Heterotopic ossification of small saphenous vein and panniculitis ossificans of chronic venous insufficiency presenting with livedo racemosa

2013 ◽  
Vol 29 (6) ◽  
pp. 401-406 ◽  
Author(s):  
Chris Lekich ◽  
Kurosh Parsi
Keyword(s):  
Venous Thrombosis ◽  
Heterotopic Ossification ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Livedo Reticularis ◽  
Lower Limbs ◽  
Livedo Racemosa ◽  
History Of ◽  
Diagnostic Investigations

Objectives Livedo racemosa is a reticulate eruption that presents with branched and partially blanchable incomplete rings. Livedo racemosa is distinct from livedo reticularis, a similar condition that presents with a diffuse and symmetrical blanchable eruption. In contrast to livedo reticularis which may be physiological, livedo racemosa is always associated with an underlying pathology. To our knowledge, this is the first report of panniculitis ossificans and heterotopic ossification of small saphenous vein (SSV) presenting with livedo racemosa. Methods We present a 70-year-old male referred for investigation and management of progressive pigmentation and ‘lipodermatosclerosis’ of lower limbs. There was no history of deep venous thrombosis but an earlier ultrasound had detected a non-occlusive thrombus in the left SSV. Examination and investigations revealed the skin eruption to be livedo racemosa and the associated subcutaneous induration and nodularity to be due to panniculitis ossificans. Biopsy of the SSV demonstrated segmental heterotopic ossification. Duplex ultrasound demonstrated bilateral superficial and deep venous incompetence but no evidence of an acute or chronic venous thrombosis. The patient was diagnosed with heterotopic ossification secondary to venous insufficiency and managed conservatively. Conclusion Livedo racemosa may be an early sign of panniculitis ossificans and its presence should trigger further diagnostic investigations.

scholarly journals Venous hemodynamics, knowledge and miracles

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Claude Franceschi
Keyword(s):  
Fluid Mechanics ◽  
Scientific Knowledge ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
History Of ◽  
Miraculous Healing

The occurrence of the Peregrine's ulcer is scientifically explainable but its miraculous healing in one night cannot be explained by the current scientific knowledge. The long history of fluid mechanics, anatomic and pathophysiologic discoveries led to the better knowledge of hemodynamics in pathophysiology. The last technologies provided strong means to the assessment of venous insufficiency, especially Duplex Ultrasound. Renewed hemodynamic concepts provide a better explanation of the pathophysiology of venous leg ulcers as well as reliable outcomes and less recurrences for varicose veins and ulcers.

scholarly journals Primary Aneurysm of the Medial Marginal Vein of the Foot

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
D. Casian ◽  
V. Culiuc
Keyword(s):  
Duplex Ultrasound ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Venous Aneurysm ◽  
Marginal Vein ◽  
Second Trimester ◽  
Surgical Department ◽  
Previous Trauma ◽  
History Of ◽  
One Year

The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs.

Arteries masquerading as varicose veins: A trap for phlebologists

2014 ◽  
Vol 30 (10) ◽  
pp. 729-735 ◽  
Author(s):  
L Jones ◽  
K Parsi
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Tissue Loss ◽  
Injection Sclerotherapy ◽  
Ultrasound Guided ◽  
History Of ◽  
The Right

Ultrasound guided sclerotherapy may be complicated by intra-arterial injections resulting in significant tissue necrosis. Here, we present a 69-year-old man with a history of right small saphenous vein “stripping”, presenting for the treatment of symptomatic lower limb varicose veins. Duplex ultrasound of the right lower limb outlined the pathway of venous incompetence. Despite the history of “stripping”, the small saphenous vein was present but the sapheno-popliteal junction was ligated at the level of the knee crease. No other unusual findings were reported at the time. During ultrasound guided sclerotherapy, subcutaneous vessels of the right posterior calf were noted to be pulsatile on B-mode ultrasound. Treatment was interrupted. Subsequent angiography and sonography showed absence of the right distal popliteal artery. A cluster of subcutaneous vessels of the right medial and posterior calf were found to be arterial collaterals masquerading as varicose veins. Injection sclerotherapy of these vessels would have resulted in significant tissue loss. This case highlights the importance of vigilance at the time of treatment and the invaluable role of ultrasound in guiding endovenous interventions.

Metabolic and Inflamatory Proteins Differently Expressed in Platelets From Deep Venous Thrombosis Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5256-5256
Author(s):  
Mariane Cristina Flores Nascimento ◽  
Karina Kleinfelder-Fontanesi ◽  
Fernanda Loureiro de Andrade Orsi ◽  
Steven H Seeholzer ◽  
Harry Ischiropoulos ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Apolipoprotein A1 ◽  
Blood Samples ◽  
Orbitrap Mass Spectrometer ◽  
Inflammatory Processes ◽  
History Of

Abstract Abstract 5256 BACKGROUND: Deep venous thrombosis (DVT) is multi-causal disease associated to a high morbi-mortality due to complications as pulmonary embolism and post-flebitic syndrome. The incidence is about 20 to 30%, and 25% of the patients will present recurrence in 5 years. The identification of new risk factors is important in clinical practice to prevent new thrombotic events. The role of the platelets on DVT is still not well defined. AIM: The objective of this study was to analyze the hole proteins profile of platelets obtained from DVT patients and compare to the same matherial derived from healthy controls. PATIENTS: peripheral blood samples were collected from 3 spontaneous DVT patients and from 1 sibling and 1 neighbor for each patient in order to minimize the genetic and environmental interferences. These patients presented spontaneous and recurrent episodes of lower limbs proximal DVT and all of them mentioned a familiar history of coagulation disorders. METHODS: the platelets were washed, lysed, and the proteins were alkylated, reduced, precipitated with acetone and hydrolyzed by trypsin. 100mg of peptides were then separated by hydrophobicity using HPLC, and 8 fractions were obtained and directed to the LTQ-Orbitrap mass spectrometer. The proteins search was performed by Sorcerer-SEQUEST. RESULTS: We identified 5 proteins that were present on patients and absent in all the controls: Apolipoprotein A1 Binding-Protein, Coatomer (z1 sub-unit), Estradiol 11–17-b Dehydrogenase, Leucotriene A-4 Hydrolase and Sorbitol Dehydrogenase. Western-Blotting was performed with specific antibodies and validated the results. CONCLUSIONS: with this study it was possible to identify proteins up to date non-related to the physiopathology of DVT, that could be involved with metabolic and inflammatory processes. Disclosures: No relevant conflicts of interest to declare.

Anatomical Patterns in Varicose Vein Disease: A Duplex Scanning Study

1995 ◽  
Vol 10 (3) ◽  
pp. 94-97 ◽  
Author(s):  
J. J. Guex ◽  
B. Hiltbrand ◽  
J. M. Bayon ◽  
F. Henri ◽  
F. A. Allaert ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Previous Treatment ◽  
Lower Limbs ◽  
Duplex Scanning ◽  
Consecutive Series ◽  
Yield Data ◽  
Varicose Disease ◽  
Vein Disease

Objectives: To determine symptomatology, clinical class, and topographic patterns of varicose veins in a consecutive series of patients with venous complaints. Methods: We performed clinical examination and duplex scanning of 498 lower limbs in 317 patients with obvious varicose veins for whom no previous treatment had been undertaken. Results: Classes of chronic venous insufficiency (CVI) in 498 legs: grade 0: 117 (23.5%); gr 1: 310 (62.2%); gr 2: 47 (9.4%); gr 3: 24 (4.8%). Duplex-detected venous reflux was found in the greater saphenous vein territory (junction or trunk or related perforator or main tributary) in 423 limbs (85.3%) the sapheno-femoral junction was incompetent in only 342 legs (68.7%). Reflux was found in the lesser saphenous vein territory in 100 limbs (20.1%) and in sapheno-popliteal junction in 92 (18.5%). Strictly non saphenous origin of varicosities was found in 31 limbs (6.2%). Deep venous incompetence was found in 48 legs (9.6%). Conclusions: These findings yield data on the distribution and occurence of lower limbs venous lesions in patients with varicose disease.

The small saphenous vein and other 'neglected' veins of the popliteal fossa: a review

2007 ◽  
Vol 22 (4) ◽  
pp. 148-155 ◽  
Author(s):  
T F O'Donnell ◽  
M D Iafrati
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Clinical Characteristics ◽  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Popliteal Fossa ◽  
Large Series ◽  
Popliteal Vein ◽  
Anatomic Variations ◽  
Ultrasound Findings

The small saphenous vein (SSV) and other veins in the popliteal fossa merit little discussion in the literature or in didactic programmes regarding their role in chronic venous insufficiency (CVI) and, in this sense, they are neglected. The purpose of this review is to present both duplex ultrasound findings and the associated clinical characteristics of patients with SSV reflux, from several large series. Both the anatomic variations and the epidemiology of the SSV, as well as other veins of the popliteal fossa, the gastrocnemius veins, Gocamini vein, popliteal area veins and popliteal vein, will be discussed. Findings from our review of the current available literature will demonstrate the important role that these veins play in association with CVI. The implications for open and endovenous surgery will be underlined.

scholarly journals Anticoagulation alone versus combined catheter-directed thrombolysis and anticoagulation in treatment of acute ilio-femoral deep venous thrombosis

2019 ◽  
Vol 6 (8) ◽  
pp. 2698
Author(s):  
Mostafa A. Elaggory ◽  
Mahmoud S. Eldesouky ◽  
Nehad A. Zeid
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Anticoagulant Therapy ◽  
Venous Insufficiency ◽  
Absolute Risk ◽  
Duplex Ultrasound ◽  
Absolute Risk Reduction ◽  
Controlled Study ◽  
Compression Stocking ◽  
Catheter Directed Thrombolysis

Background: It was found that 50% of patients with iliofemoral deep venous thrombosis (DVT) treated by anticoagulant alone and compression stocking developed post thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase venous patency and prevent PTS. The objective of the study was to assess short-term efficacy of additional catheter directed thrombolysis (CDT) compared with standard anticoagulant therapy alone.Methods: Prospective, randomized, controlled study on 50 patients (18–75 years) with acute iliofemoral DVT and symptoms <21 days were randomized to receive additional CDT or standard anticoagulant therapy alone. After 6 months, vein patency and insufficiency (reflux) was assessed using duplex ultrasound by an investigator blinded to previous treatments.Results: Fifty patients were allocated additional CDT (n=25) or ACs alone (n=25). After CDT, grade III (complete) lysis was achieved in 17 (68%) and grade II (50%–90%) lysis in 5 patients (20%). One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 17 (68%) in the CDT group vs. 8 (32%) controls, corresponding to an absolute risk reduction 36% (95% CI, p=0.002). Femoral venous insufficiency was found to be higher among the ACs group 11 patients (44%) vs. 7 patients (28%) in the CDT group.Conclusions: After 6 months, additional CDT increased iliofemoral patency from 32% to 68% and decreased venous insufficiency from 44% to 28%.

scholarly journals VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

2013 ◽  
Vol 50 (3) ◽  
pp. 191-195 ◽  
Author(s):  
Bonno van BELLEN ◽  
Ivan de Barros GODOY ◽  
Andrea Almeida REIS ◽  
Pedro BERTEVELLO
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Venous Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thromboembolic Disease ◽  
Lower Limbs ◽  
Abdominal Circumference ◽  
Morbidly Obese ◽  
Ceap Classification

Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.

Deep Vein Thrombosis Post Radiofrequency Ablation of the Saphenous and Perforator Veins: Is Duplex Ultrasound Necessary within Five Days?

2017 ◽  
Vol 41 (1) ◽  
pp. 11-12
Author(s):  
Anita Altawan ◽  
David Golchian ◽  
Mazen Bazzi ◽  
John Iljas ◽  
Bipinchandra Patel
Keyword(s):  
Deep Vein Thrombosis ◽  
Radiofrequency Ablation ◽  
Venous Thrombosis ◽  
Radio Frequency ◽  
Deep Venous Thrombosis ◽  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Vein Thrombosis ◽  
Post Procedure ◽  
Deep Vein

Radiofrequency ablation (RFA) of the saphenous and perforator veins (“closure”) is a relatively newer option for treatment of venous insufficiency patients. A known complication of the RFA is deep vein thrombosis also known as DVT. The purpose of this study is to demonstrate the probability of acute deep venous thrombosis post radio-frequency vein ablation. This research also helped determine medical necessity of a postoperative venous duplex examination within 5 days post-procedure.

Rivaroxaban versus Warfarin in the Management of Deep Venous Thrombosis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Shawky El-metieni ◽  
Tamer Mohamed Fekry ◽  
Mohammed Ahmed Hassan Rady ◽  
Ahmed Magdy Farrag ◽  
Ahmed Mohamed Ismail
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Randomized Study ◽  
Duplex Ultrasound ◽  
Lower Limbs ◽  
P Value ◽  
Vein Thrombosis ◽  
Warfarin Group ◽  
Blood Clots ◽  
Study Population

Abstract Background Deep venous thrombosis (DVT) refers to the formation of one or more blood clots in one of the body’s large veins, most commonly in the lower limbs. The clot can cause partial or complete blocking of circulation in the vein, which in some patients leads to pain, swelling, tenderness, discolouration of the skin that is warm to touch. Aim of the Work Compare the effect of direct Oral Anticoagulant (Rivaroxaban) versus Antivitamin K (warfarin) in treatment of lower limb Deep Venous Thrombosis. Patients and Methods Type of study: prospective single blinded randomized study, study setting: was conducted at Kobri Elkobba hospitals, study period: 6 months, study population: Eligible all patients above 18 years had femoropopliteal vein thrombosis, confirmed with duplex ultrasound scanning and D-dimer test and qualified under the inclusion and exclusion criteria of the study. Results Our study shows that Rivaroxaban alone is as effective as standard therapy, with similar safety, for the treatment of acute DVT and in preventing recurrence and has low risk of bleeding. There was statistically significant increase in INR monitoring during 6 months in warfarin group than Rivaroxaban group with p-value &lt; 0.001. This because warfarin has many drug and food interaction. There's no response in treatment out come after 3 months duplex as the study was on patient of femoro popliteal DVT, however there were clinical improvement in both groups. Complete recanalization with normal augmentation by muscle compression occurred in all Rivaroxaban patients compared to 5% were partially compressible with incomplete recanalization in warfarin group after 6 months of treatment. Conclusion We concluded in patients with unprovoked VTE, rivaroxaban has the potential to reduce both the risk of major bleeding and recurrent VTE compared to warfarin. And there’s no need for adjusting the dose and INR monitoring, and Rivaroxaban has no food nor drug interactions.

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