Functional ultrasound imaging of the venous valve of the great saphenous vein in the area around the crosse using the novel vector flow technique

PURPOSE: The aim of our pilot study is to consider if the new flow presentation of the vector flow (V-flow) allows an assessment of the valve morphology of the crosses with respect to an insufficiency. MATERIAL AND METHODS: We performed a total of 50 investigations in which we documented a complete valve closure at the so called “crosse” at the valve of the large saphenous vein, a delayed valve closure or an incomplete valve closure with consecutive insufficiency at the crosse. The valve function of the crosse is crucial for the development of varicosis. For our study we recorded age and gender of the patients. One patient in the study was suffering from Covid19. For the examinations we used a 3–9 MHz probe and a high-end ultrasound device. The examination was performed in a lying position and under quiet conditions. Before examination we practiced inhalation and exhalation as well as “pressing” or coughing with the patients, which resulted in a physiological closure of the venous valves. To rule out thrombosis, we carried out compression sonography on the legs. During the examination we documented the B-scan, the Color-Coded Duplex Sonography, the HR-flow and the V-flow for 3 seconds at the estuary of the crosses and incorporated these parameters into our measurements. Via V-flow, vectors can be imaged by representing the flow of erythrocytes and visually indicate a possible insufficiency due to delayed or incomplete valve closure. RESULTS: 31 of 50 patients (age 19–81years) showed a complete valve closure of the crosses, three of them suffered from thrombosis. In eight of the 50 study participants (age 45–79 years) a delayed valve closure could be diagnosed by V-flow within 1–2 seconds. None of them had a thrombosis, but six of them suffered from cancer. In eleven patients we derived an incomplete valve closure with insufficiency (age 51–88 years). With reflux it took >2 seconds to close the valve. The patient with Covid19 also showed an incomplete valve closure with insufficiency. At the same time this patient showed a Covid19-associated deep vein thrombosis. Eight additional patients also had a thrombosis. Six of them suffered from cancer. Overall, the results were best visualized by V-Flow. CONCLUSION: The crosse as a significant venous structure can be well investigated by V-flow with respect to hemodynamic changes and a resulted reflux. Also associated changes close to the valve can be visualized well.

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Color-Coded Duplex Sonography in Patients 12 Years after Acute Deep Vein Thrombosis

Phlebology ’95 ◽

10.1007/978-1-4471-3095-6_116 ◽

1995 ◽

pp. 260-260

Author(s):

U. K. Franzeck ◽

I. Schalch ◽

A. Bollinger

Keyword(s):

Deep Vein Thrombosis ◽

Duplex Sonography ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Color Coded Duplex Sonography ◽

Deep Vein

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Diagnosis and Treatment of Postthrombotic Syndrome

Hämostaseologie ◽

10.1055/a-1145-0108 ◽

2020 ◽

Vol 40 (02) ◽

pp. 214-220

Author(s):

Guido Bruning ◽

Jasmin Woitalla-Bruning ◽

Anne-Caroline Queisser ◽

Johanna Katharina Buhr

Keyword(s):

Varicose Veins ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Venous Reflux ◽

Venous Valve ◽

Vein Thrombosis ◽

Venous Valves ◽

Fast Progression ◽

Secondary Healing ◽

Deep Vein

AbstractAfter acute treatment of deep vein thrombosis, not only the risk but also associated side effects of postthrombotic syndrome (PTS) are often underestimated.There are essentially two main types of PTS.1. Obstructive type—no sufficient recanalization of the deep vein.2. Refluctive type—sufficient recanalization of the deep vein, but insufficient venous valves in conjunction with venous reflux.A statement regarding deep vein recanalization and venous valve function can be made at the earliest after 6 months.PTS is often diagnosed without appropriate medical history. However, the assessment of the degree of recanalization and venous reflux is paramount to the medical prognosis. In our opinion, beside proximal thrombosis, sufficient recanalization combined with a strong venous reflux, especially in the popliteal vein, works as a powerful predictor for an unfavorable and fast progression of PTS and chronic venous insufficiency. Thus, the obstructive type is prognostically more favorable. For PTS in general, consistent compression therapy represents the first-line treatment option.With concomitant varicosis, one should assess whether the varicose veins represent primary varicosis with reflux or secondary varicosis without reflux. Especially in the presence of venous ulcers, the elimination of concomitant primary varicosis leads to an improved prognosis. Moist wound treatment is considered to be the standard treatment for all wounds undergoing secondary healing. A standardized set of topical therapeutic agents also facilitates the treatment. In individual cases “ulcershaving” and mesh graft transplantation proved to be successful.

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Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614936 ◽

1998 ◽

Vol 79 (03) ◽

pp. 517-519 ◽

Cited By ~ 13

Author(s):

Stephane Heymans ◽

Raymond Verhaeghe ◽

Luc Stockx ◽

Désiré Collen

Keyword(s):

Deep Vein Thrombosis ◽

Continuous Infusion ◽

High Speed ◽

Minor Bleeding ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Long Term Follow Up ◽

Valve Function ◽

Rotating Impeller ◽

Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

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Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽

10.1055/s-0037-1622198 ◽

2007 ◽

Vol 36 (06) ◽

pp. 309-312 ◽

Cited By ~ 11

Author(s):

T. Schulz ◽

M. Jünger ◽

M. Hahn

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Stage ◽

Clinical Signs ◽

Cost Effective ◽

Duplex Sonography ◽

Foam Sclerotherapy ◽

Average Loss ◽

One Year ◽

The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

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Outpatient Total Hip Arthroplasty: A Meta-Analysis

Applied Sciences ◽

10.3390/app11156853 ◽

2021 ◽

Vol 11 (15) ◽

pp. 6853

Author(s):

Filippo Migliorini ◽

Lucio Cipollaro ◽

Francesco Cuozzo ◽

Francesco Oliva ◽

Andrea Valerio Marino ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Readmission Rates ◽

Total Hip ◽

Vein Thrombosis ◽

Outpatient Group ◽

Operative Planning ◽

The Mean ◽

And Gender

Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m2. Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p < 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy.

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Preservation of Venous Valve Function After Catheter-Directed and Systemic Thrombolysis for Deep Venous Thrombosis

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70293-8 ◽

2006 ◽

Vol 2006 ◽

pp. 380-381

Author(s):

G.L. Moneta

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Venous Valve ◽

Systemic Thrombolysis ◽

Valve Function

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Carotid artery stenting and follow-up: Value of 64-MSCT angiography as complementary imaging method to color-coded duplex sonography

European Journal of Radiology ◽

10.1016/j.ejrad.2010.12.007 ◽

2012 ◽

Vol 81 (1) ◽

pp. 89-94 ◽

Cited By ~ 11

Author(s):

Richard Nolz ◽

Andreas Wibmer ◽

Dietrich Beitzke ◽

Stephan Gentzsch ◽

Andrea Willfort-Ehringer ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Duplex Sonography ◽

Imaging Method ◽

Color Coded Duplex Sonography ◽

Msct Angiography

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Intraoperative Color-coded Duplex Sonography for Localization of a Distal Middle Cerebral Artery Aneurysm: Technical Case Report

Neurosurgery ◽

10.1097/00006123-199804000-00155 ◽

1998 ◽

Vol 42 (4) ◽

pp. 942-942

Author(s):

Gary K. Steinberg

Keyword(s):

Case Report ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Duplex Sonography ◽

Middle Cerebral Artery Aneurysm ◽

Color Coded Duplex Sonography ◽

Cerebral Artery Aneurysm ◽

Distal Middle Cerebral Artery

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Performance changes of venous valves following tissue treatment with novel in vitro system

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518804360 ◽

2018 ◽

Vol 34 (5) ◽

pp. 347-354

Author(s):

Garrett Easson ◽

Megan Laughlin ◽

Hanna Jensen ◽

Kevin Haney ◽

Marc Girardot ◽

...

Keyword(s):

High Speed ◽

In Vitro Model ◽

Closing Time ◽

Venous Valve ◽

Orifice Area ◽

Treatment Methods ◽

Venous Valves ◽

Significant Difference ◽

Vitro Model

Objectives The purpose of this study is to test venous valve performance and identify differences between native tissue and replacement devices developed with traditional tissue treatment methods using a new in vitro model with synchronized hemodynamic parameters and high-speed valve image acquisition. Methods An in vitro model mimicking the venous circulation to test valve performance was developed using hydrostatic pressure driven flow. Fresh and glutaraldehyde-treated vein segments were placed in the setup and opening/closing of the valves was captured by a high-speed camera. Hemodynamic data were obtained using synchronized hardware and virtual instrumentation. Results Geometric orifice area and opening/closing time of the valves was evaluated at the same hemodynamic conditions. A reduction in geometric orifice area of 27.2 ± 14.8% (p < 0.05) was observed following glutaraldehyde fixation. No significant difference in opening/closing time following chemical fixation was observed. Conclusions The developed in vitro model was shown to be an effective method for measuring the performance of venous valves. The observed decrease in geometric orifice area following glutaraldehyde treatment indicates a decrease in flow through the valve, demonstrating the consequences of traditional tissue treatment methods.

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