Use of the Posterior Lumbar Approach for Psoas Major Injection in Hip Flexor Spasticity

ABSTRACT: Background: Hip flexor spasticity in patients with upper motor neuron syndrome of multiple etiologies has been managed with botulinum neurotoxin injections mainly targeting the “iliopsoas” muscle. A lumbar approach to target psoas major (PM) has been described; however, it has not been incorporated into clinical practice due to perceived risk of injury to surrounding structures. This study will investigate the feasibility and accuracy of ultrasound-guided (UG)-PM injection using a lumbar approach by assessing the intra/extramuscular injectate spread in cadaveric specimens. Methods: In eight lightly embalmed specimens, toluidine blue dye/saline was injected into PM using a UG-posterior lumbar approach. The posterior abdominal wall was exposed, and dye spread and surrounding structures digitized and modeled in 3D. The area and vertebral level of dye spread, distance of dye to the inferior vena cava (IVC), and abdominal aorta (AA) and dye spread to adjacent organs were quantified. Results: The models enabled visualization of the dye spread in 3D. Mean area of dye spread was 24.4 ± 2.8 cm2; most commonly between L2 and L4 vertebral levels. Mean distance of the dye to AA was 3.2 ± 1.2 cm and to IVC was 1.8 ± 0.4 cm. Dye spread remained intramuscular in all but one specimen. No dye spread occurred to any adjacent organs. Conclusions: The injection of PM using the UG-posterior lumbar approach was consistent and without spread to surrounding structures. This technique alone or in addition to the anterior approach is expected to have better clinical outcomes in the treatment of hip flexor spasticity. Further clinical studies are required.

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Management of infected caval filter with simultaneous aortic pseudoaneurysm and retroperitoneal perforation: a case report and literature review

Vascular ◽

10.1258/vasc.2011.cr0310 ◽

2012 ◽

Vol 20 (4) ◽

pp. 225-228 ◽

Cited By ~ 5

Author(s):

M Mura Assifi ◽

Gabor Bagameri ◽

Paul J Dimuzio ◽

Joshua A Eisenberg

Keyword(s):

Inferior Vena ◽

Intravenous Drug User ◽

Vena Cava ◽

Operative Management ◽

Iliopsoas Muscle ◽

Complication Rates ◽

Aortic Pseudoaneurysm ◽

Ivc Filters ◽

Multiple Structures ◽

Retroperitoneal Perforation

Inferior vena cava (IVC) filters have been reported to have complication rates up to 35%. Penetration of surrounding retroperitoneal structures is an uncommon, but potentially serious, complication, with several reports in the literature. We present a unique case of a 34-year-old intravenous drug user with infected IVC filter struts penetrating multiple structures simultaneously. Definitive operative management was necessary for removal of filter struts from the aorta, the second part of the duodenum and the iliopsoas muscle. Drainage and debridement of an associated iliopsoas abscess was performed, followed by aortic and caval reconstruction.

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Difficulty factors of adrenal venous sampling based on patient characteristics and imaging findings

Acta Radiologica ◽

10.1177/02841851211034046 ◽

2021 ◽

pp. 028418512110340

Author(s):

Soma Kumasaka ◽

Hiroyuki Tokue ◽

Yoshito Tsushima

Keyword(s):

Inferior Vena ◽

Vena Cava ◽

Patient Characteristics ◽

Sampling Procedure ◽

Adrenal Vein ◽

Adrenal Venous Sampling ◽

Transverse Diameter ◽

Venous Sampling ◽

Vertebral Level ◽

The Right

Background Primary aldosteronism is one of the most common causes of secondary hypertension. Unilateral primary aldosteronism can be treated with adrenalectomy; therefore, determining laterality is essential, for which adrenal venous sampling is considered the gold standard. However, as catheter insertion and sampling at an appropriate venous point is occasionally difficult, it is a time-consuming procedure. Purpose To evaluate the patient characteristics and imaging findings that influence the adrenal venous sampling procedure. Material and Methods A total of 69 patients who underwent adrenal venous sampling between January 2013 and December 2017 were retrospectively analyzed. The procedure was considered difficult if the duration was > 142 min (mean ± standard deviation [SD] of procedure time in this study) and/or proper sampling failed. Anatomical factors such as belly diameter, presence of adrenal nodules, diameter of the right adrenal vein and inferior vena cava, ratio of the diameters of the right adrenal vein to diameter of the inferior vena cava, vertical direction of the right adrenal vein, and vertebral level of the right adrenal vein were evaluated as predictive factors on computed tomography. Results Fifteen patients (21.7%) were considered difficult cases. The factors associated with difficulty were the long transverse diameter of the belly ( P = 0.004) and high vertebral level of the right adrenal vein ( P = 0.032). No statistical differences were observed in any other factors. Conclusion The long transverse diameter of the belly and high vertebral level of the right adrenal vein may prevent completion of the adrenal venous sampling procedure.

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Repair of Preduodenal Portal Vein Injury with Polytetrafluoroethylene Graft with Midgut Rotation and Left Sided Inferior Vena Cava

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/45553.14543 ◽

2021 ◽

Author(s):

Zuber Ansari ◽

Tuhin Subhra Mandal ◽

Koustav Jana ◽

Avik Sarkar

Keyword(s):

Inferior Vena Cava ◽

Portal Vein ◽

Inferior Vena ◽

Vena Cava ◽

Biliary Duct ◽

Ptfe Graft ◽

Biliary Stones ◽

Preduodenal Portal Vein ◽

Risk Of Injury ◽

Recurrent Pyogenic Cholangitis

Preduodenal Portal Vein (PDPV) is a rare congenital anomaly. The presence of PDPV carries the risk of injury to Portal Vein (PV) during operations involving biliary duct, duodenum and pancreas. This report is about a 50-year-old female patient with PDPV associated with midgut malrotation and left sided Inferior Vena Cava (IVC). The patient was operated for Recurrent Pyogenic Cholangitis (RPC) and associated biliary stones. The patient sustained iatrogenic injury to PV during surgery which was subsequently repaired with Polytetrafluoroethylene (PTFE) graft doppler showed patent graft at three months of follow-up. This report highlights the fact that pre-existing inflammatory conditions of bile duct and hepatoduodenal ligament further increase the risk of injury to PDPV during surgery.

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Multiple bilateral variations in urogenital vasculature-A clinico-embryological perspective

Journal of Morphological Sciences ◽

10.4322/jms.051813 ◽

2014 ◽

Vol 31 (04) ◽

pp. 236-240

Author(s):

A. Thakur ◽

H. Loh ◽

V. Mehta ◽

R. Suri ◽

G. Rath

Keyword(s):

Inferior Vena ◽

Left Renal Vein ◽

Vena Cava ◽

Renal Arteries ◽

Vertebral Level ◽

Precise Knowledge ◽

Main Renal Artery ◽

The Right ◽

Renal Transplantations ◽

Accessory Renal Arteries

AbstractPrecise knowledge of urogenital vascular anomalies has become extremely important in the past decade with increasing numbers of renal transplantations, minimally invasive vascular surgeries and numerous radiologic procedures. We report the presence of multiple variations in urogenital vasculature bilaterally in a 52 year old male Indian cadaver. Twin renal arteries were encountered bilaterally. Main renal artery was originating bilaterally at L1 vertebral level and accessory renal arteries were originating as ventral branches of abdominal aorta at L3 vertebral level and were travelling to the lower part of the respective kidneys. Twin renal veins were draining the right kidney independently whereas the left renal vein was bifurcating into two tributaries and draining separately into the inferior vena cava. Multiple testicular veins were found bilaterally. This report will prove to be helpful in various surgical and radiological interventions performed in the field of urology.

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Duplication of Inferior Vena Cava with Left Inferior Vena Cava Draining into Right Inferior Vena Cava - A Case Report

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/479 ◽

2021 ◽

Vol 10 (30) ◽

pp. 2343-2345

Author(s):

Nikita Jindal ◽

Venkata Ravi Teja Reddy Gayam ◽

Richa Jindal ◽

Dhruv Jindal

Keyword(s):

Computed Tomography ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Anatomical Variation ◽

Vena Cava ◽

Correct Interpretation ◽

Contrast Injection ◽

Vertebral Level ◽

Asymptomatic Patients ◽

Double Inferior Vena Cava

Double inferior vena cava is a rare anomaly with incidence rate of 0.2 - 3 %. It occurs due to non-regression of both right and left supracardinal veins during embryonic development. Here, we present a case with double inferior vena cava diagnosed in a patient who underwent routine computed tomography for abdominal pain. In our case, both right and left inferior vena cava are of same caliber and we believe that duplication of IVC in our case was a result of nonregression of anastomosis between left supra subcardinal, posterior subcardinal and intersubcardinal veins resulting in persistence of left subcardinal vein. The knowledge of this anatomical variation is clinically important during retroperitoneal surgeries and vascular and radiological interventional procedures. Inferior vena cava anomalies are rare and incidentally found in asymptomatic patients who undergo radiological imaging for some other diseases. The reported incidence of duplicated inferior vena cava is 0.2 to 3 %. Among all the inferior vena cava anomalies, inferior vena cava duplication and left inferior vena cava are most commonly found. 1,2 Vascular anomalies often get encountered in computed tomography (CT) scans of abdomen and pelvis obtained with contrast injection. Familiarity with these variations is essential for correct interpretation.3 Here, we present a case of duplication of inferior vena cava with left IVC draining into right IVC at upper border of L2 vertebral level.

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