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.

Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux

2009 ◽  
Vol 24 (4) ◽  
pp. 183-188 ◽  
Author(s):  
P Chapman-Smith ◽  
A Browne
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Adverse Outcomes ◽  
Patient Acceptance ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Clinical Recurrence ◽  
Over Time

Objectives The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

scholarly journals Diagnosis of stenosis within the popliteal–femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Emma Dabbs ◽  
Alina Sheikh ◽  
David Beckett ◽  
Mark S Whiteley
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Varicose Veins ◽  
Venous Ulcer ◽  
Distal Region ◽  
Duplex Ultrasonography ◽  
Venous Ulceration ◽  
Venous Collaterals ◽  
The Right ◽  
Venous Segment

This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal–femoral segment. An interventional radiologist performed venoplasty to this popliteal–femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal–femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.

Does a Double Long Saphenous Vein Exist?

1999 ◽  
Vol 14 (2) ◽  
pp. 59-64 ◽  
Author(s):  
S. Ricci ◽  
A. Caggiati
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Healthy Subjects ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Clear Definition ◽  
Arterial Grafts ◽  
Long Saphenous Vein ◽  
Saphenous Veins ◽  
Definition Of

Background: The incidence of reduplication of the long saphenous vein (LSV) reported in the literature is highly variable, perhaps due to the lack of a clear definition. Objective: To use ultrasonography to re-evaluate the incidence of LSV reduplication in healthy subjects and Patients with varicose veins on the basis of a new definition of this anatomical aspect. Methods: The presence of two parallel superficial venous channels in the lower limb was sought in a series of 610 duplex ultrasound examinations. The LSV was identified, by the ‘eye’ sign, running deeply in the hypodermis, closely ensheathed by two hyperechogenic laminae (the saphenous compartment). Tributary veins were identified by their more superficial course, lying outside the compartment. True LSV reduplication was considered to be present when two venous channels were Present within the saphenous compartment. Results: True reduplication of the LSV is extremely rare (1%) and only affects a segment of vein. Large tributaries running parallel to the LSV do not comprise true reduplication, but may act as a ‘functional double vein’. Better understanding of the anatomy of the LSV may improve operative treatment for varicose veins and improve the use of saphenous veins as arterial grafts.

scholarly journals A complete duplication of the right and a segmental duplication of the left great saphenous vein - a case report

2015 ◽  
Vol 04 (02) ◽  
pp. 93-97
Author(s):  
Mehandi V Mahajan ◽  
Durga Devi ◽  
Kalpana R.
Keyword(s):  
Case Report ◽  
Saphenous Vein ◽  
Segmental Duplication ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Medial Malleolus ◽  
Vein Thrombosis ◽  
The Right ◽  
Complete Duplication

AbstractAbnormalities of the lower limb veins lead to venous disorders such as obstructive or the ones associated with venous insufficiency. Varicose veins, deep vein thrombosis and ulcers are the common disorders. As many variations are noted in veins in comparison to arteries, the present case report expresses the need for a detailed evaluation of the veins of the lower limb. During the routine dissection of a 65 year old male cadaver, a complete duplication of the Great Saphenous vein (GSV) was noted from the medial malleolus of the tibia till the saphenofemoral junction in the right lower limb and a segmental duplication was noted in the thigh region of left lower limb. Such findings would be of great value to surgeons, orthopaedicians and interventional radiologists as iatrogenic varicosity can be prevented and for cardiovascular surgeons who can use the duplicated vein as vascular grafts in cases of Ischemia and arterial blocks.

Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein

1996 ◽  
Vol 11 (3) ◽  
pp. 125-131 ◽  
Author(s):  
K. A. Myers ◽  
G. H. Zeng ◽  
R. W. Ziegenbein ◽  
P. G. Matthews
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Injection Sclerotherapy ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins

Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.

scholarly journals Acute Common Iliac Artery Thrombosis with Concurrent Pulmonary Embolism Revealing AML M2: Role of Elevated Plasma Tissue Factor Activity

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4722-4722
Author(s):  
Hind Bennani ◽  
Raphaël Coscas ◽  
Marc Coggia ◽  
Patrick Van Dreden ◽  
Marc Vasse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Risk Factor ◽  
Ct Scan ◽  
Intermittent Claudication ◽  
Lower Limb ◽  
Elevated Plasma ◽  
History Of ◽  
The Right

Abstract Background: Cancer patients are exposed to an increased risk of thrombohemorrhagic events. Whereas patients with solid tumors are prone to venous thromboembolism, acute leukemia may cause coagulopathy associated with thrombocytopenia leading to life-threatening bleeding. Disordered coagulatory system is predominant in AML M3 and to a lesser extent in hyperleukocytic AML M4 and M5. Thromboembolic events are rare in the context of unrecognized AML. Risk factors for arterial thrombosis in AML are not well described. Tissue Factor (TF) is being increasingly acknowledged as an important player in cancer thrombosis. We report a case of non-hyperleukocytic AML M2 revealed by an arterial occlusion with concurrent pulmonary embolism (PE) highlighting the potential role of elevated plasma TF activity as a precipitating event and a risk factor for thrombosis. Clinical Case: A 67-year-old non-smoker patient presented to emergency department because of a 6-hour history of pain in the right lower limb with pallor and coolness. Pulses were abolished in all arteries of the right lower limb without any sensory loss or motor deficit. Contralateral pulses were normal. Clinical examination was otherwise normal. She had no history of intermittent claudication. Past medical history was remarkable for hypertension, thyroid disease and obesity treated two years ago by a gastric bypass surgery complicated by a first episode of PE treated by low molecular weight heparin (LMWH). No further testing for thrombophilia was performed at that time. A total occlusion of the right common and external iliac arteries was confirmed by a CT-scan angiography. The distal arterial tree was healthy. A chest X-ray found bilateral condensations. A helical CT-scan of the chest disclosed bilateral PE with pulmonary infarction. A lung ventilation/perfusion scan confirmed PE. A transthoracic echocardiography found no intracavitary thrombus nor patent foramen ovale. Laboratory values were hemoglobin 9.8 g/dl, WBC 13.8 × 103 µl-1, platelets 60 × 103 µl-1, 80% blasts in the peripheral blood smear. Routine coagulation tests were within usual values (UV). Bone marrow (BM) aspiration found AML M2, myeloblasts were 80% with a cup-like nuclear morphology. Immunophenotyping of BM blasts disclosed CD34 and HLA-DR negativity. The karyotype was normal. Molecular evaluation found NPM1 gene mutation and FLT3 gene internal tandem duplication (FLT3-ITD). Jak2 gene was not mutated. Treatment consisted in LMWH followed by standard induction chemotherapy. Complete remission was achieved after induction followed by 2 courses of consolidation. Of note, the patient still suffers from intermittent claudication of the right leg. Extensive testing for thrombophilia excluded antithrombin, protein C, protein S and protein Z deficiencies, factor II and factor V mutations and antiphospholipid antibody syndrome. Homocysteinemia was normal. Procoagulant activity of intact blasts evaluated by a one-step plasma recalcification time assay was normal. Plasma TF activity was quantified by a one-stage kinetic chromogenic assay. Briefly, this assay is based on the ability of plasma TF to bind to FVIIa and on the capacity of the TF-FVIIa complex to generate FXa. At diagnosis TF activity was elevated at 2.92 pmol (UV<0.45). After remission it returned to normal. Discussion: To the best of our knowledge this is the first report of concurrent arterial and venous thromboses at presentation of AML. Classical risk factors for thrombosis in AML include coagulopathy and hyperleukocytosis yet neither were present here. Laboratory work-up for thrombophilia was negative. The only abnormal finding was an elevated plasma TF activity before chemotherapy. Interestingly, procoagulant activity on circulating blasts was normal, suggesting TF might have been generated from other sources than AML cells such as activated endothelium and/or normal white blood cells (monocytes, polynuclear neutrophils). TF activity returned to baseline after remission, strongly suggesting it was AML-associated either directly or via innate immunity. Conclusion: We report a case of non-hyperleukocytic AML M2 with an unusual presentation including an occlusion of a large artery with concurrent PE. TF activity could be considered in the future as a risk factor for arterial and/or venous thrombosis in AML independently of classical conditions such as hyperleukocytosis and coagulopathy. Disclosures Van Dreden: Diagnostica Stago: Employment.

Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

scholarly journals Pseudoaneurisma Arteri Brakialis Pasca Kateterisasi Laporan Kasus

e-CliniC ◽  
2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Natalia Ch. Polii ◽  
Janry A. Pangemanan ◽  
Agnes L. Panda ◽  
Ira Posangi
Keyword(s):  
Brachial Artery ◽  
Colour Doppler ◽  
Ultrasound Guided ◽  
Compression Technique ◽  
Artery Pseudoaneurysm ◽  
Neck Size ◽  
Chief Complaints ◽  
Pulsed Wave Doppler ◽  
History Of ◽  
The Right

Abstract: Post-catheterization PSA occurs at the site of arterial puncture followed by incomplete hemostasis. We reported a 63-year-old male visited the emergency department of Prof Dr. R. D. Kandou Hospital with chief complaints of swelling and severe pain on the right arm, occured 6 days prior to the ER visit. His right arm looked darker and felt colder than the counterpart, felt numb, and was hard to move due to pain. Three months ago, the patient had a history of percutaneous transluminal coronary angiography through brachial artery access. Examination of the right upper extremity revealed hematoma at brachial artery puncture site, edema at 1/3 distal of the brachial region, cold acral areas, strong right brachial artery pulses, yet small radial ones. Vascular Doppler examination showed a superficial hematoma above the brachial artery and a PSA pouch of 1.23 x 1.67 cm with a small neck (<0.5 cm). Colour Doppler displayed a “yin and yang” flow at pouch, while pulsed-wave Doppler showed a “to and fro” wave through the neck. Patient was diagnosed as iatrogenic brachial artery pseudoaneurysm and managed with ultrasound-guided compression technique followed by continuous compression with elastic bandage. This technique was selected due to the PSA size less than 3 cm yet symptomatic, small neck size (<1 cm), and no size progression. Patient discharged after the PSA pouch and neck shrinked. On 6 months follow-up, neither neck nor pseudoaneurysm pouch were found.Keywords: pseudoaneurysm, ultrasound-guided compression Abstrak: PSA pasca kateterisasi terjadi pada arteri yang dipungsi tetapi tidak terjadi hemostasis sempurna. Kami melaporkan seorang laki-laki berusia 63 tahun datang di Instalasi Rawat Darurat Medik RSUP Prof. Dr. R. D. Kandou dengan keluhan utama bengkak dan nyeri hebat pada lengan kanan sejak 6 hari SMRS dan memberat pada satu hari terakhir. Tangan kanan tampak lebih gelap dibandingkan tangan kiri, teraba dingin, terasa kebas dan sulit digerakkan karena nyeri. Tiga bulan sebelumnya pasien dilakukan tindakan intervensi koroner perkutan. Pada pemeriksaan ekstremitas atas kanan tampak hematoma di daerah pungksi, edema setinggi 1/3 distal regio brachialis sampai ujung jari, akral teraba dingin, pulsasi arteri brakialis teraba kuat tetapi arteri radialis teraba kecil. Pemeriksaan Doppler vascular mendapatkan gambaran hematoma superfisial dari arteri brakialis dan tampak kantong PSA berukuran 1,23x1,67 cm dengan neck berukuran kecil (<0,5 cm) Pada colour Doppler didapatkan aliran pada kantong pseudoaneurisma seperti gambaran yin dan yang. Pada pulsed-wave Doppler di saluran PSA (neck) didapatkan gelombang “to and fro”. Berdasarkan anamnesis, pemeriksaan fisik dan penunjang pasien ini didiagnosis dengan PSA arteri brakialis iatrogenik (pasca kateterisasi). Penanganan dengan ultrasound-guided compression dan dilanjutkan dengan kompresi kontinu dengan bebat elastik. Pemilihan teknik kompresi ini berdasarkan pada ukuran kantong <3 cm namun bergejala, ukuran neck kecil <1cm serta tidak didapatkan pembesaran progresif. Pasien dipulangkan setelah kantong maupun neck PSA tampak mengecil, dan 6 bulan setelahnya tidak lagi terlihat neck maupun kantong PSA.Kata kunci: pseudoaneurisma, ultrasound-guided compression

scholarly journals «Мертвые Цари всегда должны по смерти своей быть судимы»: Посмертная судьба одного древнеегипетского обычая в русской и европейской словесности XVI – XIX вв. [“Dead Kings Must Always be Judged after Their Demise”: The Afterlife of an Ancient Egyptian Custom in the Russian and European Literature of the 16th to 19th Centuries]

2021 ◽  
Vol 8 ◽  
pp. 9-47
Author(s):  
Maria Neklyudova
Keyword(s):  
Literary Criticism ◽  
French Literature ◽  
History Of Ideas ◽  
Ancient Egyptian ◽  
Diodorus Siculus ◽  
History Of ◽  
Generous Support ◽  
The Subject ◽  
The Right

In his Bibliotheca historica, Diodorus Siculus described a peculiar Egyptian custom of judging all the dead (including the pharaohs) before their burial. The Greek historian saw it as a guarantee of Egypt’s prosperity, since the fear of being deprived of the right to burial served as a moral imperative. This story of an Egyptian custom fascinated the early modern authors, from lawyers to novelists, who often retold it in their own manner. Their interpretations varied depending on the political context: from the traditional “lesson to sovereigns” to a reassessment of the role of the subject and the duties of the orator. This article traces several intellectual trajectories that show the use and misuse of this Egyptian custom from Montaigne to Bossuet and then to Rousseau—and finally its adaptation by Pushkin and Vyazemsky, who most likely became acquainted with it through the mediation of French literature. The article was written in the framework (and with the generous support) of the RANEPA (ШАГИ РАНХиГС) state assignment research program. KEYWORDS: 16th to 19th-Century European and Russian Literature, Diodorus Siculus (1st century BC), Jean-Jacques Rousseau (1712—1778), Alexander Pushkin (1799—1837), Prince Pyotr Vyazemsky (1792—1878), Egyptian Сourt, Locus communis, Political Rhetoric, Literary Criticism, Pantheonization, History of Ideas.

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