Diagnosis and treatment of jugular phlebectasia / 中国微创外科杂志

Objective To discuss the diagnosis and treatment of jugular phlebectasia. Methods Clinical data of 13 patients with jugular phlebectasia were reviewed. The confirmation of diagnosis in the nature, range, and degree of jugular phlebectasia was made using the Valsalva maneuver, color ultrasonography, and enhancement radiological techniques. Except 2 patients with superior mediastinal tumor were transfered to the Department of Thoracic Surgery, the treatment included resection of phlebangioma in 5 patients, internal jugular vein dilatation by balloon catheter in 1 patient, jugular venoplasty in 1 patient, and conservative treatment with Aspirin in 4 patients. Results In 7 surgically treated patients, the postoperative recovery was uneventful and no complications occurred. The length of hospital stay was 2~7 days (mean, 3 d). Follow-up observations in the 7 patients for 3~32 months (mean, 14.4 months) found no recurrence and excellent cosmetic outcomes. In 4 patients receiving conservative therapy, follow-up observations were carried out for 3~55 months. No changes were observed in 3 asymptomatic patients on the dilatation extent of the internal jugular vein and the range of the lesions, while improvements were achieved in 1 patient with symptoms after symptomatic treatment. Conclusions The diagnosis of jugular phlebectasia should be made for the patients who presented with a soft cystic fluctuant mass on the anterior neck which became more prominent during the Valsalva manoeuvre. The confirmation of differential diagnoses in the nature, range and degree of jugular phlebectasia can be made by enhancement radiological examinations. Minimally invasive surgery is recommended for the patients with symptomatic and cosmetic purposes.

Selective mini-incision procedure for the treatment of superficial varicosis of lower limbs / 中国微创外科杂志

Objective To evaluate the feasibility and clinical efficacy of selective mini-incision procedure for superficial varicose veins of lower extremities. Methods A total of 89 patients with local superficial varicose veins (101 veins) treated in this hospital from January 1998 to July 2003 entered the study.Stetho-Doppler and finger pressure examination were performed preoperatively in all the patients to locate the malfunctioned venous valves.Ligation of communicating veins combined with saphenectomy was carried out by way of mini-incision under local anesthesia. Results The sutured wounds in all the patients healed by first intention.Out of 36 limbs with swelling and heaviness,symptoms disappeared in 29 limbs and relieved in 7 limbs.Localized subcutaneous hematoma beneath the incision occurred in 3 patients,but no skin numbness or other complications took place.Follow-up ranged from 1 month to 5 years [(30 2?18 8)months] and 65 patients were followed for more than 1 year.No recurrence of superficial varicosis of lower limbs was seen. Conclusions Selective mini-incision procedure for the treatment of varicose vein of lower extremities is feasible,simple,safe and effective.

Mini-incision surgery for the treatment of venous varicosis of lower limbs / 中国微创外科杂志

Objective To evaluate the therapeutic effect of mini-incision surgery for the treatment of varicose vein of lower extremities. Methods 106 limbs of 95 paitnets with varicose vein underwent saphenectomy combined with ligation of communicating veins by way of mini-incision from November 1997 to April 2001. The ascending venography and StethoDoppler examination were performed preoperatively in all of the patients. Results Venous reflux in deep vein of lower extremities were at grade 0 in 62 limbs, at grade Ⅰ in 28 limbs and at grade Ⅱ in 16 limbs demonstrated by ascending venography with Valsalva test. StethoDoppler examination showed that valve insufficiency of great saphenous vein at saphenofemoral junction was in 99 limbs, the insufficiency of small saphenous vein at saphenopopliteal in 5 limbs and incompetent perforating vein in all of the limbs. Postoperative course was uneventful, the average hospitalization days after operation were 2.8 days and no recurrent varicose veins occurred in all the patients during the follow-up period lasting 1-30 months. Conclusions With the help of preoperative StehoDoppler examination, the mini-incision surgery for the treatment of varicose vein of lower extremities is safe, simple, effective and lower costs.

Anastomotic Pseudoaneurysm Following Aorto-femoral Artery Reconstruction / 日本心臓血管外科学会雑誌

One of the complications after Dacron vascular reconstruction for both occlusive disease and aneurysmal disease is anastomotic false aneurysm. We reviewed 22 aneurysms of 13 patients who underwent aorto-femoral reconstruction in our department during the past 14 years. The indication for initial prosthetic reconstruction had been an atherosclerosis obliterans (ASO) in 12 patients and infrarenal aortic occlusion with liver abscess in 1 patient. The mean interval from initial surgery was 40.6 months (range, 2 to 142 months). Seven anastomotic pseudoaneurysms occurred within 6 months after operation and the remaining fifteen occurred in the late follow-up period (22 to 142 months). Unilateral aneurysm was found in 7, bilateral in 5 and 5 in one patient. Distal femoral anastomotic symptoms at presentation included critical limb ischemia in one, inguinal pain in three, abscess in two, mass in seven and asymptomatic in seven. Proximal aortic anastomotic symptoms included abdominal pain in one case and another case was asymptomatic. The asymptomatic aneurysm was diagnosed by routine sonographic surveillance. Surgical management in all patients included aneurysmectomy with aneurysmoplasty in 2 and prosthetic graft interposition or bypass in 11 as an elective operation, graft extirpation with extraanatomic bypass in one and graft replacement in one as an urgent operation, and thrombectomy and/or graft replacement in 6 as an emergency operation. All of the aneurysms are pseudoaneurysms were confirmed by pathological examination. Host arterial-wall degeneration was the main cause of aneurysm formation in most cases (85.7%). In our opinion, patients should be periodically studied after aortic grafting with abdominal ultrasonography for early detection of this potentially serious complication. Early diagnosis and elective repair of these aneurysms should be recommended whenever possible because of their propensity to develop serious complications.

Extended profundaplasty for lower extremity ischemia / 中国普通外科杂志

Objective To evaluate the clinical effectiveness of extended profundaplasty for treatment of critical leg ischemia. Methods Twenty-five legs (stage Ⅲ and Ⅳ in Fontaine′s classification) of 23 patients with critical leg ischemia caused by extensive occlusion of the distal arteries were reviewed during past 12 years. All patients underwent extended profundaplasty and were evaluated by clinical observation of API, tcPO 2, PSaO 2, Treadmill test, NIRS and ultrasound perioperatively. Results Fourteen legs in 13 patients had a favorable outcome, seven legs in 6 patients had an improvement on their symptom and sign, three legs in 3 patients underwent below knee and one case medio-tarsal amputation during the periods of 7 months to 7 years follow-up. Conclusion The extended profundaplasty is simple, less invasive, safe and effective for the treatment of limb-threatening ischemia.