The Main Aspects of Diagnosis and Treatment of Diffuse Congenital Vascular Malformations of Lower Extremities: Arteriovenous Forms with Microfistulas, Combined Forms and Venous Forms with Deep Venous System Anomalies

BackgroundTorcular dural sinus malformations (tDSMs) with arteriovenous shunts are rare congenital intracranial vascular malformations that carry a high rate of neurologic impairment and death in the neonatal, infant and young pediatric population. Their impact on brain venous drainage, especially the deep venous system, is one of the key factors in the clinical prognosis and natural history of the disease. We describe our therapeutic strategy for tDSMs, disconnecting the reflux into the deep venous system by performing an endovascular straight sinus occlusion.MethodsAmong all children with dural sinus malformations seen between 2002 and 2020, we retrospectively reviewed those with tDSM in whom straight sinus occlusion had been performed.ResultsOur databank included nine patients with tDSM that were embolized. Mean age at the clinical onset was 8.9±9.6 months (min–max=0–31). Five patients presented a significant reflux in the straight sinus on digital subtraction angiography. Those patients were initially clinically worse (mean modified Rankin Scale (mRS) 3.8) than those who did not present with reflux (mean mRS 2.25), this reflux being responsible for intraventricular hemorrhage in three patients. The reflux was suppressed by transarterial embolization in one patient and by transvenous straight sinus occlusion in four patients. Staged endovascular treatment resulted in a complete cure in six patients without complications, and clinical improvement in all patients.ConclusionStraight sinus occlusion is a feasible technique that needs to be considered in the treatment strategy for tDSM with deep venous reflux in order to avoid or minimize brain damage.

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Two Different Variant Veins Rarely Seen in the Deep Venous System of the Lower Extremities: Case Report

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-020-00665-7 ◽

2020 ◽

Vol 2 (12) ◽

pp. 2969-2972

Author(s):

Kaan Çimen ◽

Güldal Doğruyol ◽

Mehmet Çimen

Keyword(s):

Case Report ◽

Lower Extremities ◽

Venous System ◽

Deep Venous System

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The deep venous system of the lower extremity: new nomenclature

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.010081 ◽

2011 ◽

Vol 27 (2) ◽

pp. 48-58 ◽

Cited By ~ 12

Author(s):

D Kachlik ◽

V Pechacek ◽

V Musil ◽

V Baca

Keyword(s):

Lower Extremity ◽

Lower Extremities ◽

Venous System ◽

World Congress ◽

International Union ◽

Deep Venous System ◽

Anatomical Nomenclature ◽

Extremity Veins ◽

Terminologia Anatomica

The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

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Venous Pressure Gradient: It’s Role in Diagnosis and Treatment of Steno-Obstructions of Deep Venous System

Angiology & Vascular Surgery ◽

10.24966/avs-7397/100009 ◽

2017 ◽

Vol 2 (1) ◽

pp. 1-6

Author(s):

Sergio Petronelli ◽

Keyword(s):

Pressure Gradient ◽

Venous Pressure ◽

Venous System ◽

Diagnosis And Treatment ◽

Deep Venous System

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PATHOPHYSIOLOGICAL AND PATHOMORPHOLOGICAL ASPECTS OF RELAPSE OF VARICOSE VEINS AFTER ENDOVASCULAR LASER VEIN COAGULATION

Wiadomości Lekarskie ◽

10.36740/wlek202011124 ◽

2020 ◽

Vol 73 (11) ◽

pp. 2468-2475

Author(s):

Volodymyr B. Goshchynsky ◽

Bogdan O. Migenko ◽

Svitlana S. Riabokon

Keyword(s):

Endothelial Dysfunction ◽

Postoperative Period ◽

Varicose Vein ◽

Varicose Veins ◽

Lower Extremities ◽

Venous System ◽

Circulating Endothelial Cells ◽

Electron Microscopic ◽

Deep Venous System ◽

Vein Disease

The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC. Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed. Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria. Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.

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