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Epithelioid hemangioendothelioma of the common femoral vein: Case report and review of the literature.

A young competitive skier had venous claudication. A stenosis of the left common femoral vein was revealed by means of an examination. Exploration and vein patch angioplasty were performed, and because of both the unusual appearance (focal thickening of vein wall) and the unclear etiology of the lesion, frozen and permanent sections of the wall were obtained. Epithelioid hemangioendothelioma, a rare intravascular sarcoma, was revealed by means of an examination of the permanent sections. Two additional procedures were required to completely excise the epithelioid hemangioendothelioma. We discuss these rare vascular malignancies and include a review of the available literature. Also, oncologic principles important in both the diagnosis and therapy of intravascular sarcomas are discussed.

Adult↗

Giant synovial cyst of the hip joint presenting with femoral vein compression.

A patient is presented with signs mimicking deep venous thrombosis of the leg, which proved to be compression of the femoral vein, without thrombosis, caused by a large cyst from the adjacent hip joint. Clinical presentation, diagnostic imaging procedures and therapy are presented with a review of the literature.

Aged↗

Diameter and velocity changes in the femoral vein during thermal stress in humans.

Unlike most studies on deep veins performed with simultaneous suppression of cutaneous blood flow, a sonographic study of femoral diameter and blood flow velocity changes in response to thermal stress was performed while cutaneous flow was preserved. In 11 normal subjects, mean peak blood flow velocity and diameter of the femoral vein were measured at rest and during indirect whole body heating and cooling. Mean peak venous blood flow velocity was 0.12 +/- 0.06 m s-1 at rest, 0.35 +/- 0.23 m s-1 (P < 0.001) during heat stress, and 0.13 +/- 0.07 m s-1 during cold stress (NS). Femoral venous diameter was 5.3 +/- 0.9 mm at rest, 5.1 +/- 1.0 mm (P < 0.05) during warming, and 5.4 +/- 81.0 mm (NS) during cooling. This study showed a decrease in diameter during thermal stress. However, as mean femoral venous blood-flow velocity was doubled during heat stress, femoral venous blood flow was increased. Thus, it is suggested that during heat stress part of the increase in cutaneous flow is returned through deep veins.

Adult↗

Arteriovenous fistula construction in the thigh with transposed superficial femoral vein: our initial experience.

PURPOSE: The National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines favor autogenous vein for arteriovenous fistulas (AVFs). This report describes our experience constructing AVFs in the lower extremities of selected patients with the superficial femoral vein (SFV). PATIENTS AND METHODS: This is a retrospective analysis of 25 patients who had AVF construction with SFV from March 1998 to July 2000. In all patients upper extremity access had been exhausted. Eighteen (72%) patients were female, 15 (60%) had diabetes, and 14 (56%) were obese (body mass index > 30 kg/m(2)). The SFV was freed from the supragenicular popliteal level to the profunda femoris vein and divided distally. Eighteen (72%) patients had SFV transposition and distal superficial femoral artery reimplantation; 10 veins were banded to reduce the incidence of postoperative steal syndrome. In seven patients (28%) a composite loop fistula was constructed with a deeply buried 4- to 7-mm polytetrafluoroethylene (PTFE) graft proximally and with superficially transposed SFV distally. One of these seven patients had a PTFE above-knee femoral-popliteal bypass graft with banding of the vein at its takeoff from the distal PTFE graft. RESULTS: Mean follow-up was 9.1 months. One patient died before the fistula could be used. Seven patients (28%) experienced major wound complications. Mean ankle/brachial index before operation was 1.03, and after operation it was 0.81 (paired difference [n = 16] = -0.26.) Mean ankle circumference before operation was 19.5 cm, and after operation it was 20.7 cm (paired difference [n = 17] = +0.87.) Cumulative primary fistula patency at 6 and 12 months was 78% and 73%, respectively. Cumulative secondary fistula patency at 6 and 12 months was 91% and 86%, respectively. There were no fistula infections. One patient eventually had an above-knee amputation after experiencing an acute compartment syndrome. Eight patients required a second operation to alleviate a symptomatic steal syndrome. CONCLUSIONS: The SFV is an excellent conduit for vascular access, whether it is transposed or is part of a composite PTFE-SFV fistula. In this series, fistula infection was nonexistent, thrombosis rates were low, and clinical evidence of venous hypertension was minimal. The major impediment to unrestricted use of SFV in constructing AVFs is a high incidence of clinically significant postoperative ischemia requiring reoperation.

Arteriovenous Shunt, Surgical↗

Long-term follow-up of a superficial femoral vein injury: a case report from the Vietnam Vascular Registry.

We report a 29-year follow-up of a high-velocity superficial femoral vein injury sustained during the Vietnam War that was treated by emergent ligation. After years of suffering recurrent ulceration from chronic venous insufficiency, this patient underwent axillary vein valve transfer with improvement in his venous hypertension. Long-term follow-up of patients with deep venous injuries is necessary to avoid complications from chronic venous insufficiency.

Chronic Disease↗

Plasma catecholamine levels in the coronary sinus, aorta and femoral vein of subjects undergoing cardiac catheterization at rest and during exercise.

Plasma catecholamine (CA) levels in the coronary sinus (CS), aorta (Ao) and femoral vein (fv) were simultaneously measured in 22 patients with various heart diseases at rest and during handgrip exercise (IHG). The mean resting levels of plasma norepinephine (NE) in CS, Ao and FV were 359 +/- 49 (SEM) pg/ml, 290 +/- 27 and 234 +/- 24, respectively. The corresponding values of epinephrine (E) were 127 +/- 18 pg/ml, 186+/- 30 and 97 +/- 11, respectively. The E values in Ao were significantly greater than those in CS and in FV (p less than 0.05). IHG exercise induced an obvious elevation of plasma CA levels in every portion of the circulation studied. The mean increments of NE concentration were 81%, 54% and 67% of the resting levels at CS, Ao and FV, respectively, while IHG induced elevation of E were 70% of the resting values at each portion studied. Significant correlations were observed between individual CA concentrations in CS and in Ao, and also between those in Ao and in FV at rest. Under raised sympathoadrenal conditions, however, individual values of NE in CS failed to correlate signficantly to those in Ao and in FV, respectively. The NE output from CS was limited to only 3% and 5% of those in Ao at rest and during IHG, respectively. An actual mean increment of NE on its passing through the coronary circulation was only 2% or less of NE output in ao at both stages. It appears, thus, to be untenable that the cardiac tissue is one of the major source of circulating CA at physiological condition. From these reasons, the direct measurement of NE levels in CS may be mandatory, when plasma CA assay is designed for the purpose of studying the role of the sympathetic nerve activity in the regulation of cardiac function.

Adolescent↗

[Superficial femoral vein ligation and distal venous thrombectomy as surgical therapy for recent thrombophlebitis of the lower extremities. A clinical study (author's transl)].

Three hundred and eighty-three patients underwent superficial femoral vein ligation and distal venous thrombectomy in the treatment of deep venous thrombosis of the lower extremities. Two hundred and forty-eight patients were reviewed clinically. The results are quite satisfactory; no surgical mortality and no fatal pulmonary embolism. On long term follow-up the clinical symptoms such as pain, swelling, varicosities and ulceration are much less marked in the operated group when compared with the post-phlebitis syndrome which develops when the deep venous thrombosis is allowed to extend into the deep pelvic veins.

Adolescent↗

[Leiomyosarcoma of the femoral vein. Apropos of a case].

A 51 years old woman developed an edema of the right lower limb. Phlebographic examination revealed an occlusion of the femoral vein. This was a tumor at operation. A leiomyosarcoma was diagnosed by microscopic study. The authors emphasize the difficulty of diagnosis, value of phlebography and discuss the treatment.

Adult↗

Healing of microvenous polytetrafluoroethylene (PTFE) prostheses implanted into the rat femoral vein by means of 3M precise.

Thirty PTFE prostheses (internal diameter, 1.0 mm; length, 5.0 mm; fibril length, 30 microns) were implanted into rats' femoral veins by means of a coupling device (3M precise microvascular anastomosis system, 3M, St Paul, MN) and evaluated with electron microscopy at regular intervals from 1 day to 3 weeks after implantation to study, in detail, the healing process. Eighty-three percent of mechanically anastomosed grafts were found to be patent. At 1 and 3 days after implantation, the whole length of PTFE was covered with a clot layer containing platelets and a fibrin network. After 1 week, endothelial-like cells originating from the anastomotic sides grew in across the anastomoses. At 3 weeks, the prostheses were completely covered by an endothelial-like cell layer. These results demonstrate that the degree of neo-endothelialization in the microvenous PTFE prosthesis anastomosed with 3M rings was not delayed, as was seen in the healing of microarterial PTFE tubing that was mechanically anastomosed.

Animals↗

Repeated femoral vein cannulation for administration of chemotherapeutic agents.

A cannulation set has been designed for repeated short-term infusion of vesicant chemotherapeutic agents via the femoral vein. The major complication was thrombophlebitis in 2.1% of infusions. The procedure provides reliable venous access when therapeutic plans are changed or when the inability to provide catheter care makes an indwelling catheter unwarranted.

Antineoplastic Agents↗

[Thrombosed aneurysm of the femoral vein mimicking a strangulated crural hernia].

Venous aneurysms are usually difficult to diagnose, especially when they are located in the inguinal area where they can be misinterpreted as inguinal or femoral hernias. We report the case of a 70-year-old man with a painful thrombosed aneurysm of the femoral vein that was clinically undistinguishable from a strangulated hernia. The ultrasonogram, performed 2 months before the acute pain when the femoral swelling was painless, seemed to confirm the incorrect diagnosis of femoral hernia, and the aneurysm was finally labeled as such during surgical exploration. Massive embolism to the lungs and heart occurred peroperatively and resulted in death.

Aged↗

[Injury of the femoral vein--a complication in inguinal hernia surgery].

In a 21-year-old patient with recurrence of the right-sided inguinal hernia the right femoral vein was injured during the operative repair. The vein had to be reconstructed by the use of the right saphena vein and anticoagulative therapy was begun. Since the coagulation parameters were satisfactory the haematoma was produced in the operative wound and had to be evacuated through the second operation. The next operative course was without complications and the patient with healed operative wound was discharged from the hospital at the 13th hospitalization day.

Adult↗

The contractile mechanism of beraprost sodium, a stable prostacyclin analog, in the isolated canine femoral vein.

The vascular contractile mechanism of prostacyclin (PGI2) was investigated using beraprost sodium (BPS), a stable PGI2 analog. Ring strips without endothelium isolated from canine femoral veins and arteries were used. BPS induced a dose-dependent contraction without precontraction and after precontraction with norepinephrine (NE) or 60 mM K+ in the veins. In contrast, BPS induced a dose-dependent relaxation after precontraction with U46619, a thromboxane A2 (TXA2) analog, or prostaglandin F2 alpha (PGF2 alpha) in the veins. In the arteries, BPS induced contraction at higher concentrations after precontraction with NE. However, BPS relaxed arteries dose-dependently after precontraction with PGF2 alpha. By pretreatment with 13-azaprostanoic acid (13-APA), a TXA2/endoperoxide receptor antagonist, the dose-response curve of BPS in the veins was shifted to the right. Schild plot analysis resulted in a linear regression with a slope of 0.86 +/- 0.13, which was not significantly different from unity, and the pA2 value for 13-APA against BPS was 7.10 +/- 0.06. By pretreatment with BPS, the dose-response curve of U46619 in the veins was shifted to the right. Kaumann plot analysis resulted in a linear regression with a slope of 0.89 +/- 0.09, which was not significantly different from unity, and the pA2 value for BPS against U46619 was 5.68 +/- 0.04. These findings indicate that BPS is a partial agonist for the TXA2/endoperoxide receptors.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗