scholarly journals A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency

2017 ◽  
Vol 5 ◽  
pp. 2050313X1769293
Author(s):  
Roy Wesley Jones ◽  
Godfrey Ross Parkerson ◽  
Mary Ottinger ◽  
Eduardo Rodriguez ◽  
Brian Park
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Venous Aneurysm ◽  
Venous Stasis ◽  
High Ligation ◽  
Bilateral Lower Extremity ◽  
Duplex Imaging ◽  
The Right ◽  
Saphenofemoral Junction

Objective: We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. Methods: A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Results: Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Conclusion: Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

scholarly journals An inguinal hernia or a greater saphenous vein aneurysm? A case report

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Seyhan Yılmaz ◽  
Sabür Zengin ◽  
Fatma Gürgen ◽  
Feryaz Kızıltan
Keyword(s):  
Pulmonary Embolism ◽  
Inguinal Hernia ◽  
Saphenous Vein ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Venous Aneurysm ◽  
Soft Tissue Masses ◽  
The Right ◽  
Morbidity Risk ◽  
Saphenofemoral Junction

Superficial venous aneurysms, which are mostly asymptomatic and detected when patients were referred to for the treatment or evaluation of a femoral or inguinal hernia or soft tissue masses, are associated with a risk of developing pulmonary embolism. We aimed to present a case of a greater saphenous vein aneurysm of which its misdiagnosis possesses morbidity risk and confused with inguinal hernia. A 45- year-old female patient admitted to our clinic with swelling and pain in her right groin that had been present for about three years. The patient was also treated with inguinal hernia repair once due to her related complaints. A venous color doppler ultrasound was performed for differential diagnosis and a 70x31-mm sized fusiform proximal greater saphenous vein aneurysm and a grade-4 pathologic reflux in the right saphenofemoral junction was observed in the ultrasonographic examination. As a result, the swelling detected in the inguinal region should be evaluated in terms of possible superficial venous aneurysm, which may cause thromboembolism and ruptures, and this condition, which is frequently confused with inguinal hernia, should be taken into consideration and taken under operation as soon as possible in case of its presence.

Not Just a Dog Bite: Unmasking Underlying Chronic Venous Insufficiency

2020 ◽  
Vol 44 (4) ◽  
pp. 203-206
Author(s):  
Jessica Kralec
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Chronic Wound ◽  
Great Saphenous Vein ◽  
Venous Stasis ◽  
Dog Bite ◽  
Venous Reflux ◽  
Area Of Concern ◽  
The Right ◽  
Saphenofemoral Junction

An 81-year-old man sustained a dog bite to his right lateral calf. Despite antibiotics, the patient continued to have leg swelling, severe itching, and a chronic wound. He was evaluated at the Wound Center, at which time a diagnosis of chronic venous insufficiency was made, and a venous reflux examination was recommended. The patient was scanned using Intersocietal Accreditation Commission Vascular Testing venous reflux protocol. Imaging was directed to the area of concern at the lateral calf. A 1.1-mm vein branch off the proximal calf great saphenous vein (GSV) was identified under the itching/trauma area with venous reflux identified. Venous reflux examination findings identified significant venous reflux from the right saphenofemoral junction through the distal calf GSV and vein branches. An elective right GSV endothermal venous ablation and stab phlebectomy were performed. The patient returned per protocol on postoperative day 2. He reported no pain and complete resolution of itching. Physical examination demonstrated marked improvement in the excoriated area. Surveillance duplex revealed no evidence of an endovenous heat-induced thrombosis. Venous stasis dermatitis occurs when there is inflammation of the skin caused by chronic venous insufficiency. In the early stages, symptoms include swelling at the ankles, hyperpigmentation, dryness, and itching. The development of stasis dermatitis can be precipitated by trauma, thereby unmasking underlying chronic venous insufficiency. Stasis dermatitis in this patient resolved because we treated the cause: chronic venous insufficiency.

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency

2007 ◽  
Vol 22 (5) ◽  
pp. 207-213 ◽  
Author(s):  
A Mdez-Herrero ◽  
J Gutiérrez ◽  
L Camblor ◽  
J Carreño ◽  
J Llaneza ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Clinical State ◽  
Control Group ◽  
Superficial Venous Insufficiency ◽  
Saphenofemoral Junction

Objective: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration. Methods: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group. Results: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive. Conclusions: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.

Exercise-induced purpura – triggered by a lymphoedema

Phlebologie ◽  
2015 ◽  
Vol 44 (04) ◽  
pp. 182-183
Author(s):  
M. Stücker ◽  
M. H. Segert
Keyword(s):  
Differential Diagnosis ◽  
Lower Extremity ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Systemic Vasculitis ◽  
Compression Stockings ◽  
Important Differential Diagnosis ◽  
Typical History ◽  
Exercise Induced ◽  
The Right

SummaryExercised-induced purpura (EIP) is an frequently misdiagnosed condition that occurs most often on the lower extremities. An association with exercise is common. Most EIP have presented in healthy-appearing individuals with no sign of chronic venous insufficiency.A 62 year-old woman with primary lymphoedema of the right lower extremity presented erythematous purpuric patch only on her right medial ankle. This purpura had appeared spontaneously after an unusually long march without compression stockings. Through the typical history and symptoms diagnosis of exercise-induced purpura could be provided. This common and harmless disease should be known as an important differential diagnosis for systemic vasculitis.

Great saphenous vein sparing techniques in lower extremity venous insufficiency treatment

2020 ◽  
pp. 026835552097523
Author(s):  
Mehmet Senel Bademci ◽  
Cemal Kocaaslan ◽  
Fatih Avni Bayraktar ◽  
Ahmet Oztekin ◽  
Bilal Aydin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein

Venous Function after Restoring Valve Competence of the Great Saphenous Vein

2003 ◽  
Vol 10 (2) ◽  
pp. 350-355 ◽  
Author(s):  
Gudmundur Danielsson ◽  
Christel Jungbeck ◽  
Karin Peterson ◽  
Lars Norgren
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Prospective Clinical Study ◽  
Entry Site ◽  
Vein Diameter ◽  
Venous Function ◽  
Saphenofemoral Junction ◽  
Vein Reflux

Purpose: To measure changes in venous function after elimination of great saphenous vein reflux using endovenously-applied heat with a specially designed catheter. Methods: In a prospective clinical study, 13 patients (8 women; mean age 39 years, range 25–59) with symptomatic chronic venous insufficiency were treated for reflux at the saphenofemoral junction. A radiofrequency catheter (Restore) with expandable electrodes that shrinks the vein by controlled constriction of subendothelial collagen was used to restore valve competence. Extirpation of local varicosities was performed simultaneously. Main outcome was change in venous function as measured by plethysmography (foot volumetry) and change in diameter and reflux time at the saphenofemoral junction after 6 and 12 months. Results: Reflux in the greater saphenous vein was eliminated or reduced to below 0.5 seconds in all patients. The venous function was significantly improved after 6 months' follow-up, with decreased refilling rate/expelled volume related to foot volume (p=0.019). The patients were clinically improved, although only 7 (54%) were entirely free from reflux. Three (21%) patients had thrombus in the vein the day after the treatment, 2 at the treatment site and 1 at the entry site of the introducer. After 1 year, the patients are still satisfied with the results, although venous function is no longer significantly improved compared to baseline. Conclusions: It is possible to safely restore valvular competence by means of internally shrinking the vein diameter. The venous function is improved, although the vein has a tendency to increase in width with time; limited reflux reappears, with deterioration of venous function.

TRAUMATOLOGICAL OPERATIONS FOR CLOSED ANKLE AND LOWER / MIDDLE THIRD OF TIBIA FRACTURES ON VENOUS INSUFFICIENCY DEVELOPMENT

2019 ◽  
pp. 22-27
Author(s):  
E.P. Kukushkin ◽  
V.I. Midlenko ◽  
O.V. Midlenko ◽  
N.I. Belonogov
Keyword(s):  
Lower Extremity ◽  
Postoperative Period ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Research Data ◽  
Patient Complaints ◽  
Tibia Fractures ◽  
Closed Fractures ◽  
Open Injuries

The objective of the paper is to evaluate the effect of intraoperative damage to the saphenous vein during operations for injuries of the ankles and lower/middle third of the tibia on the incidence of venous insufficiency during postoperative period. Materials and Methods. The authors examined 213 patients operated for closed fractures of the ankle and lower / middle third of the tibia. All the patients initially demonstrated no signs of venous lower extremity insufficiency. Patients with open injuries were not included in the study. The patients were divided into 2 groups. In patients of the first group (n=103), which was formed according to retrospective analysis, a large saphenous vein was damaged during the operation. In the second group (n=110), the vein was not damaged, as a result of proprietary techniques. In the postoperative period, the authors compared patient complaints and objective research data, characterizing the development of venous insufficiency of the lower extremities. Results. During the postoperative period, the initial signs of lower extremity venous insufficiency were manifested in 33.25 % of patients with intraoperative damage to the large saphenous vein. In cases where damage to the saphenous vein during surgery was avoided, signs of lower extremity venous insufficiency in the postoperative period were observed in 8.41 % of patients. Conclusion. With intraoperative damage to the large saphenous vein during operation for injuries to the ankle and lower / middle third of the tibia, venous insufficiency of the lower extremity develops 4 times more often than wihtout intraoperative damage to the large saphenous vein. Keywords: venous insufficiency of the lower extremities, large saphenous vein, fracture of the lower / middle third of the lower leg, traumatologist. Цель исследования: оценить влияние интраоперационного повреждения большой подкожной вены при операциях по поводу травм лодыжек и нижней/средней трети большеберцовой кости на частоту развития признаков венозной недостаточности в послеоперационном периоде. Материалы и методы. Обследовано 213 пациентов, оперированных по поводу закрытых переломов лодыжек и нижней/средней трети большеберцовой кости, у которых изначально отсутствовали признаки венозной недостаточности нижних конечностей. Пациенты с открытыми травмами в исследование не включались. Наблюдались 2 группы пациентов. У пациентов первой группы (103 чел.), сформированной по данным ретроспективного анализа, во время операции повреждалась большая подкожная вена. Во второй группе (110 чел.) данного повреждения удалось избежать, в т.ч. в результате использования авторских методик. В послеоперационном периоде проводилась сравнительная оценка жалоб пациентов и данных объективного исследования, характеризующих развитие признаков венозной недостаточности нижних конечностей. Результаты. Начальные признаки венозной недостаточности нижних конечностей в послеоперационном периоде проявлялись у 33,25 % пациентов с интраоперационным повреждением большой подкожной вены. В случаях, когда повреждения большой подкожной вены во время операции удалось избежать, признаки венозной недостаточности нижних конечностей в послеоперационном периоде наблюдались у 8,41 % пациентов. Выводы. При интраоперационном повреждении большой подкожной вены во время операций по поводу травм лодыжек и нижней/средней трети большеберцовой кости венозная недостаточность нижней конечности развивается в 4 раза чаще, чем при отсутствии интраоперационного повреждения большой подкожной вены. Ключевые слова: венозная недостаточность нижних конечностей, большая подкожная вена, перелом нижней/средней трети голени, травматолог.

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