Abnormal obturator artery with ipsilateral inferior epigastric artery passed behind the femoral vein / Arteria obturatriz anómala con arteria epigástrica inferior ipsilateral que cruza posterior a la vena femoral

SUMMARY: Clear awareness of the vascular variations is critical in surgeries, which may cause massive hemorrhage during surgical procedures. During educational dissection of a male cadaver, we encountered a combined variation of the left obturator artery and ipsilateral aberrant inferior epigastric artery. The left obturator artery originated from the external iliac artery, then coursed inward, adherent to the superior pubic ramus. The left inferior epigastric artery originated from the femoral artery, and coursed behind the femoral vein. These anatomical variations shown in one person were extremely rare. This is particularly true with regard to these variations while performing pelvic and inguinal region surgeries.

El conocimiento claro de las variaciones vasculares es fundamental en las cirugías, ya que pueden causar una hemorragia masiva durante los procedimientos quirúrgicos. Durante la disección educativa de un cadáver de sexo masculino, encontramos una variación combinada de la arteria obturatriz izquierda y la arteria epigástrica inferior ipsilateral aberrante. La arteria obturatriz izquierda se originaba en la arteria ilíaca externa, luego discurrió hacia medial, adhiriéndose a la rama púbica superior. La arteria epigástrica inferior izquierda se originaba en la arteria femoral y discurría por detrás de la vena femoral. Estas variaciones anatómicas mostradas en una sola persona son extremadamente raras. Esto es importante de conocer estas variaciones cuando se realizan cirugías de las regiones pélvica e inguinal.

Application of the 3t sensorial saturation in femoral vein blood collection of premature infants / 中国实用护理杂志

Objective:To investigate the effect of the 3t sensorial saturation in the application of relieving pain and comfort due to femoral vein blood sampling in preterm infants, so as to provide the reference for the selection of clinical nursing plans.Methods:This was a quasi experimental study. A total of 110 preterm infants admitted to the neonatal unit of Shanxi Children′s Hospital from August 2021 to March 2022 were selected and divided into the control group and intervention group with 52 cases respectively by the random number table method. The control group implemented conventional care, and the intervention group implemented the 3t sensorial saturation method including taste, touch and talk on the basis of the control group. The pain and comfort of two groups were evaluated by the Premature Infant Pain Profile (PIPP) and COMFORTneo Scale at 3 min before, during, and 3 min after blood, and the heart rate and SpO 2 of the two groups were compared. Results:Finally, 52 premature infants were included in both groups. The PIPP score, the total score of the COMFORTneo Scale, the heart rate and SpO 2 were 2.00 (1.00, 3.00), 6.50 (6.00, 7.75), 4.00 (3.00, 5.00), 7.00 (6.00, 8.00), 17.00 (15.00, 19.00), 9.50 (9.00, 10.00) points, (137.29 ± 8.58), (148.31 ± 8.89), (143.06 ± 7.61) times/min, 0.980 (0.970, 0.990), 0.960 (0.950, 0.970), 0.980 (0.970, 0.990) in the intervention group, 2.00 (1.25, 3.00), 12.00 (11.00, 13.00), 7.00 (6.00, 8.00), 7.00 (6.00, 9.00), 25.00 (23.00, 27.00), 20.00 (19.00, 22.00) points, (141.54 ± 10.57), (179.71 ± 14.62), (162.00 ± 14.32) times/min, 0.980 (0.960, 0.990), 0.940 (0.920, 0.958), 0.960 (0.940, 0.978). The results of generalized estimating equation analysis showed that the PIPP score, total COMFORTneo Scale score and SpO 2 via different time points, subgroups, and subgroups with time points were statistically significant (Wald χ2 values were 16.72-2 489.71, all P<0.05). The results of two-factor repeated measures ANOVA showed that the interaction effects of heart rate via different time points, subgroups, and subgroups with time points were statistically significant ( F=253.08, 105.02, 77.17, all P<0.05). Conclusions:The 3t sensorial saturation method can effectively reduce pain during femoral vein blood sampling in preterm infants, can improve the comfort level of preterm infants, is conducive to the stabilization of vital signs in preterm infants, and is suitable for promotion and application in clinical care.

Diagnostic value of color Doppler ultrasonography in the persistent sciatic vein / 中华超声影像学杂志

Objective:To study the clinical value of color Doppler ultrasonography in the diagnosis of persistent sciatic vein(PSV).Methods:A retrospective study was performed on 17 patients who were diagnosed with PSV by color Doppler ultrasound in the Second Hospital of Shandong University and the Shandong Provincial Hospital Affiliated to Shandong First Medical University from May 2010 to December 2021. Their sonographic features were analyzed, summarized and classified.Results:In all the 17 cases, the sciatic vein showed a vein adjacent to the sciatic nerve in the pelvis or back of the thigh. According to anatomy, persistent sciatic vein could be divided into three types: complete PSV, upper PSV and lower PSV. There were 7 cases of complete PSV, 2 cases of upper PSV and 8 cases of lower PSV. Femoral vein dysplasia was found in 11 of 17 patients with PSV. In addition to 1 case of bilateral PSV, the diameter of the femoral vein on the affected side was (0.36±0.19)cm in 16 cases, and the diameter of femoral vein at the corresponding position on the healthy side was (0.61±0.11)cm, there was significant difference between the two groups ( P<0.001). Conclusions:Color Doppler ultrasonography is the effective imaging method for diagnosis of the PSV.

Damage control in abdominal vascular trauma

In patients with abdominal trauma who require laparotomy, up to a quarter or a third will have a vascular injury. The venous structures mainly injured are the vena cava (29%) and the iliac veins (20%), and arterial vessels are the iliac arteries (16%) and the aorta (14%). The initial approach is performed following the ATLS principles. This manuscript aims to present the surgical approach to abdominal vascular trauma following damage control principles. The priority in a trauma laparotomy is bleeding control. Hemorrhages of intraperitoneal origin are controlled by applying pressure, clamping, packing, and retroperitoneal with selective pressure. After the temporary bleeding control is achieved, the compromised vascular structure must be identified, according to the location of the hematomas. The management of all lesions should be oriented towards the expeditious conclusion of the laparotomy, focusing efforts on the bleeding control and contamination, with a postponement of the definitive management. Their management of vascular injuries includes ligation, transient bypass, and packing of selected low-pressure vessels and bleeding surfaces. Subsequently, the unconventional closure of the abdominal cavity should be performed, preferably with negative pressure systems, to reoperate once the hemodynamic alterations and coagulopathy have been corrected to carry out the definitive management.

En pacientes con trauma de abdomen que requieren laparotomía, hasta una cuarta o tercera parte, habrán sufrido una lesión vascular. Las estructuras venosas principalmente lesionadas son la vena cava y las iliacas, y de vasos arteriales, son las iliacas y la aorta. El abordaje de este tipo de heridas vasculares se puede ser difícil en el contexto de un paciente hemodinámicamente inestable ya que requiera medidas rápidas que permita controlar la exanguinación del paciente. El objetivo de este manuscrito es presentar el abordaje del trauma vascular abdominal de acuerdo con la filosofía de cirugía de control de daños. La primera prioridad en una laparotomía por trauma es el control de la hemorragia. Las hemorragias de origen intraperitoneal se controlan con compresión, pinzamiento o empaquetamiento, y las retroperitoneales con compresión selectiva. Posterior al control transitorio de la hemorragia, se debe identificar la estructura vascular comprometida, de acuerdo con la localización de los hematomas. El manejo de las lesiones debe orientarse a la finalización expedita de la laparotomía, enfocado en el control de la hemorragia y contaminación, con aplazamiento del manejo definitivo. Lo pertinente al tratamiento de las lesiones vasculares incluyen la ligadura, derivación transitoria y el empaquetamiento de vasos seleccionados de baja presión y de superficies sangrantes. Posteriormente se debe realizar el cierre no convencional de la cavidad abdominal, preferiblemente con sistemas de presión negativa, para consecutivamente reoperar una vez corregidas las alteraciones hemodinámicas y la coagulopatía para realizar el manejo definitivo.

Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA / Cirugía de control de daños para lesiones del opérculo torácico: nuevo abordaje mediante esternotomía mediana y REBOA

Abstract Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.

Resumen El trauma vascular torácico está asociado con una alta mortalidad y es la segunda causa más común de muerte en pacientes con trauma después del trauma craneoencefálico. Se estima que menos del 25% de los pacientes con una lesión vascular torácica alcanzan a llegar con vida para recibir atención hospitalaria y más del 50% fallecen en las primeras 24 horas. El trauma torácico penetrante con compromiso de los grandes vasos es un problema quirúrgico dado a su severidad y la asociación con lesiones a órganos adyacentes. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de las lesiones del opérculo torácico con la creación de un algoritmo de manejo quirúrgico en seis pasos prácticos de seguir basados en la clasificación de la AAST. que incluye los principios básicos del control de daños. La esternotomía mediana de resucitación junto con la colocación de un balón de resucitación de oclusión aortica (Resuscitative Endovascular Balloon Occlusion of the Aorta - REBOA) en zona 1 permiten un control primario de la hemorragia y mejoran la sobrevida de los pacientes con trauma del opérculo torácico e inestabilidad hemodinámica.

A brief comment on vasa vasorum of human saphenous vein: relevance for coronary artery bypass surgery

Abstract The importance of the vasa vasorum and blood supply to the wall of human saphenous vein (hSV) used for coronary artery bypass grafting (CABG) is briefly discussed. This is in the context of the possible physical link of the vasa vasorum connecting with the lumen of hSV and the anti-ischaemic impact of this microvessel network in the hSV used for CABG.

Clinical efficacy and application value of percutaneous interventional treatment for / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound. Methods    The clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined. Results    Satisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount  of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae. Conclusion    Percutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.

Adventitial Cystic Disease of the Common Femoral Vein: Report of a Case / 日本心臓血管外科学会雑誌

A 68-year-old man suffered a pain in his right groin and was diagnosed with deep vein thrombosis at a previous medical clinic, two months earlier. He was referred to our hospital to treat deep vein thrombosis. However, adventitial cystic disease of the femoral vein was suspected from findings of preoperative contrast CT and ultrasonography. Under general anesthesia, the operation was performed. The venous wall was resected including an adventitial cyst, which was followed by the venous reconstruction using an autologous vein patch. Anticoagulant therapy was continued after the operation for one year. He was followed for 18 months after the surgery without a recurrence of the adventitial cystic disease. Venous adventitial cystic disease is extremely rare and may be misdiagnosed as deep vein thrombosis. Careful follow-up is mandatory, because the postoperative recurrence rate is reported to be substantially high.

Incidencia, tasa de éxito, complicaciones y factores predictores de empleo de la vía femoral en procedimientos percutáneos de extracción de electrodos / Incidence, success rate, complications and predictive factors of the use of the femoral route for the removal of the electrodes after percutaneous procedures

Resumen Introducción: en los procedimientos de extracción de electrodos, la vía femoral se usa cuando la vía superior ha fracasado. Objetivo: describir la incidencia, el éxito, las complicaciones y los predictores de uso de la vía femoral. Métodos: se realizó un análisis de la incidencia del uso de la vía femoral y los factores predictores en pacientes a quienes se les realizó extracción de electrodos entre noviembre de 2011 y noviembre de 2017. Resultados: se incluyeron 85 pacientes, con edad media de 62,36 ± 11,15 años. El 38,9% de los dispositivos eran marcapasos. Se extrajeron 135 electrodos, 59,3% de fijación pasiva. La mediana de tiempo desde el implante fue de 102 (60-174) meses. Se empleó la ruta femoral en el 25,9% de los procedimientos. Se obtuvo éxito clínico en el 92,9% de los pacientes. La extracción no fue exitosa en el 22,7% de los procedimientos cuando se usó la vía femoral, en comparación con el 1,6% cuando se usó la vía superior (p 0,004). La extracción no fue completa en el 36,4% de los procedimientos cuando se empleó la vía femoral en comparación con el 9,5% por vía superior (p 0,007). Los factores que predijeron el empleo de la ruta femoral fueron la presencia de electrodos de fijación pasiva [OR IC 95% 13,69 (3,06-62,5) p 0,001] y el tiempo desde el implante del electrodo [OR IC 95% por cada 10 meses 1,04 (1,00-1,09) p 0,044]. Conclusiones: se empleó la ruta femoral en el 25,9% de los procedimientos. No fue eficaz en el 22,7% de las intervenciones. Los factores que predijeron su utilización fueron la presencia de electrodos de fijación pasiva y el tiempo desde el implante del electrodo.

Abstract Introduction: The femoral route is used in electrode removal procedures when the upper route has failed. Objective: To describe the incidence, success rate, complications and predictive factors for the use of the femoral route. Methods: An analysis was performed on the incidence of use of the femoral route and the predictive factors in patients in whom electrode removal was carried out between November 2011 and November 2017. Results: The study included 85 patients with a mean age of 62.36 ± 11.5 years. Pacemakers made up 38.9% of the devices. A total of 135 electrodes, 59.3% of passive fixation, were removed. The median time since the implant was 102 (60-174) months. The femoral route was used in 25.9% of the procedures. Clinical success was achieved in 92.9% of the patients. The removal was not successful in 22.7% of the procedures when the femoral route was used, compared to 1.6% when the upper route was used (P = .004). The removal was not completed in 36.4% of the procedures when the femoral route was used, compared to 9.5% with the upper route (P = .007). The factors that predicted the use of the femoral route were the presence of passive-fixation electrodes (OR = 13.69: 95% CI; 3.06 - 62.5, P = .001), and the time since the electrodes were implanted (OR = 1.04, 95% CI; 1.00 - 1.09, P = .044, for every 10 months). Conclusions: The femoral route was employed in 25.9% of the procedures. It was not effective in 22.7% of the interventions. The factors that predicted its use were the presence of passive-fixation electrodes and the time since the electrode implant.

Peripheral vs. central cannulation in cardiac reoperations: technical considerations and outcomes

Abstract Objective: To compare peripheral and central cannulation techniques in cardiac reoperation. Methods: This retrospective study included 258 patients undergoing cardiac reoperation between January 2013 and July 2018. Patients were divided into two groups according to the cannulation type. The first group included 145 (56.2%) patients operated with standard central cannulation through aorta and right atrium or bicaval cannulation. In this group, cardiopulmonary bypass was instituted after sternotomy. The second group consisted of 113 (43.8%) patients operated with peripheral cannulation through femoral artery, vein, and internal jugular vein. In this group, cardiopulmonary bypass was started before sternotomy and after systemic heparinisation. The two groups' operative complications and postoperative outcomes were compared. Results: Procedure-related injury was higher in the central cannulation group than in the peripheral cannulation group (8.3% vs. 1.8%, respectively, P=0.038). Cardiopulmonary bypass time was shorter in the central cannulation group (P=0.008) and total operation time was similar between the groups (P=0.115). Postoperative red blood cell requirement was higher with central cannulation (P=0.004). Operative mortality (2.8% vs. 0, P=0.186), hospital mortality (4.3% vs. 2.7%, P=0.523), and one-year survival rate (90.3% vs. 94.7%, P=0.202) were similar between the groups. Conclusion: Peripheral cannulation reduces cardiac injury and blood transfusion in cardiac reoperation. The cannulation type does not affect postoperative complication, mortality, and one-year survival.

The design of the arteriovenous vascular loop does not affect its patency: experimental study / O formato da alça vascular não afeta a patência arteriovenosa: estudo experimental

ABSTRACT Objective: To evaluate the effect of the design of a femoral vascular loop with anastomosis in the femoral artery of rabbits on the presence of flow (patency) after seven days. Methods: A total of 39 rabbits underwent arteriovenous microanastomosis using the microsurgical technique. Two loop designs were used: one circular and the other angled. The parameters evaluated were presence or absence of flow, signs of hemolysis and hemodynamic changes. Results: After seven days, flow was present in 68% of the angled loops and 75% of the circular loops (p > 0.05). There was a significant intragroup decrease in pCO2 and a significant increase in pH. For the other parameters evaluated, no significant differences between the two loop models were found. Conclusions: A reproducible vascular loop model was shown. There was no significant difference between the two vascular loop models about the presence of flow after seven days. Level of Evidence V, Animal experimental study.

RESUMO Objetivo: Avaliar, em coelhos, qual é a influência do desenho da alça de veia femoral com anastomose na artéria femoral, na presença de fluxo (patência) após sete dias. Método: 39 coelhos foram submetidos à microanastomose arteriovenosa com técnica microcirúrgica. As alças foram acomodadas em dois desenhos, um circular e outro, o mais alongado possível sem dobras na alça. Os parâmetros avaliados foram: presença ou não de fluxo, sinais de hemólise, alterações hemodinâmicas. Resultados: após sete dias, o fluxo estava presente em 68% das alças anguladas e em 75% das alças circulares (p > 0,05). Houve, intragrupo, diminuição estatisticamente significante da pCO 2 e aumento estatisticamente significante do pH. Não houve diferença estatística no restante dos parâmetros avaliados entre os dois modelos de alça. Conclusões: apresentamos um modelo reprodutível de alça vascular. Não houve diferença estatística quanto à presença de fluxo após sete dias nos dois modelos de alça vascular. Nível de Evidência V, Estudo experimental em animais.

Percutaneous mechanical thrombectomy for treatment of acute iliofemoral vein thrombi / 中国介入影像与治疗学

Objective: To observe the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in treatment of acute iliofemoral vein thrombi. Methods: PMT using Aspirex catheter was performed in 21 patients of acute iliofemoral vein thrombi after placement of inferior vena cava filter. Angiography was performed to evaluate thrombi clearance after PMT. Patients with residual thrombi were treated with adjunctive catheter directed thrombolysis (CDT) and reexamined with angiography every day. After thrombi removal, balloon dilatation and stent implantation were performed if severe stenosis or occlusion of iliac vein was found. Then inferior vena cava filter was retrieved. The complications of interventional therapy, the effect of thrombi removal and the improvement of symptoms were observed. The patency of deep vein and the Villalta scoring system were evaluated for assessment of the incidence of post-thrombotic syndrome 1, 3 and 6 months after the procedures. Results: All 21 patients were successfully treated with PMT. Eight patients had grade III thrombectomy (complete removal).The other 13 patients had grade Ⅱ thrombectomy (partial removal), and the residual thrombi were cleared with CDT. Balloon dilation and stent placement were performed in 13 patients with severe stenosis or occlusion of left iliac vein. The venous blood flow restored and symptoms of lower limb swelling and pain alleviated in all 21 patients after therapy. There was no death nor serious complication related to the procedures. No thrombosis recurrence was found, and all stents kept patent during the follow-up. One patient with 5 points of Villalta score developed mild post thrombotic syndrome 6 months after procedure. Conclusion: PMT is effective and safe for treatment of acute iliofemoral vein thrombi.

Clinical efficacy analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary valve stenosis guided by ultrasound / 中国胸心血管外科临床杂志

@#Objective    To analyze the efficacy and safety of percutaneous balloon pulmonary valvuloplasty (PBPV) for pulmonary valve stenosis guided by ultrasound. Methods    From March 2016 to July 2019, 32 patients with pulmonary valve stenosis were treated in our hospital. There were 19 males and 13 females with an average age of 1-12 (6.2±3.1) years and weight of 7-45 (22.7±9.2) kg. The clinical efficacy of PBPV guided by transthoracic echocardiography (TTE) was evaluated. Results    The transvalvular pressure gradient (PG) of the patients before PBPV was 65.4±11.9 mm Hg. All patients successfully received PBPV under TTE guidance. The PG was 19.7±4.0 mm Hg immediately after operation, which was significantly decreased (P<0.001). All patients survived without any serious complications. The PG values at 3 months, 6 months and 12 months after operation were 18.4±4.0 mm Hg, 16.4±3.9 mm Hg, 15.2±3.3 mm Hg, respectively, which were significantly lower than that before the operation (P<0.001). Conclusion    PBPV guided by echocardiography is safe and effective in the treatment of pulmonary valve stenosis with low complications rate.

Selection of perioperative venous access for simultaneous repair and reconstruction of oral cancer after radical resection / 口腔疾病防治

Objective@#To explore the characteristics of perioperative venous therapy in patients undergoing simultaneous repair and reconstruction of oral cancer after radical resection, and prevention of femoral vein catheterization complications, to provide clinical evidence for venous therapy.@*Methods@#A retrospective analysis was perfomed to assess the choice of venous access and its effects in 95 patients undergoing simultaneous reconstruction due to oral cancer during the perioperative period. @*Results @# In total, 95 patients underwent successful indwelling femoral vein catheterization with double lumens, and a midline catheter and peripheral intravenous indwelling needles were used to complete the intravenous therapy after surgery. Among the femoral vein complications, 1 case was complicated with lower extremity venous thrombosis (incidence was 1.1%), and 17 cases were complicated with puncture point bleeding (incidence was17.9%). Two cases of puncture site bleeding were noted among 28 cases using a midline catheter. Local phlebitis and infiltration were the most common complications of peripheral venous catheters. The difference in catheter-related complications among different types of catheters was statistically significant (P < 0.05). The complication rate of the midline catheter was lower than that noted with femoral vein catheterization and peripheral intravenous indwelling needles.@*Conclusion@#Based on the treatment characteristics of patients, proper venous catheters should be established during the perioperative period. The application of a femoral vein catheter during the operation combined with the use of a midline catheter and peripheral venous indwelling needles after the operation can satisfy intravenous therapy needs in patients undergoing simultaneous repair and reconstruction for oral cancer, and the midline catheter can effectively reduce venous catheter-related complications.

Caso Clínico: Rotura y Embolización de Catéter Femoral / Case Report: Rupture and Embolization of a Femoral Catheter

INTRODUCCIÓN:La embolización de cuerpos extraños intravasculares es una complicación poco frecuente; sin embargo, está asociada a alteraciones cardíacas y pulmonares en más del 50% de los casos. Actualmente se prefiere realizar el manejo utilizando técnicas de extracción por cateterismo cardíaco, esto debido a la naturaleza menos invasiva del procedimiento y a las menores tasas de mortalidad y complicaciones asociadas. A continuación se presenta un reporte de caso donde se realizó la extracción un catéter intracardiaco mediante vía percutánea. CASO CLÍNICO: Lactante de sexo masculino, de 51 días de vida, con antecedentes de prematuridad extrema y peso adecuado para edad gestacional, ingresado en el servicio de neonatología; a quien como acceso vascular central se le colocó un catéter percutáneo femoral. Tras el retiro del mismo se apreció rotura y embolización de los dos tercios distales; la evaluación radiológica evidenció catéter a nivel de cavidades cardíacas derechas. EVOLUCIÓN: Se inició antibioticoterapia por el riesgo de infección asociado. De forma exitosa se realizó la extracción del cuerpo extraño por intervencionismo percutáneo; el paciente evolucionó favorablemente, no presentó ninguna complicación. CONCLUSIÓN: La rotura y embolización del catéter es un evento poco frecuente que incrementa la morbimortalidad de los pacientes ingresados en neonatología. La extracción percutánea debe ser la primera opción por la eficacia y seguridad del procedimiento.(au)

BACKGROUND: The embolization of foreign intravascular bodies is a rare complication; however, it is associated with cardiac and pulmonary dysfunction in more than 50% of cases. Currently, it is preferred to perform the management using extraction techniques by cardiac catheterization; this is explained by the less invasive nature of the procedure and the lower mortality and complications rates. The following is a case report where an intracardiac catheter was extracted by a percutaneous procedure. CASE REPORT: Male, 52-day-old infant, with history of extreme prematurity and adequate weight for gestational age; hospitalized in the neonatology service; as central vascular access a percutaneous femoral catheter was placed. After removal, rupture and embolization of the distal two thirds were observed; the radiological evaluation showed a catheter at the level of right heart cavities. EVOLUTION: By the associated infection risk, antibiotic therapy was initiated. The foreign body was extracted successfully by percutaneous intervention; the patient presented a favorable evolution without any complications. CONCLUSIONS: The catheter rupture and embolization is a rare event that increases morbidity and mortality rates of patients admitted to neonatology. Percutaneous extraction should be the first option by the procedure efficacy and safety.(au)

The gait-dependent intermittent pneumatic compression ambulatory boot device: Preliminary reports on calf pressure and venous hemodynamics

RATIONALE@#Compression therapy has been demonstrated to be beneficial in a number of vascular conditions including chronic arterial ischemia, venous insufficiency and primary and secondary lymphedema. Its effectivity however is limited and questioned by the nature of the treatment procedure which requires that the patient be in a sitting or recumbent position while it is being administered.@*METHODS@#The author describes the development of a boot device which provides gait-dependent intermittent compression to the ankle and calf@*RESULTS@#In volunteer studies, the device produced a cycle of pressure changes from 15-40 mmHg at the interface. Simulated calf compression resulted in augmentation of venous flow recorded by duplex sonography at the superficial femoral vein area, indicating an improvement in venous hemodynamics with the use of the device.@*CONCLUSION@#These findings demonstrate the potential for an attractive ambulatory alternative to the commonly employed nonambulant therapies for venous insufficiency.

Vein valve function following pharmacomechanical thrombectomy versus simple catheter-directed thrombolysis for lower extremity deep vein thrombosis: A case control study / 中国胸心血管外科临床杂志

@#Objective To compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis. Methods We retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C. Results There were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077). Conclusion In the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.

Effect of the lateral tilt position on femoral vein cross-sectional area in anesthetized adults

BACKGROUND: A lateral tilt position can affect the size of the femoral vein (FV) due to increased venous blood volume in the dependent side of the body. METHODS: Forty-two patients, aged 20–60 years, were enrolled in this study. The crosssectional area (CSA), anteroposterior, and transverse diameters of the FV were measured 1 cm below the left inguinal line using ultrasound. The value of each parameter was recorded in the following four positions: (1) supine, (2) supine + 10° left-lateral tilt (LLT), (3) 10° reverse Trendelenburg (RT), and (4) RT + LLT. RESULTS: CSAs of the left FV in the supine, supine + LLT, RT, RT + LLT positions were 0.93 ± 0.22, 1.11 ± 0.29, 1.17 ± 0.29, and 1.31 ± 0.32 cm2, respectively. Compared to the supine position, there was a significant increase in CSA and anteroposterior diameter according to the three changed positions. The transverse diameter of the left FV was significantly increased in supine + LLT, RT, RT + LLT positions compared to that in the supine position (P = 0.010, P = 0.043, P = 0.001, respectively). There was no significant difference in the transverse diameter of the left FV between the supine + LLT and RT positions (P = 1.000). CONCLUSIONS: Adding LLT to the supine and RT positions increased the CSA of the unilateral FV significantly.

Application of real-time shear wave elastography in staging of common femoral venous thrombosis / 中国医学影像技术

Objective:To explore the value of real-time shear wave elastography (SWE) in staging of common femoral venous thrombosis (CFVT). Methods: Totally 92 patients with unilateral CFVT were divided into acute phase (1-14 d, n=41), subacute phase (15-30 d, n=24) or chronic phase (>30 d, n=27) according to the time of complaint. Young's modulus mean values and two-dimensional (2D) ultrasound scores were compared among the three phases. ROC curve was used to evaluate the diagnostic effect of 2D ultrasound and SWE for acute and chronic CFVT. Results: 2D ultrasound scores and Young's modulus values were significantly different among the three phases (P<0.001), and the differences between each two phases were all statistically significant (all P<0.05). AUC of SWE in diagnosing acute CFVT was 0.916 (P<0.05), and the cutoff Young's modulus value was 13.50 kPa, with the sensitivity of 85.37% and specificity of 82.35%. AUC of 2D ultrasound for diagnosing acute CFVT was 0.800 (P<0.05), and the cutoff ultrasound score was 2.00, with the sensitivity of 75.61% and specificity of 66.67%. AUC of the two methods for diagnosing acute CFVT had significant difference (P<0.001). AUC of SWE in diagnosing chronic CFVT was 0.917 (P<0.05), and the cutoff Young's modulus value was 16.40 kPa, with the sensitivity of 85.19% and specificity of 87.69%. AUC of 2D ultrasound in diagnosing chronic CFVT was 0.842 (P<0.05), and the cutoff ultrasound score was 2.03, with the sensitivity of 87.21% and specificity of 69.23%. AUC of these two methods for diagnosing chronic CFVT had significant difference (P=0.010). Conclusion: Real-time SWE can be used to judge the clinical stage of CFVT, and its diagnostic efficiency may be better than conventional ultrasonography.

The value of assessing femoral vein to femoral artery ratio in the treatment of patients with heart failure / 中华心血管病杂志

Objective@#To investigate the relationship between ultrasound derived ratio of femoral vein to femoral artery diameter and hemodynamics in patients with heart failure.@*Methods@#This was a case-control study. A total of 61 patients with heart failure and 49 patients with non-heart failure hospitalized in the Department of Critical Care Medicine from September 2017 to September 2018 were included in this study. Doppler ultrasound was used to measure the femoral artery and vein diameter. After deep inhalation, the femoral vein diameter was measured again, and the ratio of femoral vein and artery diameter was calculated. The central venous pressure (CVP) and mean pulmonary wedge pressure (mPAWP) were also measured. Pearson correlation analysis was used to explore the correlation between the ratio of femoral vein diameter to femoral artery diameter and CVP and mPAWP, and linear regression equation was established.@*Results@#The overall CVP and mPAWP levels were significantly higher, and the femoral vein diameter after deep inhalation was bigger in heart failure patients than in non-heart failure patients(all P<0.001). The femoral vein diameter/femoral artery diameter ratio was positively correlated with CVP (r=0.76, P<0.001), and positively correlated with mPAWP (r=0.40, P<0.001) in heart failure group. The linear regression equation established by the femoral vein/femoral artery diameter ratio and CVP in the heart failure group showed that the inner diameter of the femoral vein/the inner diameter of the femoral artery ratio≥1.3 corresponded CVP≥15.518 cmH2O(1 cmH2O=0.098 kPa) in heart failure patients.@*Conclusions@#In patients with heart failure, the inner diameter of the femoral vein/femoral artery ratio is positively correlated with CVP and mPAWP. The ratio of inner diameter of the femoral vein/femoral artery can be used to assess the volumetric load of patients with heart failure and to guide the clinical treatment of heart failure patients.