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1.
Rev. colomb. cir ; 36(1): 98-109, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1150524

ABSTRACT

La vena porta es un conducto que drena el flujo esplácnico al hígado y se puede ocluir por diferentes patologías, variando su presentación clínica de acuerdo con la causa de la obstrucción. Es muy importante diferenciar la trombosis portal asociada o no a la cirrosis, ya que su tratamiento y pronóstico es diferente. La trombosis venosa portal extrahepática es una condición netamente de origen vascular, y es la principal causa de trombosis portal en niños y adultos. Presentamos tres casos tratados con derivación meso-Rex, con seguimiento a 6 meses


The portal vein is a conduit that drains splanchnic flow to the liver, it can be occluded by different pathologies and its clinical presentation varies according to the cause of the obstruction. It is very important to differentiate portal thrombosis associated or not with cirrhosis, since its treatment and prognosis is different. Extrahepatic portal vein thrombosis (PEVT) is a condition of purely vascular origin, being the main cause of portal thrombosis in children and adults. We present three cases with meso-Rex shunt, with a 6-month follow-up


Subject(s)
Humans , Venous Thrombosis , Portal Vein , Varicose Veins , Portacaval Shunt, Surgical
2.
Autops. Case Rep ; 11: e2021330, 2021. graf
Article in English | LILACS | ID: biblio-1339242

ABSTRACT

Varix of the lower extremities is a common entity that eventually presents fatal outcome. Fatal massive bleeding due to rupture of a peripheral varicose vein is rare. The estimated incidence of these cases is 1/1000 autopsies. The case we present is unique among 26,054 autopsies performed in Milan from 1993 to 2020. It describes the investigations carried out in the suspicion of a non-natural event in an elderly woman. She was found dead at home with a large volume of blood near her feet that drained from the right leg. Pathological examination disclosed that the hemorrhage occurred by the rupture of a venous varix of the lower limb. Cases of fatal hemorrhage from peripheral variceal rupture are insidious and require proper characterization. The bloodstain pattern analysis, careful autopsy dissection by layers to demonstrate the rupture, and histologic examination of the lesion are the essential elements to find out the actual cause of death.


Subject(s)
Humans , Female , Aged, 80 and over , Varicose Veins/blood , Cause of Death , Hemorrhage/pathology , Rupture , Autopsy , Varicose Veins , Varicose Veins/pathology , Fatal Outcome , Dissection/methods
3.
Prensa méd. argent ; 106(5): 339-341, 20200000. fig
Article in English | LILACS, BINACIS | ID: biblio-1367951

ABSTRACT

Venous varicose of epidura is considered a rare cause of nerve root and thecal sac compression and impingement that leads to lower limb radiculopathy. The purpose of this study is to draw attention to this problem during operation. It also aims to focus shed a light on using magnetic resonance imaging (MRI) before the operation. This research also attempts to evaluate the outcome of the surgery. Symptoms of epidural varicose with radiculopathy are rare and the diagnosis is often inaccurate by preoperative clinical examination and radiology investigations. Thus, in many cases the diagnosis is made intra- operatively. The case was a 40 years old female who consulted our outpatient clinic complaining from acute radicular pain in the lower back and down of her right lower limb. MRI was done for her and showed paracentral disc herniation. Intra operatively, an abnormal dilatation of epidural vein impingement on L4 nerve root with no foraminal stenosis was seen. We initiated a thermo coagulation of the epidural vein from proximal to distal ends at disc level and used gel foam patch to control bleeding that was removed all at the end of operation. Then, coagulation ablation was performed. The operation resulted in relief of symptoms and neurologic recovery occurred during follow up period. According to our case and previously published case reports, the outcome is good with recovery of neurological signs and symptoms that can be obtained by coagulation ablation of epidural varicose vein.


Subject(s)
Humans , Female , Adult , Radiculopathy/therapy , Varicose Veins/therapy , Magnetic Resonance Spectroscopy , Outcome Assessment, Health Care , Minimally Invasive Surgical Procedures , Anesthesia, Epidural , Lumbosacral Region
4.
Enferm. actual Costa Rica (Online) ; (38): 209-229, Jan.-Jun. 2020. tab, graf
Article in Spanish | LILACS, BDENF | ID: biblio-1090097

ABSTRACT

Resumen El objetivo de este estudio fue analizar la mejor evidencia científica disponible relacionada con la intervención médica conservadora comparada con la intervención más invasiva incluyendo la quirúrgica para el tratamiento de venas varicosas en miembros inferiores durante el embarazo y la prevención de la aparición posterior. Inició con Se aplicó la metodología de evaluación rápida de la evidencia. Se llevó a cabo una búsqueda de literatura en las bases de datos, sin límite de fechas. Criterios de inclusión: Gestantes con patología varicosa en miembros inferiores de cualquier edad. Los tipos de estudios analizados fueron Revisiones Sistemáticas, ECA, Meta-análisis o Guías de Práctica Clínica en inglés, portugués o español. Se utilizó la plataforma FLC 2.0 y Agree II para el análisis y la plantilla de Sackett para la interpretación de niveles de evidencia y grados de recomendación. Se recuperaron 322 artículos, se seleccionaron tres. Se obtuvo que la intervención recomendada es la terapia conservadora, solo en casos excepcionales se determinará otra intervención. El tratamiento invasivo incluyendo el quirúrgico, se reserva para casos delicados ya que los riesgos superan los beneficios. Se concluye que el tratamiento de primera línea para el tratamiento de varicosidades en gestantes son las medias de compresión. Los rutósidos y anticoagulantes orales parecen ayudar pero no es seguro de utilizar durante el embarazo.


Abstract The objective of this study was to analyze the best available scientific evidence related to conservative medical intervention compared to the most invasive intervention including surgery for the treatment of varicose veins in the lower limbs during pregnancy and the prevention of subsequent onset. It started with The rapid evidence evaluation methodology was applied. A search of literature in the databases was carried out, with no date limit. Inclusion criteria: Pregnant women with varicose pathology in lower limbs of any age. The types of studies analyzed were Systematic Reviews, RCTs, Meta-analysis or Clinical Practice Guidelines in English, Portuguese or Spanish. The FLC 2.0 and Agree II platform was used for the analysis and the Sackett template for the interpretation of levels of evidence and grades of recommendation. 322 items were retrieved, three were selected. It was obtained that the recommended intervention is conservative therapy, only in exceptional cases will another intervention be determined. Invasive treatment, including surgical treatment, is reserved for sensitive cases since the risks outweigh the benefits. It is concluded that the first line treatment for the treatment of varicose veins in pregnant women is compression stockings. Routine and oral anticoagulants seem to help but it is not safe to use during pregnancy.


Resumo O objetivo deste estudo foi analisar as melhores evidências científicas disponíveis relacionadas à intervenção médica conservadora em comparação com a intervenção mais invasiva, incluindo cirurgia para o tratamento de varizes nos membros inferiores durante a gravidez e a prevenção de subsequente aparecimento. Começou com A metodologia de avaliação rápida de evidências foi aplicada. Foi realizada uma pesquisa bibliográfica nas bases de dados, sem data limite. Critérios de inclusão: Gestantes com patologia varicosa em membros inferiores de qualquer idade. Os tipos de estudos analisados foram Revisões Sistemáticas, ECR, Meta-análise ou Diretrizes de Prática Clínica em inglês, português ou espanhol. A plataforma FLC 2.0 e Agree II foi utilizada para a análise e o modelo de Sackett para a interpretação dos níveis de evidência e graus de recomendação. 322 itens foram recuperados, três foram selecionados. Foi obtido que a intervenção recomendada é terapia conservadora, apenas em casos excepcionais será determinada outra intervenção. O tratamento invasivo, incluindo o tratamento cirúrgico, é reservado para casos sensíveis, pois os riscos superam os benefícios. Conclui-se que o tratamento de primeira linha para o tratamento de varizes em gestantes são as meias de compressão. Anticoagulantes de rotina e orais parecem ajudar, mas não é seguro para uso durante a gravidez.


Subject(s)
Humans , Female , Pregnancy , Varicose Veins , Pregnancy , Pregnant Women
5.
Rev. cuba. angiol. cir. vasc ; 21(1): e79, ene.-abr. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126371

ABSTRACT

Introducción: La neuralgia del nervio safeno interno, possafenectomía, constituye la expresión natural de una lesión nerviosa de tipo troncular periférico y constituye un síndrome clínico frecuente pero poco estudiado desde todos los puntos de vista. Objetivo: Valorar la neuralgia del safeno interno en los pacientes operados de várices esenciales en miembros inferiores. Método: Se realizó un estudio descriptivo- retrospectivo en 60 pacientes operados (stripping o flebo-extracción) en el servicio de Angiología y Cirugía Vascular del Hospital Docente Clinicoquirúrgico "General Freyre de Andrade" con el diagnóstico de várices esenciales en los miembros inferiores y presencia de neuralgia del nervio safeno interno. El estudio se realizó de enero a diciembre de 2017. Las variables estudiadas fueron: sexo, localización de la safenectomía (izquierda, derecha, bilateral), presencia de neuralgia en el nervio safeno interno. Se trabajó con valores de frecuencias absolutas y relativas. Resultados: 40 por ciento de las safenectomías fueron bilaterales; 31,6 por ciento en miembro inferior derecho y 28,3 por ciento en el miembro inferior izquierdo. El 80 por ciento eran mujeres (25 por ciento lado izquierdo, 25 por ciento lado derecho y 50 por ciento bilateral) y el 20 por ciento hombres (58,3 por ciento lado derecho y 41,7 por ciento lado izquierdo). Pacientes con neuralgia del safeno interno 23,3 por ciento (41,7 por ciento hombres y 18,8 por ciento mujeres). Conclusión: El reconocimiento adecuado de la neuralgia del safeno interno permite excluir otras complicaciones de tipo vascular y establecer medidas profilácticas para evitarla(AU)


Introduction: Post-saphenectomy neuralgia of the internal saphenous nerve is the natural expression of a peripheral truncal nerve injury and constitutes a frequent clinical syndrome; however, it is rarely studied, from all points of view. Objective: To assess neuralgia of the internal saphenous nerve in patients operated on for essential varicose veins of the lower limbs. Method: A descriptive-retrospective study was carried out in 60 surgically intervened patients (stripping or phlebo-extraction) in the angiology and vascular surgery service of Freyre de Andrade Clinical-Surgical Teaching Hospital for a diagnosis of essential varicose veins of the lower limbs and manifestation of neuralgia of the internal saphenous nerve. The study was carried out from January to December 2017. The variables studied were sex, location of the saphenectomy (left, right, or bilateral), and manifestation of neuralgia in the internal saphenous nerve. We worked with absolute and relative frequency values. Results: 40 percent of the saphenectomies were bilateral, 31.6 percent were performed in the lower right limb, and 28.3percent corresponded to the lower left limb. 80 percent were women (left side: 25 percent, right side: 25 percent, and bilateral: 50 percent) and 20 percent were men (right side: 58.3 percent, and left side: 41.7 percent). Patients with neuralgia of the internal saphenous never accounted for 23.3 percent (41.7 percent were men and 18.8 percent were women). Conclusion: The correct identification of neuralgia of the internal saphenous nerve allows to exclude other vascular complications and to establish prophylactic measures to avoid it(AU)


Subject(s)
Humans , Male , Female , Varicose Veins/surgery , Retrospective Studies , Lower Extremity
6.
Säo Paulo med. j ; 138(2): 98-105, Mar.-Apr. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1139675

ABSTRACT

ABSTRACT BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.


Subject(s)
Humans , Varicose Veins , Venous Insufficiency , Saphenous Vein , Retrospective Studies , Treatment Outcome
7.
Rev. méd. Chile ; 148(3): 288-294, mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115791

ABSTRACT

Background: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. Aim: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. Material and Methods: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. Results: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). Conclusions: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.


Subject(s)
Humans , Upper Gastrointestinal Tract , Varicose Veins , Esophageal and Gastric Varices , Retrospective Studies , Gastrointestinal Hemorrhage , Length of Stay
8.
Rev. Salusvita (Online) ; 39(1): 119-126, 2020.
Article in Portuguese | LILACS | ID: biblio-1120867

ABSTRACT

Introdução: As varizes são veias que após submetidas a períodos de pressão aumentada no sistema venoso periférico se tornam dilatadas, tortuosas e alongadas. Pacientes acometidos irão referir dor no membro, além de sinais de insuficiência venosa. O exame de imagem comumente utilizado é o ultrassom com Doppler, no entanto, na presença de anomalias de drenagem venosa intraóssea, deve-se preferir a ressonância magnética. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital América, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 46 anos com dor e queimação constantes, além de edema na perna e no pé esquerdos há dois meses Ao exame físico apresenta edema da perna, tornozelo e pé esquerdos, com discreto aumento de temperatura ao toque, sem alteração da coloração da pele. A ressonância magnética demonstra varicosidades das veias tibiais posteriores com comunicação através de veia perfurante com varicosidade da veia intraóssea posterior da tíbia ­ variz intraóssea. Conclusão: Este relato demonstra a dificuldade de diagnosticar a variz intra-óssea que, além de ser uma lesão rara, é diagnosticada apenas pela ressonância magnética.


Introduction: Varicose veins are veins that after being submitted to high pressure on the peripheral venous system become dilated, tortuous and elongated. Patients affected will report pain and venous insufficiency signs in the area. The imaging exam commonly used is the Doppler ultrasound, however, when in front of an intraosseous venous drainage anomaly ­ intraosseous varix, magnetic resonance should be preferred. Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital América, a photographic record of diagnostic methods, and a review from the literature. Results: A 46-year-old man with constant pain and burning, as well as edema in his left leg and foot for two months. On physical examination, he had edema in his left leg, ankle, and foot, with a slight increase in temperature at the touch, without changing the skin color. Magnetic resonance imaging shows varicosities of the posterior tibial veins with communication through a perforating vein with varicosity of the posterior tibial intraosseous vein - intraosseous varicose vein. Conclusion: This report demonstrates the difficulty of diagnosing intraosseous varices, which, in addition to being a rare lesion, are diagnosed only by magnetic resonance imaging.


Subject(s)
Humans , Male , Middle Aged , Tibia/blood supply , Tibia/diagnostic imaging , Varicose Veins/diagnostic imaging , Veins/abnormalities , Magnetic Resonance Imaging
9.
Rev. cuba. angiol. cir. vasc ; 20(3): e27, jul.-dic. 2019. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1093135

ABSTRACT

Introducción: Las úlceras en los miembros inferiores se relacionan desde los tiempos antiguos con las venas varicosas; es aceptado que dichas úlceras son una enfermedad frecuente y un grave problema de salud pública en todo el mundo y que la gran mayoría es el resultado de una insuficiencia venosa crónica. Objetivo: Caracterizar a los a los pacientes hospitalizados por úlceras flebostáticas. Métodos: Se realizó un estudio ambispectivo en 81 pacientes ingresados con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: edad, sexo, cantidad de ingresos y estadía hospitalaria. Resultados: Se encontró un predominio del sexo femenino y de los mayores de 60 años en los 121 ingresos realizados. El 72,8 por ciento ingresó una sola vez y el 18,2 por ciento en más de una ocasión. La estadía hospitalaria fue de más de 21 días en el 55,4 por ciento. Conclusiones: Los pacientes hospitalizados con úlceras flebostáticas son predominantemente adultos mayores del sexo femenino, presentan una baja frecuencia de reingresos y una estadía hospitalaria prolongada(AU)


Introduction: The ulcers in the lower limbs are related from the old times with the varicose veins; it is accepted that the same ones are a frequent illness and a serious problem of public health in the world, and the great majority is the result of chronic venous insufficiency. Objective: To characterize the patients hospitalized due to phlebostatic ulcers. Methods: It was carried out an ambispective study in 81 patients admitted with the diagnosis of phlebostatic ulcers. The study variables were: age, sex, quantity of hospital admissions and hospital stay. Results: It was predominant in the 121 of the hospital admission: the female sex and people older than 60 years. 72.8 percent of the patients were admitted one time and 18.2 percent in more than one occasion. The hospital demurrage was of more than 21 days in 55.4 percent of the cases. Conclusions: The patients hospitalized due to phlebostatic ulcers are predominantly female elder people. It was possible to characterize the patients hospitalized with a low frequency of hospital re-admission and hospital demurrage(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Young Adult , Ulcer , Varicose Veins , Venous Insufficiency , Lower Extremity
10.
Rev. Assoc. Med. Bras. (1992) ; 65(4): 518-523, Apr. 2019. tab
Article in English | LILACS | ID: biblio-1003060

ABSTRACT

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Subject(s)
Humans , Female , Pelvis/blood supply , Varicose Veins/therapy , Pelvic Pain/therapy , Embolization, Therapeutic/methods , Syndrome , Brazil , Reproducibility of Results , Treatment Outcome , Chronic Pain , Clinical Decision-Making
11.
ABC., imagem cardiovasc ; 32(1): 14-18, jan.-mar. 2019. ilus, tab, graf
Article in Portuguese | LILACS | ID: biblio-969861

ABSTRACT

A correta identificação dos pontos de refluxo no estudo das varizes primárias dos membros inferiores é importante na abordagem terapêutica desses pacientes. Objetivo: Avaliar a associação entre a insuficiência de veias perfurantes anteriores do joelho e a insuficiência de veia safena magna em pacientes com varizes primárias de membros inferiores. Métodos: Foram avaliados 886 pacientes, correspondendo a 1.772 membros inferiores, em pacientes acima de 18 anos, de ambos os sexos, submetidos ao mapeamento venoso superficial pela ecografia vascular. Resultados: Os pacientes apresentaram idade média de 46,1 ± 14,5 anos, sendo 81,7% do sexo feminino. A insuficiência de veia safena magna foi encontrada em 38,8% dos casos. A insuficiência da perfurante anterior do joelho foi encontrada em 146 membros inferiores (8,2%), com diâmetro médio de 1,7 ± 0,15 mm, sendo predominante a localização infrapatelar (86,4%). A tributária anterior da veia safena magna originou o refluxo na perna em 34%, com relação direta desta tributária com a perfurante anterior do joelho em 79,4%. Observou-se associação entre a presença de perfurante anterior do joelho e insuficiência de veia safena magna (p = 0,0001) e sexo masculino (p = 0,001). Conclusão: Houve associação entre insuficiência de perfurante anterior do joelho e insuficiência de veia safena magna em pacientes com varizes primárias dos membros inferiores submetidos à ecografia vascular, sendo que a correta identificação desta perfurante pode ser importante na abordagem terapêutica desses pacientes


The accurate identification of reflux points in the study of primary varicose veins of the lower limbs is important in the therapeutic approach of these patients. Objective: To evaluate the association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs. Methods: The study included 886 patients, corresponding to 1,772 lower limbs, in patients older than 18, of both sexes, undergoing superficial venous mapping using vascular ultrasound. Results: The mean age of the patients was 46.1 ± 14.5 and 81.7% were females. Great saphenous vein insufficiency was found in 38.8% of the cases. Insufficiency of the anterior perforator vein of the knee was found in 146 lower limbs (8.2%), with a mean diameter of 1.7 ± 0.15 mm, prevailing in the infrapatellar area (86.4%). The anterior tributary vein of the great saphenous vein originated leg reflux in 34%, with a direct relation of this tributary vein with the anterior perforator vein of the knee in 79.4%. An association between the presence of anterior perforator vein of the knee and great saphenous vein insufficiency (p = 0.0001) and male gender (p = 0.001). Conclusion: There was an association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs at vascular ultrasound, and the accurate identification of this perforator vein may be important in the therapeutic approach of these patients


Subject(s)
Humans , Male , Female , Middle Aged , Saphenous Vein/physiopathology , Varicose Veins/diagnostic imaging , Venous Insufficiency/surgery , Lower Extremity/surgery , Diagnostic Imaging/methods , Sex Factors , Chronic Disease , Prevalence , Cross-Sectional Studies , Ultrasonography/methods
12.
Mali méd. (En ligne) ; 34(2): 52-54, 2019. ilus
Article in French | AIM, AIM | ID: biblio-1265743

ABSTRACT

Les auteurs rapportent un cas d'un syndrome de Klippel­Trenaunayrévélé par des malformations variqueuses systématisées et une ostéodystrophie avec un reflux ostial important du membre inférieur droit au CHU de Bouaké. La chirurgie classique a consisté à un éveinage étendu associé à une crossectomie droite. L'examen histologique des lacis veineux était favorable à l'existence d'un angiome. Les suites opératoires ont été simples. Après un recul de 14 mois, le patient présente une myalgie intermittente survenant à l'effort de marche. Cette observation pose le problème de l'évolution postopératoire des varices congénitales


Subject(s)
Case Reports , Klippel-Trenaunay-Weber Syndrome/diagnosis , Klippel-Trenaunay-Weber Syndrome/epidemiology , Mali , Varicose Veins/complications , Varicose Veins/surgery
13.
Article in Korean | WPRIM | ID: wpr-787214

ABSTRACT

Liver cirrhosis patients are suffering from many complications, which are directly related to a poor prognosis. Although there have been many recent advances in diagnosis and treatment for varix and hepatic encephalopathy in cirrhotic patients, the standard practice for these conditions should consider the different medical resources and etiology of these liver diseases among various countries. The Korean Association for the Study of the Liver published in 2005 a clinical practice guideline for the treatment of cirrhosis complications, and this year, they revised the guideline for treating gastroesophageal varices and hepatic encephalopathy. This review summarizes the revised practice guideline and emphasizes the updated recommendation.


Subject(s)
Diagnosis , Esophageal and Gastric Varices , Fibrosis , Hepatic Encephalopathy , Humans , Liver Cirrhosis , Liver Diseases , Liver , Prognosis , Varicose Veins
14.
Article in Korean | WPRIM | ID: wpr-761566

ABSTRACT

Liver cirrhosis patients are suffering from many complications, which are directly related to a poor prognosis. Although there have been many recent advances in diagnosis and treatment for varix and hepatic encephalopathy in cirrhotic patients, the standard practice for these conditions should consider the different medical resources and etiology of these liver diseases among various countries. The Korean Association for the Study of the Liver published in 2005 a clinical practice guideline for the treatment of cirrhosis complications, and this year, they revised the guideline for treating gastroesophageal varices and hepatic encephalopathy. This review summarizes the revised practice guideline and emphasizes the updated recommendation.


Subject(s)
Diagnosis , Esophageal and Gastric Varices , Fibrosis , Hepatic Encephalopathy , Humans , Liver Cirrhosis , Liver Diseases , Liver , Prognosis , Varicose Veins
15.
Article in English | WPRIM | ID: wpr-785652

ABSTRACT

BACKGROUND/AIMS: There is a lack of data on long-term morbidity, particularly dysphagia, following endoscopic variceal band ligation (EVL). The aim of this study are to assess the incidence of dysphagia and variables associated with this complication after EVL.METHODS: We identified individuals who completed at least one session of EVL as their sole treatment for varices from August 2012 to December 2017. Included patients achieved “complete eradication” of varices not requiring further therapy. Patients ≥90 days from their last EVL session completed a modified version of the Mayo Clinic Dysphagia Questionnaire. Individuals with dysphagia were invited to undergo a barium esophagram. Patients with pre-EVL dysphagia were excluded.RESULTS: Of the patients, 68 possessed inclusion criteria, nine (13.2%) died and 20 (29.4%) were lost to follow up. For the remaining 39 (57.4%) patients, 23 were males, mean age of 61.7±8.6 years. The most common etiology of liver disease was hepatitis C virus (n=18; 46.2%). The median number of banding sessions was 2.0 (interquartile range [IQR], 1.0–4.0) with a median of 9.0 bands placed (IQR, 3.0–14.0). Twelve patients (30.8%) developed new-onset dysphagia post-EVL. In univariate analysis, pre-EVL MELD score and non-emergent initial banding were associated with long-term dysphagia. In a regression model adjusted for age, sex, number of bands, and use of acid suppression after EVL, no factor was independently associated with dysphagia (all p>0.05). No strictures were identified on subsequent esophageal evaluation.CONCLUSIONS: Approximately 30% of patients developed new-onset, chronic dysphagia post-EVL. Incident dysphagia was associated with a non-emergent initial banding session. The mechanism for dysphagia remains unknown.


Subject(s)
Barium , Constriction, Pathologic , Deglutition Disorders , Esophageal and Gastric Varices , Esophageal Stenosis , Hepacivirus , Humans , Incidence , Ligation , Liver Diseases , Lost to Follow-Up , Male , Risk Factors , Varicose Veins
16.
Article in Korean | WPRIM | ID: wpr-758451

ABSTRACT

OBJECTIVE: The most common cause of hemorrhage after paracentesis is direct needle puncture of the inferior epigastric artery (IEA). This study examined the relationship between the amount of the ascites and the location of the IEA in liver cirrhosis. METHODS: Abdominal computed tomography (CT) examinations of patients with liver cirrhosis were reviewed retrospectively and divided into two groups according to the amount of ascites. The distances between the midline and the IEAs of both sides were measured at the umbilicus, McBurney's point, anterior superior iliac spine, and mid-inguinal level. Branching of the IEAs, abdominal wall and mesenteric varices in the abdomen below the umbilicus level were recorded. RESULTS: A total of 120 abdominal CTs were reviewed. The distances from the midline to the IEA in the large ascites group were longer than those in the small ascites group at the level of the right McBurney's point (44.5±14.6 mm vs. 39.6±11.8 mm, P=0.043) and left McBurney's point (48.6±15.3 mm vs. 43.3±11.5 mm, P=0.035). The incidence of abdominal wall varices was higher in the large ascites group (21.7% vs. 5.0%, P=0.014). CONCLUSION: In patients with liver cirrhosis, the large amount of ascites might be associated with lateralizing the location of the IEA. Moreover, it may be necessary to confirm the blood vessels in the abdominal wall and mesentery near the puncture site by bedside ultrasound before the paracentesis.


Subject(s)
Abdomen , Abdominal Wall , Ascites , Blood Vessels , Epigastric Arteries , Hemoperitoneum , Hemorrhage , Humans , Incidence , Liver Cirrhosis , Liver , Mesentery , Needles , Paracentesis , Punctures , Retrospective Studies , Spine , Tomography, X-Ray Computed , Ultrasonography , Umbilicus , Varicose Veins
17.
Article in English | WPRIM | ID: wpr-762671

ABSTRACT

PURPOSE: There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. METHODS: From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3–5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. RESULTS: Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. CONCLUSION: For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.


Subject(s)
Catheter Ablation , Extremities , Humans , Incidence , Quality of Life , Saphenous Vein , Varicose Veins , Veins
18.
Article in English | WPRIM | ID: wpr-762023

ABSTRACT

A 58-year-old male patient with severe claudication due to thrombosis of the left ilio-femoro-popliteal artery aneurysm. He also had a venous stasis ulcer with a history of multiple embolotherapy of arteriovenous malformation. Duplex sonography revealed reflux and varicose veins of the left great saphenous vein (GSV). A sequential bypass surgery was performed that consisted of excision of the left external iliac and common femoral artery aneurysm, external iliac to deep femoral interposition with an expanded polytetrafluoroethylene graft, and femoro-posterior tibial artery bypass with the reversed left GSV. Symptoms of claudication were alleviated and the chronic ulcer was healed in time. To our knowledge, this is the first report of successful bypass in a patient with arterial aneurysm, arteriovenous malformation, and venous insufficiency that can be diagnosed as an atypical case of Parkes Weber syndrome. Long-term follow-up is needed to define the fate of aneurysms and varicose vein graft.


Subject(s)
Aneurysm , Arteries , Arteriovenous Fistula , Arteriovenous Malformations , Embolization, Therapeutic , Femoral Artery , Follow-Up Studies , Humans , Male , Middle Aged , Polytetrafluoroethylene , Popliteal Artery , Saphenous Vein , Sturge-Weber Syndrome , Thrombosis , Tibial Arteries , Transplants , Ulcer , Varicose Ulcer , Varicose Veins , Venous Insufficiency
19.
Article in English | WPRIM | ID: wpr-762001

ABSTRACT

Popliteal vein aneurysms (PVAs) represent a rare form of venous aneurysms and necessitate prompt management because of their well-established risk of pulmonary embolism (PE). Herein, we report a rare case of PVA without PE, successfully treated with open surgical repair. A 27-year-old man presented to our vascular clinic with chronic pain and swelling in his left lower limb. He had a long history of facial surgeries for the removal of congenital multiple osteomas. Physical examination revealed varicosities with an abnormal distribution. Duplex ultrasound showed a left PVA measuring 2.3 cm in diameter and 4 cm in length. Open surgical excision of the PVA with lateral venorrhaphy was performed through a medial approach. Prophylactic anticoagulation was performed postoperatively. In this case, the PVA was detected, with a high degree of suspicion by the clinician, before it caused fatal PE. The patient was successfully treated with aneurysm excision and lateral venorrhaphy.


Subject(s)
Adult , Aneurysm , Chronic Pain , Humans , Lower Extremity , Osteoma , Physical Examination , Popliteal Vein , Pulmonary Embolism , Ultrasonography , Varicose Veins
20.
Clinical Endoscopy ; : 407-415, 2019.
Article in English | WPRIM | ID: wpr-763481

ABSTRACT

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.


Subject(s)
Endoscopy , Esophageal and Gastric Varices , Hemorrhage , Humans , Ligation , Liver Cirrhosis , Portasystemic Shunt, Surgical , Salvage Therapy , Varicose Veins
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