearance. Because obesity is a common health problem in industrialized societies, cancer care providers are increasingly likely to treat obese patients in their practice. Obesity is a risk factor common to VTE and many cancers, and may also impact the anticoagulant dose needed for safe and effective prophylaxis. These NCCN Guidelines Insights summarize the data supporting new dosing recommendations for VTE prophylaxis in obese patients with cancer. PMID:26358792

  3. Antiplatelet therapy in prevention of cardio- and venous thromboembolic events.

    PubMed

    Steinhubl, Steven R; Eikelboom, John W; Hylek, Elaine M; Dauerman, Harold L; Smyth, Susan S; Becker, Richard C

    2014-04-01

    The contribution of platelets in the pathophysiology of low-shear thrombosis-specifically, in atrial fibrillation (AF) and venous thromboembolic events (VTE)-remains less clear than for arterial thrombosis. AF itself appears to lead to platelet activation, offering a potential target for aspirin and other antiplatelet agents. Randomized trial results suggest a small benefit of aspirin over placebo, and of dual antiplatelet therapy (aspirin plus clopidogrel) over aspirin alone, for prevention of cardioembolic events in AF. Antiplatelet therapy thus can represent an option for patients with AF who are unsuitable for therapy with warfarin or novel oral anticoagulant agents. For VTE, the rationale for antiplatelet therapy reflects the venous response to disrupted blood flow-interactions among monocytes, neutrophil extracellular traps, and platelets. Early randomized trials generally showed poorer performance of aspirin relative to heparins and danaparoid sodium in prevention of VTE. However, results from large placebo- and dalteparin-controlled randomized trials have spurred changes in the most recent practice guidelines-aspirin is now recommended after major orthopedic surgery for patients who cannot receive other antithrombotic therapies. PMID:24221804

  4. Intercavernous Venous Communications in the Human Skull Base

    PubMed Central

    Aquini, Mauro Guidotti; Marrone, Antonio Carlos Huf; Schneider, Felipe Luis

    1994-01-01

    The intercavernous communications of the skull base were studied in 32 sphenoid blocks using electrolytic decalcification techniques, vascular filling, x-rays, and serial anatomical sections. In this study four intercavernous connections were found: anterior intercavernous sinus (AIS), posterior intercavernous sinus (PIS), inferior intercavernous sinus (IIS), and basilar plexus (BP). The AIS was present in 100% of the cases, with diameters ranging from 0.57 mm to 5.43 mm; in 17 cases (53.12%) it took up the whole anterior wall of the hypophyseal fossa. The PIS was also detected in 100% of the cases, and its diameters ranged from 0.71 mm to 4.14 mm. The IIS was identified in 31 cases (96.9%), assuming three different forms: plexuslike, venous lake, and mixed. The BP was found in 100% of the material analyzed; in 23 cases (71.9%) it proved to be the widest intercavernous communication. In 12 cases of this series the hypophysis was completely enveloped by venous structures, except at the level of the sellar diaphragm. ImagesFigure 1Figure 2Figure 3 PMID:17171164

  5. Estimation of instantaneous venous blood saturation using the photoplethysmograph waveform.

    PubMed

    Shafqat, K; Langford, R M; Kyriacou, P A

    2015-10-01

    Non-invasive estimation of regional venous saturation (SxvO2) using a conventional pulse oximeter could provide a means of obtaining clinically relevant information. This study was carried out in order to investigate the hypothesis that SxvO2 could be estimated by utilising the modulations created by positive pressure ventilation in the photoplethysmograph (PPG) signals. The modulations caused by the mechanical ventilator were extracted from oesophageal PPG signals obtained from 12 patients undergoing cardiothoracic surgery. The signals analysed in this work were acquired in a previous study. For the purpose of this analysis the raw PPG signal was considered to have three major components, ac PPG signal (cardiac related component), a static component or dc PPG signal (created mostly by the absorption of light by surrounding tissue) and the ventilator modulation component. These components were then used to estimate instantaneous arterial blood oxygen saturation (SpO2) and SxvO2 by utilising time-frequency analysis technique of smoothed-pseudo Wigner-Ville distribution (SPWVD). The results showed that there was no significant difference in the traditionally-derived (time-domain) arterial saturation and the instantaneous arterial saturation. However, the instantaneous venous saturation was found to be significantly lower than the estimated time-domain and instantaneous arterial saturation (P   =  < 0.001, n = 12). PMID:26365652

  6. Malignancy and venous thrombosis in the critical care patient.

    PubMed

    Wu, Cynthia; Lee, Agnes Y

    2010-02-01

    Venous thromboembolic disease has significant clinical consequences. There are few data available to guide its management in the critically ill cancer patient, perhaps the most complex and challenging patient population encountered. Multiple interacting and often unique factors contribute to both the thrombotic and bleeding risk in such patients. Anticoagulants are effective for prophylaxis and treatment; heparins are the best-studied agents in this setting. Whether unfractionated or low-molecular-weight heparin is the most appropriate agent depends on the exact clinical situation. Prevention of venous thrombosis is a well-recognized health priority, but thromboprophylaxis remains underused, especially in some high-risk populations such as cancer patients. Enhanced recognition of the thrombotic risk factors and a better understanding of the risks and benefits of anticoagulant therapy are necessary to improve utilization, and much research is needed to address how to implement effective thromboprophylaxis strategies. Careful consideration of the patient's overall prognosis is necessary to develop safe, effective, and individualized approaches to treating thrombosis.

  7. [Treatment of chronic venous diseases in children and adolescents].

    PubMed

    Nurmeev, I N; Mirolubov, L M; Mirolubov, A L; Nurmeev, N N; Osipov, A Yu; Nurmeeva, A R; Rashitov, L F

    2016-01-01

    Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life. PMID:27100545

  8. CDC Grand Rounds: preventing hospital-associated venous thromboembolism.

    PubMed

    Streiff, Michael B; Brady, Jeffrey P; Grant, Althea M; Grosse, Scott D; Wong, Betty; Popovic, Tanja

    2014-03-01

    Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT detaches from the site of formation and becomes mobile in the blood stream. If the circulating clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism. The disease process that includes DVT and/or pulmonary embolism is called venous thromboembolism (VTE). Each year in the United States, an estimated 350,000-900,000 persons develop incident VTE, of whom approximately 100,000 die, mostly as sudden deaths, the cause of which often goes unrecognized. In addition, 30%-50% of persons with lower-extremity DVT develop postthrombotic syndrome (a long-term complication that causes swelling, pain, discoloration, and, in severe cases, ulcers in the affected limb). Finally, 10%-30% of persons who survive the first occurrence of VTE develop another VTE within 5 years. PMID:24598595

  9. Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment

    PubMed Central

    Kucharzewski, M.; Kózka, M.; Urbanek, T.

    2013-01-01

    An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9–9.78 cm2) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2–9.4 cm2) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna's boot compression alone. PMID:23662121

  10. [Actual questions about the prevention of venous thromboembolism in cancer patients receiving chemotherapy].

    PubMed

    Losonczy, Hajna; Nagy, Ágnes; Tar, Attila

    2016-02-01

    Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients. PMID:27120721

  11. The Ultrasound-Only Central Venous Catheter Placement and Confirmation Procedure.

    PubMed

    Saul, Turandot; Doctor, Michael; Kaban, Nicole L; Avitabile, Nicholas C; Siadecki, Sebastian D; Lewiss, Resa E

    2015-07-01

    The placement of a central venous catheter remains an important intervention in the care of critically ill patients in the emergency department. We propose an ultrasound-first protocol for 3 aspects of central venous catheter placement above the diaphragm: dynamic procedural guidance, evaluation for pneumothorax, and confirmation of the catheter tip location.

  12. Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis

    PubMed Central

    2013-01-01

    Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular. CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation. Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius. CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear. PMID:23724917

  13. Cerebral venous sinus thrombosis in HIV-infected patients: report of 2 cases

    PubMed Central

    Mwita, Julius Chacha; Baliki, Kgomotso; Tema, Ludo

    2013-01-01

    Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke. PMID:24570775

  14. Radiographic and Intravascular (IVUS) Evaluation of Venous Morphology During CCSVI Treatment

    ClinicalTrials.gov

    2012-05-06

    To Determine the Safety and Validity of Venous Angioplasty and; Valvuloplasty in the Treatment of CCSVI. In Addition, it Will; Allow Researchers to Sub-classify Valve Morphology in Relation; to Treatment Success. This Will be Evidenced by Venous Patency; Forty-eight Hours by Doppler Ultrasound as Well as Clinical; Symptom Improvement.

  15. US and MRI features in venous vascular malformation of the abdominal wall. A case report

    PubMed Central

    Alessandrino, F.; Maira, A.; Tarantino, C.C.

    2012-01-01

    Vascular anomalies are classified as vascular tumors and vascular malformations. Venous vascular malformations are the most common type of vascular malformation. They may be isolated or multiple and they rarely affect the trunk. The authors report a rare case of isolated venous vascular malformation of the abdominal wall with an emphasis on the related MRI and ultrasound (US) features. PMID:23450707

  16. Deep venous thrombosis in a young woman with hypoplastic inferior vena cava.

    PubMed

    Lavens, Matthias; Moors, Boudewijn; Thomis, Sarah

    2014-05-01

    We present a 33-year-old woman with deep venous thrombosis of the left iliac vein and the left lower limb. A computed tomography scan of her abdomen revealed a hypoplastic inferior vena cava and agenesis of the right kidney. Congenital anomalies of the inferior vena cava are uncommon and are sometimes an unrecognized cause of deep venous thrombosis.

  17. A Genetic Risk Score Comprising Known Venous Thromboembolism Loci is Associated with Chronic Venous Disease in a Multi-Ethnic Cohort

    PubMed Central

    Wassel, Christina L; Rasmussen-Torvik, Laura J.; Callas, Peter W.; Denenberg, Julie O.; Durda, Peter; Reiner, Alexander P.; Smith, Nicholas L.; Allison, Matthew A.; Rosendaal, Frits R.; Criqui, Michael H.; Cushman, Mary

    2015-01-01

    Background Chronic venous disease is common and shares some risk factors with venous thromboembolism (VTE). Several genetic loci have been discovered and well-replicated for VTE in European descent populations. We examined associations of a genetic risk score (GRS), comprising known VTE loci, with chronic venous disease. Methods The San Diego Population Study (SDPS) is a multi-ethnic cohort that evaluated 2404 men and women aged 29–91 from 1994 – 1998 for chronic venous disease. The current study includes 1447 participants genotyped for 33 variants in 22 established VTE risk loci. Using these variants, unweighted and weighted GRS were constructed. Logistic regression was used to examine associations with venous disease. Results In non-Hispanic Whites, African-Americans, Hispanics, and Asians, each standard deviation increment higher of the unweighted 33-SNP GRS was associated with a 1.45-fold (95% CI (1.26, 1.67)), 1.74-fold (1.18, 2.55), a 1.80-fold (1.30, 2.51), and 1.88-fold (1.30, 2.73) greater odds, respectively, for moderate plus severe disease. The difference in c-statistics was significant between a known venous risk factor model and a model adding the 33-SNP GRS for Whites (p=0.008), African-Americans (0.03), and Hispanics (p=0.04), with marginal significance in Asians (p=0.06). Conclusions GRS comprising variants primarily from VTE findings in European descent populations were associated with chronic venous disease across all race/ethnic groups, and contributed significantly to prediction, indicating some level of generalizability to other race/ethnic groups. Future work should focus on more in depth examination of racial/ethnic group genetic architecture in relation to chronic venous disease. PMID:26442836

  18. Functional adaptation of bovine mesenteric lymphatic vessels to mesenteric venous hypertension

    PubMed Central

    Criscione, John C.; Kotiya, Akhilesh; Dongaonkar, Ranjeet M.; Hardy, Joanne; Wilson, Emily; Gashev, Anatoliy A.; Laine, Glen A.; Stewart, Randolph H.

    2014-01-01

    Lymph flow is the primary mechanism for returning interstitial fluid to the blood circulation. Currently, the adaptive response of lymphatic vessels to mesenteric venous hypertension is not known. This study sought to determine the functional responses of postnodal mesenteric lymphatic vessels. We surgically occluded bovine mesenteric veins to create mesenteric venous hypertension to elevate mesenteric lymph flow. Three days after surgery, postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 7) and sham surgery (Sham; n = 6) group animals were evaluated and compared. Contraction frequency (MVH: 2.98 ± 0.75 min−1; Sham: 5.42 ± 0.81 min−1) and fractional pump flow (MVH: 1.14 ± 0.30 min−1; Sham: 2.39 ± 0.32 min−1) were significantly lower in the venous occlusion group. These results indicate that postnodal mesenteric lymphatic vessels adapt to mesenteric venous hypertension by reducing intrinsic contractile activity. PMID:24671245

  19. Placement of a port catheter through collateral veins in a patient with central venous occlusion.

    PubMed

    Teichgräber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-01

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  20. Functional adaptation of bovine mesenteric lymphatic vessels to mesenteric venous hypertension.

    PubMed

    Quick, Christopher M; Criscione, John C; Kotiya, Akhilesh; Dongaonkar, Ranjeet M; Hardy, Joanne; Wilson, Emily; Gashev, Anatoliy A; Laine, Glen A; Stewart, Randolph H

    2014-06-15

    Lymph flow is the primary mechanism for returning interstitial fluid to the blood circulation. Currently, the adaptive response of lymphatic vessels to mesenteric venous hypertension is not known. This study sought to determine the functional responses of postnodal mesenteric lymphatic vessels. We surgically occluded bovine mesenteric veins to create mesenteric venous hypertension to elevate mesenteric lymph flow. Three days after surgery, postnodal mesenteric lymphatic vessels from mesenteric venous hypertension (MVH; n = 7) and sham surgery (Sham; n = 6) group animals were evaluated and compared. Contraction frequency (MVH: 2.98 ± 0.75 min(-1); Sham: 5.42 ± 0.81 min(-1)) and fractional pump flow (MVH: 1.14 ± 0.30 min(-1); Sham: 2.39 ± 0.32 min(-1)) were significantly lower in the venous occlusion group. These results indicate that postnodal mesenteric lymphatic vessels adapt to mesenteric venous hypertension by reducing intrinsic contractile activity.

  1. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    SciTech Connect

    Teichgraeber, Ulf Karl-Martin Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-15

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  2. Isolated deep venous thrombosis--case series, literature review and long term follow up.

    PubMed

    Kamal, Ayeesha K; Itrat, Ahmed; Shoukat, Sana; Khealani, Asumal; Kamal, Kamran

    2006-11-01

    Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are reported. Even when one patient required intubation and mechanical ventilation for stupor, both had excellent neurologic recovery. Over 6 years of follow up there has been no recurrence. In spite of stupor at presentation, complete recovery is possible without long term recurrence.

  3. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation.

    PubMed

    Casian, D; Gutsu, E; Culiuc, V

    2009-04-01

    A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.

  4. Insights from venous oxygen profiles: oxygen utilization and management in diving California sea lions.

    PubMed

    McDonald, Birgitte I; Ponganis, Paul J

    2013-09-01

    The management and depletion of O2 stores underlie the aerobic dive capacities of marine mammals. The California sea lion (Zalophus californianus) presumably optimizes O2 store management during all dives, but approaches its physiological limits during deep dives to greater than 300 m depth. Blood O2 comprises the largest component of total body O2 stores in adult sea lions. Therefore, we investigated venous blood O2 depletion during dives of California sea lions during maternal foraging trips to sea by: (1) recording venous partial pressure of O2 (P(O2)) profiles during dives, (2) characterizing the O2-hemoglobin (Hb) dissociation curve of sea lion Hb and (3) converting the P(O2) profiles into percent Hb saturation (S(O2)) profiles using the dissociation curve. The O2-Hb dissociation curve was typical of other pinnipeds (P50=28±2 mmHg at pH 7.4). In 43% of dives, initial venous S(O2) values were greater than 78% (estimated resting venous S(O2)), indicative of arterialization of venous blood. Blood O2 was far from depleted during routine shallow dives, with minimum venous S(O2) values routinely greater than 50%. However, in deep dives greater than 4 min in duration, venous S(O2) reached minimum values below 5% prior to the end of the dive, but then increased during the last 30-60 s of ascent. These deep dive profiles were consistent with transient venous blood O2 depletion followed by partial restoration of venous O2 through pulmonary gas exchange and peripheral blood flow during ascent. These differences in venous O2 profiles between shallow and deep dives of sea lions reflect distinct strategies of O2 store management and suggest that underlying cardiovascular responses will also differ.

  5. Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

    PubMed Central

    Kumar, Dharmendra; Ahmed, Syed Moied; Ali, Shahna; Ray, Utpal; Varshney, Ankur; Doley, Kashmiri

    2015-01-01

    Background: Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP. Aims: To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation. Setting and Design: Prospective observational study in Intensive Care Unit. Methods: Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°. Statistical Analysis: Pearson's correlation and Bland–Altman's analysis. Results: This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH2O. However, the correlation was good when the CVP was >10 cmH2O. Bland–Altman analysis showed 95% limits of agreement to be −2.912–9.472. Conclusion: PVP can replace CVP for guiding fluid therapy in critically ill patients. PMID:26730115

  6. Alternative venous outflow vessels in microvascular breast reconstruction.

    PubMed

    Mehrara, Babak J; Santoro, Timothy; Smith, Andrew; Arcilla, Eric A; Watson, James P; Shaw, William W; Da Lio, Andrew L

    2003-08-01

    The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction. In a retrospective analysis of 1278 microvascular breast reconstructions performed over a 10-year period, the authors identified all patients in whom the external jugular or cephalic veins were used as the outflow vessels. Patient demographics, flap choice, the reasons for the use of alternative venous drainage vessels, and the incidence of microsurgical complications were analyzed. The external jugular was used in 23 flaps performed in procedures with 22 patients. The superior gluteal and transverse rectus abdominis musculocutaneous (TRAM) flaps were used in the majority of the cases in which the external jugular vein was used (72 percent gluteal, 20 percent TRAM flap). The need for alternative venous outflow vessels was usually due to a significant vessel size mismatch between the superior gluteal and internal mammary veins (74 percent). For three of the external jugular vein flaps (13 percent), the vein was used for salvage after the primary draining vein thrombosed, and two of three flaps in these cases were eventually salvaged. In three patients, the external jugular vein thrombosed, resulting in two flap losses, while the third was salvaged using the cephalic vein. A total of two flaps were lost in the external jugular vein group. The cephalic vein was used in 11 flaps (TRAM, 64.3 percent; superior gluteal, 35.7 percent) performed in 11 patients. In five patients (54.5 percent), the cephalic vein was used to salvage a flap after the primary draining vein thrombosed; the procedure was successful in four cases. In three

  7. The Emerging Role of NETs in Venous Thrombosis and Immunothrombosis

    PubMed Central

    Kimball, Andrew S.; Obi, Andrea T.; Diaz, Jose A.; Henke, Peter K.

    2016-01-01

    Venous thrombosis (VT), a leading cause of morbidity and mortality worldwide, has recently been linked to neutrophil activation and release of neutrophil extracellular traps (NETs) via a process called NETosis. The use of various in vivo thrombosis models and genetically modified mice has more precisely defined the exact role of NETosis in the pathogenesis of VT. Translational large animal VT models and human studies have confirmed the presence of NETs in pathologic VT. Activation of neutrophils, with subsequent NETosis, has also been linked to acute infection. This innate immune response, while effective for bacterial clearance from the host by formation of an intravascular bactericidal “net,” also triggers thrombosis. Intravascular thrombosis related to such innate immune mechanisms has been coined immunothrombosis. Dysregulated immunothrombosis has been proposed as a mechanism of pathologic micro- and macrovascular thrombosis in sepsis and autoimmune disease. In this focused review, we will address the dual role of NETs in the pathogenesis of VT and immunothrombosis. PMID:27446071

  8. Portal hypertension due to portal venous thrombosis: Etiology, clinical outcomes

    PubMed Central

    Harmanci, Ozgur; Bayraktar, Yusuf

    2007-01-01

    The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting clinical pictures. There are controversial issues in nomenclature, management (including anticoagulation problems), follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients. PMID:17552000

  9. National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

    PubMed

    D'Alton, Mary E; Friedman, Alexander M; Smiley, Richard M; Montgomery, Douglas M; Paidas, Michael J; D'Oria, Robyn; Frost, Jennifer L; Hameed, Afshan B; Karsnitz, Deborah; Levy, Barbara S; Clark, Steven L

    2016-10-01

    Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. PMID:27636577

  10. National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

    PubMed

    D'Alton, Mary E; Friedman, Alexander M; Smiley, Richard M; Montgomery, Douglas M; Paidas, Michael J; D'Oria, Robyn; Frost, Jennifer L; Hameed, Afshan B; Karsnitz, Deborah; Levy, Barbara S; Clark, Steven L

    2016-01-01

    Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. PMID:27619099

  11. Inserting epidural patient controlled analgesia into a peripheral venous line.

    PubMed

    2016-01-01

    A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results.

  12. Cerebral venous thrombosis-a primer for the haematologist.

    PubMed

    Thorell, Sofia E; Parry-Jones, Adrian R; Punter, Martin; Hurford, Robert; Thachil, Jecko

    2015-01-01

    Cerebral venous thrombosis (CVT) is a condition that can affect all age groups and can often be difficult to diagnose and treat. The difficulties in diagnosis are mainly due to the non-specific presenting features of CVT, which can range from isolated headache and visual or auditory problems, to serious symptoms such as hemiparesis and coma. Therefore, it can present to various specialists including general physicians, obstetricians and neurologists. In recent years, more widespread use of cerebral imaging has led to the diagnosis being made more often. Since thrombosis is the key component, haematologists are consulted in the management of these patients including for identification of a causative factor for CVT. In this regard, the pivotal International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) has shed more light on its epidemiology and management options. This review aims to provide guidance to haematologists when faced with a patient with CVT, based on the currently available evidence. PMID:25282690

  13. Central venous catheter infection in adults in acute hospital settings.

    PubMed

    Jones, Clare A

    As well as the human cost, central venous catheter (CVC)-related bloodstream infections significantly inflate hospital costs, mainly through increased length of stay in hospital, particularly in intensive care. This literature review appraises recent research on measures used to minimize CVC-related infection and compares it with current best practice. Randomized controlled trials and systematic reviews published on the subject between 2000 and 2005 were reviewed, concentrating on non-tunnelled, short-term CVCs in the acute hospital setting. The new evidence mainly backs up current best practice. However, skin disinfection could be improved by using alcoholic chlorhexidine followed by aqueous povidone-iodine before CVC insertion. Also, alcoholic chlorhexidine is the preferred solution for cleaning the hubs/connectors before accessing the CVC. Good hand hygiene and quality control and education programmes are vital to improve patient care. More research is needed to clarify the effectiveness of certain interventions and technologies, such as antimicrobial CVCs.

  14. New anticoagulants for the treatment of venous thromboembolism

    PubMed Central

    Fernandes, Caio Julio Cesar dos Santos; Júnior, José Leonidas Alves; Gavilanes, Francisca; Prada, Luis Felipe; Morinaga, Luciana Kato; Souza, Rogerio

    2016-01-01

    Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in particular. Over the past decades, new classes of anticoagulants have been developed, such as factor Xa inhibitors and direct thrombin inhibitors, which significantly changed the therapeutic arsenal against VTE, due to their efficacy and safety when compared with the conventional treatment. The focus of this review was on evaluating the role of these new anticoagulants in this clinical context. PMID:27167437

  15. [The PICC line, a new approach for venous access].

    PubMed

    Levigoureux, E; Charbonnel, J-F; Latour, J-F; Rosay, H

    2013-03-01

    Peripheral Inserted Central Catheter (PICC) line is a peripherally inserted central catheter. This implantable medical device is placed into a peripheral vein of the arm in order to obtain an intravenous central access. This device can find its use in various applications like intravenous delivery of parenteral nutrition, anticancer agents and antibiotics, as well as for blood sampling. PICC line is not widely used in medical practice because it remains largely unknown. The aim of this review is thus to introduce PICC line to the medical and scientific community. First, we will approach its insertion and maintenance of the dressing. We will then detail the benefits and drawbacks associated with its use, and finally discuss its position with regards to the other central venous access available.

  16. L-asparaginase and venous thromboembolism in acute lymphocytic leukemia.

    PubMed

    Goyal, Gaurav; Bhatt, Vijaya Raj

    2015-01-01

    The occurrence of venous thromboembolism (VTE) in acute lymphocytic leukemia patients receiving L-asparaginase therapy may cause significant morbidity, neurological sequela and possibly worse outcomes. The prophylactic use of antithrombin infusion (to keep antithrombin activity >60%) or low molecular weight heparin (LMWH) may reduce the risk of VTE. The decision to continue L-asparaginase therapy after the development of VTE should be based on anticipated benefits, severity of VTE and the ability to continue therapeutic anticoagulation. In patients receiving asparaginase rechallenge, the use of therapeutic LMWH, monitoring of anti-Xa level and antithrombin level are important. Novel oral anticoagulants are not dependent on antithrombin level, hence offer theoretical advantages over LMWH for the prevention and therapy of asparaginase-related VTE.

  17. The importance of ideal central venous access device tip position.

    PubMed

    York, Nicola

    The use of central venous access devices (CVADs) is becoming more common in hospitals and the community. Incorrect tip placement is a common complication of CVAD insertion carried out at the bedside, and can lead to local inflammation and thrombosis. The literature recommends that a CVAD tip should be in the lower third of the superior vena cava. Anyone inserting a CVAD needs to take account of body position changes that may cause a tip to move. There are many tools and systems nurses can use to aid tip positioning, including taking body measurements, using body landmarks and electrocardiograms (ECGs). Tip position must be checked on a chest X-ray. There are several ways to determine tip postion and electromagnetic catheter tip guidance machines are being developed in the USA, which can record the position of a tip with greater accuracy. Nurses inserting CVADs at the bedside must appreciate the risks that incorrect or suboptimal tip position pose to the patient.

  18. [Superior Cava Venous syndrome as presentation of neoplasic disease].

    PubMed

    Pérez Maure, M; Subils, G; Peresin Paz, R; Cazaux, A; Cambursano, V H; Cortés, J R

    2013-01-01

    Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90% of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.

  19. Adjuvant therapy in breast cancer and venous thromboembolism.

    PubMed

    Mandalà, Mario; Tondini, Carlo

    2012-10-01

    Breast cancer patients are considered to be at relatively low risk of developing a TEE. The highest incidence of VTE events occurs in metastatic breast cancer patients likely due to extension of disease, immobility for pathologic bone fractures, cancer cachexia and venous compression by the tumour mass. Although thrombosis is less common in patients with early stage cancer compared to those with more advanced disease, it does occur and is clinically challenging. The adjuvant setting is of particular interest in order to assess the specific thrombogenic potential of systemic chemotherapy, because of the low tumor burden with only microscopic tumor foci at the time of treatment administration. This review summarizes risk factors, incidence and strategies to avoid VTE in breast cancer patients receiving adjuvant therapy.

  20. Venous thromboembolism and pancreatic cancer: incidence, pathogenesis and clinical implications.

    PubMed

    Mandalà, Mario; Moro, Cecilia; Labianca, Roberto

    2008-03-01

    Pancreatic cancer is still a major clinical challenge. Recent efforts to improve survival in locally advanced and metastatic disease have focused on combining cytotoxic drugs with targeted therapies. One of the major complications of pancreatic cancer is venous thromboembolism (VTE). Despite the general perception that patients with mucinous carcinoma of the pancreas and gastrointestinal tract present a high incidence of thromboembolic complications, there is little data regarding the incidence and pathogenesis of VTE in pancreatic cancer patients. Clinical data suggest that, among patients with unresectable pancreatic cancer, the occurrence of VTE may be associated with reduced overall survival. Furthermore emerging clinical data strongly suggest that anticoagulant treatments may improve cancer patient survival by decreasing thromboembolic complications as well as by anticancer effects. Given the lack of extensive data and the clinical relevance of this topic for both physicians and basic research scientists, this overview focuses attention on the incidence, pathogenesis and clinical implications of VTE in pancreatic cancer patients.

  1. Inserting epidural patient controlled analgesia into a peripheral venous line.

    PubMed

    2016-01-01

    A case is reported from the Safety Reporting System in Anaesthesia and Resuscitation database. The event occurred in a patient undergoing abdominal surgery in whom an epidural catheter was inserted for analgesia. After the intervention, the patient was transferred to the recovery unit where the patient controlled analgesia (PCA) is programmed. Due to an error, the PCA was connected to a peripheral venous line, which was detected early without harm to the patient. Communication and analysis of this incident served to introduce a new drug delivery protocol through PCA pumps, including the obligation to prescribe the PCA in the electronic system, a dual computerised check immediately before connecting PCA, labelling the medication bag as well as the proximal and distal lines, standardisation of daily visits to patients, and monthly monitoring of results. PMID:27062173

  2. Epidemiology, risk and outcomes of venous thromboembolism in cancer.

    PubMed

    Falanga, A; Russo, L

    2012-01-01

    Cancer is associated with a fourfold increased risk of venous thromboembolism (VTE). The risk of VTE varies according to the type of malignancy (i. e. pancreatic cancer, brain cancer, lymphoma) and its disease stage and individual factors (i. e. sex, race, age, previous VTE history, immobilization, obesity). Preventing cancer-associated VTE is important because it represents a significant cause of morbidity and mortality. In order to identify cancer patient at particularly high risk, who need thromboprophylaxis, risk prediction models have become available and are under validation. These models include clinical risk factors, but also begin to incorporate biological markers. The major American and European scientific societies have issued their recommendations to guide the management of VTE in patients with cancer. In this review the principal aspects of epidemiology, risk factors and outcome of cancer-associated VTE are summarized.

  3. Prevalence of Venous Thromboembolism in Patients With Secondary Polycythemia

    PubMed Central

    Nadeem, Omar; Gui, Jiang; Ornstein, Deborah L.

    2013-01-01

    To investigate an association between secondary polycythemia and venous thromboembolism (VTE) risk, we performed a case–control study to compare the prevalence of VTE in participants with secondary polycythemia due to chronic obstructive pulmonary disease (COPD; N = 86) to that in age- and sex-matched controls with COPD without secondary polycythemia (N = 86). Although there was a significant difference in mean hematocrit between cases and controls (53.5% vs 43.6%, respectively; P < .005), we identified no difference in the number of total or idiopathic VTE events in the 2 groups. Patients with VTE, however, had a significantly higher body mass index than patients without VTE. Our findings suggest that secondary polycythemia alone may not be a significant risk factor for VTE but that VTE risk in this population may be related to known risk factors such as obesity. The role of phlebotomy for VTE risk reduction secondary polycythemia is therefore questionable. PMID:23007895

  4. Smart medical stocking using memory polymer for chronic venous disorders.

    PubMed

    Kumar, Bipin; Hu, Jinlian; Pan, Ning

    2016-01-01

    Proper level of pressure or compression generated by medical stocking or hosiery is the key element for successful treatment or management of chronic venous disorders such as oedema, leg ulcers, etc. However achieving the recommended compression level and, more importantly, sustaining it using stockings has been a major challenge to the health practitioners supervising the treatment. This work aims to investigate and design a smart compression stocking using shape-memory polymer that allows externally controlling the pressure level in the wrapped position on the leg. Based on thermodynamical rubber theories, we first derived several criteria that have to be satisfied simultaneously in order to achieve the controlled pressure adjustment using external heat stimuli. We then presented a case where such a stocking is developed using a blend yarn consists of selected shape-memory polyurethane and nylon filaments. Extensive experimental work has also been conducted to demonstrate the feasibility and explore the influencing factors involved. PMID:26513411

  5. [Takayasu arteritis and cerebral venous thrombosis: report of a case].

    PubMed

    Rodríguez de Mingo, E; Riofrío Cabeza, S; Villa Albuger, T; Velasco Blanco, M J

    2014-01-01

    Palpitations, paresthesias and anxiety are very common reasons of consultation in primary care. We report the case of a 40 year-old Caucasian woman who came to the clinic due to these symptoms, and was finally diagnosed with Takayasu arteritis. Later, she had an episode of headache, as the initial manifestation of cerebral venous thrombosis. Takayasu arteritis is a systemic vasculitis affecting medium and large arteries, mainly leacausing stenosis of the aorta and its branches. It most frequently affects Asian women, being much rarer in Europe. The primary care doctor plays a key role in the initial diagnosis and monitoring of patients with rare diseases, such as Takayasu arteritis, and must be a basic support for the patient and family, providing information and advice, and contributing with his work to reduce the vulnerability of this group.

  6. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    SciTech Connect

    Breault, Stéphane; Glauser, Frédéric; Babaker, Malik Doenz, Francesco Qanadli, Salah Dine

    2015-06-15

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

  7. Management of venous thrombo-embolism: an update.

    PubMed

    Konstantinides, Stavros; Torbicki, Adam

    2014-11-01

    Venous thrombo-embolism is the third most frequent acute cardiovascular syndrome after myocardial infarction and stroke. Recently published landmark trials paved the way for significant progress in the management of the disease and provided the evidence for the ESC Pulmonary Embolism (PE) Guidelines 2014 update. Risk stratification strategies for non-high-risk PE continue to evolve, with an increasing emphasis on clinical prediction rules and right ventricular (RV) assessment on computed tomographic pulmonary angiography. In the field of anticoagulation treatment, pharmacogenetic testing for vitamin K antagonists on top of clinical parameters was not found to offer a significant benefit during the initiation phase; on the other hand, dosing based on the patient's clinical data seems superior to fixed loading regimens. The phase 3 trial programme of new oral anticoagulants in the treatment of venous thrombo-embolism has been completed, and the results indicate that these agents are at least as effective and probably cause less major bleeding than currently standard treatment. A multicentre prospective phase 4 trial will determine whether early discharge and out-of-hospital treatment of low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. For intermediate-risk PE defined on the basis of imaging tests and laboratory biomarkers, the bleeding risks of full-dose thrombolytic treatment appear too high to justify its use, unless clinical signs of haemodynamic decompensation appear. Patients in whom PE has resulted in chronic thrombo-embolic pulmonary hypertension and who are not suitable for pulmonary endarterectomy, may be expected to benefit from emerging pharmaceutical and interventional treatment options. PMID:25179762

  8. Isolated superior mesenteric venous thrombophlebitis with acute appendicitis

    PubMed Central

    Karam, Mohsen Mohamed; Abdalla, Mohaed Fahmy; Bedair, Said

    2011-01-01

    INTRODUCTION Isolated superior mesentericveinous thrmbophlebitis is a rarely recognised condition associated with a high morbidity. It usually develops secondary to infection in the drainage area of the portal venous system, like appendix. PRESENTATION OF CASE We report a case of neglected perforated acute appendicitis complicated by superior mesenteric venous pyelephlebitis patiant represented with a vague pain to right of umlicus, which is atypical this why cat scan was done and showed obstructed superiormesentric vein, portal vein was free with acute appendicitis. Appendicectomy and treatment with broad-spectrum antibiotics, anticoagulation, and platelets led to a full recovery. Follow-up imaging after one month revealed complete canalization of superior mesentric vein. DISCUSSION Abdominal pain if atypical like our case report need imaging diagnosis. Modern diagnostic imaging techniques help the early diagnosis of acute phase pylephlebitis. CT can detect primary source of infection, extent of pylephlebitis, CT scan is the most reliable initially. Ultrasound scan with color flow Doppler is also a sensitive test for confirming partial patency of the portal vein and portal vein thrombosis accidentally discovered complete obliteration of superior mesenteric vein with thrombosis which remained not propagated by serial Doppler ultrasound of liver. Appropriate treatment should be initiated as soon as possible. To avoid extension to portal vein. The principal treatment for pylephlebitis is to remove the source of infection as appendicectomy. Anticoagulants must be used. Regarding the treatment of portal thrombosis, post operative use of heparin has been advocated. CONCLUSION Cat scan play an important role in case of atypical abdominal pain. PMID:23500734

  9. Tunneled central venous catheters: Experience from a single center.

    PubMed

    Sampathkumar, K; Ramakrishnan, M; Sah, A K; Sooraj, Y; Mahaldhar, A; Ajeshkumar, R

    2011-04-01

    In the past vascular surgeons were called in to place tunneled central venous catheter (TVC) for hemodialysis patients. Advent of percutaneous technique has resulted in an increasing number of interventional nephrologists inserting it. A single centre three year audit of 100 TVCs with a cumulative follow up of 492 patient months is presented here. From 2007 to 2010, 100 TVCs were placed by nephrologists in a percutaneous fashion in the operative room or the interventional nephrology suite. Those who completed minimum of three months on the catheter were included in analysis. There were 69 males and 31 females with a mean age of 52.3±13.6 years.(range: 25-76). Chronic glomerulonephritis was the commonest cause of CKD (45%) followed by diabetes (39%).Right internal jugular vein was the preferred site (94%). TVC was utilized as the primary access to initiate dialysis in 25% of patients in whom a live donor was available for renal transplant. The blood flow was 250-270 ml/min. The Kaplan-Meier analysis showed that 3 months and 6 months catheter survival rates were 80% and 55%, respectively. The main complications were exit site blood ooze, catheter block and kink. Catheter related bacteremia rate was low at 0.4/1000 patient days. Primary cause of drop out was patient death unrelated to the TVCs. Those under the age of 40 years showed better survival, but there was no bearing of gender, catheter site, and etiology of CKD on survival. Tunneled central venous catheters could find a niche as the primary access of choice for pretransplant live donor renal transplants in view of its immediate usage, high blood flows, low infection rates and adequate patency rates for 3-6 months. PMID:21769173

  10. Venous Thromboembolism After Removal of Retrievable Inferior Vena Cava Filters

    SciTech Connect

    Yamagami, Takuji Tanaka, Osamu; Yoshimatsu, Rika; Miura, Hiroshi; Nishimura, Tsunehiko

    2010-02-15

    The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%) had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher's exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%).

  11. Clinical study of venous thromboembolism during pregnancy and puerperium.

    PubMed

    Adachi, T; Hashiguchi, K; Arai, Y; Ohta, H

    2001-01-01

    We encountered 16 cases of venous thromboembolism (VTE) in women during pregnancy and/or puerperium over the past 15 years at our perinatal center, representing 0.14% of all patients who delivered babies. The present study was undertaken to analyze the risk factors, clinical course and outcomes in these 16 cases. The ages of the patients varied from 29 to 39 years. Four women had pulmonary embolism (PE), 3 of which after caesarean section (C/S) at 35 to 40 weeks, and one case after ovarian cystectomy at 13 weeks of gestation. Twelve cases had deep venous thrombosis (DVT), 4 of which during pregnancy, and the remaining 8 cases after C/S. Four patients who had DVT during a normal course of pregnancy had severe thrombophilia: antiphospholipid antibody syndrome, a history of thrombosis and antithrombin (AT) deficiency. They were treated with heparin with or without AT and had healthy babies via successful vaginal deliveries. The common risk factors in 3 cases of PE with C/S was prolonged bed rest due to threatened premature delivery with total placenta previa, uterine myoma and Ehlers-Danlos syndrome. Other risk factors were massive bleeding, and positive lupus anticoagulant. However, the case of the ovarian cystectomy had only one risk factor, which was obesity. This patient died but the remaining patients recovered with treatment. Because of the low incidence of thrombosis in the Japanese population, prophylactic anticoagulant therapy has not routinely been given to patients undergoing obstetrical operations. However, proper management including prophylactic anticoagulant therapy might be considered for risk patients, depending on the risk factors.

  12. The role of perforators in chronic venous insufficiency.

    PubMed

    O'Donnell, T F

    2010-02-01

    The treatment of incompetent calf perforating veins (ICPVs) has been ascribed an important role in the therapeutic strategy for reducing superficial venous hypertension in patients with advanced chronic venous insufficiency (C4-C6). Since the open approach to ligation of ICPVs was developed by Linton over 70 years ago, there has been an evolution toward less invasive techniques with lower morbidity. This paper will review the evidence for interruption of ICPVs through a series of systematic analyses of (1) subfascial endoscopic perforating surgery (SEPS) and (2) percutaneous thermal ablation techniques (PAPS). The effectiveness and morbidity of each approach will be discussed as well as the strength of evidence supporting that technique. While there are numerous case series that suggest that SEPS is beneficial for ulcer healing and for the prevention of ulcer recurrence, the sole two RCTs that have compared either open division or SEPS for ICPVs have failed to show a statistical advantage for ICPV ablation. The results of these studies are clouded by the inclusion of patients who received concomitant treatment of their great saphenous vein (GSV). The evidence for PAPS is based on a few (n = 5) case series in peer-reviewed journals, which are limited by small patient populations, limited follow-up, and a focus on surrogate outcomes (occlusion of the perforator) rather than clinical or functional outcomes. Moreover, most of these series were carried out in patients with mild disease. Sclerotherapy of ICPVs, by either liquid or foam, shows promise, but requires greater evidence. Our current approach for limbs with C4-C6 disease is to treat the GSV first and limit treatment of ICPVs to those with high volume flow and large-diameter ICPVs. [corrected

  13. Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery

    SciTech Connect

    Peynircioglu, Bora Arslan, E. Bengi; Cil, Barbaros E.; Geyik, Serdar; Hazirolan, Tuncay; Konan, Ali; Balkanci, Ferhun

    2007-06-15

    The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up.

  14. The hepatic-arterial/portal-venous scintiangiogram in alcoholic hepatitis

    SciTech Connect

    Stewart, C.; Sakimura, I.; Siegel, M.E.; Harley, H.; Lee, K.

    1984-01-01

    This study was designed to identify abnormalities in the hepatic-arterial/portal-venous scintiangiogram (SA) in alcoholic hepatitis (AH). SA's were performed in 35 patients with acute alcoholic hepatitis (AAH), 8; acute alcoholic hepatitis superimposed on cirrhosis (A/C), 14; and cirrhosis (C), 13. Posterior flows were done with a bolus of 10 mCi Tc-99m sulfur colloid with computer time-activity curves over the liver and left kidney. Curves were analyzed for per cent of hepatic arterial (HA) and portal venous contribution using the slope ratio method. Hepatic arterialization was estimated from the angle of the HA component of the curve. Reversal of the relative contribution of the hepatic and portal components of total flow were seen in all groups. Although quite severe in AH, the degree of reversal could not be used to differentiate among the groups. The average HA angle in AAH was 48.3 +- 8.1, in A/C 41.5 +- 10.6, and in C 30.4 +- 12.1. In reviewing the data of only those in the acute clinical phase of AH and not the recovery phase (1 AAH, 3 A/C) and those without other causes of alteration in hepatic arterialization (1 hepatoma, 1 portalcaval shunt, 6 renal failure), the average HA angle in AAH was 50.1 +- 6.6, 45.4 +- 8.2 in A/C, and 23.2 +- 4.2 in C. In 6 with renal failure (2 C, 2AAH, 2 A/C) the HA angle ws 52.7 +- 5.7. In all cases cirrhosis could be differentiated from both A/C (P=.05) and AAH (P<.01) using the HA angle. In absence of renal failure, portal shunt, or hepatoma, P was <.01 in both comparisons.

  15. The use of compression stockings for venous disorders in Brazil

    PubMed Central

    Cataldo, J L; de Godoy, J M Pereira; de Barros, N

    2012-01-01

    Objective The aim of this study was to analyse the medical indication and the use of elastic compression stockings, and to assess patient adherence to treatment in different regions of Brazil. Method The prescription and clinical indication of elastic stockings were evaluated in a prospective, descriptive, cross-sectional, multicentre study for a population of private patients. In 2009, 3414 patients from 123 treatment centres in southern, south-eastern and north-eastern Brazil were evaluated using a questionnaire. The following variables were analysed: sociodemographic (gender, age, occupation and education), lifestyle (physical activity and time spent standing); classification of venous disease (CEAP [clinical, aetiological, anatomical and pathophysiological] classification – clinical criteria), indications for prescription, consumer behaviour (strength, acquisition and use of stockings) and criteria of satisfaction (improvement, duration of use, adherence). The effects of compression therapy were assessed at a follow-up visit approximately 30 days after starting treatment with the following items being assessed: complaints about pain, discomfort, burning sensation and oedema of the leg while using elastic stockings. Multivariate analysis was used to compare data with an alpha error of 5% (P value < 0.05) being considered acceptable. Results The average age increased with the severity of chronic venous insufficiency; the main indications used by physicians were leg pain and discomfort; 89.3% of patients bought stockings and thus started treatment with more than 90% of these reporting improvements in symptoms. Conclusion Elastic stockings are available to the Brazilian population, look acceptable at the time of purchase and provide good results; however, some limitations regarding their use need to be addressed. PMID:21765190

  16. Deep Venous Thrombosis in Teen With Crouzon Syndrome Post-Le Fort III Osteotomy With Rigid External Distraction.

    PubMed

    Roussel, Lauren O; Myers, Rene P; Girotto, John A

    2015-11-01

    Venous thromboembolic events are rare in pediatric patients. Risk factors associated with the development of venous thromboembolic events in pediatric patients include the use of central venous catheters, hospitalization, cancer, sepsis, trauma, surgery, and congenital prothrombotic disorders.The authors present the case of a 14-year-old man with Crouzon syndrome who required Le Fort III osteotomy with rigid external distraction for significant midface hypoplasia who presented postoperatively with an extensive deep venous thrombosis. This is the first reported case of symptomatic venous thrombosis post-Le Fort III osteotomy and rigid external distraction. Although rare, surgeons should be aware of this potential complication.

  17. Persistent primitive hepatic venous plexus with Scimitar syndrome: description of a case and review of the literature.

    PubMed

    Restrepo, M Santiago; Aldoss, Osamah; Ng, Benton

    2015-06-01

    Persistent primitive hepatic venous plexus is an anomaly of the systemic venous return characterised by postnatal persistence of the foetal intrahepatic venous drainage. Scimitar syndrome is a condition that consists of partial anomalous pulmonary venous return of the right pulmonary venous drainage into the systemic veins, associated with pulmonary artery hypoplasia with the underdeveloped right lung, pulmonary sequestration, and cardiac malposition. Both conditions are rare and together have been rarely described in the literature. We report the first case of this combination of lesions imaged by cardiac magnetic resonance imaging with a three-dimensional reconstruction and reviewed the literature to characterise this uncommon combination.

  18. Deep Venous Thrombosis in Teen With Crouzon Syndrome Post-Le Fort III Osteotomy With Rigid External Distraction.

    PubMed

    Roussel, Lauren O; Myers, Rene P; Girotto, John A

    2015-11-01

    Venous thromboembolic events are rare in pediatric patients. Risk factors associated with the development of venous thromboembolic events in pediatric patients include the use of central venous catheters, hospitalization, cancer, sepsis, trauma, surgery, and congenital prothrombotic disorders.The authors present the case of a 14-year-old man with Crouzon syndrome who required Le Fort III osteotomy with rigid external distraction for significant midface hypoplasia who presented postoperatively with an extensive deep venous thrombosis. This is the first reported case of symptomatic venous thrombosis post-Le Fort III osteotomy and rigid external distraction. Although rare, surgeons should be aware of this potential complication. PMID:26595005

  19. Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement.

    PubMed

    Mesfin, Addisu; Lum, Ying Wei; Nayfeh, Tariq; Mears, Simon C

    2011-03-11

    Massive venous thrombosis, which can occur acutely after inferior vena cava filter placement, has 2 forms: phlegmasia cerulea dolens and phlegmasia alba dolens. In phlegmasia cerulea dolens, complete occlusion of venous outflow occurs. In the milder phlegmasia alba dolens version, collateral venous flow out of the limb remains despite the venous thrombosis. This article presents, to our knowledge, the first 2 cases of massive venous thrombosis (1 phlegmasia cerulea dolens, 1 phlegmasia alba dolens) below inferior vena cava filters occurring after the acute period. Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was not addressed surgically. Phlegmasia cerulea dolens and phlegmasia alba dolens have high morbidity and mortality. The patient with phlegmasia alba dolens required leg and thigh fasciotomies and eventually required an above-knee amputation. The patient with phlegmasia cerulea dolens developed compartment syndrome in the left leg, right leg, and right thigh. Although he underwent decompression of all of these compartments, he died from multiple organ failure. A multidisciplinary approach with the vascular service and the intensivists is required in the treatment of patients with massive venous thrombosis. Treatment goals include preventing additional propagation of the thrombus via anticoagulation, with strong consideration for catheter-directed thrombolysis or thrombectomy and fasciotomies for compartment syndrome. The orthopedic surgeon should keep phlegmasia cerulea dolens and phlegmasia alba dolens in the differential for compartment syndrome, especially in patients who have had a history of acute or chronic inferior vena cava filter placement.

  20. The vertebral venous plexuses: the internal veins are muscular and external veins have valves.

    PubMed

    Stringer, Mark D; Restieaux, Matthew; Fisher, Amanda L; Crosado, Brynley

    2012-07-01

    The internal and external vertebral venous plexuses (VVP) extend the length of the vertebral column. Authoritative sources state that these veins are devoid of valves, permitting bidirectional blood flow and facilitating the hematogenous spread of malignant tumors that have venous connections with these plexuses. The aim of this investigation was to identify morphologic features that might influence blood flow in the VVP. The VVP of 12 adult cadavers (seven female, mean age 79.5 years) were examined by macro- and micro-dissection and representative veins removed for histology and immunohistochemistry (smooth muscle antibody staining). A total of 26, mostly bicuspid, valves were identified in 19 of 56 veins (34%) from the external VVP, all orientated to promote blood flow towards the internal VVP. The internal VVP was characterized by four main longitudinal channels with transverse interconnections; the maximum caliber of the longitudinal anterior internal VVP veins was significantly greater than their posterior counterparts (P < 0.001). The luminal architecture of the internal VVP veins was striking, consisting of numerous bridging trabeculae (cords, thin membranes and thick bridges) predominantly within the longitudinal venous channels. Trabeculae were composed of collagen and smooth muscle and also contained numerous small arteries and nerve fibers. A similar internal venous trabecular meshwork is known to exist within the dural venous sinuses of the skull. It may serve to prevent venous overdistension or collapse, to regulate the direction and velocity of venous blood flow, or is possibly involved in thermoregulation or other homeostatic processes. PMID:21976364

  1. Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers

    PubMed Central

    Yates, Stephanie; McNichol, Laurie; Gray, Mikel

    2016-01-01

    Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity. PMID:27163774

  2. Chronic venous ulceration of leg associated with peripheral arterial disease: an underappreciated entity in developing country.

    PubMed

    Nag, Falguni; De, Abhishek; Hazra, Avijit; Chatterjee, Gobinda; Ghosh, Arghyaprasun; Surana, Trupti V

    2014-10-01

    Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries. PMID:23170845

  3. Salvage of venous congestion using medicinal leeches for traumatic nasal flap.

    PubMed

    Jose, Mathew; Varghese, Jomy; Babu, Arun

    2015-03-01

    Medicinal leeches are extremely useful and safe in the salvage of venous outflow compromised tissue, particularly in digit replants and various forms of flaps. Although it is unusual for a partial soft tissue avulsion of the face to require medicinal leech therapy, situations may occur in which there is adequate arterial inflow but inadequate venous outflow. In such cases, medicinal leeches may play a very important role in salvaging the soft tissue segment. We report a case of a 34-year-old gentleman who showed signs of venous congestion following primary management for a traumatic nasal flap. Successful salvage of venous congestion was done using medicinal leech therapy, once daily, for 5 days. His recovery deemed satisfactory and uncomplicated. Medicinal leeches are well-known in the treatment of venous congestion or complete venous outflow obstruction in larger pedicled flaps and microvascular transfers. In trauma, it is well established that medicinal leeches are invaluable in treating venous congestion in digit replants and replantation of totally avulsed external ear segments. A limited number of other reports have demonstrated the use of medicinal leeches for salvage of other partially avulsed facial structures. Medicinal leeches have a significant role in the management of traumatic and microvascular flaps, the oral and maxillofacial surgeon should weigh the benefits of such treatment before instituting other expensive or complex treatment modalities.

  4. Congenital agenesis of inferior vena cava: a rare cause of unprovoked deep venous thrombosis.

    PubMed

    Parsa, Pouria; Lane, John S; Barleben, Andrew R; Owens, Erik L; Bandyk, Dennis

    2015-07-01

    Congenital anomalies of the inferior vena cava (IVC), although rare, are a risk factor for lower limb deep venous thrombosis (DVT). A 19-year-old male presented with a left flank and groin pain caused by iliofemoral venous thrombosis. Vascular imaging by computed tomography (CT) scanning and venography demonstrated agenesis of the IVC. Catheter-directed thrombolysis via a popliteal vein was attempted but did not alter the patency of the common femoral vein outflow collaterals into the retroperitoneal azygous venous system. The patient was anticoagulated using systemic heparin infusion and clinical symptoms resolved within 5 days. He was transitioned to oral Coumadin anticoagulation, and follow-up venous duplex testing demonstrated no infrainguinal DVT and phasic venous flow with respiration in the femoral vein indicating patent collateral veins. Anomalies of the IVC are present in 0.3-0.5% of otherwise healthy individuals. Agenesis of the IVC has an incidence of 0.0005-1% in the general population but is found in almost 5% of patients <30 years of age with unprovoked lower limb DVT. In adults, IVC agenesis anomaly can cause diagnostic problems in the paravertebral area because of the tumor-like appearance of the azygous venous collaterals on noncontrast CT imaging. In young adults presenting with unprovoked lower limb DVT, the presence of an IVC anomaly should be considered and evaluated for by venous duplex testing and if necessary CT venography.

  5. Effect of commercially available pantyhose on venous return in the lower extremity.

    PubMed

    Godin, M S; Rice, J C; Kerstein, M D

    1987-06-01

    Although compression stockings have long been recognized as a physiologically significant tool for the promotion of venous return from the lower extremity, the role of nonprescription, commercially available support hose has not been assessed in this regard. The present study involved 100 consecutive women with no known prior history of vascular disease, who responded to an advertisement for free evaluation of the venous status of their legs. The subjects, all of whom wore commercial support hose routinely, were screened for the presence of venous disease by means of Doppler ultrasonography, phleborheography, and a detailed history focusing on risk factors and unrecognized symptoms of venous disease. Photoplethysmography (PPG) was then used to evaluate the efficiency of venous return from the lower extremity with and without the support hose in place. Worsening of PPG results occurred in 43% of the women with commercial stockings in place, whereas 23% improved and 34% showed no change. Women 50 years of age and older had a somewhat higher tendency toward poorer PPG results while wearing the support hose. Furthermore, measurements in women who showed evidence of venous disease by an abnormality in one or more of the screening tests were significantly different from the overall group (p = 0.025): 61% exhibited worsening of PPG results when wearing stockings, only 14% showed improvement, and 25% were unchanged. These results suggest that the use of a commercial support hose may be particularly deleterious to older women and is contraindicated in those with evidence of venous disease in the lower extremity. PMID:3295307

  6. Risk of future arterial cardiovascular events in patients with idiopathic venous thromboembolism.

    PubMed

    Green, David

    2009-01-01

    Venous and arterial thromboses have traditionally been considered distinct pathophysiologic entities. However, the two disorders have many features in common, and there is evidence that persons with venous thrombosis may be at greater risk for arterial events. The pathogenesis of both disorders includes endothelial injury, platelet activation, elevated levels of intrinsic clotting factors and inflammatory markers, increased fibrinogen, and impaired fibrinolysis. In addition, older age, obesity, dyslipidemia, and smoking predispose to both venous and arterial thrombosis. While the evidence that arterial disease is a risk factor for venous thrombosis is inconclusive, arterial disease does appear to occur with a modestly increased frequency in patients with a history of venous thromboembolism. Reported odds ratios in such patients were 1.2 for myocardial infarction, 1.3 for stroke, 2.3 for carotid plaque, and 4.3 for coronary calcification. Of note, in persons under age 40 with unprovoked venous thrombosis, the odds ratio for acute myocardial infarction was as high as 3.9. In general, however, venous disease is considered to be a weak risk factor for arterial thrombosis, and the use of agents specifically targeted to the prevention of heart attack or stroke in the majority of persons with VTE cannot be recommended at present.

  7. [Venous aneurysm as a therapeutic problem: various management strategies in selected patients: our experience].

    PubMed

    Dorobisz, A T; Korta, K; Milnerowicz, A; Iznerowicz, A; Dorobisz, T A

    2012-10-01

    Venous system aneurysms appear relatively rarely, and are even more rarely diagnosed, especially if asymptomatic. In the material of our clinic we provide a variety of practices in three patients with venous aneurysms depending on the location, symptoms and main disease. In some patients the occurrence of pulmonary embolism is the first symptom of venous aneurysms, having influence on the selection of further diagnostics, conservative treatment, as well as on endovascular or operating procedure. The proper diagnosis of a venous aneurysm takes place in case of doubling or tripling of the diameter of the basic dimension of the lumen, often with the presence of thrombotic material. Asymptomatic venous aneurysms are usually detected during routine pre-operative diagnosis also including duplex-Doppler studies. In the presence of pulmonary embolism positive angio-CT and scintigraphy raise the suspicion of venous aneurysm unless any other reason is apparent. There is no standard treatment of venous aneurysms. This has to do with the relatively low epidemiology, diversity of location, difficulties in determining the proper primary and secondary aetiology, anatomy and coexisting diseases. Despite the many unknowns a few issues should be considered before appropriate treatment is undertaken. Undoubtedly, the shape itself, the location and size of the aneurysm with the presence or not of thrombotic material are of great value in evaluating the risk of complications, including possibly lethal pulmonary embolism, local symptoms of venous hypertension and possible complications of surgery. In this paper we present 3 patients treated for venous aneurysms located in different regions: popliteal vein, brachial vein and iliac internal vein. PMID:23136107

  8. Comparison of capillary earlobe and venous blood monitoring for occupational lead surveillance.

    PubMed

    Taylor, Lauralynn; Jones, Robert L; Ashley, Kevin; Deddens, James A; Kwan, Lorna

    2004-04-01

    Biological monitoring for occupational lead exposure involves routine venous blood draws from exposed employees. This uncomfortable procedure normally yields more blood than what is needed for analysis. Capillary blood sampling is less invasive but introduces the possibility of surface contamination. The objective of this study was to compare venous and capillary (earlobe) blood lead samples obtained from occupationally exposed individuals. Phlebotomists trained specifically in the collection of blood samples for lead determination collected 2 venous blood samples and 2 capillary earlobe samples from each participating employee. Before the capillary draw, the employee's earlobe was cleansed with an alcohol wipe in an effort to remove potential lead contamination. A second alcohol wipe was then used to sanitize the lancing area and was retained for lead analysis. Both the venous and capillary samples were subsequently analyzed with the use of graphite furnace atomic absorption spectrometry (GFAAS). GFAAS of venous blood specimens was considered the reference method of sampling and analysis. We collected and analyzed 126 paired earlobe and venous samples. Earlobe sampling was preferred to venous sampling by 54% of the employees surveyed. The mean difference between the capillary and venous results was 38.8 +/- 48.1 microg/dL. Lead concentrations in earlobe blood were more than twice those found in venous samples in more than half of the samples (64 of 126). Despite simple cleansing with an alcohol wipe and no visible skin contamination, 94% of the wipe samples from earlobes contained more than 1 microg of lead. Even low concentrations of contamination can significantly alter the concentration of lead in the blood; for example, sample contamination of 0.3 microg lead in a 200-microL blood sample would yield an increase of 150 microg/dL in the measured lead concentration. The findings of this study suggest that until satisfactory skin cleansing and decontamination

  9. Spontaneous Recanalization of Occluded Dural Venous Sinuses after Successful Trans Arterial Embolisation of a Dural Arteriovenous Shunt

    PubMed Central

    Brew, S.; Taylor, W.; Lasjaunias, P.

    2002-01-01

    Summary Dural arteriovenous shunts (DAVS) occur within the walls of dural venous sinuses or their tributaries. They may be related to previous episodes of sinus thrombosis. The presence of impediments to venous outflow results in venous congestion, predisposing to haemorrhage and cerebral parenchymal damage. Cerebral venous congestion is an indication for treatment. This case is unusual in some respects; firstly, the patient was relatively well despite worrisome features on imaging and secondly the occluded dural venous sinuses appeared to spontaneously recanalize after treatment of the DAVS. Anticoagulation may have had a role in avoiding thrombosis of the patient's precarious venous drainage after embolisation and in encouraging recanalization of the thrombosed dural venous sinuses. PMID:20594510

  10. A case of portal venous gas after extracorporeal shockwave lithotripsy and obstructive pyelonephritis.

    PubMed

    Rana, Abbas A; Sylla, Patricia; Woodland, David C; Feingold, Daniel L

    2008-03-01

    The presence of gas in the portal venous system is considered an ominous sign often mandating immediate exploratory laparotomy; however, there are numerous reports of benign incidences of this finding. This report describes a case of portal venous gas after extracorporeal shockwave lithotripsy. The patient had the rare complication of obstructive pyleonephritis that progressed to sepsis and subsequently underwent a negative exploratory laparotomy. It is suggested that the radiographic finding of portal venous gas should be correlated with the likely cause and overall clinical picture.

  11. "Venous congestion" as a cause of subcortical white matter T2 hypointensity on magnetic resonance images.

    PubMed

    Kamble, Jayaprakash Harsha; Parameswaran, Krishnan

    2016-01-01

    Subcortical T2 hypointensity is an uncommon finding seen in very limited conditions such as multiple sclerosis, Sturge-Weber syndrome, and meningitis. Some of the conditions such as moyamoya disease, severe ischemic-anoxic insults, early cortical ischemia, and infarcts are of "arterial origin." We describe two conditions in which "venous congestion" plays a major role in T2 hypointensity - cerebral venous sinus thrombosis (CVST) and dural arteriovenous fistula (dAVF). The third case is a case of meningitis, showing T2 hypointensity as well, and can be explained by the "venous congestion" hypothesis. The same hypothesis can explain few of the other conditions causing subcortical T2 hypointensity. PMID:27570403

  12. HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy

    PubMed Central

    Dag, Zeynep Ozcan; Işik, Yuksel; Simsek, Yavuz; Tulmac, Ozlem Banu; Demiray, Demet

    2014-01-01

    Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy. PMID:25317347

  13. Anticoagulation and delayed bowel resection in the management of mesenteric venous thrombosis.

    PubMed

    Kim, Hyung-Kee; Chun, Jae Min; Huh, Seung

    2013-08-14

    Acute mesenteric venous thrombosis is potentially lethal because it can result in mesenteric ischemia and, ultimately, bowel infarction requiring surgical intervention. Systemic anticoagulation for the prevention of thrombus propagation is a well-recognized treatment modality and the current mainstay therapy for patients with acute mesenteric venous thrombosis. However, the decision between prompt surgical exploration vs conservative treatment with anticoagulation is somewhat difficult in patients with suspected bowel ischemia. Here we describe a patient with acute mesenteric venous thrombosis who presented with bowel ischemia and was treated with anticoagulation and delayed short-segment bowel resection.

  14. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

    PubMed Central

    Hosaka, Ai; Yamaguchi, Tetsuto; Yamamoto, Fumiko; Shibagaki, Yasuro

    2015-01-01

    Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. PMID:26693366

  15. Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma.

    PubMed

    Hosaka, Ai; Yamaguchi, Tetsuto; Yamamoto, Fumiko; Shibagaki, Yasuro

    2015-01-01

    Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures. PMID:26693366

  16. Novel Wound Healing Powder Formulation for the Treatment of Venous Leg Ulcers

    PubMed Central

    Ghatnekar, Angela V.; Elstrom, Tuan; Ghatnekar, Gautam S.; Kelechi, Teresa

    2011-01-01

    Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers. PMID:24527167

  17. Effect of body temperature on peripheral venous pressure measurements and its agreement with central venous pressure in neurosurgical patients.

    PubMed

    Sahin, Altan; Salman, M Alper; Salman, A Ebru; Aypar, Ulka

    2005-04-01

    Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical settings. The effect of body temperature on PVP and its agreement with CVP in patients under general anesthesia are investigated in this study. Fifteen American Society of Anesthesiologists I-II patients undergoing elective craniotomy were included in the study. CVP, PVP, and core (Tc) and peripheral (Tp) temperatures were monitored throughout the study. A total of 950 simultaneous measurements of CVP, PVP, Tc, and Tp from 15 subjects were recorded at 5-minute intervals. The measurements were divided into low- and high-Tc and -Tp groups by medians as cutoff points. Bland-Altman assessment for agreement was used for CVP and PVP in all groups. PVP measurements were within range of +/-2 mm Hg of CVP values in 94% of the measurements. Considering all measurements, mean bias was 0.064 mm Hg (95% confidence interval -0.018-0.146). Corrected bias for repeated measurements was 0.173 +/- 3.567 mm Hg (mean +/- SD(corrected)). All of the measurements were within mean +/- 2 SD of bias, which means that PVP and CVP are interchangeable in our setting. As all the measurements were within 1 SD of bias when Tc was > or = 35.8 degrees C, even a better agreement of PVP and CVP was evident. The effect of peripheral hypothermia was not as prominent as core hypothermia. PVP measurement may be a noninvasive alternative for estimating CVP. Body temperature affects the agreement of CVP and PVP, which deteriorates at lower temperatures.

  18. Lessons from French National Guidelines on the treatment of venous thrombosis and central venous catheter thrombosis in cancer patients.

    PubMed

    Farge, Dominique; Durant, Cecile; Villiers, Stéphane; Long, Anne; Mahr, Alfred; Marty, Michel; Debourdeau, Philippe

    2010-04-01

    Increased prevalence of Venous thromboembolism (VTE), as defined by deep-vein thrombosis (DVT), central venous catheter (CVC) related thrombosis or pulmonary embolism (PE) in cancer patients has become a major therapeutic issue. Considering the epidemiology and each national recommendations on the treatment of VTE in cancer patients, we analysed guidelines implementation in clinical practice. Thrombosis is the second-leading cause of death in cancer patients and cancer is a major risk factor of VTE, due to activation of coagulation, use of long-term CVC, the thrombogenic effects of chemotherapy and anti-angiogenic drugs. Three pivotal trials (CANTHANOX, LITE and CLOT) and several meta-analysis led to recommend the long term (3 to 6 months) use of LMWH during for treating VTE in cancer patients with a high level of evidence. The Italian Association of Medical Oncology (AIOM), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), the French "Institut National du Cancer" (INCa), the European Society of Medical Oncology (ESMO) and the American College of Chest Physicians (ACCCP) have published specific guidelines for health care providers regarding the prevention and treatment of cancer-associated VTE. Critical appraisal of these guidelines, difficulties in implementation of prophylaxis regimen, tolerance and cost effectiveness of long term use of LMWH may account for large heterogenity in daily clinical practice. Homogenization of these guidelines in international consensus using an adapted independent methodological approach followed by educational and active implementation strategies at each national level would be very valuable to improve the care of VTE in cancer patients. PMID:20433988

  19. Endovascular treatment options in the management of lower limb deep venous thrombosis.

    PubMed

    Nazir, Sarfraz Ahmed; Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman

    2009-09-01

    Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

  20. [Phlebography in chronic venous insufficiency of the lower extremities. Technic and value of different tests].

    PubMed

    Genevois, A; Bolot, J E; Michel, C

    1988-01-01

    Remainder of the various phlebographic procedures in chronic venous insufficiency of the lower extremities: peripheral phlebography, popliteal phlebography, femoral phlebography, varicography. The techniques and the informations they provide are presented for each one of these examinations. PMID:3043478

  1. Tetralogy of fallot, dextrocardia, and situs inversus associated with total anomalous pulmonary venous return.

    PubMed

    Talwar, Sachin; Rajashekar, Palleti; Muthukkumaran, Subramanian; Airan, Balram

    2013-09-01

    We report a 3-year-old patient with tetralogy of Fallot (TOF), dextrocardia, situs inversus (SI), and total anomalous pulmonary venous return. This combination of anomalies is extremely unusual. The management is discussed and the literature is reviewed.

  2. Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission.

    PubMed

    Meher, Lalit Kumar; Dalai, Siba Prasad; Panda, Sameer; Hui, Pankaj Kumar; Nayak, Sachidananda

    2016-05-01

    Ulcerative colitis (UC) is an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Cerebral venous sinus thrombosis along with deep vein thrombosis, pulmonary embolism and arterial thrombosis have occasionally been reported as a complication in the active phase of UC being attributed to its pro-thrombotic state. This paper depicts a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures. Subsequent diagnosis of cerebral venous sinus thrombosis was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms. The highlights of this case underscore the importance of evaluating cerebral venous sinus thrombosis as a cause of acute onset neurological deterioration in a setting of inflammatory bowel disease. It also emphasizes on the hypothesis that the risk of venous thrombosis or other hypercoagulable states have no direct relationship with the disease activity or flare-up. PMID:27437291

  3. Influence of central venous pressure upon sinus node responses to arterial baroreflex stimulation in man

    NASA Technical Reports Server (NTRS)

    Mark, A. L.; Takeshita, A.; Eckberg, D. L.; Abboud, F. M.

    1978-01-01

    Measurements were made of sinus node responses to arterial baroreceptor stimulation with phenylephrine injection or neck suction, before and during changes of central venous pressure provoked by lower body negative pressure or leg and lower truck elevation. Variations of central venous pressure between 1.1 and 9.0 mm Hg did not influence arterial baroreflex mediated bradycardia. Baroreflex sinus node responses were augmented by intravenous propranolol, but the level of responses after propranolol was comparable during the control state, lower body negative pressure, and leg and trunk elevation. Sinus node responses to very brief baroreceptor stimuli applied during the transitions of central venous pressure also were comparable in the three states. The authors conclude that physiological variations of central venous pressure do not influence sinus node responses to arterial baroreceptor stimulation in man.

  4. Primary Iliac Venous Leiomyosarcoma: A Rare Cause of Deep Vein Thrombosis in a Young Patient

    PubMed Central

    Oliveira, Nelson; Dias, Emanuel; Lima, Ricardo; Oliveira, Fernando; Cássio, Isabel

    2011-01-01

    Introduction. Primary venous tumours are a rare cause of deep vein thrombosis. The authors present a case where the definitive diagnosis was delayed by inconclusive complementary imaging. Clinical Case. A thirty-seven-year-old female presented with an iliofemoral venous thrombosis of the right lower limb. The patient had presented with an episode of femoral-popliteal vein thrombosis five months before and was currently under anticoagulation. Phlegmasia alba dolens installed progressively, as thrombus rapidly extended to the inferior vena cava despite systemic thrombolysis and anticoagulation. Diagnostic imaging failed to identify the underlying aetiology of the deep vein thrombosis. The definitive diagnosis of primary venous leiomyosarcoma was reached by a subcutaneous abdominal wall nodule biopsy. Conclusion. Primary venous leiomyosarcoma of the iliac vein is a rare cause of deep vein thrombosis, which must be considered in young patients with recurrent or refractory to treatment deep vein thrombosis. PMID:21738532

  5. Primary iliac venous leiomyosarcoma: a rare cause of deep vein thrombosis in a young patient.

    PubMed

    Oliveira, Nelson; Dias, Emanuel; Lima, Ricardo; Oliveira, Fernando; Cássio, Isabel

    2011-01-01

    Introduction. Primary venous tumours are a rare cause of deep vein thrombosis. The authors present a case where the definitive diagnosis was delayed by inconclusive complementary imaging. Clinical Case. A thirty-seven-year-old female presented with an iliofemoral venous thrombosis of the right lower limb. The patient had presented with an episode of femoral-popliteal vein thrombosis five months before and was currently under anticoagulation. Phlegmasia alba dolens installed progressively, as thrombus rapidly extended to the inferior vena cava despite systemic thrombolysis and anticoagulation. Diagnostic imaging failed to identify the underlying aetiology of the deep vein thrombosis. The definitive diagnosis of primary venous leiomyosarcoma was reached by a subcutaneous abdominal wall nodule biopsy. Conclusion. Primary venous leiomyosarcoma of the iliac vein is a rare cause of deep vein thrombosis, which must be considered in young patients with recurrent or refractory to treatment deep vein thrombosis.

  6. Instillation of alcohol into venous malformations of the head and neck.

    PubMed

    Svendsen, P; Wikholm, G; Fogdestam, I; Naredi, S; Edén, E

    1994-12-01

    Vascular malformations are errors of vascular morphogenesis, and must be differentiated from vascular tumours such as haemangiomas, because the natural history and treatment are different. Vascular malformations may be arteriovenous with high blood flow, or venous with low blood flow. Venous vascular malformations grow among soft tissues and are difficult to delineate at operation. Direct puncture under fluoroscopy with injection of contrast medium is one method of visualising the cavities of a venous malformation. Instillation of concentrated alcohol directly into such cavities is a possible treatment. Forty-four patients with venous malformations of the head or neck have been treated since 1984, of whom 31 responded to a follow up questionnaire. Twenty-three responded to injection of ethanol alone, and eight also required reconstructive surgery; 26 of the 31 described the result as "good" or "excellent" (84%).

  7. Incidental Finding of Inferior Vena Cava Atresia Presenting with Deep Venous Thrombosis following Physical Exertion

    PubMed Central

    Koppisetty, Shalini; Smith, Alton G.; Dhillon, Ravneet K.

    2015-01-01

    Inferior vena cava atresia (IVCA) is a rare but well described vascular anomaly. It is a rare risk factor for deep venous thrombosis (DVT), found in approximately 5% of cases of unprovoked lower extremity (LE) DVT in patients <30 years of age. Affected population is in the early thirties, predominantly male, often with a history of major physical exertion and presents with extensive or bilateral DVTs. Patients with IVC anomalies usually develop compensatory circulation through the collateral veins with enlarged azygous/hemizygous veins. Despite the compensatory circulation, the venous drainage of the lower limbs is often insufficient leading to venous stasis and thrombosis. We describe a case of extensive and bilateral deep venous thrombosis following physical exertion in a thirty-six-year-old male patient with incidental finding of IVCA on imaging. PMID:26640723

  8. Spectrum of pulmonary sequestration: association with anomalous pulmonary venous drainage in infants.

    PubMed

    Thilenius, O G; Ruschhaupt, D G; Replogle, R L; Bharati, S; Herman, T; Arcilla, R A

    1983-01-01

    Pulmonary sequestration is a spectrum of related lesions, each of which may be absent or present: (1) bronchial sequestration of pulmonary parenchyma; (2) arterial supply from systemic circulation; (3) anomalous pulmonary venous drainage to the right atrium; (4) communications between bronchus and esophagus; (5) defects of diaphragm; (6) gross lung anomalies, such as horseshoe lungs or hypoplasia. Any combination of these primary lesions can occur in an individual patient. Diagnosis should be directed towards each component of the spectrum. Of special importance is the venous connection, as anomalous pulmonary venous drainage can involve not only the sequestered segment but the entire ipsilateral lung, making surgical therapy far more complex. Treatment of choice is surgical resection, associated, if needed, with rerouting of the pulmonary venous return. Classification of sequestration of the lung as intra- and extralobar is of secondary importance: these 2 groups do not represent lesions of different embryological significance.

  9. Interlocking Stents for Improving Stent Fixation at Graft-Venous Anastomosis

    SciTech Connect

    Eyal, Abraham; Hebron, Dan

    1998-03-15

    To lower the risk of stent migration in a graft-venous anastomosis stenosis following failed percutaneous transluminal angioplasty, two Strecker stents of different caliber were placed in partly overlapping fashion across the stenosis. In contrast to other methods, stent 'floating' on the venous side was eliminated by using a stent with a caliber matching the tapering postanastomotic vein and anchoring it to both the venous wall and the second stent. Using this method we believe we accomplished better fixation of the stent placed mostly in the venous side of the anastomosis, thus lowering its risk of migration. At 6 months follow-up the stents are in place and the anastomosis is patent.

  10. Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

    SciTech Connect

    Nazir, Sarfraz Ahmed Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman

    2009-09-15

    Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

  11. Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission

    PubMed Central

    Meher, Lalit Kumar; Panda, Sameer; Hui, Pankaj Kumar; Nayak, Sachidananda

    2016-01-01

    Ulcerative colitis (UC) is an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Cerebral venous sinus thrombosis along with deep vein thrombosis, pulmonary embolism and arterial thrombosis have occasionally been reported as a complication in the active phase of UC being attributed to its pro-thrombotic state. This paper depicts a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures. Subsequent diagnosis of cerebral venous sinus thrombosis was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms. The highlights of this case underscore the importance of evaluating cerebral venous sinus thrombosis as a cause of acute onset neurological deterioration in a setting of inflammatory bowel disease. It also emphasizes on the hypothesis that the risk of venous thrombosis or other hypercoagulable states have no direct relationship with the disease activity or flare-up. PMID:27437291

  12. [Phlebography in chronic venous insufficiency of the lower extremities. Technic and value of different tests].

    PubMed

    Genevois, A; Bolot, J E; Michel, C

    1988-01-01

    Remainder of the various phlebographic procedures in chronic venous insufficiency of the lower extremities: peripheral phlebography, popliteal phlebography, femoral phlebography, varicography. The techniques and the informations they provide are presented for each one of these examinations.

  13. Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

    SciTech Connect

    Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

    2001-03-15

    Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

  14. Enhancement of venous drainage with vein stripper for reversed pedicled neurocutaneous flaps.

    PubMed

    Sonmez, Erhan; Silistireli, Özlem Karataş; Karaaslan, Önder; Kamburoğlu, Haldun Onuralp; Safak, Tunc

    2013-05-01

    The flaps based on the vascular axis of superficial sensitive cutaneous nerves had gained increased popularity in reconstructive surgery because of such major advantages as preservation of major extremity arteries and avoidance of microsurgical procedures. However, postoperative venous congestion resulting in partial or total necrosis is still a common problem for these flaps. The aim of the current study is to introduce a new method for reducing the postoperative venous congestion of neural island flap with the results of reconstruction of the soft tissue defects of foot and ankle. This method was used to treat 19 patients with various chronic soft tissue defects of the foot and ankle between 2011 and 2012. We observed that the novel method presented in this report enables effective venous drainage, solving the postoperative venous congestion problem of these flaps.

  15. Substitution of Fingertip Blood for Venous Blood in the Measurement of Hematocrit and Hemoglobin Following Exercise

    ERIC Educational Resources Information Center

    Fahey, Thomas D.; And Others

    1977-01-01

    Results from comparative testing indicate that fingertip blood is a valid indicator of antecubital venous hematocrit (hct) and hemoglobin (hgb), and that hct ratios determined on the Coulter counter are comparable to those found by the microhematocrit method. (MB)

  16. Acquired and Heritable Thrombophilia in Indian Patients With Pediatric Deep Venous Thrombosis (DVT).

    PubMed

    Pai, Navin; Ghosh, Kanjaksha; Shetty, Shrimati

    2014-09-01

    Deep venous thrombosis (DVT) in children is more often associated with underlying pathological conditions than with hereditary thrombophilia. The present study is a retrospective analysis of thrombophilia in 285 pediatric patients with venous thrombosis at different sites. Four common thrombophilia markers, that is protein C, protein S, antithrombin III, and factor V Leiden (FVL) mutation, were analyzed. Thrombosis in hepatic and portal veins was more common in pediatric patients (73%) when compared to other sites (27%). Overall, hereditary thrombophilia accounted for 15.5% of the patients with venous thrombosis. The FVL mutation, which was the major causative factor in Budd-Chiari syndrome and portal vein thrombosis cases in the adult group, was not a major contributing factor in pediatric group, that is, 1.8% of the patients. In conclusion, the risk factors for venous thrombosis vary in different age groups.

  17. Venous Congestion, Endothelial and Neurohormonal Activation in Acute Decompensated Heart Failure: Cause or Effect?

    PubMed Central

    Colombo, Paolo C.; Doran, Amanda C.; Onat, Duygu; Wong, Ka Yuk; Ahmad, Myra; Sabbah, Hani N.; Demmer, Ryan T.

    2015-01-01

    Venous congestion and endothelial and neurohormonal activation are known to occur in acute decompensated heart failure (ADHF), yet the temporal role of these processes in the pathophysiology of decompensation is not fully understood. Conventional wisdom presumes congestion to be a consequence of worsening cardiovascular function; however, the biomechanically driven effects of venous congestion are biologically plausible contributors to ADHF that remain largely unexplored in vivo. Recent experimental evidence from human models suggests that fluid accumulation and venous congestion are not simply consequences of poor cardiovascular function, but rather are fundamental pro-oxidant, pro-inflammatory, and hemodynamic stimuli that contribute to acute decompensation. The latest advances in the monitoring of volume status using implantable devices allow for the detection of venous congestion before symptoms arise. This may ultimately lead to improved treatment strategies including not only diuretics, but also specific, adjuvant interventions to counteract endothelial and neurohormonal activation during early preclinical decompensation. PMID:25740404

  18. Treatment of Pelvic Venous Spur (May-Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

    SciTech Connect

    Binkert, Christoph A.; Schoch, Eric; Stuckmann, Gerd; Largiader, Jon; Wigger, Pius; Schoepke, Wolfdietrich; Zollikofer, Christoph L.

    1998-01-15

    Purpose: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. Methods: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. Results: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. Conclusion: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur.

  19. The affinity of troxerutin for the venous wall measured by laser scanning microscopy.

    PubMed

    Patwardhan, A; Carlsson, K; Poullain, J C; Taccoen, A; Gerentes, I

    1995-08-01

    The uptake and localization of troxerutin, a trihydroxy-ethyl-rutoside, in the venous wall have been studied in patients undergoing long saphenous vein surgery. Troxerutin, an autofluorescent drug, is currently used to relieve oedema and subjective symptoms in patients with chronic venous insufficiency. In order to determine the localization of the troxerutin, a confocal scanning laser microscope has been used to record the fluorescence from vein cross sections. The quantified fluorescence was used as a measure of the local concentration of troxerutin. In order to reduce the effects of local variation, several images have been scanned from each specimen. Then the recorded data have been analysed to see how the fluorescence varies in the radial direction within the venous wall. Results showed that troxerutin was significantly accumulated in both inner and outer parts of the venous wall. Whereas inner wall troxerutin uptake resulted from direct diffusion through the lumen, the outer wall uptake proceeded likely from the vasa vasorum circulation.

  20. Venous Oxygenation Mapping using Velocity-Selective Excitation and Arterial Nulling (VSEAN)

    PubMed Central

    Guo, Jia; Wong, Eric C.

    2011-01-01

    A new MRI technique to map the oxygenation of venous blood is presented. The method uses velocity-selective excitation and arterial nulling pulses, combined with phase sensitive signal detection to isolate the venous blood signal. The T2 of this signal along with a T2-Y calibration curve yields estimates of venous oxygenation in situ. Results from phantoms and healthy human subjects under normoxic and hypoxic conditions are shown, and venous saturation levels estimated from both sagittal sinus and grey matter based ROIs are compared to the related techniques TRUST and QUIXOTIC. In addition, combined with an additional scan without arterial nulling pulses, the oxygen saturation level on arterial side can also be estimated. PMID:22294414

  1. Use of a Novel Two-layer Bandage in the Treatment of Chronic Venous Hypertension

    PubMed Central

    Lullove, Eric J.; Newton, Elizabeth

    2014-01-01

    Since the development of Unna boot therapies, there has been development in newer technologies for venous compression syndromes and chronic venous hypertension. Chronic lower extremity venous insufficiency results in venous stasis, edema and hypercongestion of the lower extremities. Given the breadth of potential uses, the goal of this study was to retrospectively compile and analyze the clinical application and effectiveness of a 2-layer zinc-impregnated foam Unna boot bandage (Andover Healthcare, Salisbury, MA) in patients with lower extremity swelling with or without wounds treated by a single physician and monitored for 12 weeks post-application in the outpatient setting. In patients with complex comorbidities, the use of this new foam-impregnated multi-layer compression Unna boot shows efficacy in reduction of edema and wound size within 12 weeks. This newer therapy shows extensive promise in the ability to keep patients adherent to treatment regimens with higher rates of success. PMID:26199883

  2. [The use of magnetic resonance venography in diagnosis of cerebral venous blood flow disorders].

    PubMed

    Semenov, S E; Abalmasov, V G

    2000-01-01

    The paper presents an examination of 85 patients aged 16-72 years with cerebral venous dyscirculation resulted from the obstruction of cerebral venous sinuses, major veins of the neck and upper regions of the mediastenum. 70 healthy volunteers were also observed. Magnetic-resonance venography of brachyocephal veins and venous sinuses and ultrasound duplex scanning of internal jugular veins together with colored mapping of the blood flow were performed. Both the causes and the magnetic-resonance semiotics of the obstructive damages of brachyocephal veins and of the cerebral venous sinuses were described. The criteria for hemodynamic significance of the obstruction of brachyocephal veins were defined in case of extravasal compression of brachyocephal veins.

  3. [Clinico-roentgenologic diagnosis of chronic venous insufficiency of the ovaries].

    PubMed

    Grakova, L S; Galkin, E V; Naumova, E B

    1989-01-01

    The paper is devoted to clinico-roentgenological correlations of venous reno-gonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinico-laboratory investigation was followed by visceral and parietal phlebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. A retrograde blood flow along the internal ovarian vein with the development of venostasis and secondary pelvic varicocele was diagnosed in 67 women with disturbed reproductive function. In 17 women without disorders of reproductive function a reno-gonadal venous reflux was undetectable. Clinico-roentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele.

  4. Induced venous pooling and cardiorespiratory responses to exercise after bed rest

    NASA Technical Reports Server (NTRS)

    Convertino, V. A.; Sandler, H.; Webb, P.; Annis, J. F.

    1982-01-01

    Venous pooling induced by a specially constructed garment is investigated as a possible means for reversing the reduction in maximal oxygen uptake regularly observed following bed rest. Experiments involved a 15-day period of bed rest during which four healthy male subjects, while remaining recumbent in bed, received daily 210-min venous pooling treatments from a reverse gradient garment supplying counterpressure to the torso. Results of exercise testing indicate that while maximal oxygen uptake endurance time and plasma volume were reduced and maximal heart rate increased after bed rest in the control group, those parameters remained essentially unchanged for the group undergoing venous pooling treatment. Results demonstrate the importance of fluid shifts and venous pooling within the cardiovascular system in addition to physical activity to the maintenance of cardiovascular conditioning.

  5. Diet as prophylaxis and treatment for venous thromboembolism?

    PubMed Central

    2010-01-01

    Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT) and pulmonary emboli (PE)) with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs) showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE) without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%). However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%). Additionally, an FPE rate of about 0.012% (35/28,400) in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with the rationale of using

  6. Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization

    PubMed Central

    Chang, Michael C.; Shim, John J.

    2012-01-01

    Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs. PMID:23378884

  7. Cerebral Venous Thrombosis as an Extrahepatic Manifestation of Acute Anicteric Hepatitis A Infection

    PubMed Central

    Zis, Panagiotis; Kontogeorgi, Elli; Karakalos, Dimitrios; Pavlopoulou, Despoina; Sevastianos, Vassilios A.

    2012-01-01

    Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis has been regarded as a rare associated condition. We report the case of a 31-year-old woman presenting with CVT associated with hepatitis A virus (HAV) infection, outlining probable pathogenic mechanisms. We suggest that hepatitis A serological markers should be routinely included in the investigation of cerebral venous thrombosis of unknown etiology, in nonvaccinated patients with risk factors of a recent HAV exposure. PMID:22934203

  8. Matrix Metalloproteinases as Potential Targets in the Venous Dilation Associated with Varicose Veins

    PubMed Central

    Kucukguven, Arda; Khalil, Raouf A.

    2013-01-01

    Varicose veins (VVs) are a common venous disease of the lower extremity characterized by incompetent valves, venous reflux, and dilated and tortuous veins. If untreated, VVs could lead to venous thrombosis, thrombophlebitis and chronic venous leg ulcers. Various genetic, hormonal and environmental factors may lead to structural changes in the vein valves and make them incompetent, leading to venous reflux, increased venous pressure and vein wall dilation. Prolonged increases in venous pressure and vein wall tension are thought to increase the expression/activity of matrix metalloproteinases (MMPs). Members of the MMPs family include collagenases, gelatinases, stromelysins, matrilysins, membrane-type MMPs and others. MMPs are known to degrade various components of the extracellular matrix (ECM). MMPs may also affect the endothelium and vascular smooth muscle, causing changes in the vein relaxation and contraction mechanisms. ECs injury also triggers leukocyte infiltration, activation and inflammation, which lead to further vein wall damage. The vein wall dilation and valve dysfunction, and the MMP activation and superimposed inflammation and fibrosis would lead to progressive venous dilation and VVs formation. Surgical ablation is an effective treatment for VVs, but may be associated with high recurrence rate, and other less invasive approaches that target the cause of the disease are needed. MMP inhibitors including endogenous tissue inhibitors (TIMPs) and pharmacological inhibitors such as zinc chelators, doxycycline, batimastat and marimastat, have been used as diagnostic and therapeutic tools in cancer, autoimmune and cardiovascular disease. However, MMP inhibitors may have side effects especially on the musculoskeletal system. With the advent of new genetic and pharmacological tools, specific MMP inhibitors with fewer undesirable effects could be useful to retard the progression and prevent the recurrence of VVs. PMID:23316963

  9. Matrix metalloproteinases as potential targets in the venous dilation associated with varicose veins.

    PubMed

    Kucukguven, Arda; Khalil, Raouf A

    2013-03-01

    Varicose veins (VVs) are a common venous disease of the lower extremity characterized by incompetent valves, venous reflux, and dilated and tortuous veins. If untreated, VVs could lead to venous thrombosis, thrombophlebitis and chronic venous leg ulcers. Various genetic, hormonal and environmental factors may lead to structural changes in the vein valves and make them incompetent, leading to venous reflux, increased venous pressure and vein wall dilation. Prolonged increases in venous pressure and vein wall tension are thought to increase the expression/activity of matrix metalloproteinases (MMPs). Members of the MMPs family include collagenases, gelatinases, stromelysins, matrilysins, membrane- type MMPs and others. MMPs are known to degrade various components of the extracellular matrix (ECM). MMPs may also affect the endothelium and vascular smooth muscle, causing changes in the vein relaxation and contraction mechanisms. Endothelial cell injury also triggers leukocyte infiltration, activation and inflammation, which lead to further vein wall damage. The vein wall dilation and valve dysfunction, and the MMP activation and superimposed inflammation and fibrosis would lead to progressive venous dilation and VVs formation. Surgical ablation is an effective treatment for VVs, but may be associated with high recurrence rate, and other less invasive approaches that target the cause of the disease are needed. MMP inhibitors including endogenous tissue inhibitors (TIMPs) and pharmacological inhibitors such as zinc chelators, doxycycline, batimastat and marimastat, have been used as diagnostic and therapeutic tools in cancer, autoimmune and cardiovascular disease. However, MMP inhibitors may have side effects especially on the musculoskeletal system. With the advent of new genetic and pharmacological tools, specific MMP inhibitors with fewer undesirable effects could be useful to retard the progression and prevent the recurrence of VVs.

  10. [Anomalous pulmonary venous return in a pregnant woman identified by cardiac magnetic resonance].

    PubMed

    Souto, Fernanda Maria; Andrade, Stephanie Macedo; Barreto, Ana Terra Fonseca; Souto, Maria Júlia Silveira; Russo, Maria Amélia; de Mendonça, José Teles; Oliveira, Joselina Luzia Menezes; Gonçalves, Luiz Flávio Galvão

    2014-06-01

    Anomalous pulmonary venous return (APVR) is a rare cardiac anomaly defined as one or more pulmonary veins draining into a structure other than the left atrium, with venous return directly or indirectly to the right atrium. The most common form is partial APVR, in which one to three pulmonary veins drain into systemic veins or into the right atrium. We report the case of a woman diagnosed with partial APVR by magnetic resonance imaging during pregnancy.

  11. Palmar arch reconstruction using dorsal venous arch of foot for revascularisation of multiple digits

    PubMed Central

    Krishnakumar, K. S.; Petkar, Kiran; Lateef, Sameer; Rasalkar, Jyoti; Arun, T. J.; Suresh, V.

    2014-01-01

    A case of trauma causing total loss of superficial and deep palmar arches of hand with ischemia of all the digits was managed using dorsal venous arch of the foot to reconstruct the palmar arch. The ends of the venous arch were anastomosed to radial and ulnar arteries and the tributaries to the arch were coapted to the cut ends of the common digital vessels and princeps pollicis. The surgery yielded gratifying results, successfully revascularising all the digits. PMID:24987216

  12. Immediate use of medicinal leeches to salvage venous congested reverse pedicled neurocutaneous flaps.

    PubMed

    Gideroglu, Kaan; Yildirim, Serkan; Akan, Mithat; Akoz, Tayfun

    2003-01-01

    Reverse pedicled neurocutaneous flaps have recently become popular for reconstructing soft tissue defects of the lower extremity. Venous congestion is a relatively common problem in these flaps in diabetic patients and those with electric burns, and this may cause partial or complete loss if capillary perfusion is not re-established urgently. We describe our experience of 13 neurocutaneous flaps, of which five developed venous congestion and were treated successfully with leeches placed immediately.

  13. Right Renal Vein Aplasia Associated With Diverted Renal Venous Drainage Through Lower Pole

    SciTech Connect

    Bozlar, Ugur; Ugurel, Mehmet Sahin; Bedir, Selahattin; Ors, Fatih; Coskun, Unsal; Aydur, Emin

    2008-07-15

    We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.

  14. Prediction of Liver Function by Using Magnetic Resonance-based Portal Venous Perfusion Imaging

    PubMed Central

    Cao, Yue; Wang, Hesheng; Johnson, Timothy D.; Pan, Charlie; Hussain, Hero; Balter, James M.; Normolle, Daniel; Ben-Josef, Edgar; Ten Haken, Randall K.; Lawrence, Theodore S.; Feng, Mary

    2013-01-01

    Purpose To evaluate whether liver function can be assessed globally and spatially by using volumetric dynamic contrast-enhanced magnetic resonance imaging MRI (DCE-MRI) to potentially aid in adaptive treatment planning. Methods and Materials Seventeen patients with intrahepatic cancer undergoing focal radiation therapy (RT) were enrolled in institution review board-approved prospective studies to obtain DCE-MRI (to measure regional perfusion) and indocyanine green (ICG) clearance rates (to measure overall liver function) prior to, during, and at 1 and 2 months after treatment. The volumetric distribution of portal venous perfusion in the whole liver was estimated for each scan. We assessed the correlation between mean portal venous perfusion in the nontumor volume of the liver and overall liver function measured by ICG before, during, and after RT. The dose response for regional portal venous perfusion to RT was determined using a linear mixed effects model. Results There was a significant correlation between the ICG clearance rate and mean portal venous perfusion in the functioning liver parenchyma, suggesting that portal venous perfusion could be used as a surrogate for function. Reduction in regional venous perfusion 1 month after RT was predicted by the locally accumulated biologically corrected dose at the end of RT (P<.0007). Regional portal venous perfusion measured during RT was a significant predictor for regional venous perfusion assessed 1 month after RT (P<.00001). Global hypovenous perfusion pre-RT was observed in 4 patients (3 patients with hepatocellular carcinoma and cirrhosis), 3 of whom had recovered from hypoperfusion, except in the highest dose regions, post-RT. In addition, 3 patients who had normal perfusion pre-RT had marked hypervenous perfusion or reperfusion in low-dose regions post-RT. Conclusions This study suggests that MR-based volumetric hepatic perfusion imaging may be a biomarker for spatial distribution of liver function, which

  15. [Use of Doppler ultrasound in the examination of the extent of venous angiomas].

    PubMed

    Van Der Molen, H R

    1976-01-01

    After emphasizing that the treatment of a strawberry naevus in a newborn is usually unnecessary, the author shows the value of the Sonar Doppler in delimiting the extent of pseudovaricose and cavernous, venous angiomas. Arterio-venous fistulas above a certain size can be localized by this procedure. Sometimes these disappear spontaneously (traumatism, thrombosis). On the other hand, the delicate arteriovenous fistulas found in cases of the Klippel and Trenaunay triad are inaccessible to this procedure.

  16. Prediction of Liver Function by Using Magnetic Resonance-based Portal Venous Perfusion Imaging

    SciTech Connect

    Cao Yue; Wang Hesheng; Johnson, Timothy D.; Pan, Charlie; Hussain, Hero; Balter, James M.; Normolle, Daniel; Ben-Josef, Edgar; Ten Haken, Randall K.; Lawrence, Theodore S.; Feng, Mary

    2013-01-01

    Purpose: To evaluate whether liver function can be assessed globally and spatially by using volumetric dynamic contrast-enhanced magnetic resonance imaging MRI (DCE-MRI) to potentially aid in adaptive treatment planning. Methods and Materials: Seventeen patients with intrahepatic cancer undergoing focal radiation therapy (RT) were enrolled in institution review board-approved prospective studies to obtain DCE-MRI (to measure regional perfusion) and indocyanine green (ICG) clearance rates (to measure overall liver function) prior to, during, and at 1 and 2 months after treatment. The volumetric distribution of portal venous perfusion in the whole liver was estimated for each scan. We assessed the correlation between mean portal venous perfusion in the nontumor volume of the liver and overall liver function measured by ICG before, during, and after RT. The dose response for regional portal venous perfusion to RT was determined using a linear mixed effects model. Results: There was a significant correlation between the ICG clearance rate and mean portal venous perfusion in the functioning liver parenchyma, suggesting that portal venous perfusion could be used as a surrogate for function. Reduction in regional venous perfusion 1 month after RT was predicted by the locally accumulated biologically corrected dose at the end of RT (P<.0007). Regional portal venous perfusion measured during RT was a significant predictor for regional venous perfusion assessed 1 month after RT (P<.00001). Global hypovenous perfusion pre-RT was observed in 4 patients (3 patients with hepatocellular carcinoma and cirrhosis), 3 of whom had recovered from hypoperfusion, except in the highest dose regions, post-RT. In addition, 3 patients who had normal perfusion pre-RT had marked hypervenous perfusion or reperfusion in low-dose regions post-RT. Conclusions: This study suggests that MR-based volumetric hepatic perfusion imaging may be a biomarker for spatial distribution of liver function, which

  17. Effect of Hydroxyethylrutosides on Blood Oxygen Levels and Venous Insufficiency Symptoms in Varicose Veins

    PubMed Central

    McEwan, Andrew J.; McArdle, Colin S.

    1971-01-01

    Oxygen levels (tension, saturation, and content) in blood from varicose leg veins were found to be significantly lower than those in blood from normal leg veins at the same site on the limb under the same laboratory conditions. Treatment with hydroxyethylrutosides significantly increased the oxygen levels in blood from varicose veins, and this was associated with an improvement in leg symptoms attributable to venous insufficiency. Hydroxyethylrutosides have been shown to have a beneficial effect on capillary dysfunction in venous stasis. PMID:5581491

  18. Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature

    PubMed Central

    Amuluru, Krishna; Al-Mufti, Fawaz; Hannaford, Stephen; Singh, Inder Paul; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2016-01-01

    Background Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. Summary We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. Key Message The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions. PMID:27051409

  19. Quantitative Analysis of Fundus-Image Sequences Reveals Phase of Spontaneous Venous Pulsations

    PubMed Central

    Moret, Fabrice; Reiff, Charlotte M.; Lagrèze, Wolf A.; Bach, Michael

    2015-01-01

    Purpose Spontaneous venous pulsation correlates negatively with elevated intracranial pressure and papilledema, and it relates to glaucoma. Yet, its etiology remains unclear. A key element to elucidate its underlying mechanism is the time at which collapse occurs with respect to the heart cycle, but previous reports are contradictory. We assessed this question in healthy subjects using quantitative measurements of both vein diameters and artery lateral displacements; the latter being used as the marker of the ocular systole time. Methods We recorded 5-second fundus sequences with a near-infrared scanning laser ophthalmoscope in 12 young healthy subjects. The image sequences were coregistered, cleaned from microsaccades, and filtered via a principal component analysis to remove nonpulsatile dynamic features. Time courses of arterial lateral displacement and of diameter at sites of spontaneous venous pulsation or proximal to the disk were retrieved from those image sequences and compared. Results Four subjects displayed both arterial and venous pulsatile waveforms. On those, we observed venous diameter waveforms differing markedly among the subjects, ranging from a waveform matching the typical intraocular pressure waveform to a close replica of the arterial waveform. Conclusions The heterogeneity in waveforms and arteriovenous phases suggests that the mechanism governing the venous outflow resistance differs among healthy subjects. Translational relevance Further characterizations are necessary to understand the heterogeneous mechanisms governing the venous outflow resistance as this resistance is altered in glaucoma and is instrumental when monitoring intracranial hypertension based on fundus observations. PMID:26396929

  20. Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion.

    PubMed

    Barami, Kaveh

    2016-09-01

    Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the "Starling resistor," prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients. PMID:27581321