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PubMed2004

Adventitial cystic disease of the femoral vein: report of a case.

Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.

Blood Vessel Prosthesis Implantation↗
PubMed1993

Endomyocardial biopsy in heterotopic heart transplant recipients via the femoral vein.

The results of endomyocardial biopsy (EMB) via the femoral vein in heterotopic heart transplant recipients were retrospectively analyzed and compared with those obtained using the right internal jugular vein approach. A total of 139 EMB were performed in 8 patients using the femoral (35) or the jugular (104) approach. Twenty three (64.7%) of the procedures performed via the femoral vein were part of the yearly hemodynamic and coronary artery study, and 12 (35.3%) constituted a routine postoperative evaluation of the myocardium rejection state in patients with imperviousness of the right internal jugular vein. Comparing the results obtained with the femoral approach, we observed a higher overall success rate (94.3 vs 88.5%, NS) and obtained more samples that were useful for histologic evaluation (95.5 vs 85.9%, NS); with the jugular procedure, the fragments were significatively larger in diameter (1.28 +/- 0.55 vs 1.61 +/- 0.85 mm, mean +/- SD) and in area (1.49 +/- 1.16 vs 2.28 +/- 2.24 mm2, mean +/- SD). No cardiac or local complications were noted when the femoral approach was used, while two attempts to perform biopsy via the jugular vein resulted in obstruction of this vessel. Our data suggest that the femoral venous approach for endomyocardial biopsy in heterotopic heart transplant recipients is a valid alternative to the more commonly used routes.

Biopsy↗
PubMed1986

Venous blood flow in the leg after ligation of the femoral vein during cardiac catheterization in young children.

In the period from 1963 to 1973, 143 heart catheterizations were carried out in children under two years of age. In 33 patients, the femoral vein was exposed by cutdown and ligated afterward. Ten of these patients (the other 23 having died in the intervening years) were available for follow-up and the venous outflow of the lower extremities was studied. Nine of the ten patients showed no abnormality, but one patient had developed varicose veins. In this patient, plethysmography showed reduced venous outflow, and phlebography showed narrowing of the common femoral vein at the site of earlier ligation, indicating recanalization. It is concluded that, if the femoral vein must be used, careful dissection is necessary to secure the bifurcation of the femoral vein and avoid ligation of the common femoral vein.

Cardiac Catheterization↗
PubMed1993

Characterization of postsynaptic alpha-1 and alpha-2 adrenoceptors in the feline saphenous and femoral veins [corrected].

Experiments were designed to characterize the effects mediated by alpha-1 and alpha-2 adrenoceptors in saphenous and femoral veins of the cat. Ring segments of saphenous and femoral veins were mounted for isometric tension recording in modified Krebs-bicarbonate solution, gassed with 95% O2-5% CO2 and maintained at 37 degrees C. Norepinephrine (a mixed alpha 1 and alpha 2 agonist), phenylephrine (a preferential alpha 1 agonist) and clonidine (a preferential alpha 2 agonist) caused dose (concentration)-dependent contractions in saphenous and femoral veins. The maximal contractions produced by clonidine were significantly less than those produced by norepinephrine or phenylephrine in both veins. However, threshold dose and EC50 values indicated that clonidine was more potent than norepinephrine and phenylephrine. Contractile responses to these agonists were attenuated when the veins were pretreated with alpha 1-or alpha 2-adrenoceptor antagonists, prazosin and yohimbine, respectively. The contractile responses to norepinephrine and tyramine were inhibited to a greater extent by yohimbine than by prazosin in both saphenous and femoral veins, suggesting that norepinephrine released from perivascular nerve terminals activates preferentially postsynaptic alpha 2-adrenoceptors. Further examination of alpha-adrenoceptor subtypes was achieved by comparing pA2 values of prazosin and yohimbine from Arunlakshana and Schild plots. Chronic sympathetic denervation by removing lumbar sympathetic chain significantly reduced the contractile responses evoked by tyramine. Denervation did not significantly affect the concentration-response curve to phenylephrine but significantly augmented the contractile responses evoked by clonidine in both veins.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗
PubMed1982

Dual effect of dihydroergotamine and dihydroergotoxin in isolated human femoral veins and arteries.

In human femoral vein strips, dihydroergotamine and dihydroergotoxin caused a slowly proceeding, long-lasting increase in tone. Dihydroergotamine had markedly higher affinity than noradrenaline, it possessed nearly the same intrinsic activity as noradrenaline. Dihydroergotoxin was less effective than dihydroergotamine. In isolated femoral artery strips, dihydroergotamine showed lower affinity and lower intrinsic activity in terms of noradrenaline. Dihydroergotoxin had negligible vasoconstrictor effects in arteries. In veins, dihydroergotoxin had a stronger alpha-adrenolytic effect than in arteries. In isolated arteries, dihydroergotoxin was equieffective to dihydroergotamine whose alpha-adrenoceptor blocking effect did not significantly differ in veins and arteries. Our results show that dihydroergotamine at very low concentrations exerted predominantly venoconstrictor effects and, therefore, it is more suited to increase the venous tone than dihydroergotoxin which at low concentrations showed alpha-adrenoceptor blocking activity.

Dihydroergotamine↗
PubMed1996

Frequency of complications with prolonged femoral vein catheterization for hemodialysis access.

Analysis of 120 cases of femoral vein catheterization for > or = 2 days for hemodialysis in 89 hospitalized patients was performed to determine the frequency of catheter-related complications including infection and venous thrombosis. The rate of clinically significant complications was < 3.5% and compared favorably with published complication rates of central vein catheters. We conclude that prolonged femoral vein catheterization for hemodialysis is associated with an acceptably low rate of complications when appropriate techniques for placement and catheter care are followed and should be considered a reasonable option for vascular access in hospitalized patients.

Adolescent↗
PubMed2002

Acute effects of 17beta -estradiol on femoral veins from adult gonadally intact and ovariectomized female pigs.

Our experiments were designed to determine the acute effects of 17beta-estradiol on femoral veins from intact and ovariectomized female pigs. Rings of femoral veins with or without endothelium were suspended in organ chambers for measurement of isometric force. Concentration-response curves to 17beta-estradiol (10(-9) to 10(-5) M) were obtained in veins contracted with prostaglandin F(2alpha) in the absence and presence of inhibitors of either estrogen receptors (ICI-182780; 10(-5) M), nitric oxide synthase [N(G)-monomethyl-l-arginine (l-NMMA); 10(-4) M], soluble guanylate cyclase (1-H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one; 10(-5) M), or potassium channels (tetraethylammonium; 10(-2) M). Estrogen receptors were identified with the use of Western blotting and immunostaining in veins of both groups. 17beta-Estradiol caused acute endothelium-dependent relaxations in both groups. Relaxations to 17beta-estradiol were inhibited by l-NMMA and 1-H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one but not ICI-182780. Tetraethylammonium inhibited relaxations only in veins with endothelium from intact females. Results indicate that 17beta-estradiol causes acute endothelium-dependent relaxations in femoral veins. The relative contribution of nitric oxide and K(+) channels as mechanisms involved in relaxations to 17beta-estradiol in femoral veins is modulated by ovarian status.

Animals↗
PubMed1987

Effects of calcium channel blockers on the contractile response to dihydroergotamine in isolated human femoral veins.

Contractions induced in spirally cut human postmortem femoral veins by dihydroergotamine, noradrenaline, or 5-hydroxytryptamine (5-HT) were measured isometrically. The influence of calcium channel blockers (verapamil, diltiazem and nifedipine), lanthanum chloride and withdrawal of external calcium on the contractile response of veins to dihydroergotamine was investigated. The agonists noradrenaline and 5-HT were studied in comparison. Verapamil and nifedipine up to a concentration of 1 mumol/l caused a shift to the right of the cumulative concentration-response curves for noradrenaline and 5-HT with a reduction of the maximum contraction. Diltiazem affected the contractile response to 5-HT slightly. The venocontractions induced by dihydroergotamine at a concentration of 0.03 mumol/l were inhibited by the calcium channel blockers in a concentration-dependent manner. Verapamil was most effective, followed by nifedipine and diltiazem. In dihydroergotamine-precontracted veins nifedipine produced a more pronounced relaxation than verapamil. Lanthanum chloride (5 mmol/l) inhibited the dihydroergotamine-induced contraction by about 90%. Exposure of veins to a calcium-free medium for 30 min resulted in an inhibition of the dihydroergotamine-induced venocontraction by more than 90%. The addition of calcium ions to the medium caused an increase in the contraction with a maximum which closely resembled that of the control. The present studies demonstrate that the contractile response of human femoral veins to dihydroergotamine depends to a great extent on extracellular calcium. However, the calcium channel blockers verapamil, diltiazem and nifedipine, inhibit the agonist-induced venocontractions in part only.

Adult↗
PubMed2004

[The evaluation for the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency].

OBJECTIVE: To evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI). METHODS: Ninety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation. RESULTS: The difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05). CONCLUSIONS: Clinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.

Adult↗
PubMed1999

External femoral vein valvuloplasty with limited anterior plication (LAP): a 10-year randomized, follow-up study.

The aim of this study was to evaluate the effects after 10 years of external valvuloplasty of the femoral vein (limited anterior plication or LAP). After informed consent patients with venous hypertension due to deep and superficial venous incompetence were randomized into two treatment groups. Both groups were treated with superficial vein surgery (ligation and section of the major incompetent superficial veins). Group 2 was treated with the same procedure and with LAP. External valvuloplasty of the superficial femoral vein was performed with plication of the anterior vein wall after limited dissection of the vein. Results were evaluated with color-duplex scanning and ambulatory venous pressure (AVP) measurements. Endpoints were AVP, refilling time (RT), presence/absence of reflux at the superficial femoral vein, the variation in the diameter of the vein, and quality of life score (QLS). No complications were observed. All femoral veins treated with LAP were competent after 10 years. Significantly lower AVP and longer RT were observed in the LAP group. Also the average diameter of the vein was smaller in the LAP group. Moreover, QLS was significantly better in the LAP group after 10 years. In conclusion, in selected subjects, with moderate deep venous incompetence, functional cusps, or incompetence mainly due to relative enlargement of the femoral vein, LAP may be an effective alternative to external valvuloplasty.

Adult↗
PubMed1981

Femoral vein pressure measurements for evaluation of venous function in patients with postthrombotic iliac veins.

Fifty patients with postthrombotic disease were examined by phlebography and by bilateral femoral vein pressure measurements. The degree of obstruction to venous flow was best evaluated by measuring the pressure elevation and pressure difference after exercise and the time required for these parameters to return to pre-exercise levels; pressures during rest and exercise were less conclusive indicators of obstruction. Good correspondence was found between femoral vein pressure and the severity of postthrombotic symptoms, while phleboraphy provided largely morphologic, rather than functional, information. We, therefore, consider it important to determine femoral vein pressure during and after exercise to evaluate the significance of postthrombotic iliac vein disease.

Adult↗
PubMed2005

False aneurysm of the common femoral vein in a footballer.

Traumatic false aneurysm of the femoral vein has never been reported in the English literature. The case is here reported of a footballer with a traumatic false aneurysm of the common femoral vein which was initially misdiagnosed as an arterial pseudoaneurysm. This is a very rare clinical condition, but this diagnosis should be among those considered for post-traumatic unexplained thigh pain after trauma.

Adult↗
PubMed1985

[Structural and histochemical characteristics of different variants of the perimuscularization of the femoral vein in an experiment].

Structural and histochemical changes in the region of perivenous muscular constrictors created by means of experimental perimuscularization of the femoral vein were studied and compared. Thirty-two mongrel dogs were operated on. In 18 dogs, perimuscularization was made by placing the femoral vein beneath a flap from the medial head of the musculus quadriceps femoris. In 14 dogs, the proximal segment of the dissected femoral vein was introduced through a tunnel formed in the medial head of the musculus quadriceps femoris followed by restoration of the vein continuity by an angiography apparatus. It has been shown that the method of the femoral vein introduction through the muscular tunnel is very promising, since it results in minimal histostructural changes in the vessel and the adjacent muscle.

Animals↗
PubMed2000

Specific determination of endothelial cell viability in the whole cell fraction from cryopreserved canine femoral veins using flow cytometry.

Abstract: An efficient method for specifically determining the viability of endothelial cells (EC) from cells dissociated from the human saphenous vein was investigated. Three different methods, trypan blue staining assay, [3H]-proline incorporation assay, and flow cytometry (FCM), combined with the fluorescein isothiocyanate conjugated with Griffonia simplicifolia agglutins (GS1-FITC)/propidium iodide (PI) double staining, were used. Both trypan blue staining and [3H] proline incorporation assays demonstrated less sensitivity to determine viability of EC differentially from the other cells. FITC-GS1 showed prominent binding to the vascular EC and could be counted by FCM including PI on dead cells. Following the cryopreservation process, the GS1-FITC/PI FCM analytical method was adopted to test simultaneously the viability of whole cells and EC from the same tissue, human saphenous veins, and mongrel dogs' femoral veins after harvesting, antibiotic solution treatment, and thawing. The viability of the whole cells from veins decreased with a significant difference (p < 0.05) from that of EC after thawing.

Animals↗
PubMed2000

Phlegmasia cerulea dolens with compartment syndrome: a complication of femoral vein catheterization.

OBJECTIVE: Central venous catheterization is commonly performed in the critically ill. The femoral vein is widely accepted as an insertion site with complications thought to be comparable to other central access sites. We used serial ultrasound examinations with Doppler to examine the evolution of a heretofore undescribed complication of femoral vein catheterization, phlegmasia cerulea dolens with compartment syndrome. DESIGN: Serial ultrasounds were performed in patients before the insertion of femoral venous catheters and sequentially every 48 hrs while the catheters were in place. The noncatheterized leg served as a control. SETTING: A trauma and life support center of a tertiary multidisciplinary critical care unit. PATIENT: A 32-yr-old man with respiratory failure as a consequence of a severe community-acquired pneumonia that required central venous access for antibiotics because no peripheral sites could be obtained. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The initial ultrasound examination of both legs before femoral catheter insertion revealed no sign of venous thrombosis. Ultrasound of the catheterized leg at 48 hrs revealed a small nonocclusive thrombosis, whereas the opposite leg remained normal. At 72 hrs, the catheterized leg had clinical and ultrasonographic evidence of a massive thrombosis. A compartment syndrome defined by pressure measurements soon ensued and required emergent surgical release. CONCLUSIONS: This case report and a review of the available literature suggest that thrombosis associated with femoral vein catheterization should be considered when clinicians decide where to obtain central venous access when multiple sites are available. This report also suggests the utility of serial ultrasound examinations to define clinically nonapparent thrombosis as an early indicator of a potentially catastrophic complication.

Adult↗
PubMed2002

[Long-term results after femoral vein valve repair for chronic venous insufficiency].

OBJECTIVE: Our long-term results with anterior venous sinus plication (AVSP) for femoral vein reconstruction will be presented. PATIENTS AND METHODS: Between 1986 and 2001 we treated 2 100 patients in our hospital for chronic venous insufficiency. In 3.3 % of the patients (n = 70) an AVSP of the target valve, which is the highest valve of the femoral vein distally of the profundal vein branch was carried out. 50 patients could be followed for 2-15 (average 4.6) years postoperatively by phlebographic control. RESULTS: Four recovery patterns after valve repair were seen on venography. The most typical type was the plicated site stop seen in 22 of 50 patients (44 %). Here the venous reflux was stopped at the plicated site directly. The clinical results were good or excellent for all patients. No patient underwent a second procedure for recurrence of the symptoms. A profundal femoral vein reflux did not negatively influence patient outcome. CONCLUSION: AVSP is an excellent method of valve repair in strictly selected patients with chronic venous insufficiency (= no postthrombotic syndrome, no thrombotic occlusion of the femoral veins). Long-term results up to 15 years were highly satisfactory.

Adult↗
PubMedDate not supplied

[The ostial valve of the junction of the internal saphenous vein and the wall of the femoral vein].

Anatomical, pathological and Doppler-ultrasonographic study has enabled analysis of the various mechanisms participating in normal valve function as well as during insufficiency of the deep and superficial venous systems. This leads to definition of normal morphology and of that of its various pathological changes, analysis of the various mechanisms via study of vein wall and valve behaviour and, finally, to determination that the absolute integrity of the vein wall and its valves is essential if a good hemodynamic result is to be obtained and that these two factors must work together since the inadequacy of one or other would result in valvular insufficiency. The following abnormalities of the ostial valve have been identified: a) loss of insertion into the vein wall of a valve segment, this being the most common; b) valve retraction; c) total destruction of the valve with persistence of fragments. Doppler-ultrasonography has shown that the only visible part of the valve system is the vein wall and the free edge of each valve, enabling determination in a context of valvular insufficiency of the existence of: Vein wall distension. Abnormal valve movements: a) valve prolapse; b) paradoxal movements; c) valve rigidity; d) trans-valve reflux. This same investigation also enabled us to confirm certain differences concerning relative valvular insufficiency, i.e. major vein wall distension accompanied by absence of contact, at the mid-line, with the free edge of each valve. It was possible in the group of patients with insufficiency of the deep venous system to closely evaluate the action of the reflux hypertensive wave on the ostial valve, in the case of total valve absence and in cases showing insufficiency of the first vein wall valve.

Adult↗