Tratamento endovascular de síndrome congestiva venosa pélvica em paciente com duplicação de veia cava inferior e anatomia venosa pélvica incomum: revisão bibliográfica / Endovascular treatment of pelvic venous congestion syndrome in a patient with duplication of the inferior vena cava and unusual pelvic venous anatomy: literature review

Resumo A dor pélvica crônica afeta aproximadamente 1/3 de todas as mulheres e é responsável por cerca de 20% de todas as consultas ginecológicas. Os autores relatam um raro caso de congestão venosa pélvica sintomática na presença de duplicação de veia cava inferior e comunicação interilíaca através de veia hipogástrica direita tratado com abordagem endovascular, por embolização das veias varicosas pélvicas e revisão da literatura publicada.

Abstract Chronic pelvic pain affects approximately one-third of all women and is responsible for about 20% of all gynecological consultations. The authors report a rare case of symptomatic pelvic venous congestion in the presence of duplication of the inferior vena cava and inter-iliac communication through the right hypogastric vein that was treated via an endovascular approach with embolization of varicose pelvic veins. The published literature is reviewed.

Research of multi-tube composite negative pressure suction device for the treatment of venous congestion flap / 中华整形外科杂志

Objective@#To compare the multi-tube composite negative pressure suction device with a single tube negative pressure suction device for the treatment of venous congestion flap.@*Methods@#15 New Zealand white rabbits were selected. Two lower abdomen skin flaps were larvested as venous congestion flap models in each rabbit. The 30 flaps were randomly divided into three groups, as group A(multi-tube composite negative pressure suction device, 10 flaps), group B(the single tube negative pressure suction device, 10 flaps) and group C(no pressure suction device, 10 flaps). The 10 flaps in each group were again randomly divided into six flaps for histological study and four flaps for observation. The six flaps were harvested at 4, 8, 24 hours and 3, 7 d after operation for detection of S-phase ratio(S-phase fraction, SPF) and cell apoptosis by flow cytometry. The 4 flaps were observed for flaps color, swelling, finger pressure reaction. The survival rate was measured 7 days after operation.@*Results@#The difference between group A and B or between B and C was significant in surface temperature (group A> B>C, P<0.05), flap survival area(group A> B>C, P<0.05), flap SPF(group A> B>C, P<0.05) and flap early apoptosis(group A< B<C, P<0.05).@*Conclusions@#Compostie negative pressure suction device can treat venous congestion flap, especially multi-tube device. It can promote flap tissue cell proliferation, reduce the apoptosis and increase the flap survival area.

Brainstem Congestion due to Dural Ateriovenous Fistula at the Craniocervical Junction

Dural ateriovenous fistula (DAVF) at the craniocervical junction is rare. We report a patient presenting with brainstem dysfunction as an uncommon onset. Brainstem lesion was suggested by magnetic resonance image study. Angiogram revealed a DAVF at a high cervical segment supplied by the meningeal branch of the right vertebral artery, with ascending and descending venous drainage. Complete obliteration of the fistula was achieved via transarterial Onyx embolization. Clinical cure was achieved in the follow-up period; meanwhile, imaging abnormalities of this case disappeared. Accordingly, we hypothesize that a brainstem lesion of this case was caused by craniocervical DAVF, which induced venous hypertension. Thus, venous drainage patterns should be paid attention to because they are important for diagnosis and theraputic strategy.

Lumbar Disc Herniation Associated with Contralateral Neurological Deficit: Can Venous Congestion Be the Cause?

Lumbar disc herniation (LDH) associated with a contralateral neurological deficit is sometimes encountered by surgeons. Compression against the opposite pedicle in case of a large discal herniation and prominent stenotic changes of contralateral side are held responsible for contralateral symptoms and findings. In this study, we report a case of LDH associated with a painless contralateral neurological deficit. Prominent venous engorgement and congestion at the contralateral side of discal herniation were detected during the operation. It's treatment with bipolar coagulation and significant improvement was seen after the operation.

Clinical and imaging study on hepatic venous congestion of Ⅴ, Ⅷ segments in living donor liver transplantation / 中华普通外科杂志

Objective To evaluate MSCT appearance and impaction of Ⅴ, Ⅷ segments' hepatic venous congestion ( HVC ) on hepatic functional recovery in living donor liver transplantation (LDLT).Methods In this study, 83 patients undergoing LDLT in our hospital were included, all subjects received plain and contrast MSCT examinations at early stage (within 1 month) and later stage (3 months later) after LDLT. MSCT appearance of HVC was recorded, at the same time, gutamic pyruvic transaminase ( ALT),glutamic oxalacetic transaminase (AST), total bilirubin (TB) and prothrombin time (PT) of 1 to 7 days after LDLT between congestion group and non-congestion group were recorded and compared.Results Segments Ⅴ and Ⅷ congestion was identified by after LDLT CT scanning in 20 patients (24. 10% ). Congestion volume and congestion ratio was (218. 25 ± 130. 29) cm3 and 16. 68% ±8. 81%,respectively. HVC often appear as hypoattenuation on plain CT scan and arterial phase, mixed or hyperattenuation on portal vein phase. There was no significant difference of ALT, AST, TB and PT after LDLT between congestion group and non-congestion group (P ＞ 0. 05). Conclusions MSCT is a valuable method to evaluate Ⅴ, Ⅷ segments' HVC after LDLT, most HVC has no impaction on hepatic functional recovery in LDLT patients.

Changes of microcirculation in congested flap / 中华医学美学美容杂志

Objective To explore the change patterns of microcirculation in congested flap. Methods A congested flap model for long-term microeirculation observation was set up, and the mi-crocireulation of the congested tissues was observed carefully. Results Following congestion, the number of the capillaries in the congested flap were decreasing, the velocity of the bloodstreams were getting slower, and the aggregation of the red blood cells and the formation of the white thrombus were becoming more serious. About 72 hours later, the original microcirculation system of the flap was nearly exhausted. About 36 hours later, the neogenetie capillaries could be observed, with clear neogenetie capillaries observed at 48 hours. The congested tissues with nascent capillaries survived, while the capillaries without nascent formation suffered from necrosis in the end. Conclusions If the cause is not removed, the microcirculation status of the congested flap would get worse irreversibly, and the nascent capillaries would play an important role in the survival of congested tissues.

Change of Venous Pressure of Superficial Vascular System during Free TRAM Flap Elevation

PURPOSE: Free transverse rectus abdominis musculocutaneous(TRAM) flap is one of the most popular methods of breast reconstruction. But if fat necrosis and fatty induration occur at the reconstructed breast, they can make the breast harder and make it difficult to differentiate a tumor recurrence from them. To expect and prevent these complications, we measured the pressure change of the superficial venous system whose congestion can be the cause of them. METHODS: An intraoperative clinical study was done to compare venous pressure of superficial inferior epigastric vein(SIEV) before and after the elevation of free TRAM flap. Fourteen TRAM flaps were included and the pressures of SIEV were measured two times at the beginning of the elevation and just before the division of the inferior pedicle. RESULTS: The venous pressure in free TRAM flap was significantly higher after the flap elevation at both contralateral side and ipsilateral(p=0.005 and p=0.026 respectively). The four cases with vertical scar shower significantly greater increase at contralateral side than ipsilateral side(p=0.020). CONCLUSION: Intraoperative venous pressure recording can be an objective data for evaluating the congestion of TRAM flap and can help to prevent the complications of fat necrosis and fatty induration with venous superdrainage.

Change of Venous Pressure of Superficial Vascular System during Free TRAM Flap Elevation

PURPOSE: Free transverse rectus abdominis musculocutaneous(TRAM) flap is one of the most popular methods of breast reconstruction. But if fat necrosis and fatty induration occur at the reconstructed breast, they can make the breast harder and make it difficult to differentiate a tumor recurrence from them. To expect and prevent these complications, we measured the pressure change of the superficial venous system whose congestion can be the cause of them. METHODS: An intraoperative clinical study was done to compare venous pressure of superficial inferior epigastric vein(SIEV) before and after the elevation of free TRAM flap. Fourteen TRAM flaps were included and the pressures of SIEV were measured two times at the beginning of the elevation and just before the division of the inferior pedicle. RESULTS: The venous pressure in free TRAM flap was significantly higher after the flap elevation at both contralateral side and ipsilateral(p=0.005 and p=0.026 respectively). The four cases with vertical scar shower significantly greater increase at contralateral side than ipsilateral side(p=0.020). CONCLUSION: Intraoperative venous pressure recording can be an objective data for evaluating the congestion of TRAM flap and can help to prevent the complications of fat necrosis and fatty induration with venous superdrainage.

Hepatic Vein Reconstruction for Living Donor Liver Transplantation using a Modified Right lobe Graft: Experience at Asan Medical Center and focused on Middle Hepatic Vein Reconstruction

Living donor liver transplantation is now widely accepted as a therapeutic option for adult patients suffering with various end-stage liver diseases. The major concerns for use of a right lobe (RL) graft have focused on the safety for the donor and the necessity for including the middle hepatic vein (MHV) into the graft to avoid congestion of the right anterior segment. There are 5 types of RL grafts (simple RL, modified RL, modified extended RL, extended RL with V4b preservation and extended RL), and the selection is usually determined after consideration of the graft size to the recipient, the availability of a vessel graft, the amount of hepatic venous congestion and the reconstruction technique. Various kinds of vessel grafts have been used in practice: 1) greater saphenous vein, paraumbilical vein, portal vein and internal jugular vein from the recipient, 2) various veins and arteries from the deceased donors and 3) bovine pericardium and synthetic vessels. Interposition of a vessel graft is the basic principle for MHV reconstruction. Triphasic liver computed tomography and Doppler ultrasonography are the most useful tools for posttransplant follow-up. When outflow obstruction occurs at the interposed vessel grafts that replace the MHV trunk, then radiological intervention with metallic stent insertion seems to be a feasible and reliable treatment modality. At Asan Medical Center, 200 cases of adult living donor liver transplantation using a modified RL graft revealed a > 90% 2-week patency rate regardless of the types of vessel grafts. In conclusion, it is recommended to make the MHV reconstruction resemble the original configuration of the donor's MHV trunk according to the hemodynamic principles.

Dural Arteriovenous Fistula of the Cavernous Sinus Presenting with Progressive Venous Congestion of the Pons and Cerebrum: Report of one case

A 61-year-old woman with a left cavernous sinus dural arteriovenous fistula presented with left 6th nerve palsy. Initial brain MRI showed findings consistent with left-sided pontine infarction. Follow-up MRIs revealed an enlarged pontine lesion, and additional lesions in the right hippocampus, both basal ganglia and centrum semiovale mimicking a brain tumor or a demyelinating disease. We suggest that the MRI lesions are venous congestions caused by the shunting of blood flow from the left carotid artery into the venous system. (J Korean Neurol Assoc 19(5):520~525, 2001)