Distribution of saphenous vein valves and its pratical importance / Distribuição das válvulas da veia safena magna e sua importância prática

Objective: Among the veins used as a graft in myocardial revascularizations and ends, great saphenous vein is the most used. Knowing the presence and location of valves has great importance when evaluating the surgical anatomy of the great saphenous vein. Despite major surgical application and many works involving great saphenous vein, the number of valves present in it from the saphenous hiatus to the medial epicondyle of the femur is still described inaccurately. The objective of this study is to quantify the valves of the great saphenous vein from the saphenous hiatus to the medial epicondyle of the femur to determine the best portion of the great saphenous vein to perform revascularization surgeries. Methods: This is a crosssectional observational study in which it was analyzed great saphenous vein extracted from 30 cadavers. It was measured the length of the veins; (diameter) at its proximal, middle and distal, quantifying the number of valves in each one and the total number of valves at the great saphenous vein. Results: The frequency of valves in the great saphenous vein taken from the medial epicondyle of the femur to the saphenous hiatus was 4.82, ranging between 2 and 9. Moreover, there is a significant difference in the number of valves in the proximal and distal relative to the average. Conclusion: the median and distal portions of the saphenous vein in the thigh, are the best options for the realization of bridges due to the fact that these portions have fewer valves which therefore would tend to decrease the risk of complications connected with the valves in these grafts. .

Objetivo: Dentre as veias empregadas para revascularizações do miocárdio e de extremidades, a veia safena magna é a mais utilizada. Conhecer a presença e localização de válvulas é de grande importância quando se avalia a anatomia cirúrgica da veia safena magna. Apesar de grande aplicação cirúrgica e de muitos trabalhos envolvendo a veia safena magna, o número de válvulas presente nela desde o hiato safeno até o epicôndilo medial do fêmur ainda é descrito de forma imprecisa. O objetivo do presente trabalho é quantificar as válvulas da veia safena magna desde o hiato safeno até o epicôndilo medial do fêmur para determinar a melhor porção da veia safena magna para a realização de cirurgias de revascularização. Métodos: Este é um estudo transversal e observacional em que foram analisadas veias safena magna extraídas de 30 cadáveres. Foram realizadas as medidas das variáveis do comprimento das veias; (diâmetro) em suas porções proximal, média e distal; quantificação do número de válvulas nestas e número de válvulas total na veia safena magna. Resultados: A frequência de válvulas da veia safena contadas desde o epicôndilo medial do fêmur até o hiato safeno foi de 4,82, podendo variar entre 2 e 9. Além disso, houve diferença significante do número de válvulas da porção proximal em relação à média e distal. Conclusão: As porções média e distal da veia safena magna na coxa são as melhores opções para a realização de pontes em decorrência do fato destas porções terem menor quantidade de válvulas o que, portanto, tenderia a diminuir o risco de complicações relacionadas as válvulas nestes enxertos. .

Caracterización de la insuficiencia venosa crónica profunda por reflujo valvular / Characterization of chronic deep venous insufficiency produced by valve reflux

Las enfermedades venosas de los miembros inferiores se describen desde épocas muy antiguas, todavía en la actualidad repercute en los pacientes de forma frecuente causando un importante impacto socioeconómico.Objetivo: caracterización de la insuficiencia venosa crónica profunda por reflujo valvular.Método: se realizó un estudio descriptivo y longitudinal con todos los pacientes atendidos en consulta de angiología con el diagnóstico de insuficiencia venosa crónica profunda, en el Hospital Provincial Universitario Docente Manuel Ascunce Domenech de Camagüey, desde marzo de 2012 a junio de 2013. El universo estuvo constituido por 60 pacientes, se aplicó un muestreo no probabilístico, que reunió los criterios de inclusión y exclusión establecidos. La información obtenida se procesó mediante programa estadístico SPSS-11,5 para Windows y estadística descriptiva para obtener distribuciones de frecuencias y por cientos. Los resultados del estudio se expusieron en tablas.Resultado: se encontró que el mayor número correspondió al sexo femenino y predominó el intervalo de 46 a 55 años. Se pudo detectar que predominaron los antecedentes patológicos familiares de insuficiencia venosa crónica, seguido del estreñimiento crónico, la obesidad- sedentarismo, antecedentes patológicos personales de trombosis venosa profunda y la multipariedad. El mayor número de casos según clasificación clínica se encontraron en los estadios cuatro y tres.Conclusiones: la insuficiencia venosa crónica es una enfermedad progresiva con una alta morbilidad y gran repercusión socio-económica. Conocer sus factores predisponentes así como sus formas de presentación, ayuda a prevenir y evitar sus estadios avanzados y mejorar la calidad de vida de estos pacientes...

Venous diseases of the lower extremities have been described since ancient times; at present, they still frequently have an effect in patients and cause an important socioeconomic impact.Objective: to characterize the chronic deep venous insufficiency produced by valve reflux.Method: a descriptive, longitudinal study was carried out to all the patients that assisted to the consultation of angiology with the diagnosis of chronic deep venous insufficiency at Manuel Ascunce Domenech University Provincial Hospital of Camagüey, from March, 2012 to June, 2013. The universe was composed of 60 patients. A non-probabilistic sampling, including the established inclusion and exclusion criteria, was applied. The information obtained was processed through the statistical program SPSS-11.5 for Windows and through descriptive statistics to obtain distributions of frequencies and percents. The results of the study were presented in charts.Result: most of patients were female with 30 cases (61.2 percent)The ages between 46 and 55 years old predominated with 22 patients. Pathological family history of chronic venous insufficiency predominated with 44 cases (89.8 percent), followed by chronic constipation, obesity and sedentary lifestyle, pathological medical history of deep vein thrombosis, and multiparity. According to the clinical classification, most of cases were in stages three and four.Conclusions: chronic venous insufficiency is a progressive disease with a high morbidity and a great socioeconomic repercussion. Knowing the predisposing factors, as well as the ways of presentation of the disease, helps to prevent the advanced stages and improve the quality of life of patients...

The application of popliteal vein anatomy study and valve construction procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze anatomy data of popliteal veins (PV), with the purpose of selection of popliteal venous valves construction segment via venography, and to evaluate the surgical results.</p><p><b>METHODS</b>From February 1998 to November 2010, after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases, 102 patients (69 male and 33 female patients, aged from 48 to 71 years, mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures. Doppler ultrasound, continuous dynamic venography, and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre- and postoperatively. Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.</p><p><b>RESULT</b>In the 102 patients, 93.7% patients had one pair of valves in popliteal vein (PV), locating in the distal 1/3 segment of PV, with gastrocnemius veins (GV) joining with PV above PV valves. Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs. 150.2 ml/min, t = 8.979, P < 0.001). The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H(2)O vs. (15 ± 3) cm H(2)O, 1 cm H(2)O = 0.098 kPa, t = 8.049, P < 0.001). VCSS score was significantly lower after the surgery ((34 ± 15) cm H(2)O vs. (41 ± 14) cm H(2)O, t = 59.780, P < 0.001). Pre- and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs. 1.8 ± 1.0, t = 59.780, P < 0.001). Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%, and a 3.7% ulcer recurrent rate.</p><p><b>CONCLUSIONS</b>Popliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection, which stayed proximal to the communications of GV and PV. Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.</p>

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.

Analysis of the Anatomy of the Venae Comitantes Related to the Digital Artery

PURPOSE: Many descriptions of the digital arterial anatomy including skin territory of the finger have been published. Relatively few studies on venous architecture of the finger have been performed in this area, in part, attributable to the technical difficulties encountered in dissecting small vessels. The purpose of this study is to present the precise microsurgical anatomy of the vein related to the digital artery and venae comitantes of the components. METHODS: Arterial and venous anatomy of their relation to the fingers were examined in 38 specimens of two fresh cadavers and 36 clinical cases. All specimens were evaluated grossly, surgical microscopically, or/and light microscopically to observe the three & two-dimensional structure of the artery and joining vein, evidence of the venae comitantes, and venous valve. RESULTS: No longitudinal venae comitantes along the digital artery were found in any specimens. The size of the venae comitantes of each digital artery was much smaller than other vein, but always existed any level of digital artery. One or two venae comitantes in the digital artery ran spiral, oblique, helical, fibrillar, or irregular branched shape. The authors also found the vein of the finger, that had bicuspid valves, but not in venae comitantes. CONCLUSION: Recently, venous outflow problem rather than arterial circulation is the most common cause tissue failure after microvascular surgery in the hand. Sometimes, if it is not recognized early, there is an increased risk of tissue damage and loss. The authors concluded that this study presents a useful knowledge for the characterization of the venous structure and evidence for venae comitantes like a venule in the digital artery at varying levels of the finger.

Catheter Directed Thrombolysis for Deep Vein Thrombosis during the First Trimester of Pregnancy: Two Case Reports

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

Endovascular Management of Deep Venous Thrombotic Diseases of the Lower Extremity

Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

Surgical Technique for the Removal of Deep Vein Thrombi of the Lower Extremities / 대한흉부외과학회지

The conventional surgery method of thrombectomy of venous thrombi from the deep veins of the lower extremity was the use of Forgarty balloon catheter. The catheter is inconvenient due to the presence of the balloon and prohibiting venous valves within the venous trees. With the use of a stone-forceps(Fig. 1), thrombi within iliofemoral vein could be easily removed without the obstacle of the valves because the instrument keeps valves open. This instrument is also useful in monitoring the back-flow from the iliac vein. Thrombi within the veins below the level of inguinal incision are removed successfully only by effective manual compression of the calf and thigh muscles. I recommend operating on the iliac vein first rather than the lower venous tree.

Developmental Morphology of the Atrial Venous Component in the iv/iv Mouse

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.

Developmental Morphology of the Atrial Venous Component in the iv/iv Mouse

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.

Human Embryos of Carnegie Stage 13 / 체질인류학회지

Three cases of human embryo of Carnegie stage 13 were described. The CR length of these embryos were 3.0-5.3mm. The authors made a reconstruction model using photograph, photocopy and computer. These embryos were characterized externally by 4 limb buds and 4 pairs of branchial arches, and internally closed otic pits, appearance of venous valves, septum primum and foramen primum in the heart, beginning of the right and left lung buds, appearance of lens disk.