scholarly journals Gastric venous reconstruction to reduce gastric venous congestion after total pancreatectomy: study protocol of a single-centre prospective non-randomised observational study (IDEAL Phase 2A) - GENDER study (Gastric vENous DrainagE Reconstruction)

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052745
Author(s):  
Arianeb Mehrabi ◽  
Martin Loos ◽  
Ali Ramouz ◽  
Arash Dooghaie Moghadam ◽  
Pascal Probst ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Study Protocol ◽  
Venous Drainage ◽  
Abdominal Sepsis ◽  
Endoscopic Examination ◽  
Venous Congestion ◽  
Single Centre ◽  
Venous Outflow ◽  
Venous Infarction ◽  
Gastric Ischaemia

IntroductionTotal pancreatoduodenectomy (TP) is the standard surgical approach for treating extended pancreas tumours. If TP is performed with splenectomy, the left gastric vein (LGV) sometimes needs to be sacrificed for oncological or technical reasons, which can result in gastric venous congestion (GVC). GVC can lead to gastric venous infarction, which in turn causes gastric perforation with abdominal sepsis. To avoid gastric venous infarction, partial or total gastrectomy is usually performed if GVC occurs after TP. However, gastrectomy can be avoided by reconstructing the gastric venous outflow to overcome GVC and avoid gastric venous infarction. The current study aims to assess the role of gastric venous outflow reconstruction to prevent GVC after TP and avoid gastrectomy.Methods and analysisIn the current single-centre observational pilot study, 20 patients will be assigned to study after intraoperative evaluation of gastric venous drainage after LGV resection during TP. During surgery, on-site evaluation by the surgeon, endoscopic examination, indocyanine green, gastric venous drainage flowmetry and spectral analysis will be performed. Postoperatively, patients will receive standard post-TP care and treatment. During hospitalisation, endoscopic examination with indocyanine green will be performed on the 1st, 3rd and 7th postoperative day to evaluate gastric ischaemia. Ischaemia markers will be evaluated daily after surgery. After discharge, patients will be followed-up for 90 days, during which mortality and morbidities will be recorded. The main endpoints of the study will include, rate of GVC, rate of gastric ischaemia, rate of postpancreatectomy gastrectomy, rate of reoperation, morbidity and mortality.Ethics and disseminationThe study protocol has been reviewed and approved by the Ethics Committee of the University of Heidelberg. The results will be actively disseminated through peer-reviewed journals and conference presentations, and are expected in 2022.Trial registration numberNCT04850430.

scholarly journals Use of the Mechanical Leech for Successful Zone I Replantation

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Sang Wha Kim ◽  
Hyun Ho Han ◽  
Sung-No Jung
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Venous Drainage ◽  
Venous Congestion ◽  
Overall Survival Rate ◽  
Internal Circulation ◽  
Venous Outflow ◽  
Finger Injuries ◽  
Central Artery ◽  
Emergent Surgery

Replantation of zone I finger injuries remains a challenge, particularly if the fingertip was previously scarred or atrophied, which makes it difficult to secure a suitable vein at the amputation site. In cases of artery-only anastomosis, we propose using a mechanical leech technique to maintain sufficient venous outflow until the internal circulation regenerates. We applied this procedure to eight patients who had zone 1 amputations without veins that were suitable for anastomosis. Emergent surgery was performed and an artery-only anastomosis was created. As there were no veins available, we cut a branch of the central artery and anastomosed it with a 24-gauge angioneedle, which served as a conduit for venous drainage. The overall survival rate for zone I replantation using mechanical leech was 87.5% and the average time to maintain the mechanical leech was 5 days. The mechanical leech technique may serve as an alternative option for the management of venous congestion when no viable veins are available.

scholarly journals P11: NEAR INFRARED FLUORESCENT CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE FEASIBILITY STUDY. THE OPTIMUM DOSING REGIME, LIMITATIONS AND WHERE NEXT?

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
G Armstrong ◽  
G Toogood ◽  
DG Jayne ◽  
AM Smith
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Feasibility Study ◽  
Near Infrared ◽  
Intravenous Dose ◽  
Structure Identification ◽  
Dosing Regimen ◽  
Single Centre ◽  
Fluorescent Cholangiography

Abstract Introduction This study explored near-infrared fluorescent cholangiography (NIRFC) with Indocyanine Green (ICG) during laparoscopic cholecystectomy (LC) surgery in a tertiary referral hepatobiliary unit. ICG binds to albumin and is excreted in bile. NIRFC utilises the fluorescent and excretory properties of ICG to provide dynamic extrahepatic bile duct mapping during LC. Method Non-randomised single centre feasibility study. Twenty-two participants were sequentially allocated to four dosing subgroups prior to NIRFC assisted LC. Each received a single intravenous dose of ICG prior to LC with the Stryker Novadaq NIR laparoscope. The biliary anatomy was assessed with NIRFC at three time-points, detection was compared to radiological cholangiogram where available and surgeon satisfaction was assessed. Result Eight participants received 2.5mg ICG 20-40min before surgery, four 0.25mg/kg 20-40min, five 90min – 180min and five 12 – 36 hour pre-operatively. Average age 50 years (S.D±15), BMI 27.5m2 (S.D±3.6), 6/22 were acute LC procedures. The prolonged dosing interval produced increased extrahepatic biliary structure identification (p = 0.016), reduced noise to signal ratio and was consistently preferred by the operating surgeon. NIRFC was inferior to radiological cholangiogram (n = 10) (p = 0.014) for bile duct mapping. We observed iatrogenic bile spillage saturating the field and obscuring structure differentiation and peri-hilar inflammation impeding fluorescent detection in acute LC. Conclusion The dosing regimen 0.25mg/kg ICG 12 to 36 hours prior to surgery provides optimum NIRFC structure visualisation. Fluorescent tissue penetrance is limited in acute peri-hilar inflammation. More research in to the efficiency of NIRFC in emergency LC is required. Take-home message An intravenous dose of 0.25mg/kg of Indocyanine Green 12 to 36 hours before surgery is the optimum dosing regimen for increased extra-hepatic bile duct structures with near infrared fluorescent cholangiography. The role of NIRFC in acute laparoscopic cholecystectomy surgery remains ill-defined.

Potential Involvement of Impaired Venous Outflow from the Brain in Neurodegeneration: Lessons Learned from the Research on Chronic Cerebrospinal Venous Insufficiency

2019 ◽  
Vol 14 (4) ◽  
pp. 235-236 ◽  
Author(s):  
Marian Simka ◽  
Marcin Skuła
Keyword(s):  
Venous Insufficiency ◽  
Neurological Diseases ◽  
Venous Drainage ◽  
Lessons Learned ◽  
Causative Role ◽  
Venous Outflow ◽  
Chronic Cerebrospinal Venous Insufficiency ◽  
Parkinson’S Diseases ◽  
Multiple Sclerosis Patients ◽  
The Brain

About 10 years ago, the so-called chronic cerebrospinal venous insufficiency syndrome was discovered. This clinical entity, which is associated with extracranial venous abnormalities that impair venous outflow from the brain, was initially found exclusively in multiple sclerosis patients. Currently, we know that such venous lesions can also be revealed in other neurological pathologies, including Alzheimer’s and Parkinson’s diseases. Although direct causative role of chronic cerebrospinal venous insufficiency in these neurological diseases still remains elusive, in this paper, we suggest that perhaps an abnormal venous drainage of the brain affects functioning of the glymphatic system, which in turn results in the accumulation of pathological proteins in the cerebral tissue (such as β-synuclein, β-amyloid and α-synuclein) and triggers the venous outflow from the cranial cavity and circulation of the cerebrospinal fluid in the settings of neurodegenerative disease.

Quantitation of anterior descending vs. circumflex venous drainage in the canine great cardiac vein and coronary sinus

1978 ◽  
Vol 234 (2) ◽  
pp. H163-H166 ◽  
Author(s):  
H. K. Nakazawa ◽  
D. L. Roberts ◽  
F. J. Klocke
Keyword(s):  
Indocyanine Green ◽  
Coronary Sinus ◽  
Venous Drainage ◽  
Right Heart ◽  
Great Cardiac Vein ◽  
Indocyanine Green Dye ◽  
Right Heart Bypass ◽  
Heart Bypass

The fractions of left anterior descending (LAD) and circumflex (LC) inflow drainage into the canine great cardiac vein (GCV) and coronary sinus (CS) have been quantitated by use of a right heart bypass preparation in which GCV outflow was isolated from the remainder of CS outflow. Following direct LAD injection of indocyanine green dye (ICG), 63 +/- 8% (SD) of the total amount of dye recovered appeared in GCV outflow and the remainder in CS outflow. CS recovery of ICG was decreased appreciably by ligation of epicardial venous connections between the LAD and LC beds, but was not affected by selective reductions of LAD or LC inflow. Only 3 +/- 3% of ICG injected into the LC was recovered in GVC outflow under basal conditions, and these low values were not affected measurably by selective reductions of LAD or LC inflow. CS drainage of LAD inflow could be augmented by selective increments of GCV pressure exceeding 7-10 mmHg. Increments of LC drainage in GCV outflow required CS pressures that exceeded GCV pressures by greater than 10 mmHg.

Deep venous thrombosis and postthrombotic syndrome: Invasive management

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 59-66 ◽  
Author(s):  
AJ Comerota
Keyword(s):  
Deep Vein Thrombosis ◽  
Vena Cava ◽  
Venous Drainage ◽  
Percutaneous Treatment ◽  
Postthrombotic Syndrome ◽  
Venous Outflow ◽  
Vein Thrombosis ◽  
Valvular Function ◽  
Deep Vein ◽  
Invasive Management

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.

scholarly journals Treatment with l-citrulline and metformin in Duchenne muscular dystrophy: study protocol for a single-centre, randomised, placebo-controlled trial

Trials ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Patricia Hafner ◽  
Ulrike Bonati ◽  
Daniela Rubino ◽  
Vanya Gocheva ◽  
Thomas Zumbrunn ◽  
...  
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Study Protocol ◽  
Controlled Trial ◽  
Single Centre

Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience

2015 ◽  
Vol 87 (3) ◽  
pp. 182-185 ◽  
Author(s):  
Joel Arudchelvam ◽  
Adam Bartlett ◽  
John McCall ◽  
Peter Johnston ◽  
Edward Gane ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Single Centre ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Hepatic Venous Outflow Obstruction ◽  
Single Centre Experience ◽  
Hepatic Venous Outflow ◽  
Venous Outflow Obstruction

THROMBOSED BRAINSTEM DEVELOPMENTAL VENOUS ANOMALY CAUSING HYDROCEPHALUS

2015 ◽  
Vol 86 (11) ◽  
pp. e4.99-e4
Author(s):  
Katherine Dodd ◽  
Emily Pegg ◽  
Sachin Mathur ◽  
Chhetri Suresh
Keyword(s):  
Posterior Fossa ◽  
Drainage System ◽  
Venous Drainage ◽  
Cerebellar Hemisphere ◽  
Cerebral Peduncle ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Venous Infarction ◽  
Heparin Infusion ◽  
The Right

Developmental venous anomaly (DVA) is a commonly encountered congenital abnormality of the venous drainage system. Spontaneous thrombosis of DVA is rare. We present a case of thrombosed brainstem DVA leading to venous infarction and oedema within the posterior fossa.A 49 year old, previously fit gentleman presented to the local hospital with a one day history of headache, slurred speech and incoordination. Examination demonstrated GCS of 13/15, cerebellar dysarthria, horizontal nystagmus to the left, mild right sided pyramidal weakness, right sided cerebellar ataxia and bilateral extensor plantars.CT venogram revealed a cerebellar DVA with thrombosis of one of the veins. There was surrounding venous infarction and oedema within the posterior fossa, causing compression of the fourth ventricle and dilatation of the lateral ventricles. MRI demonstrated extensive T2 change in the right cerebellar hemisphere, dorsal pons and right cerebral peduncle. No underlying thrombotic tendency was identified. He was treated successfully with intravenous heparin infusion. He improved over the next 3 weeks, and was discharged on warfarin with mild right sided ataxia and cerebellar dysarthria.Our case demonstrates that DVAs, generally considered as common insignificant anatomical variants, can uncommonly lead to significant complications.

Selective transvenous embolization of dural carotid—cavernous sinus fistulas with preservation of sylvian venous outflow

1998 ◽  
Vol 89 (5) ◽  
pp. 825-829 ◽  
Author(s):  
Mitsugu Nakamura ◽  
Norihiko Tamaki ◽  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita
Keyword(s):  
Cavernous Sinus ◽  
Nerve Palsy ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
The Other ◽  
Oculomotor Nerve Palsy ◽  
Transvenous Embolization ◽  
Venous Outflow ◽  
Residual Shunt ◽  
Abducent Nerve Palsy

✓ A transvenous embolization technique in which normal cerebral venous drainage can be spared is described. Of 26 dural carotid—cavernous fistulas treated by the authors, the affected cavernous sinus received not only the shunted flow but also the sylvian venous drainage in three cases. Two patients presented with an abducent nerve palsy, and one with an oculomotor nerve palsy. Selective transvenous embolization of the fistulous portions of the affected cavernous sinus was achieved, with preservation of the sylvian venous outflow. Postembolization angiograms revealed complete occlusion of the fistula in one patient and only a small amount of residual shunt in the other two. One of these two underwent subsequent transarterial embolization, and the other was followed without additional treatment. The patients' symptoms resolved between 1 and 2 months posttreatment. Follow-up angiograms revealed that the remnant shunt had disappeared and the sylvian venous pathway had been preserved. The authors conclude that selective transvenous embolization of fistulous compartments in an affected sinus can be used to treat dural arteriovenous fistulas involving a cavernous sinus that also receives the sylvian venous outflow.

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