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The proximal part of the venous system of lower extremities is not always damaged in patients with the varicose disease. The greater the area of the damaged femoral veins by the varicose process, the greater the frequency of insufficient valves appearing against the background of ectasy of the corresponding veins and is of a relative character. The blood reflux may occur in any venous vessel.
Ultrasound-guided thrombin injection is a highly effective therapy for postcatheterization pseudoaneurysm. Despite a very low complication rate, a number of severe arterial thrombotic events have been reported. We present an unusual case of acute femoral vein thrombosis occurring several hours after successful treatment of femoral artery pseudoaneurysm by ultrasound-guided thrombin injection. Pathophysiologic mechanisms are discussed. This case highlights the potential hazards of instilling such a powerful thrombogenic substance in the immediate vicinity of other vascular structures.
Soft-tissue masses uncommonly completely occlude or engulf a major vessel. Complete occlusion of a major vein suggests that the mass originates in the wall of the vein. Such tumours are rare, the most frequently encountered type being leiomyosarcoma. The authors present a case of leiomyosarcoma of the femoral vein.
The Bird's Nest Filter femoral catheter set has proven to be too short in some patients to permit placement in close proximity to the renal veins via the left femoral vein approach. The use of the longer, but otherwise identical Bird's Nest Filter jugular catheter set via the left femoral vein eliminates this problem.
Successful implantations of PTFE microvenous prostheses with 3M precise anastomosis systems were presented. Twelve PTFE prostheses (Gore-Tex;I.D.1.0 mm) were implanted into rat femoral veins by means of 3M precise technique to evaluated the patency rate. In the control group, PTFE prostheses (n = 12) were implanted by means of end-to-end technique. In the experimental group, patency of the PTFE prostheses was evaluated at 3 (n = 6) and 6 (n = 6) weeks after implantation by means of macroscopic inspection and scanning electron microscopy. All prostheses except one were patent at the time of removal (patency rate 91.7 percent). All the microvenous prostheses were completely covered by an endothelial layer at 3 and 6 weeks after implantation, and no stenosis was observed at the anastomotic sites. In the control group, all prostheses except one were found to be occluded 3 weeks after implantation. These results demonstrate the value of the 3M precise technique when implanting PTFE microvenous prostheses.
The authors report a case of false positive diagnosis of iliac vein thrombosis on duplex ultrasound. The misreading of the duplex scan was based on the presence of an incompressible common femoral vein. External compression on the iliac veins, caused by enormous postoperative lymphoceles, was responsible for the false positive diagnosis.
Lipomatous tumors of the heart and major central veins are unusual pathologic findings. We report an intravascular lipoma arising directly from the wall of the left common femoral vein (LCFV) in a patient who had progressive left leg swelling and in whom a deep venous thrombosis in the LCFV was initially diagnosed. this is the first case report if such a tumor in the literature. the computed tomography, magnetic resonance imaging, and intraoperative features are presented. the procedure of tumor excision and venous reconstruction with a cadaveric allograft is described.
Right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal-type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.
We examined the natural course of endothelium-dependent and -independent responses in reversed autogenous vein grafts during regeneration and tissue repair processes after vein grafting in dogs. Vein grafts implanted in the canine femoral artery were removed, cut into rings, and suspended in organ chambers for isometric tension recording at 3 days and 1, 2, 4, and 6 weeks after implantation. Endothelial cells were denuded from some rings. Control veins were taken from nonsurgically treated femoral veins. Acetylcholine caused endothelium-dependent relaxations in the control veins, whereas in the vein grafts there was no evidence of endothelium-dependent relaxations to acetylcholine 3 days after the operation. Acetylcholine caused endothelium-independent contractions throughout the study. The endothelium-dependent responses to ADP and calcium ionophore A23187 were constantly maintained. Three days after the operation, the amplitude of norepinephrine-induced contractions of the vein grafts was impaired, and at 1 week the amplitude was recovered, although it was significantly smaller than the amplitude of contractions of the control veins at any postoperative period. Endothelium-independent relaxations to sodium nitroprusside were maintained throughout the study. Thus, there was a selective loss of acetylcholine-mediated relaxation in vein grafts in the early postoperative stage, a time when the intima is not thickened. These altered responses in vein grafts in the early postoperative period may have a role in graft failure.
We present a patient with phakomatosis pigmentovascularis (PPV) type IIb accompanied with venous hypoplasia, from the inferior vena cava to the superficial femoral vein. Although it is not obvious whether this vascular anomaly, which is probably congenital, is coincidental or not, it is possible that the 2 diseases have some relationship each other, because PPV is thought to result from abnormal vasomotor activity during the embryonic period. In the diagnosis of type II PPV, careful examination and several studies are required to determine systemic involvement that may include large vessel changes.
Clinical, hemodynamic, and venographic studies were performed on 46 patients undergoing reconstruction of the incompetent femoral vein and followed up for 13 years. Operations included 32 valve repairs and 14 vein segment transpositions. Twenty-four patients had perforator vein interruption in addition to valve surgery; 16 had only valve procedures; and six had had previous perforator surgery. The results indicate that ambulatory venous pressure is the most reliable hemodynamic test; it is sensitive but not specific. Descending venography proved the durability of valve repair up to 12 years. Perforator interruption improved the clinical and the hemodynamic outcomes. Good to excellent long-term results were found in 83% of the patients operated on for ulceration and, of those with recurrence, all were seen within the first four postoperative years. Restoration of competence in the femoropopliteal segment produces a long-term favorable effect. Optimal clinical, venographic, and hemodynamic results occur when all abnormal venous divisions (saphenous, perforating, and deep) are corrected.
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Previous techniques for cannulation of the coronary sinus have required entry into the right atrium from the superior vena cava. We describe a new technique for cannulation of the coronary sinus from the femoral vein using a standard, unmodified Simmons II catheter. This method was successful in 97% of the patients attempted. The method for using this catheter from the femoral route is described.
Cannulation of the coronary sinus has been usually accomplished by advancing a catheter through the brachial vein, subclavian vein, or internal jugular vein by venous cutdown or a sheath method. We here describe a technique for cannulation into the coronary sinus through the femoral vein by using a modified catheter. This catheter was easily inserted into the coronary sinus in all of 40 consecutive patients in whom it was attempted.
PURPOSE: In this study we assessed the normal common femoral vein (CFV) dimensions and related hemodynamics in a cohort assembled to permit contrasts by means of sex, age, and ethnicity. METHODS: The CFV diameter and the flow velocity were analyzed by means of duplex ultrasonography at rest and with a standardized Valsalva maneuver, with the subject in a 15% reverse Trendelenberg position. Mean levels of each of the CFV measurements were analyzed with age category, sex, and ethnicity, each adjusted for the other two. Multiple linear regression was used as a means of assessing the independent associations of age, sex, ethnicity, body mass index (BMI), and height to the CFV measurements. RESULTS: The average CFV diameter at rest was 11.84 mm, increasing to 14.27 mm during the Valsalva maneuver. There was a significant (P <.0001) decline in both diameter measures beginning in patients 60 years old. The CFV diameter was larger in men (12.90 mm) than in women (11.22 mm; P <.0001). The average CFV diameter in Hispanics, Africian Americans, and Asians was significantly smaller (P <.001) than in the non-Hispanic whites in multivarate analysis. The independence of these associations was confirmed by means of multivariate analysis, and positive associations of CFV diameter with height and BMI were documented. The Valsalva response was higher in men than in women (2.67 mm vs 2.29 mm), but the percentage change was similar. CFV velocity at rest decreased significantly (P <.0001) in patients older than 50 years. The mean CFV velocity was 13.87 cm/s, and the values were significantly (P <.0001) higher in women (14.58 cm/s) than in men (12.67 cm/s). In multivariate analysis CFV velocity was higher in African Americans than in the other ethnic groups. We also documented an independent inverse association of CFV with BMI. The CFV velocity response (peak expiration post-Valsalva) increased significantly at all ages, from 52% to 83%. The percentage increase in women (68%) was slightly higher than that in men (58%). African American subjects had a somewhat higher percentage increase (74%) than the other three ethnic groups (63% to 64%). Because the flow rate is determined more by the diameter than the velocity, CFV flow associations were similar to those for diameter. Because an older age predicted both decreased diameter and velocity, the flow reduction with age was pronounced. CONCLUSION: Quantitative normative data that are age-, sex-, and ethnic group-specific are reported on CFV diameter, velocity, and total flow rate, both at rest and with the Valsalva maneuver. CFV diameter, velocity, and flow rate varied significantly as a function of age, sex, ethnicity, height, and BMI. The data also provide a baseline assessment for subsequent evaluations of changes with time in this cohort.
In situ autogenous reconstruction is an alternative therapy for abdominal aortic prosthetic graft infection. We have used the superficial femoral vein (SFV) as an arterial substitute for proximal aortic anastomosis in seven patients. Six patients presented with aortic perigraft infections and one had a mycotic aneurysm of the infrarenal aorta with a primary aortoenteric fistula. There were no intraoperative but two postoperative deaths. During follow-up (mean: 19.8 months), one patient died at 5 months unrelated to his preceding vascular procedures; the others were doing well with patient SFV grafts 6-36 months after autogenous aortoiliac reconstruction. The SFV is a valuable donor vessel for autogenous reconstruction in the management of aortoiliac prosthetic graft infection. We explain both perioperative deaths in our treatment group with respect to the extent of the underlying infection and the virulence of the causative organism.
The effect of diosmin, a flavone derivative, on the Ca2+ sensitivity of the venous contractile apparatus was investigated in chemically (beta-escin) skinned strips from the rat isolated femoral vein. Diosmin (0.5-10 microM) shifted to the left the concentration-response curve to Ca2+ (0.05-5 microM). The maximal effect was observed in the presence of 1 microM diosmin which increased the contractile response evoked by 0.15 microM Ca2+ from 26.3% to 78.9% of the maximal Ca(2+)-induced response. This work demonstrates that the venotonic action of diosmin involves an increase in the Ca2+ sensitivity of the contractile apparatus. Such a mechanism of action could represent a new and important means of therapeutic control of vasomotor activity.
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