The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation

2016 ◽  
Vol 32 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Omar Rodriguez-Acevedo ◽  
Kristen Elstner ◽  
Aaron Zea ◽  
Jenny Diaz ◽  
Kui Martinic ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Sural Nerve ◽  
Duplex Ultrasound ◽  
Anatomical Variations ◽  
Neurological Complications ◽  
Reference Points ◽  
Deep Fascia ◽  
Cross Sectional ◽  
The Right

Background Neurological complications are well documented in association with both surgical stripping or disconnection and thermal ablation of the small saphenous vein. The sural nerve (medial sural cutaneous nerve) is most vulnerable due to its close relationship to the small saphenous vein. Objective This is a cross-sectional observational study of the sonographic anatomy of 115 Australian patients to determine the course of the sural nerve and its relationship to the small saphenous vein, and to identify its relevance in the thermal ablation of the small saphenous vein. Method Sonographic mapping of the right sural nerve was performed with a Philips L12.5 and Sonosite 10.5 MHz ultrasound machine on 115 patients. The sural nerve was traced proximally from the level of the lateral malleolus to the popliteal fossa in order to measure its distance from the small saphenous vein at four reference points in the lower leg. Results A total of 115 patients were studied (females 82, males 33). The sural nerve was identified in 100% of patients; 64 patients (55.7%) showed usual sural nerve anatomy, while 51 patients (44.3%) demonstrated a range of anatomical variations, including the sural nerve becoming epifascial at a higher point than usual. Conclusion The sural nerve was identifiable on duplex ultrasound in 100% of cases. Classic anatomical relations and the perceived protection of the sural nerve conferred by the deep fascia of the upper calf are unreliable. Preoperative strategies can help to approach and protect the sural nerve in the endovenous ablation setting.

Hydrodisplacement of sural nerve for safety and efficacy of endovenous thermal ablation for small saphenous vein incompetence

2016 ◽  
Vol 32 (7) ◽  
pp. 482-487 ◽  
Author(s):  
Omar Rodriguez-Acevedo ◽  
Kristen E Elstner ◽  
Kui Martinic ◽  
Aaron Zea ◽  
Jenny Diaz ◽  
...  
Keyword(s):  
Radio Frequency ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Duplex Ultrasound ◽  
Complete Recovery ◽  
Venous Access ◽  
Radio Frequency Ablation ◽  
Foot Drop ◽  
Deep Fascia ◽  
Vein Segment

Background Endovenous radio frequency ablation for small saphenous vein incompetence by and large appears to be superior and safer than conventional open surgery. Small saphenous vein ablation from approximately mid-calf to the point proximally where the small saphenous vein dives into the popliteal fossa is considered to be safe, as the sural nerve is in most cases separated from this segment of the small saphenous vein by the deep fascia. The outcome of the distal incompetent small saphenous vein remains unclear. Efficacy of the endovenous radio frequency ablation can be enhanced by increasing the length of the ablatable small saphenous vein segment. Methodology To optimise endovenous radio frequency ablation outcome, the distal small saphenous vein may be made amenable to ablation if safety of the sural nerve can be assured. The sural nerve was successfully located using duplex ultrasound in 100% of our cohort in this study. The standard entry point for venous access was just above the lateral malleolus. After introduction of the introducer sheath, the radio frequency catheter was advanced proximally; the sural nerve was displaced from the small saphenous vein by approximately 1 cm with the administration of tumescent anaesthesia ( hydrodisplacement). A total of 118 patients underwent extended endovenous radio frequency ablation of 124 incompetent small saphenous vein trunks using the method described. Results Successful extended ablation of the small saphenous vein was achieved in 100% of cases and it was confirmed by duplex scanning at one and six weeks. Two neurological events were recorded during the study:  1. One patient with temporary foot drop lasting for less than 6 h with complete recovery.  2. A second patient with a sural nerve sensory deficit reported by the patient at day 2–3, which remains current at six weeks. Conclusions Extended endovenous radio frequency ablation of the small saphenous vein to optimise length of the ablatable vein segment is feasible with careful identification and hydrodisplacement of the sural nerve. This method is shown to be associated with fewer neurological complications than other methods reported in the literature.

scholarly journals Endovenous Ablation of Varicose Veins Experience at Tertiary Neurological Center

2018 ◽  
Vol 1 (2) ◽  
pp. 94-96
Author(s):  
Sandeep Raj Pandey ◽  
George Bush Jung Katwal ◽  
Sharad Hari Gajuryal
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Normal Activity ◽  
Vein Thrombosis ◽  
Long Term Follow Up ◽  
Endovenous Thermal Ablation

Introduction: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein.Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction.Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3.Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required.  Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.

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.

scholarly journals Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Marcelo de Pinho Teixeira Alves ◽  
João Pedro Gouveia Nóbrega
Keyword(s):  
Median Nerve ◽  
Metabolic Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Right

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

scholarly journals Anatomical Variations of Frontal Sinuses Among The Male and Female Genders Living in Karachi

2019 ◽  
Vol 10 (1) ◽  
pp. 44-48
Author(s):  
Quratulain Javaid ◽  
Ambreen Usmani ◽  
Aisha Qamar
Keyword(s):  
Demographic Data ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Radiology Department ◽  
Research Subjects ◽  
Cross Sectional ◽  
Male And Female ◽  
Frontal Sinuses ◽  
The Right ◽  
Study Participants

Objective: To determine morphology and variation in dimensions of frontal air sinuses in male and female genders living in Karachi. Study Design and Setting: It was a cross sectional study and was conducted at Radiology Department, JPMC. Methodology: The total number of study participants were 216. The research subjects were divided into two equal groups of males and females each having 108 members. The mean age of the participants was calculated to be 35.14 ± 8.68 years. The study subjects were recruited from Radiology Department, JPMC, Karachi. After taking written informed consent, Water’s (occipito-mental) view radiography was done to measure the parameters of height, width and area of the frontal air sinuses. The included variables were the demographic data and the physical examination to exclude facial anomalies. All the measurements were recorded and the measurements were saved by the help of Radiant DICOM digital software. Results: The parameters of height, width and the area of frontal sinuses showed highly significant variability on both the right and the left sides. All the dimensions were highly significantly greater in the males as compared to the female study participants (p=0.000). The Independent-Samples T Test was applied to compare the two gender groups. Conclusion: The parameters of height, width and area of frontal sinuses were greater in the males as compared to the females on both the left and the right sides

scholarly journals A Cross-sectional Study of Anatomical Variations of Coronary Ostia in the Adult Human Hearts and its Clinical Significance

2021 ◽  
Author(s):  
Najma Mobin ◽  
H Basavanagowdappa ◽  
B Madhu
Keyword(s):  
Coronary Artery ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Aortic Sinus ◽  
Cross Sectional ◽  
Adult Human ◽  
Coronary Ostia ◽  
Sedentary Life Style ◽  
The Right

Introduction: The knowledge of anatomical variations of the coronary ostia is an important factor in the study of Coronary Heart Disease (CHD). With the adaptation of sedentary life style and increasing stress, CHD has become the major cause of death in many countries. Aim: To describe the location, size and shape of the coronary ostia in cadaveric hearts. Materials and Methods: Descriptive cross-sectional study was carried out in 110 adult human hearts, 90 males and 20 females with a mean age of 66 years, which were collected from the mortuary from March 2017 to March 2019. The aorta was dissected and the aortic sinuses were opened, the number, location, size, shape and anomalous presence of accessory coronary ostia was noted and the measurements were taken using vernier calipers. Results: The Right Coronary Artery (RCA) was seen taking origin from the anterior aortic sinus and the Left Coronary Artery (LCA) from the left posterior aortic sinus in all the 110 hearts. The mean diameter of the Left Coronary Ostia (LCO) was 3.66±0.40 mm and found to be greater than the Right Coronary Ostia (RCO) 3.43±0.38 mm. Variations in the location and shape of the RCO and LCO were noted, and presence of single accessory coronary ostia was observed in five cases. Presence of multiple accessory coronary ostia was observed in only one case and its presence was found to be very rare. Conclusion: The diameter of the LCO was found to be greater than the RCO and the shape was circular in most of the coronary ostia. The majority of the coronary ostia were found to be located within the aortic sinuses below the Sinutubular Junction (STJ). Anatomical knowledge of the coronary ostia in the ascending aorta is very important during cardiac interventions around the aortic root.

scholarly journals Study on Anatomical Variations in Fissures of Lung by CT Scan

2022 ◽  
Author(s):  
M. Manjunath ◽  
M. Vishnu Sharma ◽  
Kollanur Janso ◽  
Praveen Kumar John ◽  
N. Anupama ◽  
...  
Keyword(s):  
Ct Scan ◽  
Imaging Techniques ◽  
Lung Resection ◽  
Left Lung ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Ct Images ◽  
Cross Sectional ◽  
The Right ◽  
Accessory Fissure

Abstract Introduction Refinements in the modern computed tomography (CT) imaging techniques have led to anatomical variations in the fissures of lung being diagnosed more frequently. So far, majority of the studies conducted are cadaveric. There is paucity of studies in this aspect based on chest CT images. Hence, we undertook this study to find the anatomical variations in the fissures. Prior detection of anatomical abnormalities is important to reduce postoperative complications in lung resection surgeries. Materials and Methods This was a cross-sectional study conducted over a period of 2 years. Data were collected from the patients who underwent CT scan thorax. Patients in whom normal anatomy of lung was distorted and cases where both lungs were not visualized completely were excluded from the study. All the CT images were reviewed by a single radiologist. The presence or absence of the normal and accessory pulmonary fissures, as well as the continuity of each fissure, was recorded by the radiologist. Data were compiled and analyzed. Results The study population consisted of 394 (70.4%) males and 166 (29.6%) females, totaling 560 cases. Fissural variations were detected in 22.9% (n = 128). Also, 17.5% (n = 98) fissural variations were seen in males and 5.4% (n = 30) fissural variations were seen in females. Further, 54.7% (n = 70) of variations were detected in the right lung and 45.3% (n = 58) in the left lung. The most common fissural variation noted was right incomplete oblique fissure with a frequency of 8.4% cases (n = 47). The most common accessory fissure detected was inferior accessory fissure. Total 22 cases were detected in both the lungs, 17 cases in male and 5 in female. Conclusion Anatomical variations in fissures were found to be more in the right lung than the left lung. Accessory fissures were detected in higher incidence on the right side.

scholarly journals Anatomical Variations of Radial Artery-Its morphology and Clinical Implications

2020 ◽  
Vol 1 (1) ◽  
pp. 86-90
Author(s):  
Muhammad Tariq
Keyword(s):  
Radial Artery ◽  
Local Population ◽  
Anatomical Variations ◽  
P Value ◽  
Internal Diameter ◽  
Terminal Branch ◽  
Cross Sectional ◽  
Female Ratio ◽  
Morphological Variations ◽  
The Right

Background: The radial artery is the smaller terminal branch of the brachial artery. It is one of the most commonly used arteries for various interventions. Anatomical variations exist and can predispose patients to iatrogenic injury if the operator is unaware of normal radial artery morphology. The present study focuses on giving detailed information about radial artery measurements in our local population. Methods: This was a cross-sectional observational study, conducted in the anatomy department of Jinnah Medical College Peshawar from 2017 to 2018. This study was conducted on 42 formalin-fixed cadavers, yielding 84 upper limbs. The radial artery was dissected and studied; length, external and internal diameters were measured. Data was entered in SPSS v20 and analyzed. Results: The mean age of the study population was 36 ± 11.25. Male to female ratio was 1:1. The most common site of origin of the radial artery was distal to head of the radius. The right radial artery was longer than the left. The right radial artery was broader in males as compared to females with a p-value of <0.05. The external and internal diameters of the radial artery decreased gradually from start to the endpoint for both the genders. The external diameters of the left radial artery were greater than those on the right side. The right radial artery had a larger internal diameter than the left side. Conclusion: The anatomy and morphology of radial artery have many documented variations. Radiologist and surgeons should have a good understanding of normal morphological variations of radial artery.

scholarly journals A Cross-Sectional Study of Complications and Management of Varicose Veins at SVRRGGH, Tirupati

2021 ◽  
Vol 8 (23) ◽  
pp. 1954-1959
Author(s):  
Vasudha S ◽  
Sabita P ◽  
Prakash G.V. ◽  
Nagamuneiah S ◽  
Ahmed Sheriff ◽  
...  
Keyword(s):  
Surgical Management ◽  
Saphenous Vein ◽  
Varicose Veins ◽  
Cross Sectional Study ◽  
High Recurrence Rate ◽  
Complete Evaluation ◽  
Cross Sectional ◽  
Recurrent Varicose Veins ◽  
Initial Surgery ◽  
The Right

BACKGROUND Chronic venous disorders are an important cause of disease and disability worldwide. Varicose veins are dilated, tortuous elongated veins. Varicose veins are either primary or secondary. Most of the patients are asymptomatic. Indian populations present with complications like venous bleed, thrombophlebitis, chronic venous insufficiency leading to edema, eczema, lipodermatosclerosis, and venous ulcers. Varicose vein surgery is characterized by a high recurrence rate of 20 % to 60 % after 5 years and even higher after longer periods of observation. Recurrence may be due to several causes like inaccurate initial diagnosis, progression of disease, inadequate initial surgery, altered venous dynamics, and neovascularisation. METHODS In this cross sectional single center study, 100 patients above 18 years of of age of both genders presenting with complications of varicose veins and cases of postoperative recurrent varicose veins were included. This study was conducted in the Department of General Surgery, Sri Venkateswara Ramnarayan Ruia Government General Hospital (SVRRGGH), Tirupati, over a period of one year. RESULTS In the present study, the great saphenous vein (GSV) was involved in 85 % of cases, the short saphenous vein (SSV) in 2 %, and both long and short saphenous in 9 %. The commonest complication was edema in 88 % of the patients, followed by 43 % with eczema. Recurrent varicose veins were seen in 4 % of patients. CONCLUSIONS Complications were more common in our setting at the time of presentation. Variable anatomy of the venous system of the lower limb makes prior duplex scan assessment compulsory in the surgical management of cases. Surgical management is to be planned properly after complete evaluation and should be planned at the right time, as it is a progressing clinical entity. KEYWORDS Varicose Veins, Complications, Recurrence, Management

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 404-407
Author(s):  
Maras ◽  
Tzormpatzoglou ◽  
Papas ◽  
Papanas ◽  
Kotsikoris ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Variable Degree ◽  
Operative Complications ◽  
The Right ◽  
Ica Stenosis ◽  
Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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