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At least 55 records · Page 3Linked to original sources
PubMed1990

The use of internal jugular vein as interposition graft for femoral vein reconstruction following traumatic venous injury: a useful approach in selected cases.

Complex venous injuries remain a controversial and interesting challenge to the vascular and trauma surgeon. Data from the Vietnam Vascular Registry, combined with experience from recent civilian series, seem to indicate that the best results are obtained when venous repair is undertaken. This is especially true of combined arterial and venous injury where compromised venous outflow may lead to limb loss in spite of patent arterial reconstruction. The larger size of veins, however, has required the construction of complex and time-consuming panel and spiral-vein grafts. This makes them far from ideal in the trauma treatment setting, where minimization of blood loss and operating room time are high priorities. We present a case of combined injury to both femoral artery and vein, where the femoral vein injury was repaired using autologous internal jugular vein as interposition graft while the arterial injury was repaired with autologous saphenous vein from the opposite limb. The avoidance of prosthetics, ease of harvest, size match, and little associated morbidity all make a strong case for use of the internal jugular vein where speedy reconstruction of large venous conduits is indicated.

Adolescent↗
PubMed1986

Effect of cooling on alpha-1 and alpha-2 adrenergic responses in canine saphenous and femoral veins.

Experiments were designed to determine the effects of cooling on alpha-1 and alpha-2 adrenergic responses in isolated canine veins. Rings of saphenous and femoral veins were suspended for isometric tension recording in modified Krebs-Ringer bicarbonate solution, gassed with 95% O2 and 5% CO2. Cooling (from 37-24 degrees C) augmented contractions to norepinephrine in saphenous but caused depression in femoral veins. Cooling (to 24 degrees C) had no effect on alpha-1 adrenergic responses evoked by phenylephrine in saphenous veins but caused depression in femoral veins. Alpha-2 adrenergic responses produced by UK 14,304 were augmented by cooling in the saphenous but were virtually abolished by cooling in femoral veins. Cooling decreased the dissociation constant (i.e., increased affinity) of corynanthine for alpha-1 adrenoceptors in saphenous and femoral veins (approximately 3-fold), and the dissociation constant of rauwolscine for alpha-2 adrenoceptors in saphenous veins (approximately 7.5-fold). The influence of cooling on alpha adrenoceptor responsiveness was analyzed using computer-generated receptor-models. The results suggest that the differential sensitivity of cutaneous and deep blood vessels to cooling results from differences in efficiency of alpha-1 and alpha-2 adrenoceptor response coupling. In the saphenous vein, there is a large alpha-1 adrenoceptor reserve which buffers the alpha-1 adrenergic response from the inhibitory influence of cooling. This coupled with a cooling-induced increase in alpha-2 adrenoceptor affinity ensures that cooling augments the response to norepinephrine. In the femoral vein, there is no alpha-1 adrenoceptor reserve and cooling therefore depresses alpha-1 adrenergic responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Management of superior vena cava syndrome by internal jugular to femoral vein bypass.

We report a 30-year-old man with superior vena cava syndrome due to fibrosis from a previously irradiated malignant thymoma. The patient presented 4 years after the initial treatment, after having been lost to follow-up. Investigations revealed total obstruction of the superior vena cava, and right subclavian and right internal jugular vein. The patient underwent an extra-anatomic bypass (ringed polytetrafluoroethylene graft 10-mm diameter) between the left internal jugular vein and the left femoral vein brought in a subcutaneous tunnel over the anterior chest and abdominal wall. Entry to the thoracic cavity was avoided due to extensive fibrotic changes visualized in the computed tomographic chest scan. Follow-up Doppler at 2 months, 6 months, 1 year, and 3 years showed a patent graft. An internal jugular vein to the femoral vein bypass is a simple method for palliation of superior vena cava syndrome.

Adult↗
PubMed1993

Femoral vein delivery of contrast medium enhances transthoracic echocardiographic detection of patent foramen ovale.

OBJECTIVES: We postulated that femoral vein delivery of contrast medium because of streaming, might enhance precordial echocardiographic detection of patent foramen ovale. BACKGROUND: Although precordial contrast echocardiography is widely used to diagnose patent foramen ovale, this method is limited by poor sensitivity. Previous investigators have demonstrated enhanced detection of atrial defects by the dye-dilution technique after delivery of contrast medium into the inferior rather than the superior vena cava. METHODS: Transthoracic contrast examinations were performed in a randomly selected group of 70 patients (without previous history of cerebral or systemic embolus) undergoing cardiac catheterization. Paired contrast agent injections (10 ml dextrose in water/0.25 ml air) were administered from an upper extremity vein and femoral vein in each patient during spontaneous respiration, cough and Valsalva maneuvers. Studies were interpreted by an experienced echocardiographer unaware of the sequence and site of injections. Positive studies were semiquantitatively graded from +1 (minimal left ventricular opacification) to +4 (intense left ventricular opacification). Catheterization and echocardiographic assessment of patent foramen ovale were compared in 21 subjects. RESULTS: Patent foramen ovale was detected significantly more often during femoral vein versus upper extremity contrast delivery (23 of 70 patients [prevalence 33%] vs. 9 of 70 patients [prevalence 13%], p < 0.001). The intensity of left ventricular opacification was also greater during femoral vein contrast injection. Precordial echocardiography combined with femoral contrast delivery was significantly more sensitive than cardiac catheterization for assessment of patent foramen ovale (8 of 21 patients vs. 2 of 21 patients, p < 0.05). CONCLUSIONS: Femoral vein contrast delivery significantly enhances the ability of precordial contrast echocardiography to diagnose patent foramen ovale. Physiologic patency of the foramen ovale is more common (prevalence 33%) than previously documented.

Arm↗
PubMed2005

Common femoral vein aneurysm simulating an inguinal hernia.

Common femoral vein aneurysms are rare, yet knowledge of this entity is important for the surgeon who performs hernia repairs. This is because common femoral vein aneurysms can simulate inguinal or femoral hernias, and misdiagnosis can lead to significant morbidity if treated incorrectly. To our knowledge, only five other cases of femoral aneurysms simulating inguinal or femoral hernias have been reported. We present the case of a 50-year-old male with inguinal pain and swelling who was found to have a common femoral vein aneurysm at surgical exploration for hernia repair. The etiology, diagnostic strategy, and management options for common femoral vein aneurysm are presented and are followed by recommendations for operative management. In the case of an unanticipated femoral aneurysm found during hernia repair, we recommend termination of the procedure followed by elective repair to be performed after appropriate diagnostic testing has been completed.

Aneurysm↗
PubMed2003

[Evaluation of the hemodynamic significance of femoral vein insufficiency].

Deep vein incompetence is generally regarded as the main cause of severe chronic venous insufficiency, without specifying which deep vein segments are really meant. Opinions concerning hemodynamic significance of femoral vein incompetence differ considerably. Femoral vein incompetence can be part of a postthrombotic syndrome, it can occur as a primary incompetence described by Kistner or as a secondary incompetence due to vein dilatation. Therapeutic possibilities and outcome of valvuloplasty and valve transplantation described in the literature are presented. The results of valve transplantation into the popliteal vein in postthrombotic patients were disappointing. In primary varicose veins the saphenous incompetence is often accompanied by femoral vein reflux which mostly disappears after removal of incompetent saphenous vein; the possible mechanism causing this phenomenon is discussed. In cases with combined saphenous and femoral vein reflux the most important factor causing venous derangement is the saphenous reflux, not the femoral vein incompetence; therefore, the first therapeutic step in such cases must be the abolition of saphenous reflux. The question whether femoral vein incompetence deteriorates the natural course of primary varicose veins can't so far be answered conclusively, but the first reports concerning this issue show that it could be answered yes.

Femoral Vein↗
PubMed2006

Ultrasonographic investigation of the effect of reverse Trendelenburg on the cross-sectional area of the femoral vein.

Emergency physicians often obtain central venous access via the femoral vein in critically ill patients or patients with difficult peripheral access due to chronic intravenous drug use. Previous studies using two-dimensional ultrasonography have demonstrated that the Trendelenburg position increases the cross-sectional area of the internal jugular vein. This study is designed to determine the effect of the Reverse Trendelenburg position on femoral vein dimensions using bedside ED ultrasonography. A prospective, non-randomized observational study was conducted that enrolled subjects at an urban Level I Trauma Center and an affiliated School of Medicine over a 2-month period. Informed consent was obtained from 52 adult subjects with no history of deep venous thrombosis or vascular surgery in the lower limbs. Using two-dimensional ultrasound with a 7.5-MHz linear transducer, femoral vein cross-sectional areas on the right and left sides were measured with subjects supine, and in approximately 15 degrees reverse Trendelenburg. The data was analyzed using a two-tailed Student's t test. The mean cross-sectional area of the femoral vein with subjects supine was 0.85 cm(2) (SD +/- 0.41 cm(2)), and 1.22 cm(2) (SD +/- 0.51 cm(2)) with subjects in reverse Trendelenberg. The cross-sectional area of the femoral vein increased significantly (p < 0.001) with the reverse Trendelenburg position [55.2% +/- 9.1% (95% CI)]. In conclusion, a significant increase in femoral vein cross-sectional area can be achieved with the reverse Trendelenburg position. This maneuver may increase the rate of successful femoral vein catheterization.

Adult↗
PubMed1987

Endothelium-dependent responses in autogenous femoral veins grafted into the arterial circulation of the dog.

Endothelium-dependent responses differ in arteries and veins of the dog. Experiments were performed to determine whether chronic grafting of veins into the arterial circulation would alter the endothelium-dependent responses of the veins. Segments of femoral veins were grafted to the femoral artery of the dog. 6 wk after surgery the venous grafts were removed from the dog, cut into rings, and suspended in organ chambers for isometric tension recording. In some rings the endothelial cells were removed. Acetylcholine and alpha 2-adrenergic agonists did not cause endothelium-dependent relaxations in venous grafts. The calcium ionophore (A23187) initiated such relaxations which were not mediated by prostanoids. Endothelium-dependent relaxations were also observed in venous grafts to ADP, thrombin, and arachidonic acid. In segments of graft where myo-intimal hyperplasia was prominent, relaxations to ADP, thrombin, and A23187 were blunted and in some segments contractions were observed. These results demonstrate the ability of the endothelium of venous grafts to initiate changes in tone of the smooth muscle.

Acetylcholine↗
PubMed1990

Femoral vein occlusion during hip arthroplasty.

The mechanism of femoral vein occlusion when the hip joint is dislocated and manipulated during arthroplasty has been studied in fresh anatomic specimens. Flow studies show that moderate degrees of flexion and adduction in association with dislocation obstruct venous flow just distal to the femoral sheath at normal pressures and flow rates. Internal femoral rotation during a posterior approach to the hip causes "scissoring" of the femoral vein between femur and pubic bone. External femoral rotation during an anterior approach does not occlude flow. Injection of Batson's acrylic and neoprene latex showed that obstruction is also due to about 4 cm of shortening caused by proximal migration of the femur after dislocation in association with adduction and flexion. The femoral vein in the unsupported segment distal to the femoral sheath subsequently buckles and kinks. During operative manipulation, intermittent obstruction at this level is therefore likely to cause intermittent venous distension distally. This mechanism depletes the femoral vein of fibrinolytic activity distal to the occlusion and may explain the incidence of deep femoral thrombosis peculiar to this procedure.

Femoral Vein↗
PubMed1989

Femoral vein thrombosis following percutaneous placement of the Greenfield filter.

Following percutaneous insertion of the Greenfield inferior vena cava filter via the femoral route, patients were evaluated for femoral vein thrombosis by real-time ultrasound or Duplex sonography. In 23 patients (24 veins) the femoral vein was dilated with an 8-mm (24 F) angioplasty balloon catheter. Eight of 24 common femoral veins were thrombosed (33%). These findings indicate that thrombosis is a significant complication of percutaneous filter insertion. Dilation was performed in 20 patients (22 veins) with a 9-mm (27 F) balloon catheter; only three veins were thrombosed (14%). Over-dilation of the femoral vein to 27 F to accommodate the 24 F sheath/dilator set may decrease the incidence of thrombosis.

Bloodletting↗
PubMed2003

Repeated femoral vein puncturing for maintenance haemodialysis vascular access.

BACKGROUND: When access cannot be achieved using a native arteriovenous fistula or a synthetic prosthetic graft, central venous catheters are usually placed. This mode of access is short-lived, prone to infection, stenosis and thrombosis of central veins. To overcome access problems, we developed a new native vascular access ('femoral vein access') and devices. We report here on our experience with the availability, longevity, procedure and morbidity of haemodialysis (HD) using femoral vein access. METHODS: Repeated (three times a week) patient's native femoral vein puncturing has been used as the vascular access (femoral vein access) for maintenance HD in 30 patients (mean age +/- SD: 61.70 +/- 15.27 years old; 18 female/12 male). The femoral vein was punctured beneath the inguinal ligament (on a length ranging from 30 to 100 mm) after disinfection and local anaesthesia. Long (effective length 56 mm) 19- and 18-gauge needles with four side holes were used for the femoral vein puncture as an arterial site of the extracorporeal circuit of HD and shorter (effective length 40 mm) similar gauge needles for the subcutaneous vein puncture used as the return site. The needle is inserted blind into the femoral vein after the femoral artery has been located by palpation and the perception of a pulse. Patients returned home the same day. RESULTS: The mean duration of HD treatment using femoral vein repeated puncture was 4.99 +/- 3.42 years (up to 16.0 years). This represented a total experience of 23 369 femoral vein punctures. The mean blood flow achieved on dialysis was 165 +/- 20 ml/min. The average Kt/V was 1.74 +/- 0.48 per session. CONCLUSIONS: The femoral vein repeated puncture technique has substantial advantages over venous catheters. It does not require surgery, while permitting adequate blood flow. This method can be used as a long-term (over 10 years) blood access. Apart from a few local haematomas, no serious complications have been observed. Moreover, it does not carry a heavy financial burden.

Adult↗
PubMedDate not supplied

[Results of vascular repairs in trauma of the femoral veins, iliac veins and the inferior vena cava].

We examined the records of 12 patients operated for lesions of the inferior vena cava, the iliac vein, or the common femoral vein were examined. The results of venous grafts, treatment of the lesions of the posterior inferior vena cava or the supra hepatic vena cava and the permeability after repair of these large vessels was studied. Treatment included simple suture (n = 9), venous patch (lateral iliac vein, n = 1), and venous autografts (common femoral veins, n = 2). For 3 lesions of the posterior or supra-hepatic inferior vena cava, haemostasis was obtain by double clamping (n = 2) or four-way clamping (n = 1) with right hepatectomy. In 9 cases, the patients were followed-up for a mean of 59 months. Morphologic exploration with phlebography (n = 1) or echo-Doppler examination (n = 7) was performed during the follow-up period. There were no post-operative deaths. There were no functional sequellae affecting the lower limbs. In one case, the echo-Doppler examination revealed repermeabilization of a thrombosed lateral iliac vein after simple suture. Lesion repair of large diameter veins with autografts using the internal jugular or internal saphenous vein gave good results. Haemostais of posterior or supra-hepatic lesions to the inferior vena cava was obtained with clamping. In cases with associated hepatic involvement, haemostasis was controlled with a four-way clamp and trans-hepatic access or digitoclasty. Long-term permeability of venous repair was good.

Abdominal Injuries↗
PubMed2000

Femoral vein size in newborns and infants: preliminary investigation.

BACKGROUND: The femoral vein is an important site for central venous access in newborns and infants. The objectives of this study are to determine whether age or weight can be used clinically to predict the size of the femoral vein in newborns and infants, and to compare the size of the vein in each individual in both the supine and reverse Trendelenburg positions. RESULTS: Analysis was done in 24 euvolemic individuals, each studied in both the supine and reverse Trendelenburg positions. Twelve of these individuals were newborns and 12 were infants. We used two-factor analysis of variance to explore differences between groups and multiple linear regression analysis to estimate the strength of the relationship between variables. In the infant group, there was a correlation between femoral vein diameter and weight. There was no correlation between weight and vessel size in newborns. In both the newborn and infant groups, vessel diameter increased with subjects in the reverse Trendelenburg position (P < 0.01). CONCLUSION: Weight is predictive of femoral vein diameter in infants, but not in newborns. In infants, weight might serve as a more sensitive index for estimating size of the femoral vein in order to determine accurately the size of intravascular catheter appropriate for cannulation. The diameter of the femoral vein increases in the reverse Trendelenburg position compared with that in the supine position in both newborns and infants. A large prospective study is required to validate these findings.

Body Height↗
PubMed1991

[Venous insufficiency following lack of a healthy superficial femoral vein and popliteal vein].

Using the superficial femoral yein in ultimate arterial reconstructive surgery we have not found distinct signs of venous insufficiency concerning the clinical status, the strain gauge plethysmography and the measurement of limb circumference. For special indications the use of the superficial femoral vein presents a valuable addition to our armamentarium of arterial substitutes.

Adult↗
PubMed1992

Constriction of the femoral vein after McVay inguinal hernia repair.

The femoral vein is easily constricted during McVay herniorrhaphy, yet this complication is rarely reported. A case of femoral vein constriction caused by McVay herniorrhaphy that has been documented by venous duplex scanning is presented. A review of the literature is provided with a discussion of the technical aspects of McVay hernia repair. Venous duplex scanning is demonstrated to be an excellent noninvasive means of evaluating possible femoral vein constriction after herniorrhaphy.

Adult↗
PubMed1997

A rare variation of deep femoral vein.

Venous pattern particularly in the lower limbs is of great clinical importance, while ligating the veins to prevent the spread of thrombus. Normally deep femoral vein drains the area supplied by profunda femoris artery, follows the pattern of branches of this artery and ends independently into the femoral vein. However in few cases it establishes communication with popliteal vein of femoral vein at a lower level. In the present study the deep femoral vein replaced most of the popliteal vein by establishing communication with the tibial veins.

Adult↗