Popliteal venous aneurysm: a report on three cases presenting with chronic venous insufficiency without embolic events

2007 ◽  
Vol 22 (2) ◽  
pp. 56-59 ◽  
Author(s):  
J T Christenson
Keyword(s):  
Pulmonary Embolism ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Anticoagulation Therapy ◽  
Duplex Scanning ◽  
Venous Aneurysm ◽  
Safe Procedure ◽  
The Mean ◽  
Superficial Venous Insufficiency

Objectives: Popliteal venous aneurysms (PVA) are rare, but represent a significant potential source of thromboembolus. Most often the patients present with pulmonary embolism, which can also be detected in patients presenting with chronic venous insufficiency. Methods: Three patients without any clinical evidence of pulmonary emboli were diagnosed by venous duplex scanning during workup for superficial venous insufficiency. None of the PVAs contained thrombus. The mean diameter of the aneurysm was 30 mm. Surgery included tangential aneurysmectomy and lateral venorrhaphy. Results: None of the patients had evidence of pulmonary embolism, and there were no postoperative deep venous thromboses diagnosed. All patients received anticoagulation therapy for three months postoperatively, and patency was confirmed by duplex scanning during follow-up four, nine and 12 months after surgery. Conclusions: It is recommended that PVAs should be ruled out in patients undergoing workup for chronic venous insufficiency, even in the absence of embolic events. A good quality venous duplex scanning is sufficient for diagnosis and treatment. Surgical treatment of PVAs is advocated. Tangential aneurysmectomy with lateral venorrhaphy is the surgical technique of choice. It is a safe procedure with a low complication rate.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

scholarly journals Klippel–Trénaunay Syndrome – A Very Rare and Interesting Syndrome

2015 ◽  
Vol 9 ◽  
pp. CCRPM.S21645 ◽  
Author(s):  
Deepak Sharma ◽  
Sachin Lamba ◽  
Aakash Pandita ◽  
Sweta Shastri
Keyword(s):  
Soft Tissue ◽  
Vascular Malformation ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Port Wine ◽  
Bone Deformity ◽  
Klippel Trenaunay Syndrome

Klippel–Trénaunay syndrome (KTS or KT) is an infrequently seen dermatological syndrome, which is often viewed as a triad of vascular malformation (capillary malformations or port-wine brands), venous varicosity, and soft tissue and/or bony hypertrophy. We report a case of a 12-year-old male who presented to us with the symptoms of varicose plaques over both lower limbs and was diagnosed as a case of KTS. Management is normally conservative and includes stockings for compression of the branches to reduce edema because of chronic venous insufficiency; modern devices that cause on and off pneumatic compression; and rarely, surgical correction of varicose veins with lifelong follow-up. The orthopedic abnormalities are treated with epiphysiodesis in order to prevent (stop) overgrowing of limb and correction of bone deformity.

Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency—Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System

2019 ◽  
Vol 34 (8) ◽  
pp. 543-551 ◽  
Author(s):  
Tjun Y Tang ◽  
Harsha P Rathnaweera ◽  
Jia W Kam ◽  
Tze T Chong ◽  
Edward C Choke ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Asian Population ◽  
Closure System ◽  
Cyanoacrylate Glue ◽  
Catheter Technique

Objectives The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required.

Anatomical Distribution of Chronic Venous Insufficiency in a Chinese Population

1999 ◽  
Vol 14 (1) ◽  
pp. 29-32 ◽  
Author(s):  
A. C. W. Ting ◽  
S. W. K. Cheng ◽  
L. L. H. Wu ◽  
G. C. Y. Cheung
Keyword(s):  
Chronic Venous Insufficiency ◽  
Chinese Population ◽  
Venous Insufficiency ◽  
Duplex Scanning ◽  
Venous Reflux ◽  
Anatomical Distribution ◽  
Group Iii ◽  
Vein Thrombosis ◽  
Group I ◽  
Deep Vein

Objective: To study the anatomical distribution of chronic venous insufficiency (CVI) in a Chinese population by means of duplex scanning. Procedures: A total of 582 limbs in 291 patients with primary venous insufficiency were classified clinically into three different groups according to SVS/ISCVS criteria and evaluated prospectively with duplex scanning. Results: One hundred and thirty-one limbs were classified into group I (CEAP clinical class 0), 291 into group II (CEAP clinical classes 1 and 2) and 160 into group III (CEAP clinical classes 3–6). Mixed deep and superficial venous incompetence was found in 70% and 83% of limbs in groups II and III, respectively. Reflux was also demonstrated in 73% of group I limbs. Conclusions: Most of our patients had mixed deep and superficial venous incompetence. The prevalence of deep venous incompetence in this population, in which deep vein thrombosis is rare, suggests a pattern of venous incompetence other than postphlebitic deep vein valvular dysfunction. The prevalence of reflux in the asymptomatic contralateral limbs implies a bilateral predisposition to venous reflux and thus a possible developmental origin of CVI.

scholarly journals A novel noninstrumented surgical approach for foramen reconstruction for isthmic spondylolisthesis in patients with radiculopathy: preliminary clinical and radiographic outcomes

2018 ◽  
Vol 44 (1) ◽  
pp. E7
Author(s):  
Jochem K. H. Spoor ◽  
Alof H. G. Dallenga ◽  
Pravesh S. Gadjradj ◽  
Luuk de Klerk ◽  
Frans C. van Biezen ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Autologous Bone Graft ◽  
Posterolateral Fusion ◽  
Leg Pain ◽  
Safe Procedure ◽  
Isthmic Spondylolisthesis ◽  
Bony Fusion ◽  
Duration Of Surgery ◽  
The Mean

OBJECTIVEThe health care costs for instrumented spine surgery have increased dramatically in the last few decades. The authors present a novel noninstrumented surgical approach for patients with isthmic spondylolisthesis, with clinical and radiographic results.METHODSCharts of patients who underwent this technique were reviewed. The procedure consisted of nerve root decompression by reconstruction of the intervertebral foramen. This was achieved by removal of the pedicle followed by noninstrumented posterolateral fusion in which autologous bone graft from the right iliac crest was used. Outcomes regarding radicular complaints, bony fusion, progression of the slip, and complications were evaluated using patient history and radiographs obtained at follow-up intervals of 3–18 months after surgery.RESULTSA total of 58 patients with a mean age of 47 years were treated with this method. Partial removal of the pedicle was performed in 93.1% of the cases, whereas in 6.9% of the cases the entire pedicle was removed. The mean duration of surgery was 216.5 ± 54.5 minutes (range 91–340 minutes). The mean (± SD) duration of hospitalization was 10.1 ± 2.9 days (range 5–18 days).After 3 months of follow-up, 86% of the patients reported no leg pain, and this dropped to 81% at last follow-up. Radiographic follow-up showed bony fusion in 87.7% of the patients. At 1 year, 5 patients showed progression of the slip, which in 1 patient prompted a second operation within 1 year. No major complications occurred.CONCLUSIONSTreatment of isthmic spondylolisthesis by reconstruction of the intervertebral neuroforamen and posterolateral fusion in situ is a safe procedure and has comparable results with the existing techniques. Cost-effectiveness research comparing this technique to conventional instrumented fusion techniques is necessary to evaluate the merits for both patients and society.

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.

Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children

2018 ◽  
Vol 102 (8) ◽  
pp. 1103-1108 ◽  
Author(s):  
Uri Elbaz ◽  
Caitriona Kirwan ◽  
Carl Shen ◽  
Asim Ali
Keyword(s):  
Paediatric Population ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Lamellar Thickness ◽  
Layer By Layer ◽  
Safe Procedure ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
The Mean

Background/aimsTo describe the visual and clinical outcomes of manual layer-by-layer deep anterior lamellar keratoplasty (DALK) in a paediatric population.MethodsThe charts of all children who underwent DALK surgery between January 2007 and January 2015 were reviewed retrospectively. Data collected included preoperative and postoperative spectacle-corrected distance visual acuity (CDVA), intraoperative and postoperative complications including graft rejection and failure. Residual posterior lamellar thickness (RPLT) and endothelial cell density (ECD) were measured in eyes with follow-up longer than 6 months.ResultsFifty-one eyes of 42 patients were included in the study. The mean patient age at surgery was 11.2±5.2 years and the mean follow-up time was 36.5±23.7 months. The most common indications for surgery were mucopolysaccharidosis (29.4%) and keratoconus (23.5%). Nine eyes (17.6%) had intraoperative microperforation, none of which were converted to penetrating keratoplasty (PKP). Only one eye (2.0%) was converted to PKP. Five eyes (9.8%) had a stromal rejection episode of which one eye failed. Another four eyes (7.8%) experienced graft failure among which three eyes (75%) had infectious keratitis. Three of the five failed grafts had a successful repeat DALK. The average RPLT was 81.9±36.5μm. ECD was significantly lower in the operated eye compared with the normal eye (3096±333 cells/mm2 vs 3376±342 cells/mm2, n=11, P=0.003). The mean postoperative CDVA was 0.5±0.4 logarithm of the minimum angle of resolution (logMAR) reflecting a gain of 0.3 logMAR (P<0.001).ConclusionManual dissection DALK is a safe procedure in children with stromal opacities. Despite successful structural rehabilitation, functional recovery is still suboptimal mostly due to amblyopia.

scholarly journals Outcome of 1470nm laser diode ablation for superficial venous insufficiency

2015 ◽  
Vol 14 (2) ◽  
pp. 115-122
Author(s):  
Gilberto do Nascimento Galego ◽  
Guilherme Baumgardt Barbosa Lima ◽  
Rafael Narciso Franklin ◽  
Cristiano Torres Bortoluzzi ◽  
Pierre Galvagni Silveira
Keyword(s):  
Diode Laser ◽  
Saphenous Vein ◽  
Doppler Ultrasonography ◽  
Venous Insufficiency ◽  
Success Rates ◽  
Total Occlusion ◽  
Saphenous Veins ◽  
Radial Fiber ◽  
Superficial Venous Insufficiency

BACKGROUND: Endovenous laser ablation is a minimally invasive procedure that can be used to treat superficial venous insufficiency. We believe that using a longer wavelength will reduce the frequency of the most common adverse effects associated with the use of shorter wavelengths.OBJECTIVES: To report the results of an initial series of patients with chronic superficial venous insufficiency treated using a 1470 nanometer diode laser and to compare results using linear and radial laser fibers.METHODS: We conducted an observational cohort study. Seventy-four patients, for whom at least two postoperative Doppler ultrasonography scans were available, were recruited with a total of 121 saphenous veins treated (92 great and 29 small saphenous veins). There were 57 patients in Group A (treated with the linear fiber) and 17 in Group B (radial fiber). Follow-up ideally comprised clinical consultation and Doppler ultrasonography at 1 month, 6 months and 12 months after the procedure. Success was defined as total occlusion of the venous segment that had been treated.RESULTS: Success rates at mean follow-up of 13.4 months (range 7 - 27) were 83% for great saphenous veins and 89% for small saphenous veins. Patients treated with the radial fiber required less energy to achieve occlusion of the small saphenous vein and exhibited fewer adverse reactions, with statistical significance.CONCLUSIONS: Treatment of great and small saphenous vein insufficiency using the 1470 nm diode laser is safe and effective. The radial fiber was associated with fewer intercurrent conditions than the linear fiber, although success rates were similar.

Radiation exposure during non-thrombotic iliac vein stenting

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Jesse Chait ◽  
Nikolay Davis ◽  
Yuriy Ostrozhynskyy ◽  
Sareh Rajaee ◽  
Natalie Marks ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Intravascular Ultrasound ◽  
Stent Placement ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Vena Cava ◽  
Iliac Vein ◽  
Fluoroscopy Time ◽  
Air Kerma ◽  
The Mean

Objective Fluoroscopic-guided interventions have become a major part of the modern vascular surgeon’s practice. Imaging is typically required to safely and effectively perform both simple and complex endovascular interventions. With an ever-increasing volume of fluoroscopic-guided interventions being performed each year, the minimization of harmful radiation exposure has become of paramount concern for both patients and providers. The purpose of this study was to identify the extent of radiation exposure associated with venography and iliac vein stenting, an intervention utilized in the management of chronic venous insufficiency. Methods This was a single-center, retrospective analysis of 40 venograms performed on 29 unique patients over a three-month period. Patients with signs and symptoms of chronic venous insufficiency who failed conservative therapy underwent evaluation of the vena cava and iliofemoral veins with venography and intravascular ultrasound. Stent placement was performed if a >50% cross-sectional area or diameter reduction was identified via intravascular ultrasound. All patients were found to have non-thrombotic iliac vein lesions. All patients wore two individual film badge dosimeters – one on their chest and the other on the abdomen. The same mobile C-arm system was used for all interventions. Results There were 15 males and 14 females, with an average age of 70.6 years old (SD ± 9.5; range 53–89) and a mean body mass index of 33.9 kg/m2. Sixteen limbs had C6 disease, 10 had C4 disease, and 14 had C3 disease. Thirty-eight of the 40 procedures resulted in stent placement, with an average of 1.13 stents placed per intervention. The average fluoroscopy time was 76.5 s (SD ± 36.9; range 7.8–209.5), and the mean cumulative air kerma was 1.08 mGy (SD ± 0.55; range 0.362–2.24). Average cumulative air kerma was higher in procedures resulting >1 stent placement compared to those with placement of ≤1 stent (1.44 vs. 1.02 mGy; p = 0.04). Fluoroscopy time was also higher in procedures with >1 stent placed (120.1 vs. 68.8 s; p = 0.0004). The mean deep dose equivalent per procedure from the patient-worn abdominal badge was 0.221 mSv. Conclusion With the adjunctive use of intravascular ultrasound, iliac vein stenting can be safely and effectively performed with very low utilization of fluoroscopy, and therefore radiation exposure can be minimized for both patients and surgeons. Placement of >1 iliac vein stent resulted in higher cumulative air kerma and fluoroscopy time.

Comparative Study between Percutaneous Approach and Transurethral Approach for Treatment of Urinary Bladder Stones

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Taema ◽  
Hossam Mohammed El Awady ◽  
Mahmoud Mohammed El Shahawy
Keyword(s):  
Urinary Bladder ◽  
Safe Procedure ◽  
University Hospitals ◽  
Percutaneous Approach ◽  
Bladder Stones ◽  
Operative Complications ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Purpose The aim of this study is to compare outcome of percutaneous cystolithotripsy approach (pccl) vs transurethral cystolithotripsy approach (tucl) in treatment of large urinary bladder stones regarding efficacy, safety and peri-operative complications. Methods This study included 60 patients who had urinary bladder stone, treated at Ain Shams University hospitals in Egypt from March 2019 to March 2020 and randomly assigned into two groups: group A: percutaneous cystolithotripsy (PCCL) and group B: transurethral using nephroscope combined with meurmayer stone punch (tucl). Baseline and perioperative data were recorded and compared between two groups. Results Baseline parameters and the peri-operative complications (fever, transient haematuria, urinary bladder perforation, suprapubic wound infection and persistent leakage from suprapubic site) were compared between the two groups. Complete stone clearance was achieved in all the patients. The mean operative time in pccl group and tucl group was (30±7 min and 32±7 min) respectively. Urinary catheter duration in Pccl group was significantly more than Tucl group. Till the last follow-up, 6.6% patients (n = 2) developed urethral stricture in Tucl group. Conclusions PCCL is a safe procedure with acceptable morbidity and can be used as an alternative to tucl in treating (2-4 cm) urinary bladder stones.

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