Applied Anatomy of the Femoral Veins in Macaca fascicularis / Anatomía Aplicada de las Venas Femorales en Macaca fascicularis

The aim was to understand the anatomical features of the venous valve in Macaca fascicularis and to compare it with that of humans. The bilateral lower limbs (24 limbs from 12 animals) of Macaca fascicularis cadavers were dissected, and the femoral veins (FVs) were equally divided into distal, intermediate, and proximal sections. The external diameter of the FV in each section was measured. The venous valves were observed microscopically and stained with hematoxylin and eosin as well as trichrome. Data describing the human venous valve were collected from the current literature. No great saphenous veins were found among the 24 lower limbs from the Macaca fascicularis cadavers. The external diameters of the FVs in the distal, intermediate, and proximal sections were 3.53 ± 0.37 mm, 3.42 ± 0.55 mm, and 3.37 ± 0.54 mm, respectively. In most cases, there was one venous bivalve located in the FV approximately 0-2.71 mm below the junction of the FV and the deep femoral vein. Endothelium covered the luminal and sinusal surfaces of the leaflets. Abundant collagen fibers were found under the endothelial cells beneath the luminal surface of the leaflets. An elastin fiber network was located under the sinus endothelial surface. Smooth muscle cells in the FV extend to the edge of the valve. The venous valve of Macaca fascicularis is similar to that of humans, both morphologically and histologically. However, there is only one venous bivalve and no great saphenous vein in Macaca fascicularis.

El objetivo fue comprender las características anatómicas de la válvula venosa en Macaca fascicularis y compararla con la de los humanos. Fueron disecados bilateralmente los miembros pélvicos (24 miembros de 12 animales) de cadáveres de Macaca fascicularis; las venas femorales (VF) fueron divididas en secciones distal, media y proximal. Se midió el diámetro externo de las VFs en cada sección. Las válvulas venosas se observaron microscópicamente y se tiñeron con H-E y tricrómico. Los datos para describir la válvula venosa humana se obtuvieron desde la literatura. No se encontraron venas safenas magnas entre los 24 miembros inferiores. Los diámetros externos de las VFs en las secciones distal, media y proximal fueron 3,53±0,37 mm, 3,42 mm±0,55, y 3,37±0,54 mm, respectivamente. En la mayoría de los casos, hubo vena bivalva situada aproximadamente 0-2,71 mm debajo de la unión de la VF y la vena femoral profunda. El endotelio cubrió las superficies luminal y sinusal. Se observaron abundantes fibras de colágeno en las células endoteliales bajo la superficie luminal de las válvulas. Una red de fibras de elastina se encontró bajo la superficie del seno endotelial. Las células musculares lisas en las VFs se extiendían hasta el margen de la válvula. La válvula venosa del Macaca fascicularis es similar a la de los seres humanos, morfológica e histológicamente. Sin embargo, sólo hubo una vena bivalvular, y no se observaron venas safenas en Macaca fascicularis.

Three-Dimensional Evaluation of the Anatomic Variations of the Femoral Vein and Popliteal Vein in Relation to the Accompanying Artery by Using CT Venography

OBJECTIVE: We wanted to describe the three-dimensional (3D) anatomic variations of the femoral vein (FV) and popliteal vein (PV) in relation to the accompanying artery using CT venography. MATERIALS AND METHODS: We performed a retrospective review of 445 bilateral (890 limbs) lower limb CT venograms. After the 3D relationship between the FV and PV and accompanying artery was analyzed, the presence or absence of variation was determined and the observed variations were classified. In each patient, the extent and location of the variations and the location of the adductor hiatus were recorded to investigate the regional frequency of the variations. RESULTS: There were four distinct categories of variations: agenesis (3 limbs, 0.3%), multiplication (isolated in the FV: 190 limbs, 21%; isolated in the PV: 14 limbs, 2%; and in both the FV and PV: 51 limbs, 6%), anatomical course variation (75 limbs, 8%) and high union of the tibial veins (737 limbs, 83%). The course variations included medial malposition (60 limbs, 7%), anterior rotation (11 limbs, 1%) and posterior rotation (4 limbs, 0.4%). Mapping the individual variations revealed regional differences in the pattern and frequency of the variations. CONCLUSION: CT venography helps to confirm a high incidence of variations in the lower limb venous anatomy and it also revealed various positional venous anomalies in relation to the respective artery.

Regional differences in veins wall viscosity, compliance. energetics and damping: analysis of the pressure-diameter relationship during cyclical overloads

Background: The characterization of the dynamic process of veins walls is essential to understand venous functioning under normal and pathological conditions. However, little work has been done on dynamic venous properties. Aim: To characterize vein compliance (C), viscosity (η), peak-strain (W St) and dissipated (W D) energy, damping (ξ), and their regional differences in order to evalúate their role in venous functioning during volume-pressure overloads. Methods: In a mock circulation, pressure (P) and diameter (D) of different veins (anterior cava, jugular and femoral; from 7 sheep), were registered during cyclical volume-pressure pulses. From the P-D relationship, C, W St and ξ (at low and high P-D leveis), η and W D were calculated. Resulls: For each vein there were P-dependent differences in biomechanical, energetics, and damping capability. There were regional-differences in C, η), W St and W D (p<0.05), but not in ξ. Conclusión: The regional-dependent differences in dynamics and energetics, and regional-similitude in damping could be important to ensure venous functioning during acute overloads. The lower C and higher W St and W D found in back-limb veins (femoral), commonly submitted to high volume-pressure loads (i.e. during walking), could be considered relevant to ensure adequate venous system functionality and venous wall protection simultaneously.

Inserción de catéteres percutáneos en vena subclavia por abordaje supraclavicular en pacientes pediátricos gravemente enfermos / Supraclavicular insertion on percutaneous catheters in the subclavian vein in critcally ill child

Introducción. En la actualidad el manejo del paciente en estado crítico se ve facilitado al contar con un catéter venoso central por considerarse como un arma para su tratamiento integral. Las vías utilizadas tradicionalmente para su colocación por punción percutánea son: la vena yugular interna, la femoral y la subclavia (VSc) por aboradaje infraclavicular. Se presenta una serie en la cual se colocó catetér venoso central por punción percutánea en VSc por vía supraclavicular. Material y métodos. En dos años se intentó la colocación percutánea de 53 catéteres subclavios por abordaje supraclavicular en 48 pacientes pediátricos en estado crítico cuando había fracasado la colocación por otra vía. Resultados. Se colocaron exitosamente 50 catéteres (94 por ciento) en pacientes pediátricos con edad promedio de 3.7 años, peso mínimo de 1.9 kg y máxima de 60 kg. La principal indicación fue la vigilancia hemodinámica y la técnica más utilizada fue la descrita por Seldinger. Unicamente la colocación falló en 3 intentos. La única complicación mayor fue neumotórax en 4 pacientes, sin consecuencias. Conclusiones. La colocación de catéter venoso central subclavio por abordaje supraclavicular tiene un alto porcenjate de éxito en paciente pediátricos, convirtiéndose en una excelente opción; sin embargo, no se considera que sea una vía de primera elección en la colocación de catéteres venosos centrales. Se sugiere como una buena alternativa cuando se ha fracasado por otras vías

Catéter venoso femoral en el paciente grave / Femoral venous catheter in critically ill patients

Introducción. La cateterización de las venas centrales es una habilidad que es necesario posean los intensivistas. Objetivo. Dar a conocer nuestra experiencia en la cateterización de la vena femoral en pacientes graves. Pacientes y métodos. Estudiamos 38 pacientes a los que se les practicó cateterización de la vena femoral en una unidad de cuidados intensivos de julio de 1991, usando la técnica de Seldinger. Resultados. Se insertaron 38 catéteres en 38 pacientes con una duración media de cinco días. No hubo complicaciones mayores. Las complicaciones menores consistieron en punciones arteriales (8 por ciento) y hematomas (4 por ciento). Los médicos adscritos colocaron 14 catéteres en 19 intentos (media 1.3) y los médicos residentes 24 en 32 intentos (media 1.3). Conclusión. La cateterización de la vena femoral ofrece un sitio alterno para el acceso central en el paciente crítico

Anatomical observation on draining patterns of saphenous tributaries in Korean adults

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males and 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.

Retalho epigástrico no rato como monitor de perviedade. Padronizaçäo técnica do modelo e emprego no estudo comparativo de enxertos microvasculares arteriais e venosos, com avaliaçäo histológica, radiológica e pelo ultra-som / Epigastric flap as monitor of vascular perviety in the rat. Technical standardization and comparative study of arterial and venous microvascular grafts: histological, radiological and ultrasonographic evaluation

Estudou-se o modelo de um retalho em ilha na regiäo inguinal direita do rato, denominado retalho epigástrico, o qual foi padronizado em seu traçado e levantamento, descrevendo-se com minúcias todos os detalhes relativos a sua confecçäo. O retalho foi observado clinicamente durante duas semanas, tendo a funçäo principal de servir como monitor de perviedade da artéria femoral, após a realizaçäo de procedimentos vasculares com uso de técnica microcirúrgica. Os 45 animais aproveitados foram distribuídos em um grupo piloto e quatro grupos tratados, a saber: grupo GI - dissecçäo do pedículo do retalho; grupo GII - anastomose arterial término-terminal única; grupos GIII e GIV - interposiçäo de enxertos arteriais e venosos autólogos. Para avaliaçäo do modelo proposto foram analisados 20 atributos distribuídos em três categorias:(1) atributos gerais de controle, (2) clínicos e (3) para atender às finalidades do próprio trabalho. Foram igualmente descritas as complicaçöes observadas ao longo da realizaçäo do procedimento experimental, e as medidas empregadas para solucioná-las. Além de monitorizada clinicamente pelo retalho, a patência das microanastomoses e enxertos microvasculares foi também avaliada em estudo angiogástrico (empregando como contraste a massa de Schlesinger modificada) e histopatológico (microscopia ótica - coloraçäo pelo H.E.). O fluxo vascular pré, trans e pós-operatório foi avaliado com uso de um estetoscópio ultra-sonográfico ("doppler"), sendo discutida sua importância e limitaçöes. Dentre as complicaçöes ocorridas a infecçäo foi a que apresentou maior gravidade, tendo sido solucionada principalmente com uso tópico de antibióticos. A esterilizaçäo química do material cirúrgico, embora tenha sido empregada, foi considerada de menor importância para prevenir tal ocorrência. Outra complicaçäo enfrentada foi a autocanibalizaçäo. Para evitá-la ou simplesmente para impedir que o retalho fosse atingido, improvisou-se um colete cervical (confeccionado com tubos plásticos) algumas vezes associado a pequena haste de madeira (ou plástico). O modelo experimental analisado, na realidade constituindo a junçäo de dois outros modelos mais simples, permanece muito pouco explorado em sua funçäo de monitorizar a perviedade dos componentes de seu pedículo vascular. No exaustivo levantamento bibliográfico realizado, näo se encontrou nenhum trabalho que propusesse uma padronizaçäo do traçado ou levantamento do retalho epigástrico...