VALVES OF THE ILIAC AND FEMORAL VEINS.
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Prosthetic aortic infection still represents an enormous challenge to the possibilities of contemporary reconstructive vascular surgery, particularly in terms of diagnosis and surgical management, and is accompanied by high mortality and morbidity rates. Several surgical methods have been devised and employed, including the extra-anatomic bypasses and the in "situ" revascularization. The later uses either antibiotic bounded prosthesis, or biologic homologous conduits, including cryopreserved allografts or autologous arteries and veins. The authors report the clinical condition of a 73 years old male with an infected aortic prosthesis, who underwent the complete removal of the infected graft, followed by an interposition of a venous autograft composed by two superficial femoral veins, removed from both thighs (Clagett's operation). The procedure was extremely well succeeded and the patient was discharged one month later. Reviewed one year later he was found in good condition and free of symptoms.
Primary venous aneurysms are rarely encountered lesions. Case reports have been described throughout the venous system. The lesions are usually symptom-free being found as a subcutaneous mass, an incidental finding on an imaging study, or during the work-up for deep venous thrombosis. However, embolism and rupture have been rarely described. A femoral vein aneurysm is reported, along with a current review of the literature of venous aneurysms.
Colour Doppler sonography (CDS) is becoming an increasingly popular method of examining the deep venous system of the lower limb, particularly in the investigation of possible deep venous thrombosis (DVT). We describe a further application of CDS observed in three intravenous (i.v.) drug abusers who presented with symptoms mimicking a DVT. All three cases had femoral vein stenosis occurring at their injection site. This was demonstrated by CDS and at the same time DVT excluded.
A nine-year-old, male Siberian husky was presented with fever, decreased appetite and activity, non-weightbearing lameness, and oedematous swelling of the right inguinal and preputial area and the right hindlimb. An abscess within the right iliopsoas muscle, with severe thrombosis of the iliac and femoral vein, was diagnosed by haematology and diagnostic imaging. The abscess and adjoining lymph node were removed surgically through a median coellotomy. The isolated pathogen was Staphylococcus intermedius. Clinical signs resolved completely after surgery. Antimicrobial therapy was continued for four weeks. Within the follow-up period of six months, no recurrence of the clinical signs was detected.
Extrinsic (tissue-type) plasminogen activator (plasminogen activator) was isolated either as a single-chain or as a two-chain molecule from the culture medium of a human melanoma cell line. The thrombolytic activity of both molecular forms of activator was investigated in beagle dogs with an experimental femoral vein thrombosis and compared with that of urokinase. The 125I-fibrinogen-labeled thrombus was formed in an isolated 4-cm segment of the vein, aged for 30 min, and the thrombolytic substances were infused over a 4-h period. The degree of thrombolysis was measured 2 h later as the difference between the injected and recovered 125I. In six control animals with a saline infusion the extent of thrombolysis was 16.3 +/- 3.8% (mean +/- SEM), in five dogs receiving 100,000 IU urokinase, 17.4 +/- 3.7% (P less than 0.4) and in four dogs with 1,000,000 IU urokinase 40.6 +/- 4.8% (P less than 0.001). Infusion of 100.000 IU single-chain plasminogen activator in five dogs resulted in 3.5 +/- 7.8% lysis (P less than 0.05) and of 100,000 IU two-chain plasminogen activator in five dogs in 60.1 +/- 10.8% (P less than 0.001). Infusion of 300,000 IU one-chain plasminogen activator yielded 57.5% lysis and of the same amount of two-chain plasminogen activator 72.9%. Significant activation of plasminogen, consumption of alpha 2-antiplasmin, and fibrinogen breakdown in plasma was only observed in animals receiving the high doses of urokinase but not in the saline, plasminogen activator, or the low-dose urokinase groups. It is thus concluded that in this thrombosis model human extrinsic plasminogen activator has a higher specific thrombolytic effect that urokinase. Plasminogen activator also appears to induce thrombolysis without systemic fibrinolytic activation and fibrinogen breakdown.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
It is well known that blood access is essential for long-term hemodialysis treatment. Arteriovenouos fistula (AVF) is the most widely used method. However, this method of access frequently fails (access failure) as a result of stenosis. We attempt simple femoral vein puncture (FV-method) instead of AVF in such patients and have experienced 12 patients who were undergoing hemodialysis treatment using the FV-method, three times a week for more than one year. We devised special needles (18- and 19-gauge) for the FV-method. Generally, we use a 19-gauge needle with 4 side holes. We discuss here the results of 12 patients consisting of 4 males and 8 females with a mean age of 57.9 years, a mean duration of dialysis of 10.0 years, and a mean duration of FV-method of 3.5 years. Their underlying diseases were chronic glomerulonephritis (9 patients), diabetic nephropathy (2 patients) and nephrosclerosis (1 patient). Before the use of the FV-method, AVFs were attempted a man of 3.8 times and an artificial graft, 4 times in 3 patients. Ten patients were outpatients and 2 were inpatients. As for the indications of the FV-method, 11 patients had access failure and another had suffered from heart failure resulting from an over flow of blood through AVF. KT/V, PCR and TACBUN were measured monthly and were within the normal range in almost all of the patients. Concerning complications of the FV-method, hematoma formation after detachment of the needle at the end of dialysis and pain at needle puncture were sometimes noted.(ABSTRACT TRUNCATED AT 250 WORDS)
Might leg elevation and avoidance of poor postures provide better prophylaxis against venous thromboembolism than heparin or mechanical methods? 12 supine subjects tilted in 3 degrees increments from 6 degrees leg-down to 12 degrees leg-up showed linear increase in mean peak blood velocity and reduction in calibre in the common femoral vein (colour-duplex ultrasound). Between horizontal and 6 degrees leg-up, velocity was increased by 17% and diameter reduced by 14%. A ranking of mean peak velocities in six postures (sitting; standing; trunk raised 35 degrees to legs which were first horizontal and then tilted up 6 degrees; supine, first horizontal then 6 degrees leg-up) showed significant increases in velocity between consecutive positions.
We have devised a new method for right ventricular endomyocardial biopsy, in which the use of a right ventriculography catheter (Nishiya Type) allows us to ensure the introduction of a guiding sheath (Cordis, right-angled long sheath) to the apical portion of the right ventricle by way of the femoral vein. With this method, we have biopsied the endomyocardium in 52 patients during the last 4 years. In each case, it only took us several minutes to complete the biopsy procedure. Neither failed applications nor significant complications were seen. We believe that this technique provides a clinically beneficial means as it enables us to readily and safely achieve right ventricular endomyocardial biopsy.
Venous thrombosis is a very rare occurrence in patients with haemophilia A. We report the case of a haemophiliac in whom initially a calf haematoma was suspected, but neither this nor deep venous thrombosis (DVT) could be confirmed on ultrasound scanning. Subsequently, a high segment venous thrombosis was diagnosed by venography in a portion of a duplicated superficial femoral vein. Treatment with factor VIII (FVIII) and low molecular weight heparin led to a successful resolution. The only other case we have been able to find in the literature occurred during FVIII replacement therapy, which was not the situation with our patient.