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Schwartz DA, Talbott J, Callen A, Laguna B, Narvid J, Ch'ang JH, Singh V. Classification of traumatic injury to the dural venous sinus using CT venography. J Neuroimaging 2024; 34:205-210. [PMID: 38146071 DOI: 10.1111/jon.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis (CVST) is an underrecognized cause of morbidity in acute traumatic brain injury (TBI). Radiologic diagnosis is challenging in the setting of concurrent extra-axial injury and a lack of standardized diagnostic criteria. The prevalence of traumatic thrombosis versus compression is unknown. Treatment with anticoagulation is often determined by the appropriate classification of the type of traumatic venous injury. METHODS We developed a two-part radiologic grading method for standardized assessment of traumatic CVST based on (1) the degree of flow limitation through the affected sinus and (2) the location of venous pathology (ie, external compression vs. intrinsic thrombosis) based on computed tomography venography. We applied this grading method to a retrospective cohort of TBI patients presenting to a Level 1 Trauma center. Chart review was performed to identify potential clinical correlates. A senior neuroradiologist graded the entire cohort and a random subsample was selected for blinded rating by two independent neuroradiologists. RESULTS Seventy-six of 221 patients were identified for inclusion after excluding nontraumatic mechanisms. Seven unique grades were employed to characterize the full extent of venous injuries. The plurality of patients from the cohort (43/76 = 43.4%) suffered compressive injuries. Inter-rater reliability was moderate for the combined grade, kappa = 0.48, p<.05, and substantial for the flow limitation component, kappa = 0.69, p<.05. CONCLUSIONS We introduce a standardized two-part classification system for traumatic venous sinus injury with moderate-substantial inter-rater reliability. Compressive injuries were more common than thrombotic injuries. Further prospective work is needed to validate the clinical significance of this classification system.
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Affiliation(s)
- Daniel A Schwartz
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Neuro-Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jason Talbott
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Andrew Callen
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
- Department of Neuroradiology, University of Colorado, Aurora, Colorado, USA
| | - Benjamin Laguna
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Jared Narvid
- Department of Neuroradiology, University of California San Francisco, San Francisco, California, USA
| | - Judy H Ch'ang
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Vineeta Singh
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, California, USA
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Schwehn R, Engelke E, Seiler C, Fischer D, Seifert H, Pfarrer C, Fehr M, Legler M. Blood Vessel Topography of the Feet in Selected Species of Birds of Prey and Owls. Vet Sci 2024; 11:88. [PMID: 38393107 PMCID: PMC10892245 DOI: 10.3390/vetsci11020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Birds of prey and owls are susceptible to diseases of and traumatic injuries to their feet, which regularly require surgical intervention. A precise knowledge of the blood vessel topography is essential for a targeted therapy. Therefore, the metatarsal and digital vasculature was examined in eight species of birds of prey and owls. The study included contrast micro-computed tomography scans and anatomical dissections after intravascular injection of colored latex. In all examined species, the dorsal metatarsal arteries provided the main supply to the foot and their branching pattern and number differed between species. They continued distally as digital arteries. All examined species showed a basic pattern of four collaterally located digital blood vessels per toe: a prominent artery and small vein on one side and a small artery and prominent vein on the other side. Digital veins united to form common digital veins, most of which joined into a superficial, medially located metatarsal vein. This vein provided the main drainage of the foot. The detailed visualization of the topography of pedal blood vessels will help veterinary surgeons during surgical procedures. In addition, differences in the plantar arterial arch between hawks and falcons were discussed regarding their possible influence on the prevalence of pododermatitis (bumblefoot).
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Affiliation(s)
- Rebekka Schwehn
- Department of Small Mammal, Reptile and Avian Medicine and Surgery, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany; (M.F.); (M.L.)
| | - Elisabeth Engelke
- Institute for Anatomy, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany; (E.E.); (C.P.)
| | - Christian Seiler
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Dominik Fischer
- Clinic for Birds, Reptiles, Amphibians and Fish, Justus Liebig University Giessen, Frankfurter Str. 114, 35392 Giessen, Germany;
- Zoo Wuppertal, Hubertusallee 30, 42117 Wuppertal, Germany
| | - Hermann Seifert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Christiane Pfarrer
- Institute for Anatomy, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany; (E.E.); (C.P.)
| | - Michael Fehr
- Department of Small Mammal, Reptile and Avian Medicine and Surgery, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany; (M.F.); (M.L.)
| | - Marko Legler
- Department of Small Mammal, Reptile and Avian Medicine and Surgery, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany; (M.F.); (M.L.)
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Hicks AC, Sangroula D, Dwivedi AJ, Wayne EJ, Sigdel A. Inferior vena cava perforation during percutaneous filter removal. Vascular 2024; 32:190-194. [PMID: 36269323 DOI: 10.1177/17085381221135268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous Inferior Venacava (IVC) filter retrieval can be challenging when the filter is grossly angulated, embedded in the wall or penetrates through the IVC. When conventional filter removal technique fails, the use of advanced retrieval techniques often improves the chances of percutaneous filter retrieval. These techniques, however, are associated with a high rate of complications. METHODS We report a case of 26-year-old female who had IVC filter placed on postpartum day 4. Attempted percutaneous filter retrieval 3 weeks later with loop snare technique and endobronchial forceps assisted filter removal technique resulted in gross filter deformity, malposition, and IVC perforation. RESULT Open IVC filter removal was performed with midline laparotomy and cavotomy with lateral venorrhapy. The deformed filter along with adherent thrombus was completely removed. The patient had an uneventful recovery with no immediate or long-term complications. CONCLUSION Use of advanced endovascular IVC filter retrieval techniques could result in serious complications like filter fracture, migration and IVC perforation. Since excessive tilt of the filter at the time of placement often results in difficult retrieval, it is important to ensure proper deployment of the filter with minimal tilt. If encountered with excessively tilted or embedded filter, one should refrain from excessive manipulation of the filter and consider open filter removal.
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Kumar S, Mondal S, Kumar R. Unusual Case Report of Headache in 10-Year-Old Female Child. Cureus 2024; 16:e53590. [PMID: 38449939 PMCID: PMC10915452 DOI: 10.7759/cureus.53590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
According to the literature, transverse sinus hypoplasia is not a normal variant and has a serious potential effect on cerebral blood flow. We are presenting a rare case of chronic headache due to severe hypoplasia of the left transverse and sigmoidal sinus. A 12-year-old female girl was admitted with a complaint of gradual progressive severe headache, throbbing in nature, confined to a bitemporal and frontal region in the last 4-5 months. Headache is not associated with fever, vomiting, photophobia, or vision problems. The child had no history of recurrent running nose, refractory vision, ear discharge, head trauma, exanthemata rash, or any drug history. On examination, the child was conscious and oriented. Vital signs are normal. The child was neurologically normal and had no focal signs. Other systemic examinations were normal. Based on History and examination, differential diagnosis was made, like Pseudo tumor cerebri, migraine, deep vein sinus thrombosis, and functional and Posterior fossa tumor. The child had normal routine investigations like complete blood count, electrolyte, and D-dimer. The fundoscopy was normal. In MRI, brain hypoplasia of the left transverse and sinusoidal sinus was suspected and confirmed by MRI venography. Thus, for any patient in an emergency with a chronic headache without focal signs and normal fundoscopy, one deferential should be considered for transverse and sigmoid sinus hypoplasia.
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Affiliation(s)
- Sudesh Kumar
- Pediatrics, Mata Gujri Memorial Medical College, Kishanganj, IND
| | | | - Roshan Kumar
- Medicine, Mata Gujri Memorial Medical College, Kishanganj, IND
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Tang M, Fan W, Cui J, Liu Q, Chang X, He M, Fang Q, Wang S, Chen M, Yin S. Diagnostic Value of Lower Extremity Venous Duplication via Digital Subtraction Angiography Guided Venography. Vasc Endovascular Surg 2024; 58:166-171. [PMID: 37607668 DOI: 10.1177/15385744231198355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Lower limb venous anomalies, including duplicated veins, are common and have significant impacts on the outcomes and efficacy of venous surgery. Digital subtraction angiography (DSA) guided venography, serving as the tertiary diagnostic option for venous disorders, offers valuable informations to clinical practitioners. PATIENTS AND METHODS A retrospective study was conducted on 195 patients with suspected venous disease, evaluating 259 limbs with venography imaging. Two experienced interventional vascularists evaluated the images to determine the incidence and characteristics of variances in the femoral, popliteal, great saphenous, and small saphenous veins. Moreover, blood samples were collected to assess the safety of the venography procedure by monitoring changes in renal function. RESULT Duplication variations were found in the lower limb veins, with the highest prevalence in the femoral vein (11.28%, 22/195), followed by the great saphenous vein (4.1%, 8/195), and the popliteal vein (1.54%, 3/195). No severe contrast agent allergies or postoperative complications were reported. No statistically significant differences were found in creatinine and urea levels pre- and post-operation for patients without duplication variations, those with duplication of the great saphenous, femoral, or popliteal vein (P < .05). CONCLUSION DSA-guided venography is effective in identifying venous variations in lower limb disease. DFV is the most common recurrent vein, while DPV is the least. Adequate preparation ensures safety, high spatial resolution, dynamic imaging, and low tissue interference.
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Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Weijian Fan
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianwei Cui
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qingling Liu
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingfei He
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Siyuan Wang
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mianpeng Chen
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, The Second People's Hospital of Hefei, Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
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Wang C, Chen S, Mi D. A task-driven cerebral angiographic imaging based on CT perfusion. Front Neurol 2024; 14:1328184. [PMID: 38375352 PMCID: PMC10875991 DOI: 10.3389/fneur.2023.1328184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/29/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction Current clinical computed tomography arteriography (cCTA) and clinical computed tomography venography (cCTV) images often display restricted cerebrovascular profiles, incomplete brain tissue segmentation, and incomplete artery-vein segmentation. Especially for vessels associated with diseases, capturing their complete profiles proves challenging. Methods In this work, we developed a Task-driven Cerebral Angiographic Imaging (TDCAI) technique using computed tomography perfusion (CTP) images of stroke patients. A evaluation on intracranial hemorrhagic stroke (IHS) and acute ischemic stroke (AIS) cases was performed with CT perfusion imaging. The TDCAI technique processed the CTP images, resulting in supplementary diagnostic images, including CTA, CTV, centerline images of the vessels-of-interest [internal carotid artery (ICA) for AIS patients, Labbé vein for IHS patients], and straightened images of the vessels-of-interest. Results We conducted a comparison between the obtained CTA/CTV images and the cCTA/cCTV images in terms of overall image quality and visibility of the vessels-of-interest. By constructing a virtual vascular phantom, we extracted its centerline and compared it with the actual centerline to calculate maximum and average deviations. This allowed us to evaluate both the accuracy of the centerline extraction algorithm and its capability to resist the influence of side branches. We assessed whether vascular stenosis and dilatation could be expressed in straightened vessel images, conducting statistical analyses to establish the superiority of TDCAI technique. Discussion This study proposes a TDCAI technique to eliminate bone and soft tissue interference, effectively segregate the comprehensive cerebral venous and arterial systems, and extract centerlines and straighten the vessels-of-interest, which would aid doctors in assessing the outflow profiles of vessels after a stroke and seeking imaging biomarkers correlated with clinical outcomes.
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Affiliation(s)
- Cheng Wang
- Research Center for Medical Artificial Intelligence, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Siqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Czajkowski M, Polewczyk A, Jacheć W, Nowosielecka D, Tułecki Ł, Stefańczyk P, Kutarski A. Pacemaker leads as a potential source of problems in patients who might need a central venous access port. Cardiovasc Diagn Ther 2023; 13:1068-1079. [PMID: 38162103 PMCID: PMC10753236 DOI: 10.21037/cdt-23-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 01/03/2024]
Abstract
Background Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs). Methods We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated. Results In 2,318 (75.38%) patients, venography showed no potential obstacles to venous port implantation on the ipsilateral side. In patients with leads on the left side, significant narrowing more often affected the subclavian vein than the brachiocephalic vein [1,595 (55.29%) vs. 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED. Conclusions (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III) venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.
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Affiliation(s)
- Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Dorota Nowosielecka
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Paweł Stefańczyk
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
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Milhem A, Allix‐Béguec C, Laurençon V, Treguer F, Cesari O. Four typical pulmonary venous pressure curves displaying the level of occlusion during atrial fibrillation ablation by cryoballoon. J Arrhythm 2023; 39:997-1000. [PMID: 38045456 PMCID: PMC10692852 DOI: 10.1002/joa3.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background Cryoballoon ablation is safe and effective for pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. To monitor adhesion between the balloon and the pulmonary vein, an alternative technique to pulmonary venography is to analyze changes in the pressure curve. Methods We have described the adhesion level characterized by four types of pressure waveforms. Results These correlated with the extent of contrast agent leakage (Cohen's kappa of 0.81 [IC 95%: 0.63-0.99]). Conclusion Monitoring the venous pressure curve is easy to perform and has the advantage of being able to detect balloon movement during the first few seconds of treatment.
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Affiliation(s)
- Antoine Milhem
- Cardiology DepartmentGroupe Hospitalier de la Rochelle Ré AunisLa RochelleFrance
| | | | - Virginie Laurençon
- Clinical Research UnitGroupe Hospitalier de la Rochelle Ré AunisLa RochelleFrance
| | | | - Olivier Cesari
- Cardiology PracticeClinique Saint AugustinBordeauxFrance
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Shen Z, Xu S, Guan S, Chen B, Li Q, Yu M, Gao Z. Utility of right adrenal signature veins in venous sampling for primary aldosteronism. Ann Med 2023; 55:2234934. [PMID: 37452706 PMCID: PMC10351465 DOI: 10.1080/07853890.2023.2234934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND This study aimed to identify the appropriate signature veins for the right adrenal gland using a 3D model fused with adrenal venography images and to verify their accuracy through the selectivity index (SI) >2. METHODS We analyzed the right adrenal venography images of 41 patients who underwent adrenal venous sampling (AVS). These images were merged with a 3D structure of the adrenal gland to identify the signature veins of the right adrenal gland. We then used the signature veins observed during adrenal venography to determine the optimal position of the catheter tip during AVS for 53 other patients. Finally, we verified the accuracy of this method according to the SI. RESULTS We successfully fused the 3D models of 41 cases with adrenal venography images. We identified the trunk branch type as the major venous morphology in the right anterior oblique at degrees of 30 (38 cases, 92.7%). In addition, the central vein, brush vein, uvula vein, and capsular vein were identified as signature veins for the right AVS. The accuracy of AVS was 100% in the other 53 patients, as verified by an SI >2. CONCLUSIONS Our study identified the right adrenal signature veins, including the previously overlooked uvula vein, which can be used to determine the position of the catheter tip and improve the success rate of AVS.
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Affiliation(s)
- Zhenglin Shen
- Hybrid Operation Room, Xiangyang Central Hospital, Affiliated Xiangyang Hospital of Hubei College of Arts and Sciences, Xiangyang, Hubei, China
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Siyu Guan
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Bo Chen
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Qingan Li
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ming Yu
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Setiani RU, Batubara EAD, Adiarto S, Siddiq T, Indriani S, Siahaan IH. Successful Ovarian Vein Embolization of a Multiparous Woman with Pelvic Congestion Syndrome. Int J Angiol 2023; 32:299-302. [PMID: 37927827 PMCID: PMC10624537 DOI: 10.1055/s-0041-1731272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Pelvic congestion syndrome (PCS) is a clinical syndrome supported by specific findings, such as ovarian vein's dilatation, that cause pelvic vein congestion. Although many theories are explaining the pathophysiologies of this condition, the underlying cause remains unknown. The clinical manifestations of PCS are various including chronic pelvic pain (CPP), voiding disturbances, or ureteral obstruction. Imaging modality, such as ultrasonography, computed tomography (CT scan), magnetic resonance imaging (MRI), and venography, are needed to confirm and exclude the differential diagnosis. Currently, American venous forum guidelines recommended endovascular therapy which is percutaneous embolization as the first option therapy of PCS. Here, we reported a 35-year-old woman with PCS who underwent successful percutaneous embolization therapy.
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Affiliation(s)
- Rissa U. Setiani
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Edwin A. D. Batubara
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Suci Indriani
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irwan H. Siahaan
- Department of Cardiology and Vascular Medicine, Persahabatan Public Hospital, Jakarta, Indonesia
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Yagi T, Maeda N, Nakanishi K. A Retrospective Analysis of Venographic Images of a Central Venous Port without Blood Return and Its Usable Period. Intern Med 2023; 62:2827-2831. [PMID: 36823086 PMCID: PMC10602839 DOI: 10.2169/internalmedicine.1249-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/11/2023] [Indexed: 02/23/2023] Open
Abstract
Objective In routine practice, central venous ports without blood return (CVPWBRs) are common. However, very few studies have reported on the viable period of CVPWBR use. We therefore investigated this period by retrospectively analyzing the venographic images of CVPWBRs. Methods We examined patients' venography through the CVPs at the point when they became CVPWBRs for the first time and analyzed the reasons for becoming CVPWBRs. For patients with minor complications of CVPs or normal venographic findings, we used the Kaplan-Meier method to evaluate the period for which such CVPWBRs could be used. Patients Eighty-four patients with malignancy whose CVPs became CVPWBRs for the first time between July 31, 2015, and March 12, 2020, were included. Results Nine (10.7%) patients had major complications that made the CVPs unusable. Thirty-three (39.3%) patients had minor complications, and the remaining 42 (50.0%) had normal venographic findings. For the 75 patients with minor complications or normal venographic findings who continued to use their CVPWBRs, the Kaplan-Meier method estimated that 25% of complications that might make it unusable would occur within 1,273 days. Conclusion There are two learning points in our study. First, venography is needed when the CVP becomes a CVPWBR for the first time due to the high risk, and second, CVPWBRs can be used for a relatively long period in patients without major complications. It is necessary to develop an appropriate follow-up management method for CVPWBRs in prospective studies.
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Affiliation(s)
- Toshinari Yagi
- Department of Outpatient Chemotherapy, Osaka International Cancer Institute, Japan
| | - Noboru Maeda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Japan
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Abramov R, Rufizen L, Gilshtein H. Resection of Extrapulmonary Lymphangiomyoma and Post-Operative Management Considerations. Vasc Endovascular Surg 2023; 57:756-759. [PMID: 36952511 DOI: 10.1177/15385744221144503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Background: Lymphangiomyomatosis is a rare disease involving the lymph vessels, causing obstruction and cystic formation with an incidence of 3-8 per million women. The disease might be sporadic or inherited. Lymphangiomyomatosis mostly affects the pulmonary system, whereas extrapulmonary Lymphangiomyomatosis may present in various site, occasionally as a localized abdominal mass. The diagnostic process might entail surgical resection to obtain a specimen for pathology that may also help to achieve a long-term control of the disease. Methods: Herein, we present a case of a 45 years old female, who suffered from pulmonary symptoms, and during her workup an abdominal mass was found. The patient underwent exploratory laparotomy with resection of a left retroperitoneal bilobar mass. Results: Histopathological report revealed Lymphangiomyoma. She had a complication of a lymphatic leakage that required a second laparotomy with satisfactory clinical outcome. Conclusions: Surgeons should be aware of the pathological lymphatics and manage post-operative complications by a trial of conservative.
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Affiliation(s)
- Roi Abramov
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Liel Rufizen
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Hayim Gilshtein
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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13
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Cornman-Homonoff J, Lozada JCP, Marino AG, Mojibian H. Use of a funneled sheath for embolic protection during removal of thrombosed Simon Nitinol filters. Diagn Interv Radiol 2023; 29:733-735. [PMID: 37593925 PMCID: PMC10679551 DOI: 10.4274/dir.2023.232267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023]
Abstract
Inferior vena cava (IVC) filters should be removed when no longer needed, given their association with complications such as thrombosis of the IVC and lower extremities, fracture, migration, and growth into adjacent structures. While this is generally straightforward in the setting of retrievable filters, permanent filters present more of a challenge. In fact, many operators will not attempt to do so for fear of intraprocedural complications, among them, filter fracture and fragment embolization. Despite this, leaving the filters in situ places patients at risk of the complications described above. Here, the authors illustrate a novel technique for retrieving permanent filters using a funneled sheath to protect against embolization.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Juan Carlos Perez Lozada
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Angelo G Marino
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale University School of Medicine, New Haven, United States
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14
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Müller M, Wolf F, Loewe C, Beitzke D, Zehetmayer S, Gschwandtner ME, Willfort-Ehringer A, Koppensteiner R, Schlager O. Preprocedural imaging modalities in patients undergoing iliocaval venous recanalization and stent placement. Vasc Med 2023; 28:315-323. [PMID: 37036105 PMCID: PMC10408242 DOI: 10.1177/1358863x231161938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
PURPOSE To determine the diagnostic accuracy of preinterventional imaging modalities in patients being evaluated for iliocaval venous recanalization and stent placement. METHODS Consecutive patients with iliocaval postthrombotic obstructions or nonthrombotic iliac vein lesions (NIVL), who were scheduled for recanalization, underwent duplex ultrasound (DUS), magnetic resonance venography (MRV), multiplanar venography (MPV), and intravascular ultrasound (IVUS). The diagnostic accuracies of DUS, MRV, and MPV were analyzed using IVUS as reference. RESULTS A total of 216 limbs in 108 patients (80 patients with postthrombotic obstructions, 28 patients with NIVL) were examined. In patients with postthrombotic obstructions, the diagnostic sensitivities for the detection of lesions of the common femoral vein were 81% (95% CI 71-89%) for DUS, 76% (95% CI 65-85%) for MRV, and 86% (95% CI 76-93%) for MPV. The sensitivities for detecting lesions of the iliac veins were 96% (95% CI 89-99%) for DUS, 99% (95% CI 92-100%) for MRV, and 100% (95% CI 94-100%) for MPV. Regarding the inferior vena cava, the sensitivities were 44% (95% CI 24-65%) for DUS, 52% (95% CI 31-73%) for MRV, and 70% (95% CI 47-86%) for MPV. The sensitivities for detecting NIVL were 58% (95% CI 34-79%) for DUS, 90% (95% CI 68-97%) for MRV, and 95% (95% CI 73-99%) for MPV. CONCLUSION In patients scheduled for recanalization of iliocaval postthrombotic obstructions, the sensitivities of DUS, MRV, and MPV were similar. In patients with suspected inferior vena cava involvement and in patients with NIVL, additional imaging with MR or conventional venography is required.
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Affiliation(s)
- Markus Müller
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Department of Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Department of Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Sonja Zehetmayer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael E Gschwandtner
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | | | - Renate Koppensteiner
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Oliver Schlager
- Department of Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
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15
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Tsukahara Y, Todoroki K, Suzuki T, Yamada A, Kurozumi M, Fujinaga Y. Can expiratory or inspiratory contrast-enhanced computed tomography be more efficient for fast-track cannulation of the right adrenal vein in adrenal venous sampling? Diagn Interv Radiol 2023; 29:640-646. [PMID: 37191468 PMCID: PMC10679638 DOI: 10.4274/dir.2023.222045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE This study compares the usefulness of expiratory arterial phase (EAP)-contrast-enhanced computed tomography (CT) (CECT) with that of inspiratory arterial phase (IAP)-CECT in adrenal venous sampling (AVS). METHODS Sixty-four patients who underwent AVS and CECT at the authors' hospital between April 2013 and June 2019 were included in this study. The patients were classified into the following two groups: EAP (32 patients) and IAP (32 patients) groups. The single arterial phase images were obtained at 40 seconds in the IAP group. The double arterial phase images were obtained at 40 seconds in the early arterial phase and 55 seconds in the late arterial phase in the EAP group. The authors then compared the right adrenal vein (RAV) visualization rate on the CECT, the difference between the CECT images and adrenal venograms in the localization of the RAV orifice, the cannulation time to the RAV, and the volume of contrast agent administered intraoperatively between the two groups. RESULTS The rates of the RAV visualization in the EAP group were 84.4% in the early arterial phase, 93.8% in the late arterial phase, and 100% in the combined early and late arterial phases. The rate of the RAV visualization in the IAP group was 96.9%. There was no significant difference between the two groups in terms of the rate of the RAV visualization. However, there was a small difference in the location of the RAV orifice between the CECT images and adrenal venograms in the EAP group as compared with the IAP group (P < 0.001). The median time to the RAV catheterization was significantly shorter in the EAP group (27.5 minutes) than in the IAP group (35.5 minutes; P = 0.035). The rates of the RAV visualization in the EAP group were not significant between the early arterial phase, late arterial phase, and combined early and late arterial phases (P = 0.066). However, the mean volume CT dose index in the combined early and late arterial phases was significantly higher than in the early and late arterial phases (P < 0.001). CONCLUSION The EAP-CECT is more useful for increasing the speed of the RAV cannulation due to the small difference in the localization of the RAV orifice compared to IAP-CECT. However, since EAP-CECT has double contrast arterial phases and increased radiation exposure compared to IAP-CECT, only the late arterial phase may be acceptable to reduce radiation exposure.
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Affiliation(s)
- Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keisuke Todoroki
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Suzuki
- Department of Radiology, Nagano Municipal Hospital, Nagano, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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16
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Chandra P, Chinnappan S, Chandran G. Tumor Thrombus within the Superior Sagittal Sinus Detected on FDG PET Venography. Indian J Nucl Med 2023; 38:292-293. [PMID: 38046973 PMCID: PMC10693361 DOI: 10.4103/ijnm.ijnm_190_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/24/2022] [Indexed: 12/05/2023] Open
Abstract
Early detection of cereberal venous sinus thrombosis is important to prevent complication. Here we present an interstecting case of tumor thrombsosis of the superior sagittal venous sinus in a follow up case of adenocarcinoma esophagus, highlighting the feasibility for FDG PET venography for detection of the same.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine Zydus Hospitals, Vadodara, Gujrat, India
| | - Sheela Chinnappan
- Department of Radiodiagnosis Zydus Hospitals, Vadodara, Gujrat, India
| | - Ganesan Chandran
- Department of Nuclear Medicine Zydus Hospitals, Vadodara, Gujrat, India
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17
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Love AN, Nasser GA, Yost C. A Not So Common Iliac Vein Anomaly: A Case Report. Cureus 2023; 15:e38145. [PMID: 37252602 PMCID: PMC10214882 DOI: 10.7759/cureus.38145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Arising from the external and internal iliac veins, the common iliac veins (CIVs) carry blood from the lower extremities and pelvic region into the inferior vena cava at the level of the fifth lumbar vertebra. It is sometimes common to observe slight anomalies in vascular anatomy in patients; however, anomalies of the CIVs are rare. We present a case of a patient with significant edema of the left lower extremity due to extrinsic compression (May-Thurner syndrome [MTS]) involving a duplicated left CIV found during vascular angiography. Anomalies in pelvic vasculature are well documented in the medical literature; however, documented cases of a duplicated CIV remain few and far between. These anomalies in pelvic vascular anatomy are essential to be aware of to avoid surgical complications and understand their implications in associated pathologies.
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Affiliation(s)
- Avery N Love
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
| | - George A Nasser
- Cardiology, Nasser Cardiology and Vein Center, Woodlands, USA
| | - Connor Yost
- Internal Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona (ATSU-SOMA), Mesa, USA
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18
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Liu Y, Wang Q, He C. Cystic Adventitial Disease of the Common Femoral Vein Presenting with Lower Limb Swelling: A Case Report. Vasc Endovascular Surg 2023:15385744231165991. [PMID: 36938599 DOI: 10.1177/15385744231165991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Cystic adventitial disease (CAD) is a rare vascular disorder predominantly seen in adults without cardiovascular risk factors. We report a case of CAD involving the common femoral vein in a 38-year-old female presented with right lower extremity swelling that was initially misdiagnosed as deep vein thrombosis (DVT). A computed tomography revealed a cystic structure that compressed the right common femoral vein with resultant severe stenosis of the vascular lumen. Complete evacuation of the cyst with excision of the cyst wall was performed, and the patient remained symptom-free at 3 year follow-up. This case highlighted that the rare venous CAD should be incorporated in the differential diagnosis of unilateral lower extremity swelling suspicious for a DVT. Complete evacuation and surgical excision of the cyst often conferred favorable clinical outcome.
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Affiliation(s)
- Yang Liu
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiqi Wang
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chunshui He
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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19
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Jahanshahi F, Parsaei A, Naderi D, Zeraatian Nejad Davani S, Khaleghian M. Potentially fatal atrium perforation due to right jugular vein catheterization recognized by venography: A case report. Clin Case Rep 2023; 11:e6911. [PMID: 36789307 PMCID: PMC9909251 DOI: 10.1002/ccr3.6911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/10/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Central venous catheters are the prevalent path for dialysis. Our case was a 54-years-old male with a new case of end-stage renal disease with a complaint of right jugular hemodialysis catheter dysfunction. In our case, the early dysfunctional catheter should be evaluated with contrast studies to achieve accurate information.
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Affiliation(s)
- Fatemeh Jahanshahi
- Faculty of MedicineIran University of Medical ScienceTehranIran
- Urology Research CenterTehran University of Medical SciencesTehranIran
| | | | - Delaram Naderi
- Allied Medical SciencesIran University of Medical SciencesTehranIran
| | - Sam Zeraatian Nejad Davani
- Rockingham Medical Research Center, ADKWA MedicalPerthWestern AustraliaAustralia
- Department of Cardiovascular Surgery and Faculty of Transplant and Organ DonationIran University of Medical ScienceTehranIran
| | - Mohsen Khaleghian
- Department of Vascular SurgeryIran University of Medical ScienceTehranIran
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20
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Sun C, Zheng W, Wang S, Wu Y. Embolization of a duplicated femoral vein for treatment of lower extremity deep venous insufficiency: A case report. Vascular 2023:17085381231154434. [PMID: 36696562 DOI: 10.1177/17085381231154434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Lower extremity deep venous insufficiency (DVI) occurs secondary to structural or functional abnormalities of deep venous valves in the affected extremities. The effectiveness of surgical treatment for improvement of the hemodynamic status in these patients remains controversial in clinical practice. METHOD In this case report, we describe a patient who presented with severe right lower extremity edema and liposclerosis and underwent venography, which suggested a variation in the number of femoral veins. The valve within the duplicated femoral vein was significantly incompetent; however, the valve of the main trunk of the femoral vein showed normal function. We performed embolization of the duplicated femoral vein. RESULTS The patient tolerated the procedure well without recurrent symptoms. CONCLUSIONS Individualized assessment based on venography findings is useful to establish the therapeutic approach in patients with DVI.
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Affiliation(s)
- Chun Sun
- Department of Vascular Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Zheng
- Department of Vascular Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingfeng Wu
- Department of Vascular Surgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
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21
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Renella P, Li J, Prosper AE, Finn JP, Nguyen KL. Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease. Children (Basel) 2022; 9. [PMID: 36553257 DOI: 10.3390/children9121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.
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22
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Milman A, Leshem E, Massalha E, Jia K, Meitus A, Kariv S, Shafir Y, Glikson M, Luria D, Sabbag A, Beinart R, Nof E. Occluded vein as a predictor for complications in non-infectious transvenous lead extraction. Front Cardiovasc Med 2022; 9:1016657. [PMID: 36312249 PMCID: PMC9601735 DOI: 10.3389/fcvm.2022.1016657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of cardiovascular implantable electronic device (CIED) is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous lead extraction (TLE) can facilitate the re-implantation of new leads. Aims This study aims to explore predictors and complications of non-infectious TLE. Methods This study involves a retrospective analysis and comparison of characteristics, complications, and outcomes of patients with and without occluded veins (OVs) undergoing TLE at our center. Results In total, eighty-eight patients underwent TLE for non-infectious reasons. Indications for TLE were lead malfunction (62; 70.5%) and need for CIED upgrade (22; 25%). Fourteen patients referred due to lead malfunction had an OV observed during venography. The OV group (36 patients) were significantly older (65.7 ± 14.1 vs. 53.8 ± 15.9, p = 0.001) and had more comorbidities. Ejection fraction (EF) was significantly lower for the OV group (27.5 vs. 57.5%, p = 0.001) and had a longer lead dwelling time (3,226 ± 2,324 vs. 2,191 ± 1,355 days, p = 0.012). Major complications were exclusive for the OV group (5.5% vs. none, p = 0.17), and most minor complications occurred in the OV group as well (33.3 vs. 4.1%, p < 0.001). Laser sheath and mechanical tools for TLE were frequently used for OV as compared to the non-occluded group (94.4 vs. 73.5%, respectively, p = 0.012). Procedure success was higher in the non-occluded group compared to the OV group (98 vs. 83.3%, respectively, p = 0.047). Despite these results, periprocedural mortality was similar between groups. Conclusion Among the TLE for non-infectious reasons, vein occlusion appears as a major predictor of complex TLE tool use, complications, and procedural success. Venography should be considered prior to non-infectious TLE to identify high-risk patients.
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Affiliation(s)
- Anat Milman
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,*Correspondence: Anat Milman
| | - Eran Leshem
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Massalha
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Jia
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Meitus
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saar Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Shafir
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel,Hebrew University in Jerusalem Medical School, Jerusalem, Israel
| | - David Luria
- Hebrew University in Jerusalem Medical School, Jerusalem, Israel,Hadassah Medical Center, Heart Institute, Jerusalem, Israel
| | - Avi Sabbag
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nof
- Leviev Heart Institute, The Chaim Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Saleem T. Clinical improvement after iliac vein stenting stratified by CEAP class. Ann Vasc Surg 2022; 86:e3. [PMID: 35926789 DOI: 10.1016/j.avsg.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Taimur Saleem
- The Rane Center for Venous and Lymphatic Diseases, Jackson, MS.
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24
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Hall N, Krysa J, Lesche S, Hill BG, Letts JA, McNaughton A, Clifford K, Jones GT. Near infra-red fluorescence imaging to demonstrate reflux in the superficial microvenous network of the leg. Eur J Vasc Endovasc Surg 2022; 64:377-386. [PMID: 35667596 DOI: 10.1016/j.ejvs.2022.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/29/2022] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Reflux within the superficial microvenous network may play a critical role in the development of skin changes which can be associated with chronic venous insufficiency. This study aimed to determine if near infra-red fluorescence (NIRF) imaging could be used to accurately determine superficial venous reflux in the leg. METHODS A total of nine limbs were examined ex vivo from patients undergoing limb amputation for peripheral arterial disease. Cannulation of the distal great saphenous vein was used to sequentially perform X-ray contrast enhanced venography, NIRF imaging and venous corrosion casts. RESULTS Fluorescence imaging visualised a range of different microvenous reflux patterns ex vivo, which were generally not evident by x-ray venography, but were consistent with retrograde resin vascular casts. These included both focal and diffuse regions of fluorescence within the skin and, consistent with previous observations, the vascular casts indicated that regions of venous reflux were typically associated with incompetent valves. CONCLUSION The findings from this study suggest a potential method for investigating early stage superficial venous disease, prior to the appearance of visible signs of advanced venous disease, such as skin changes. However, further studies are required to confirm the, in vivo, clinical utility of these observations.
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Affiliation(s)
- Nicholas Hall
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Jolanta Krysa
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Sarah Lesche
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Brigid G Hill
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - James A Letts
- Radiology Department, Southern District Health Board, Dunedin, New Zealand
| | - Andrew McNaughton
- Otago Micro and Nanoscale Imaging (OMNI), University of Otago, Dunedin, New Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin Medical Campus, University of Otago, Dunedin, New Zealand.
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25
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Besuden KT, Meyer-Lindenberg A, Brühschwein A. Computed tomography venography description of the normal anatomy of the canine hindlimb venous system. Anat Histol Embryol 2022; 51:459-467. [PMID: 35510896 DOI: 10.1111/ahe.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
This study was performed to provide a description of the normal anatomy of the canine hindlimb veins using helical CT images. The studies of 30 dogs that underwent CT venography with a 64-slice helical CT scanner were retrospectively reviewed. The dogs were positioned in a head-first prone or head-first supine body position. A topogram CT scan was performed from the pelvic limbs cranial to the iliac wings to the tips of the paws. Bolus-tracking software was used for the dual-phase angiogram, and contrast medium was administered in a cephalic vein. The venous phase was scanned after a delay time of a few seconds after the arterial phase in a caudocranial direction. Three-dimensional images were generated using maximum intensity projections and volume rendering technique. Representative images of three of the 30 dogs were selected and anatomic structures labelled.
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Affiliation(s)
- Klara Theresia Besuden
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Brühschwein
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
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Liu Q, Chen W, Wang YL, Wang ZY, Peng ZQ, Xiang JF, Chen L, Pan YC, Sha Y. A new method of monitoring catheter-directed thrombolysis for deep venous thrombosis-application of D-dimer and fibrinogen testing. Phlebology 2022; 37:216-222. [PMID: 35236191 DOI: 10.1177/02683555211064026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-directed thrombolysis (CDT) is one of the main treatment methods for acute deep venous thrombosis (DVT), which has the characteristics of long treatment time and large dosage of thrombolytic drugs. In the absence of good monitoring methods, problems such as low thrombolytic efficiency and high risk of bleeding are easy to occur. OBJECTIVE To evaluate the value of D-dimer (D-D) and fibrinogen (FIB) testing as a thrombolysis-monitoring method during CDT for acute DVT. METHODS Twenty patients with acute DVT were divided into group A and group B. During CDT, the D-D and FIB testing every 8 h were used in group A, and the venography and FIB testing every 24 h in group B. The thrombolysis rate, thrombolysis time, urokinase dosage, and X-ray radiation dose were compared. RESULTS The thrombolysis rate in group A was significantly higher than that in group B (p < 0.05), but the number of venography and radiation dose were significantly lower than those in group B (p < 0.05). CONCLUSION D-D and FIB testing can improve the thrombolysis rate, reduce the risk of bleeding, and decrease the number of angiograms and X-ray radiation dose during CDT.
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Affiliation(s)
- Qiang Liu
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Wei Chen
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Yong-Li Wang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zheng-Yu Wang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zhi-Qing Peng
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Jian-Feng Xiang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Liang Chen
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yu-Cheng Pan
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
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Aboelhassan M, Bontempi L, Cerini M, Salghetti F, Arabia G, Giacopelli D, Fouad DA, F Abdelmegid MAK, Ahmed TAN, Dell'Aquila A, Curnis A. The Role of Preoperative Venography in Predicting the Difficulty of a Transvenous Lead Extraction Procedure. J Cardiovasc Electrophysiol 2022; 33:1034-1040. [PMID: 35243712 DOI: 10.1111/jce.15435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty. METHODS AND RESULTS A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age 71 years; 72% male) with a median of 2(1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31(30%), complete occlusion in 15(14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103(98%) patients. Fifty-five (52%) were advanced extractions as they required a power mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p<0.001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio 2.89[1.14-7.32], p=0.025). The fluoroscopy time was also significantly longer (14.0[8.2-18.7] vs. 5.1[2.1-10.0] min, p<0.001). The rate of complications did not differ based on the presence of venous lesions. CONCLUSION Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were 3 times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mohamed Aboelhassan
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Luca Bontempi
- Cardiology Department, Spedali Civili, Brescia, Italy
| | - Manuel Cerini
- Cardiology Department, Spedali Civili, Brescia, Italy
| | | | | | - Daniele Giacopelli
- Clinical Research, Biotronik Italia, Milan, Italy.,Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy
| | - Doaa A Fouad
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | | | - Tarek A N Ahmed
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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Keyser A, Jungbauer C, Rennert J, Linnemann B, Schmid C, Schopka S. Assessment of Association Between Venous Occlusion and Infection of Cardiac Implantable Electronic Devices. Angiology 2022; 73:252-259. [PMID: 34362260 PMCID: PMC8873966 DOI: 10.1177/00033197211038376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increasing number of patients treated with cardiac implantable electronic devices (CIEDs) and indications for complex pacing requires system revisions. Currently, data on venous patency in repeat CIED surgery involving lead (re)placement or extraction are largely missing. This study aimed to assess venous patency and risk factors in patients referred for repeat CIED lead surgery, emphasizing CIED infection. All consecutive patients requiring extraction, exchange, or additional placement of ≥1 CIED leads during reoperative procedures from January 2015 to March 2020 were evaluated in this retrospective study. Venography was performed in 475 patients. Venous patency could be assessed in 387 patients (81.5%). CIED infection with venous occlusion was detected in 74 patients compared with venous occlusion without infection in 14 patients (P < .05). Concerning venous patency, novel oral anticoagulant medication appeared to be protective (P < .05; odds ratio [OR]: .35). Infection of the CIED appeared to be strongly associated with venous occlusion (OR: 16.0). The sensitivity was only 64.15%, but the specificity was 96.1%. Number of leads involved and previous CIED procedures were not associated with venous occlusion. In conclusion, in patients with CIED, venous occlusion was strongly associated with device infection, but not with the number of leads or previous CIED procedures.
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Affiliation(s)
- Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Cardiology, University Medical Center, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - Birgit Linnemann
- Department of Vascular Surgery and Angiology, University Medical Center, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
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Steckiewicz R, Stolarz P, Lange B. The different forms of the left brachiocephalic vein visualised during cardiovascular implantable electronic device implantation procedures. Folia Morphol (Warsz) 2021; 82:127-136. [PMID: 34845716 DOI: 10.5603/fm.a2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among the factors ensuring successful completion of such minimally invasive procedures as cardiac implantable electronic device (CIED) implantation and central venous catheter (CVC) placement are the morphometry and topography of the vessels used for cardiac lead or catheter advancement. Venous access through the left clavipectoral triangle makes use of the left brachiocephalic vein (BCV). The purpose of this study was to present the radiology images of various individual forms of this vessel observed during CIED implantation procedures. MATERIALS AND METHODS Our analysis included 100 venography recordings illustrating the left BCV, obtained during de novo CIED implantation procedures. We assessed the mediastinal course of the left BCV, with its natural angles, including angle α (in the middle section of the vessel) and the two angles created by the left BCV and the left subclavian vein (angle β) and the left BCV and the superior vena cava (angle γ). RESULTS The mean values of angle α tended to be higher (approximately 141°) than those of the two remaining angles (γ and β), which were comparable at 123° and 127°, respectively. An increase in mean angle α values were accompanied by increased mean angle γ and β values (p = 0.05), with only 5% of β and γ angles, in total, having values close to those of a right angle (90 ± 10º). CONCLUSIONS Individual variability of left BCV topography and morphology comes from developmental formation of the physiological angle in the middle section of this mediastinal vessel's course. The presence of near-right angles along the course of left BCV may potentially result in injuries to the vessel during intravascular procedures.
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Affiliation(s)
- R Steckiewicz
- Department of Cardiology, Central University Hospital in Warsaw, Poland.
| | - P Stolarz
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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Abstract
The persistence of the left superior vena cava is one of the most common abnormalities that could affect the thoracic venous return, despite its rare occurrence. It can usually be found as the only or in combination with other congenital cardiac abnormalities. Even though it is usually asymptomatic and it rarely has important consequences on the hemodynamics, it could sometimes represent a serious threat. In this regard, PLSVC often represents an incidental finding during an invasive procedure or imaging. We present an interesting case of a 66-year-old patient, with permanent atrial fibrillation and chronic kidney disease who presented to our clinic for a syncope due to complete atrioventricular block. The implant procedure was marked by the incidental intraprocedural finding of unusual venous anatomy. This anomaly included the absence of the superior vena cava, with the communication of the right brachiocephalic trunk and right subclavian vein with a persistent left superior vena cava which drainage directly into the coronary sinus. The right-side approach, as well as the limitation of using contrast-based venography, due to the kidney disease, made the procedure more difficult, but the final position of an active fixation ventricular lead was successfully achieved with optimal and stable pacing parameters through the formation of a particular curve of the lead stylet. Persistence of the left superior vena cava is a venous anomaly, which is frequently suspicioned at transthoracic echocardiography examination when the examiner found a dilated coronary sinus but diagnosed on the implant table of a cardiac device. These anomalies can pose problems and exponentially increase the procedural time even in experienced hands.
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Affiliation(s)
- Alexandru Bostan
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | | | - Narcis Tăbăcaru
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | - Ștefan Ailoaei
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | - Cristian Stătescu
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Steckiewicz R, Stolarz P, Marchel M, Michalak M, Konecki D, Szczerba E, Kowara M, Grabowska-Derlatka L, Grabowski M. Double superior vena cava and left brachiocephalic vein agenesis: a rare systemic vein anomaly and potential source of cardiac implantable electronic device and central venous catheter placement complications. Folia Morphol (Warsz) 2021; 81:1066-1071. [PMID: 34699053 DOI: 10.5603/fm.a2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/11/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies - detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter placement - may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double superior vena cava and left brachiocephalic vein agenesis, who ultimately required reoperation.
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Affiliation(s)
- R Steckiewicz
- Department of Cardiology, Central University Hospital in Warsaw, Poland.
| | - P Stolarz
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - M Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - M Michalak
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - D Konecki
- 2nd Department of Radiology Medical University of Warsaw, Poland
| | - E Szczerba
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - M Kowara
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - M Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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Doğan E, Apaydın M. The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography. Folia Morphol (Warsz) 2021; 81:314-323. [PMID: 33749805 DOI: 10.5603/fm.a2021.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of our study is to determine the ability of the PC-CMRV technique to detect cranial anatomy, variations, thrombosis, to reveal the deficits of the technique and to discuss the reasons for these deficits on a physics basis. MATERIALS AND METHODS PC's detection rates of anatomic variations and physiological filling defects (FDs) were evaluated in 136 patients and compared with the time-of-flight (TOF) technique MRI and cadaveric studies. RESULTS The dominance correlation between the three evaluated sinuses (transverse sinus (TS), sigmoid sinus, jugular vein) which originated from different embryological buds were statistically significant and the right vessel chain was dominant. PC is inadequate to show some vessels like inferior sagittal sinus (anatomically, this vessel is approximately present in 100% of the cases, but it was only visualized in 41.2% of the patients in PC-MRI). Visualization of major veins was sufficient. PC-MRI creates physiological FDs in 27.2% (72,3% middle,10.3% inner,17% outer part) of the patients. The FDs were concentrated in the middle part and not observed in the dominant sinus. CONCLUSIONS The defects of visualization are present due to the PC's technique. It can be misdiagnosed as agenesis or thrombosis. PC creates a high incidence of physiologic FDs in TS. The results are not reliable, especially if FDs are in the middle part or non-dominant side.
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Affiliation(s)
- E Doğan
- Department of Radiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey.
| | - M Apaydın
- Department of Radiology, İzmir Atatürk Education and Research Hospital, Izmir, Turkey
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Tseng YH, Chen CW, Wong MY, Yang TY, Lin BS, Ting H, Huang YK. Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique. J Pers Med 2021; 11:jpm11040242. [PMID: 33810500 PMCID: PMC8066982 DOI: 10.3390/jpm11040242] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Teng-Yao Yang
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Correspondence:
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Tokairin K, Osanai T, Fujima N, Ishizaka K, Motegi H, Ishi Y, Kameda H, Sugiyama T, Kazumata K, Nakayama N. Use of magnetic resonance venography for inferior petrosal sinus sampling. J Vasc Access 2021; 23:422-429. [PMID: 33626978 DOI: 10.1177/1129729821997263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing's disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. METHODS Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group (N = 8) and no-MRV group (N = 11) before IPSS. RESULTS There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group (p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. CONCLUSIONS Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.
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Affiliation(s)
- Kikutaro Tokairin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kinya Ishizaka
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Szary C, Wilczko J, Zawadzki M, Grzela T. Hemodynamic and Radiological Classification of Ovarian Veins System Insufficiency. J Clin Med 2021; 10:646. [PMID: 33567554 DOI: 10.3390/jcm10040646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/30/2022] Open
Abstract
Ovarian veins system insufficiency is one of the most common reasons for pelvic venous insufficiency (PVI). PVI is a hemodynamic phenomenon responsible for the occurrence of venous insufficiency of the lower extremities and recurrent varicose veins in nulliparous and parous women, as well as for a set of symptoms described as pelvic congestion syndrome (PCS). In the years 2017–2019, 535 patients admitted to our center with symptoms of venous insufficiency of the lower extremities, underwent complete ultrasound diagnostics (color-duplex ultrasound) of the venous system of the abdomen, pelvis and lower limbs, as well as extended imaging diagnostics using computed tomography (CT) or magnetic resonance (MR) venography. On the basis of the obtained results, the authors proposed a 4-grade hemodynamic and radiological classification (grades I-IV) defining the stratification of ovarian veins insufficiency. Using the above mentioned classification approx. 32% patients were identified as Grade I and I/II, approximately 35% revealed morphological and hemodynamic changes corresponding to Grade II and II/III, approximately 25% were classified as Grade III, whereas the remaining 8% were assessed as Grade IV. The described classification allows for the grading of ovarian veins insufficiency based on transparent radiological criteria, making it easy to use in everyday clinical practice. According to the authors, the proposed classification could facilitate communication between diagnostic physicians, specialists dealing with the treatment of venous insufficiency and gynecologists, who admit patients with symptoms suggesting venous insufficiency of the pelvis.
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Abstract
Nutcracker syndrome (NCS) refers to characteristic clinical symptoms that develop secondary to the nutcracker phenomenon (NCP), defined as compression of the left renal vein between the superior mesenteric artery and the aorta. A 22-year-old Chinese man presented with a 2-year history of hypertension and left flank pain after activity; his blood pressure fluctuated within 130–150/90–100 mmHg without treatment. He had microscopic hematuria (2+) and increased plasma renin activity. The findings of both color Doppler ultrasound and computed tomography angiography were consistent with a diagnosis of NCS. The patient had no history of familial hypertension or special medications. Secondary hypertension-related examinations showed no significant abnormalities. After placement of an endovascular stent in the left renal vein, normal blood flow resumed and the collateral circulation was reduced. Both the hypertension and flank pain were alleviated within 3 days after the intervention and did not reappear during the following 11 months. NCP/NCS accompanied by hypertension is very rare. The possibility of NCP/NCS should be considered when secondary hypertension cannot be explained by other factors. The mechanism by which hypertension is caused by NCP/NCS is rather complex and deserves further investigation.
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Affiliation(s)
- Rui-Feng Wang
- Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chun-Ze Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yu-Qin Fu
- Department of Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wei-Fu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Nocera I, Aliboni B, Ben David L, Gracia-Calvo LA, Sgorbini M, Citi S. Radiographic and Venographic Appearance of Healthy and Laminitic Feet in Amiata Donkeys. Front Vet Sci 2020; 7:601665. [PMID: 33409297 PMCID: PMC7779588 DOI: 10.3389/fvets.2020.601665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Laminitis is a debilitating disorder resulting in irreversible anatomical changes in the feet of equids. Assessing specific anatomical features through radiography and venography provides diagnostic and prognostic information. The reference ranges are well-established in horses, but not in donkeys. It is also uncertain as to whether these ranges can be applied to every donkey breed. The present study characterizes the radiological and venographic hoof anatomy of healthy feet of Amiata donkeys and defines the changes associated with severe and mild laminitis. Materials and Methods: A total of 16 forefeet were evaluated in 8 Amiata jennies. The animals underwent musculoskeletal examination, Obel grading assessment and radiological evaluation. Based on clinical examination and radiographic findings, the forefeet were grouped as healthy, mild or severe laminitic feet, thus the digital venograms were performed according to the group definition. Results: Radiology revealed 7/16 healthy, 4/16 mild laminitic, and 5/16 severe laminitic forefeet. Statistical analysis showed differences between the healthy and laminitic forefeet for the dorsal angle (p < 0.0001) and angle of solar aspect (p < 0.0001) of the distal phalanx, for deviation between dorsal aspect of distal phalanx and the hoof wall (p < 0.0001) and phalangeal rotation angle (p = 0.0032). Venography was abnormal in mild and severe laminitic forefeet. In particular, the vascularization was reduced or absent at the lamellar-circumflex junction dorsally, at the sub-lamellar vascular bed and at the circumflex veins. Coronary plexus vascularization was absent in severe laminitic forefeet. Discussion and Conclusions: This study provides the radiological parameters for the assessment of healthy and laminitic forefeet of Amiata donkeys. The mild laminitic foot venogram showed decreased vascularization mainly on lamellar-circumflex junction and sub-lamellar vascular bed, in latero-medial views. The severe laminitic foot showed very poor or absent vascularization in multiple areas. The technique is easily applicable and provides diagnostic support in laminitis.
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Affiliation(s)
- Irene Nocera
- Department of Veterinary Science, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | - Benedetta Aliboni
- Department of Veterinary Science, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | | | - Luis Alfonso Gracia-Calvo
- Faculty of Veterinary Science, Veterinary Teaching Hospital, University of Helsinki, Helsinki, Finland
| | - Micaela Sgorbini
- Department of Veterinary Science, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Science, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
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Abstract
OBJECTIVE External jugular vein (EJV) aneurysm is an extremely uncommon clinical condition. We have studied the clinical profile and need for surgery in this present seven case series of primary external jugular vein aneurysms. METHOD Over the past three years, we have diagnosed and managed aneurysms of external jugular vein in seven patients, who presented with swelling in the posterior triangle of the neck. Venous duplex was obtained in all the patients, followed by computed tomography (CT) in three patients and one patient reported with magnetic resonance (MR) venography from another hospital. Three patients had symptoms ranging from mild intermittent discomfort to moderate pain underwent excision of aneurysm after ligation of both ends of EJV. Four patients had swelling on the lateral side of the neck due to EJV aneurysm, with no other associated symptoms. They were kept on six monthly follow-ups. RESULT We operated three patients, as they were symptomatic, of which only two had thrombus in the aneurysmal sac. All three symptomatic patients had aneurysm of size >5 cm. Post-surgery and on subsequent follow-ups they were asymptomatic. The four asymptomatic patients kept on conservative management did not develop any thrombosis of aneurysm sac in follow up. CONCLUSION Surgical excision is indicated for symptomatic patients with EJV aneurysm, preferably for size > 5 cm because of their higher association with thrombosis or symptoms. Asymptomatic patients can be managed non-operatively with regular surveillance by clinical examination and venous duplex or can be treated if patients insist due to cosmetic reasons.
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Affiliation(s)
- Uttam Kumar Thakur
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Savlania
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil L Naik
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Charan Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Ahmed T, Chait J, Kibrik P, Alsheekh A, Ostrozshynskyy Y, Hingorani A, Ascher E. Dyeless iliac vein stenting. Vascular 2020; 29:424-428. [PMID: 32990527 DOI: 10.1177/1708538120960869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Iliac vein stenting is increasingly being explored for the treatment of chronic venous insufficiency. While venography is considered the gold standard for assessing iliac veins, some have proposed that intravascular ultrasound should be utilized instead due to its greater sensitivity at detecting stenotic lesions. Routinely, our service uses both intravascular ultrasound and venography, but we have noted that some patients cannot tolerate dye due to allergy, renal insufficiency, or deemed high-risk by the interventionalist due to uncontrolled medical co-morbidities. This study aimed to investigate whether forgoing dye had an impact on iliac vein stent thrombosis. METHODS From 2012 to 2016, 1482 iliac vein procedures (91 intravascular ultrasound-only and 1391 intravascular ultrasound plus venography) were performed on 992 patients who failed conservative treatment for chronic venous insufficiency. Our mean patient age was 65.8 years (range 21-99; SD ± 14.3) with 347 male and 645 female patients. The clinical presenting symptoms per clinical-etiology-anatomy-pathophysiology classification for the intravascular ultrasound-only cohort were C1:0, C2:3, C3:31, C433, C5:5, C6:20 and for the intravascular ultrasound plus venography cohort were C1:0, C2:24, C3:566, C4:583, C5:30, C6:188. Stent thrombi that developed within or at 30 days of stenting were categorized as early and greater than 30 days as late. Transcutaneous duplex ultrasound classified stent thrombi as either partial or occlusive. Our average follow-up time was 19.4 months (0-42, SD ± 12.5). RESULTS A total of 2.2% intravascular ultrasound-only patients versus 2.75% intravascular ultrasound plus venogram patients developed early stent thrombosis, p = 0.35. Early partial stent thrombosis occurred in 1.1% of the intravascular ultrasound-only group versus 2.6% of the intravascular ultrasound plus venogram group, p = 0.38. Early occlusive stent thromboses occurred in 1.1% of intravascular ultrasound-only patients and 0.15% of intravascular ultrasound plus venogram patients, p = 0.06. Late stent thromboses developed in 4% of patients in the intravascular ultrasound-only cohort and 4% in the intravascular ultrasound plus venogram cohort, p = 0.97. Late partial stent thromboses occurred in 2.7% of intravascular ultrasound-only patients versus 2.6% in intravascular ultrasound plus venogram patients, p = 0.99. Late occlusive stent thromboses occurred in 1.3% of intravascular ultrasound-only patients versus 1.4% of intravascular ultrasound plus venogram patients, p = 0.95. Moreover, the formation of any stent was 6.2% in the intravascular ultrasound-only versus 6.75% in the intravascular ultrasound plus venogram group, p = 0.55. CONCLUSION Results of our study show no significant difference in stent thrombosis between the intravascular ultrasound-only and intravascular ultrasound plus venogram cohorts. This concludes that using intravascular ultrasound alone is safe for iliac vein stenting.
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Affiliation(s)
- Taqwa Ahmed
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
| | - Jesse Chait
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
| | - Pavel Kibrik
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
| | - Ahmad Alsheekh
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
| | | | - Anil Hingorani
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
| | - Enrico Ascher
- Vascular Institute of New York, Brooklyn, NY, USA.,Summary
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Chen CW, Tseng YH, Wong MY, Wu CM, Lin BS, Huang YK. Stasis Leg Ulcers: Venous System Revises by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging. Diagnostics (Basel) 2020; 10:E707. [PMID: 32957628 DOI: 10.3390/diagnostics10090707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives: The distribution of venous pathology in stasis leg ulcers is unclear. The main reason for this uncertainty is the lack of objective diagnostic tools. To fill this gap, we assessed the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in determining the venous status of patients with stasis leg ulcers. Methods: This prospective observational study included the data of 23 patients with stasis leg ulcers who underwent TRANCE-MRI between April 2017 and May 2020; the data were retrospectively analyzed. TRANCE MRI utilizes differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing not only a venogram but also an arteriogram without the use of contrast agents or radiation. Results: TRANCE MRI revealed that the stasis leg ulcers of nine of the 23 patients could be attributed to valvular insufficiency and venous occlusion (including deep venous thrombosis [DVT], May–Thurner syndrome, and other external compression). Moreover, TRANCE MRI demonstrated no venous pathology in five patients (21.7%). We analyzed TRANCE MRI hemodynamic parameters, namely stroke volume, forward flow volume, backward flow volume, regurgitant fraction, absolute volume, mean flux, stroke distance, and mean velocity, in the external iliac vein, femoral vein, popliteal vein, and great saphenous vein (GSV) in three of the patients with valvular insufficiency and three of those with venous occlusion. We found that the mean velocity and stroke volume in the GSV was higher than that in the popliteal vein in all patients with venous valvular insufficiency. Conclusions: Stasis leg ulcers may have no underlying venous disease and could be confirmed by TRANCE-MRI. TRANCE MRI has good Interrater reliability between Duplex study in greater saphenous venous insufficiency. It also potentially surpasses existing diagnostic modalities in terms of distinguishable hemodynamic figures. Accordingly, TRANCE-MRI is a safe and useful tool for examining stasis leg ulcers and is extensively applied currently.
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Steckiewicz R, Stolarz P, Świętoń EB. Types of left brachiocephalic vein aberrations detected during cardiac implantable electronic device implantation procedures. Folia Morphol (Warsz) 2020; 80:317-323. [PMID: 32639573 DOI: 10.5603/fm.a2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/08/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) implantation procedures with transvenous lead placement afford an opportunity to observe vascular anatomic variations. The course of CIED implantation depends largely on morphometric and topographic characteristics of the relevant brachiocephalic vein (BCV), which is the left BCV in the case of lead insertion via the left clavipectoral triangle. This study aims to present left BCV anomalies arising from abnormal systemic vein embryogenesis and encountered during CIED implantation. MATERIALS AND METHODS Venograms obtained during CIED implantation procedures and illustrating left BCV topography/morphometry were analysed retrospectively for two types of anomalies: anomalies of the left BCV itself (data from the period 2014-2018) and a combination of left BCV variations with a persistent left superior vena cava (PLSVC); since the latter instances are rare, the analysed period was longer (2003-2018). RESULTS Analysis of data from the first, 5-year-long, period included data from a group of 1812 patients and revealed 5 (0.3%) cases of developmental left-BCV anomalies (3 double left BCV and 2 cases of a single subaortic left BCV). The 16-year-long analysed period included 6110 CIED implantation procedures, which showed 12 (0.2%) cases of PLSVC including 4 (33%) cases of left BCV agenesis. CONCLUSIONS The analysed venograms rarely showed isolated left-BCV aberrations (0.3%), with the combination of left-BCV agenesis and PLSVC being much more common (33%). The morphometry and/or topography of aberrant left-BCV may result in difficulties during cardiac lead insertion.
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Affiliation(s)
- R Steckiewicz
- 1st Department of Cardiology, Central University Hospital in Warsaw, Poland.
| | - P Stolarz
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - E B Świętoń
- 1st Department of Cardiology, Central University Hospital in Warsaw, Poland
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Kao CC, Chen CW, Tseng YH, Tsai YH, Wang SC, Huang YK. Non-contrast-enhanced magnetic resonance imaging: Objective figures in differentiation between acute and chronic deep venous thrombosis in the lower extremities. Phlebology 2020; 35:777-783. [PMID: 32635819 DOI: 10.1177/0268355520939375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Deep vein thrombosis is a severe health problem. Treatment options may differ between acute and chronic deep vein thrombosis. Thus, distinguishing acute from chronic deep vein thrombosis is essential for patients with deep vein thrombosis.Triggered angiography non-contrast enhanced is an innovative magnetic resonance imaging protocol that may provide objective evidence in differentiating acute from chronic deep vein thrombosis. METHOD We prospectively collected information on consecutive patients who had been evaluated through triggered angiography non-contrast enhanced magnetic resonance imaging for venous pathology in their lower extremities at a vascular wound care center in a tertiary hospital between April 2017 and January 2020. Patients included were divided into two groups with the onset time cutoff point of 21 days. All were undergone non-contrast-enhanced magnetic resonance imaging evaluation. Non-contrast-enhanced magnetic resonance imaging images were evaluated by a radiologist, and lower extremity venous thrombosis, collateral-vein development, and subcutaneous honeycombing were emphasized. Cohen's kappa coefficient was used to measure interrater agreement between the development of collateral veins, subcutaneous honeycombing, and symptom onset over 21 days. RESULTS Interrater agreement analysis revealed that the development of collateral veins was substantially correlated with the onset of symptoms over 21 days (Table 1). Additionally, the development of subcutaneous honeycombing detected through triggered angiography non-contrast enhanced magnetic resonance imaging also substantially agreed with the onset of symptoms over 21 days (Table 2). CONCLUSION The diagnostic power of triggered angiography non-contrast enhanced magnetic resonance imaging in deep vein thrombosis is rival to current gold standard, color Doppler sonography. Triggered angiography non-contrast enhanced magnetic resonance imaging provides objective information on onset timing in patients with deep vein thrombosis that could differentiate acute from chronic deep vein thrombosis and provides guidance for treatment planning.
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Affiliation(s)
- Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
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Chen CW, Tseng YH, Lin CC, Kao CC, Wong MY, Lin BS, Huang YK. Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics (Basel) 2020; 10:E355. [PMID: 32485855 DOI: 10.3390/diagnostics10060355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. METHODS An observational study with retrospective data analysis. MATERIALS Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. RESULTS In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. CONCLUSIONS TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
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Shammas AN, Shammas NW, Knowles MF, Christensen L. The Venovo Venous Stent in Pregnancy. J Invasive Cardiol 2020; 32:E76-E77. [PMID: 32123148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We present the case of a young woman who became pregnant following placement of a Venovo venous stent (BD/Bard) in her left common iliac vein. Our case illustrates the safety of the Venovo stent during pregnancy. This needs further validation with a larger registry.
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Affiliation(s)
| | - Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA, 52803 USA.
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Abstract
PURPOSE/AIM OF THE STUDY To report on the successful treatment of idiopathic intracranial hypertension (IIH) in a patient with venous sinus stenosis secondary to a persistent occipital-marginal sinus (POMS) utilizing venous sinus stenting. MATERIALS/METHODS A 55-year-old female presented with headaches and blurry vision. Ophthalmologic examination demonstrated papilledema. Two lumbar punctures demonstrated opening pressures of 31 and 38 cmH2O and provided temporary symptom relief. Cerebral venography demonstrated hypoplastic bilateral transverse-sigmoid sinuses with dominant drainage through a persistent occipital-marginal sinus (POMS). Multiple enlarged arachnoid granulations resulted in stenosis in the marginal sinus with an 18 mmHg mean pressure gradient across the stenosis. RESULTS The decision was made for venous sinus stenting of the POMS. Immediate post-stenting venography demonstrated resolution of the POMS stenosis with flow only into the POMS and a mean pressure gradient across the stenosis normalized to 2 mmHg. Six-month follow-up venography demonstrated continued stent patency and clinical symptoms remained resolved. She has remained symptom free at 18 months. CONCLUSION This writing summarizes the utility of endovascular dural sinus stenting and the importance of recognizing the dominant dural sinus drainage route in the treatment of IIH.
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Affiliation(s)
- Anthony M Alvarado
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Alan Reeves
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael G Abraham
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA.,Departments of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Ferral H. Commentary: "Brave Dreams" Reanalysis Sheds New Light on Angioplasty for Venous Anomalies in Some Multiple Sclerosis Patients With Chronic Cerebrospinal Venous Insufficiency. J Endovasc Ther 2020; 27:18-19. [PMID: 31948374 DOI: 10.1177/1526602819894300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hector Ferral
- Section of Interventional Radiology, NorthShore University Health System, Evanston Hospital, Evanston, IL, USA
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Zamboni P, Galeotti R, Salvi F, Giaquinta A, Setacci C, Alborino S, Guzzardi G, Sclafani SJ, Maietti E, Veroux P. Effects of Venous Angioplasty on Cerebral Lesions in Multiple Sclerosis: Expanded Analysis of the Brave Dreams Double-Blind, Sham-Controlled Randomized Trial. J Endovasc Ther 2019; 27:1526602819890110. [PMID: 31735108 PMCID: PMC6970429 DOI: 10.1177/1526602819890110] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate if jugular vein flow restoration in various venographic defects indicative of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients can have positive effects on cerebral lesions identified using magnetic resonance imaging (MRI). Materials and Methods: The Brave Dreams trial (ClinicalTrials.gov identifier NCT01371760) was a multicenter, randomized, parallel group, double-blind, sham-controlled trial to assess the efficacy of jugular venoplasty in MS patients with CCSVI. Between August 2012 and March 2016, 130 patients (mean age 39.9±10.6 years; 81 women) with relapsing/remitting (n=115) or secondary/progressive (n=15) MS were randomized 2:1 to venography plus angioplasty (n=86) or venography (sham; n=44). Patients and study personnel (except the interventionist) were masked to treatment assignment. MRI data acquired at 6 and 12 months after randomization were compared to the preoperative scan for new and/or >30% enlargement of T2 lesions plus new gadolinium enhancement of pre-existing lesions. The relative risks (RR) with 95% confidence interval (CI) were estimated and compared. In a post hoc assessment, venograms of patients who underwent venous angioplasty were graded as “favorable” (n=38) or “unfavorable” (n=30) for dilation according to the Giaquinta grading system by 4 investigators blinded to outcomes. These subgroups were also compared. Results: Of the 130 patients enrolled, 125 (96%) completed the 12-month MRI follow-up. Analysis showed that the likelihood of being free of new cerebral lesions at 1 year was significantly higher after venoplasty compared to the sham group (RR 1.42, 95% CI 1.00 to 2.01, p=0.032). Patients with favorable venograms had a significantly higher probability of being free of new cerebral lesions than patients with unfavorable venograms (RR 1.82, 95% CI 1.17 to 2.83, p=0.005) or patients in the sham arm (RR 1.66, 95% CI 1.16 to 2.37, p=0.005). Conclusion: Expanded analysis of the Brave Dreams data that included secondary/progressive MS patients in addition to the relapsing/remitting patients analyzed previously showed that venoplasty decreases new cerebral lesions at 1 year. Post hoc analysis confirmed the efficacy of the Giaquinta grading system in selecting patients appropriate for venoplasty who were more likely to be free from accumulation of new cerebral lesions at MRI.
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Affiliation(s)
- Paolo Zamboni
- HUB Center for Venous and Lymphatics Disorders of the Emilia Romagna Region, S. Anna University Hospital, Ferrara, Italy
| | - Roberto Galeotti
- Unit of Interventional Radiology, S. Anna University Hospital, Ferrara, Italy
| | - Fabrizio Salvi
- IRCCS of the Neurosciences, Bellaria Hospital, Bologna, Italy
| | - Alessia Giaquinta
- Unit of Vascular Surgery and Transplantation, University of Catania, Italy
| | - Carlo Setacci
- Unit of Vascular Surgery, University of Siena, Siena, Italy
| | | | | | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Italy
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Kitamura T, Vlachos K, Denis A, Andre C, Martin R, Pambrun T, Duchateau J, Frontera A, Takigawa M, Thompson N, Cheniti G, Martin CA, Lam A, Bourier F, Sacher F, Hocini M, Haissaguerre M, Jais P, Derval N. Ethanol infusion for Marshall bundle epicardial connections in Marshall bundle-related atrial tachycardias following atrial fibrillation ablation: The accessibility and success rate of ethanol infusion by using a femoral approach. J Cardiovasc Electrophysiol 2019; 30:1443-1451. [PMID: 31187516 DOI: 10.1111/jce.14019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ethanol infusion of the vein of Marshall (VOM) may be effective to treat Marshall bundle-related atrial tachycardia (MB-AT). However, methods and clinical results of ethanol infusion for MB-AT have been not established. OBJECTIVE To assess the accessibility of the VOM and the success rate of ethanol infusion using a femoral approach for MB-AT. METHODS A single-center observational study included consecutive patients who had MB-AT and in whom we attempted to treat MB-AT during AT by ethanol infusion. When the VOM was able to be cannulated following VOM venogram using a femoral approach, we systematically performed ethanol infusion with selective balloon occlusion of the VOM. We analyzed in detail the efficacy of ethanol infusion of VOM in patients who were in MB-AT during ethanol infusion. RESULTS We enrolled 54 consecutive patients in whom we attempted to treat MB-AT by ethanol infusion. Of those, the VOM was accessible in 92.5% of patients (50 of 54). Of the 50 patients treated by ethanol infusion during MB-AT, AT was successfully terminated in 56% percent of the patients (28 of 50) by solo treatment of ethanol infusion without RF ablation. The remainder required additional RF application to terminate the MB-AT. A mean of 6.2 ± 2.8 mL of ethanol was infused resulting in the low-voltage area significantly larger than that before ethanol infusion (12.7 ± 8.3 vs 6.6 ± 5.3 cm2 , P < .001). CONCLUSION The present study demonstrated that the VOM was highly accessible and MB-AT was amenable to treatment by ethanol infusion by using a femoral approach.
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Affiliation(s)
- Takeshi Kitamura
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Arnaud Denis
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Clementine Andre
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Ruairidh Martin
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Antonio Frontera
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | | | - Ghassen Cheniti
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Claire A Martin
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Anna Lam
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Felix Bourier
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Frederic Sacher
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Meleze Hocini
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | | | - Pierre Jais
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
| | - Nicolas Derval
- CHU de Bordeaux, LIRYC, University of Bordeaux, Bordeaux, France
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Monroe EJ, Jeyakumar A, Ingraham CR, Shivaram G, Koo KSH, Hsu EK, Dick AAS. Doppler ultrasound predictors of transplant hepatic venous outflow obstruction in pediatric patients. Pediatr Transplant 2018; 22:e13310. [PMID: 30338622 DOI: 10.1111/petr.13310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/25/2018] [Accepted: 09/03/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate Doppler US and catheter venogram correlates to improve detection of transplant HVOO and avoid unnecessary invasive imaging procedures. MATERIALS AND METHODS A retrospective review was performed in all pediatric OLT patients undergoing catheter venography of the hepatic veins between 2007 and 2017 at a single large tertiary pediatric liver transplant institution. RESULTS Forty-four transplant hepatic venograms in 32 OLT patients were included (mean 1.38, range 1-4 venograms per patient). All venograms were preceded by an independent Doppler US examination. Twenty-one (47.7%) venograms were performed for the investigation of suspected HVOO based on Doppler US alone, 19 (43.2%) were performed for TJLB without suspected HVOO, 4 (9.1%) were performed for both. Sixteen (36.3%) instances of >50% anastomotic stenosis were identified. Mean peak anastomotic velocities were 208 cm/s and 116 cm/s in the presence and absence of a >50% venographic stenosis, respectively (P < 0.004). In all cases where there was a monophasic waveform seen on Doppler US, there was a > 50% stenosis seen on hepatic vein venogram. In all cases where a triphasic waveform was seen on Doppler US, there was no stenosis seen on hepatic vein venogram. CONCLUSION While a Doppler US velocity threshold providing both high sensitivity and specificity has yet to be identified, increasing peak anastomotic velocity and decreasing intrahepatic venous velocity correlate strongly with venographic outflow stenosis. The presence of a triphasic intrahepatic waveform provides good NPV.
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Affiliation(s)
- Eric J Monroe
- Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Arthie Jeyakumar
- Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Christopher R Ingraham
- Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Giri Shivaram
- Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Kevin S H Koo
- Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Evelyn K Hsu
- Gastroenterology and Hepatology, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Andre A S Dick
- Pediatric Transplantation, Seattle Children's Hospital and University of Washington, Seattle, Washington
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Lee HS, Song YR, Kim JK, Choi SR, Joo N, Kim HJ, Park P, Kim SG. Anatomical variants of upper arm veins on preoperative mapping venography for hemodialysis access in Korean adults. J Vasc Access 2018; 20:270-275. [PMID: 30306819 DOI: 10.1177/1129729818803870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation. METHODS A total of 494 venograms were performed on 251 patients for primary access creation from June 2014 to June 2017 in this single-center, retrospective study. The venograms were classified into eight subtypes, based on the anatomical relationship between the basilic and brachial veins. The presence of bifid cephalic arches and brachial-basilic ladders was also examined. RESULTS The presence of bifid cephalic arches and brachial-basilic ladders was identified in 8.7% and 14.0% of cases, respectively. Paired brachial veins joined separately with the basilic vein in 67.4% of venograms, whereas these veins merged into a common brachial vein before connecting to the basilic vein in 13.1% of cases. A single brachial vein was present in 19.3% of cases. 15.7% of cases were considered unsuitable for basilic vein transposition due to the early confluence of the brachial-basilic vein, posing a risk of obliterating the deep venous drainage if transposed. CONCLUSION There are significant anatomical variations of upper arm veins, and the recognition of certain variants can affect surgical planning and outcomes of access placement. It is important to identify anatomical variants of the upper arm veins during preoperative vein mapping.
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Affiliation(s)
- Hyung Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Jwa Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Sun Ryoung Choi
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Narae Joo
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Hyung Jik Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Pyoungju Park
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
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