[Course of pregnancy and labor after sustained thrombophlebitis of the deep femoral vein].
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Female↗
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Superior vena caval bypass using the superficial femoral vein for treatment of superior vena cava syndrome.
We present the case of a 71-year-old woman who had benign, symptomatic, superior vena cava syndrome that was treated with open surgical bypass using the superficial femoral vein. The patient had an uneventful hospital course and experienced relief of her symptoms. We conclude that the superficial femoral vein is an acceptable bypass conduit for open surgical management of superior vena cava syndrome.
Aged↗
Nitric oxide in the periendothelial area of femoral vein of the dog assessed in vivo by a porphyrinic sensor.
Nitric oxide concentration in the periendothelial are of the femoral vein in anaesthetized dogs was measured directly with a catheter- protected porphyrinic sensor. A 2- to 4-fold increase occurred in the basal NO concentration of 90 +/- 12 nM after acetylcholine injection (1-1.5 micrograms/kg). A linear correlation was found between femoral artery blood flow and NO concentration in the periendothelial area of the femoral vein. Noradrenaline decreased NO levels below the detection limit of the porphyrinic sensor (10 nM).
Acetylcholine↗
Melioidosis presenting as an infected intrathoracic subclavian artery pseudoaneurysm treated with femoral vein interposition graft.
We present the first case of in situ replacement of an infected subclavian artery using superficial femoral vein and the fourth reported case of an infected arterial pseudoaneurysm caused by pseudomonas pseudomallei. Sepsis and hoarseness developed in a 58-year-old man after recent travel to Borneo, Indonesia. Indirect laryngoscopy revealed a paralyzed right vocal cord. Computed tomography and arteriography revealed a 6.5-cm pseudoaneurysm of the proximal right subclavian artery. Blood cultures grew pseudomonas pseudomallei. An abnormal cardiac stress test prompted a coronary angiography, which revealed severe coronary artery disease.The patient underwent coronary artery bypass and in situ replacement of the infected subclavian artery pseudoaneurysm with a superficial femoral vein, along with placement of a pectoralis major muscle flap to cover the vein graft. Operative cultures of the pseudoaneurysm grew pseudomonas pseudomallei. The patient was treated with a 6-week course of intravenous ceftazidime and oral doxycycline and then continued on oral amoxicillin-clavulanate. One week after discontinuing intravenous antibiotics, the patient presented to the emergency department with a rapidly expanding, pulsatile mass in the right supraclavicular space. He was taken emergently to the operating room. After hypothermic circulatory arrest was accomplished, the disrupted vein graft and aneurysm cavity were resected and the subclavian artery was oversewn proximally and distally. Parenteral ceftazidime was continued for 3 months and oral amoxicillin-clavulanate (augmentin) was continued indefinitely. There was no evidence of infection clinically or by computed tomographic scan 2 years later. Although autogenous vein replacement of infected arteries and grafts may be successful in the majority of cases, this strategy should probably be avoided when particularly virulent bacteria such as the organism in this case are present.
Aneurysm, False↗
Hemodialysis graft infections treated with cryopreserved femoral vein.
Introduction. Treatment of infected hemodialysis grafts is associated with prolonged hospitalization and wound care. The use of cryopreserved femoral vein (CFV) for angioaccess in infected hemodialysis grafts was prospectively evaluated.Methods. Forty-three CFV arteriovenous grafts (AVGs) were placed in 43 patients with prosthetic AVG infections. Thirty-two of the CFV AVGs were constructed adjacent to the infected AVG using a parallel tunnel tract, while 11 were placed into the infected field. All patients were prospectively followed at three-month intervals for graft complications and recurrent infections.Results. With a mean follow-up of 418 days, there was one recurrent infection (2.3%). The one-year primary and secondary graft patency rates were 42% and 68%, respectively. The two-year primary and secondary patency rates were 31% and 63%, respectively.Conclusions. Cryopreserved femoral vein proved useful in the treatment of infected hemodialysis grafts. The absence of infection after implantation around an infected area shows promise for salvaging an angioaccess site that would otherwise have been abandoned.
Adult↗
Hyperpolarization contributes to endothelium-dependent relaxations to acetylcholine in femoral veins of rats.
The contribution of membrane hyperpolarization to endothelium-dependent relaxations induced by acetylcholine was investigated in the femoral vein of the rat using a microelectrode technique and isometric tension recordings. Acetylcholine caused endothelium-dependent relaxations and hyperpolarization in tissues contracted with norepinephrine. The relaxation was sustained during a prolonged exposure to acetylcholine (less than or equal to 10 min). In contrast, the hyperpolarization declined with time. In the presence of nitro-L-arginine, a blocker of nitric oxide synthesis, the relaxation became smaller and transient, whereas the hyperpolarization was not affected. There was a temporal relationship between the relaxation and the hyperpolarization in the presence of nitro-L-arginine, when the two parameters were recorded simultaneously. In tissues contracted with 60 mM K+, in which hyperpolarization could not be observed, acetylcholine caused relaxations and these relaxations were abolished by nitro-L-arginine. The results suggest a contribution of both nitric oxide and membrane hyperpolarization to the endothelium-dependent relaxation induced by acetylcholine in the femoral vein of the rat.
Acetylcholine↗
Haemodynamic changes in the rat femur and tibia following femoral vein ligation.
Interference with venous outflow from a limb to stimulate fracture repair and bone growth has a long history, and its beneficial effects have been confirmed by many experimental and clinical studies. With the development of fracture fixation systems, the therapeutic use of circulatory intervention became redundant. Recently, a venous tourniquet effect has been cited to explain the enhancement of bone healing observed after fracture fixation with the Aircast system. As bone appears to be altered by venous stasis, it is important to characterise the vascular perturbations leading to these changes. Previous studies have often given conflicting results. This study investigated the short and long term haemodynamic effects of femoral vein ligation. Changes in blood flow rate and blood volume in the distal femur and proximal tibia of the rat were examined at 6 h and 1, 3 and 7 d following unilateral femoral vein ligation, and at 8 and 16 wk. Blood flows and volumes were generally reduced in the ligated limb 6 h after femoral vein ligation. This initial depression was followed by a relative increase (comparing the ligated limb with the contralateral unoperated bone) in blood volume during the 1st week. A significant relative reduction in epiphyseal vascular space was observed after 16 wk. A sustained reduction of arterial input to whole femora and tibiae was present in the ligated limb throughout the investigation although, for the cancellous knee joint epiphysis of the tibia, a localised relative increase in flow was apparent during the 1st week, again comparing the ligated limb with the nonligated contralateral bone.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Central venous catheter insertion by femoral vein: safety and effectiveness for the pediatric patient.
Prospective observations made during surveillance of routine central venous catheterizations for hemodynamic monitoring were evaluated to determine the safety and effectiveness of femoral insertion of central venous catheters and to demonstrate the feasibility of teaching pediatric residents to perform this procedure. During a 19-month period of observation, 29 pediatric patients requiring a central venous catheter underwent attempted percutaneous femoral vein catheterization. Femoral catheterization was successful in 86% of patients attempted, and insertions by pediatric residents were successful in 68% of patients attempted. Arterial puncture was the only significant complication of insertion, occurring in 14%, and was not associated with adverse sequelae. During 33 months of observations, complications of indwelling femoral central venous catheters did not significantly exceed the frequency for internal and external jugular, subclavian, and antecubital central venous catheters. During more than 4 years of observation, the significant complications associated with indwelling femoral central venous catheters were swelling of the leg or documented thrombosis in 11% of 74 critically ill patients. These observations indicate safety and effectiveness of femoral central venous catheters which compares favorably to central venous catheter insertion by other routes. In contrast to previous reports of central venous catheter insertion via subclavian and internal jugular veins, we observed no cardiorespiratory compromise as a result of femoral central venous catheter complications. Skill in this technique is a feasible educational goal for pediatric residents.
Accident Prevention↗
Comparison of fibrinolytic activity in the femoral vein and the right atrium.
Local fibrinolytic activity in leg veins has not been completely explored. Since the blood in the right atrium is a mixture of venous blood supplied from the whole body, the fibrinolytic activity in the right atrium may be used as a reference value to which local values can be compared in order to identify local hyperfibrinolysis or hypofibrinolysis. We compared fibrinolytic parameters [tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), euglobulin clot lysis time] measured in the femoral vein with those in the right atrium. The blood samples were obtained during right heart catheterization of 51 patients. No differences in t-PA antigen [9.6 ng/ml (6.6-11.9 ng/ml) versus 8.1 ng/ml (6.7-11.3 ng/ml)] [median (interquartile range)] and PAI-1 antigen [9.3 ng/ml (7.1-16.0 ng/ml) versus 8.4 ng/ml (5.5-14.3 ng/ml)] levels were found, whereas t-PA activity was significantly higher [183 IU/ml (39-1097 IU/ml) versus 92 IU/ml (5-680 IU/ml), P < 0.05], PAI-1 activity significantly lower [7.2 IU/ml (5.1-10.2 IU/ml) versus 7.9 IU/ml (5.8-10.3 IU/ml), P < 0.05], and the euglobulin clot lysis time was significantly shorter [6.2 1000/min (4.8-10.0 1000/min) versus 5.5 1000/min (4.1-9.1 1000/min), P < 0.05] in the femoral vein compared with the right atrium. In conclusion, our results show that local fibrinolytic activity in the femoral vein is higher than in the right atrium, and thus demonstrate that increased local fibrinolysis is present in leg veins.
Adult↗
[Reconstruction of femoral vein using ePTFE grafts].
Rare cases of reconstruction of peripheral veins were reported. We experienced two patients with liposarcomas of the thigh in which the femoral vessels were resected with the tumor and reconstructed with ePTFE grafts. In a 51-year-old male, the left femoral vein was reconstructed with an ePTFE graft 6 mm in diameter and 11 cm in length; but the graft occluded early in the postoperative period. In another case, a 33-year-old male, the right femoral vein was reconstructed with a ringed ePTFE graft 8 mm in diameter and 9 cm in length, with an arterio-venous fistula. The graft maintained its patency for 7 months after surgery.
Adult↗
Measurement of femoral vein blood flow during total hip replacement. Duplex ultrasound imaging with and without the use of a foot pump.
We examined ten femoral veins with duplex ultrasound during total hip replacement to demonstrate the operative manoeuvres which cause venous obstruction and to assess prophylactic measures which may overcome it. Exposure of the acetabulum by distraction of the femur with a hook was less likely to occlude flow than retraction with bone levers. Adequate exposure of the femoral shaft by adduction, flexion and either internal or external rotation caused cessation of flow in all cases. In four cases an A-V Impulse System foot pump was activated during periods of stasis. In each case it overcame the obstruction and produced peak velocities which were twice that of the resting state. In five cases, towards the end of the procedure, debris was seen travelling proximally through the femoral vein.
Blood Flow Velocity↗
Activation of soluble guanylate cyclase and potassium channels contribute to relaxations to nitric oxide in smooth muscle derived from canine femoral veins.
Experiments were designed to examine mechanisms of relaxations to nitric oxide (NO) in venous smooth muscle. Rings of canine femoral veins without endothelium were suspended for measurement of isometric force in organ chambers. Concentration-response curves to NO and 8-Br-cyclic guanosine monophosphate (cGMP) were obtained in veins contracted with KCl (60 mM) or prostaglandin F2alpha (PGF2alpha; 2x10(-6) M) in the absence and presence of inhibitors of soluble or particulate guanylate cyclase or K+ channel antagonists. In rings contracted with PGF2alpha, relaxations to NO were reduced significantly by inhibition of soluble but not particulate guanylate cyclase. Relaxations to NO were reduced in rings contracted with KCI. Tetraethylammonium (10(-2) M) and glibenclamide (10(-7) M) + charybdotoxin (10(-7) M) significantly reduced relaxations to NO in rings contracted with PGF2alpha. Relaxations to 8-Br-cGMP were decreased significantly only by charybdotoxin. These results suggest that relaxations to NO in canine femoral veins involve at least two intracellular processes: activation of soluble guanylate cyclase and activation of adenosine triphosphate (ATP)-sensitive and large-conductance, Ca+2-activated K+ channels. The large-conductance, Ca+2-activated K+ channels seem to be activated by cGMP-dependent mechanisms. Therefore relaxations to NO in venous smooth muscle involve intracellular processes similar to those in arterial smooth muscle.
Animals↗
Duplication of the superficial femoral vein: recognition with duplex ultrasonography.
Duplication of the superficial femoral vein (SFV) is a normal variant seen in 20% of contrast phlebograms. Failure to identify thrombus in one limb of a SFV may lead to inappropriate management and subsequent complications. Colour Doppler imaging (CDI) is now the imaging technique of choice in the diagnosis of a deep vein thrombosis (DVT). The purpose of this study was to identify the prevalence of duplication of the SFV at CDI and to compare this with the known prevalence at contrast phlebography. CDI was performed on 58 healthy volunteers (116 limbs examined). Duplication of the SFV was present in 29 examinations (25%). Ultrasonic measurement of the diameter of the SFV was performed in all patients. In the presence of duplication a significant reduction in the diameter of both limbs of the SFV was noted when compared with an unduplicated vessel. The prevalence of duplication of the SFV at CDI is comparable to that at contrast phlebography. Recognition of this variant may help reduce false negative CDI examinations.
Adult↗
Massive retroperitoneal hemorrhage associated with femoral vein cannulation.
The right external iliac artery was inadvertently punctured during attempted right femoral vein catheterization. Severe hypotension developed several minutes after the arterial puncture. Concurrently, a large right lower abdominal quadrant swelling (approximately 5 cm in diameter) became apparent. Laparoscopic observation of the retroperitoneal region immediately revealed massive retroperitoneal hemorrhage. Abdominal computerized tomographic scan indicated development of a huge (approximately 10 cm in the maximum diameter) retroperitoneal hematoma along the right psoas muscle from the level of the right external iliac vessels up to the level of the upper pole of the right kidney. Consideration of the anatomy of the "right" femoral and retroperitoneal vessels (ie, mediolateral relationship between the vein and artery) led us to conclude that the site for insertion of the needle was too proximal and the angle for advancement of the needle too low in our patient, allowing the needle to reach and injure the "incompressible" external iliac artery, thereby causing massive retroperitoneal hemorrhage. Although femoral vein catheterization has generally been considered a relatively safe method of intravenous access, a life-threatening serious complication can occur with the inappropriate technique used in our case.
Catheterization, Peripheral↗
Prevention of femoral vein occlusion by local injection of Thrombolysin in the rat.
An experimental model was developed that will produce femoral vein occlusion greater than 90% of the time in rats weighing less than 500 grams. This standard venous clot, produced by combining intimal trauma with local venous stasis, can simulate clinical crush and replantation problems. Using this standard clot model, Thrombolysin was injected in the femoral artery after trauma to the vein but before venous stasis. Femoral vein patency was determined at the end of the 30 minute period of venous stasis. With the appropriate dosage, ipsilateral venous occlusion was prevented (P less than 0.00001) without preventing contralateral venous occlusion (P less than 0.02). Except for decreased fibrinogen levels, there was no significant change in the factors studied between the control and experimental groups. It is possible, therefore, to prevent thrombosis in a vein with intimal damage, even in the presence of a low-flow state by the local injection of Thrombolysin, without producing systemic anticoagulation.
Animals↗
Successful reconstruction of stripped superficial femoral vein.
A 69-year-old man who had hemorrhagic shock after inadvertent stripping of the right superficial femoral-popliteal vein during surgery for greater saphenous vein varicosis in another hospital was referred to us. Phlebography revealed a ruptured popliteal vein with intact profunda femoris and common femoral veins. The stripped superficial femoral-popliteal vein brought in a jar was reimplanted. Phlebography performed during the patient's follow-up visits in our outpatient clinic 11 months postoperatively showed a patent femoral vein.
Aged↗
Continuous quantitative monitoring of mural, platelet-dependent, thrombus kinetics in the crushed rat femoral vein.
A new in vivo method to study the size and dynamics of a growing mural thrombus was set up in the rat femoral vein. The method uses a standardized crush injury to induce a thrombus, and a newly developed transilluminator combined with digital analysis of video recordings. Thrombi in this model formed rapidly, reaching a maximum size 391 +/- 35 sec following injury, after which they degraded with a half-life of 197 +/- 31 sec. Histological examination indicated that the thrombi consisted mainly of platelets. The quantitative nature of the transillumination technique was demonstrated by simultaneous measurement of the incorporation of 111In labeled platelets into the thrombus. Thrombus formation, studied at 30 min interval in both femoral veins, showed satisfactory reproducibility overall and within a given animal. With this method we were able to induce a thrombus using a clinically relevant injury and to monitor continuously and reproducibly the kinetics of thrombus formation in a vessel of clinically and surgically relevant size.
Animals↗
Transgraft infusion of heparin to prevent early thrombosis of expanded PTFE grafts in canine femoral veins.
Recently we designed an expanded polytetrafluoroethylene (ePTFE)-based local infusion device that delivers therapeutic agents directly through the graft wall in the region adjacent to the upstream anastomosis, thereby achieving a high drug concentration downstream along the graft-blood interface. In this study we evaluated the effects of infusing heparin by this method on graft patency and neointimal hyperplasia in a canine model of femoral vein replacement. Five dogs underwent bilateral femoral vein replacement with the device. In each case one graft was infused with continuous heparin (48 U/kg/day) while the contralateral control graft received phosphate-buffered saline solution for 14 days. All heparin-treated grafts were patent and all control grafts were thrombosed at 14 days. There was no significant difference in systemic activated partial thromboplastin time among samples taken preoperatively, at 48 hours, and at 14 days of implantation (p > 0.5). There was no significant difference in neointimal hyperplasia between the upstream and downstream anastomoses in heparin-treated grafts. These data demonstrate that the transgraft infusion of heparin preserved venous ePTFE graft patency without measurable systemic anticoagulation. Thus this approach may represent an attractive strategy for maintaining patency of synthetic venous grafts.
Anastomosis, Surgical↗