Retrograde Tempofilter II(TM) Placement within the Superior Vena Cava in a Patient with Acute Upper Extremity Deep Venous Thrombosis: the Filter Stands on Its Head

The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofilter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis.

Ambulatory Phlebectomy at Radiologic Outpatient Clinic

PURPOSE: To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. MATERIALS AND METHODS: Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RESULTS: RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. CONCLUSION: An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic.

Adventitial Cystic Disease of the Left External Iliac Vein: A Case Report

Adventitial cystic disease (ACD) is a rare, but well-characterized vascular disease. It is most commonly seen in the popliteal artery, but it has also been reported in the venous system. The most commonly involved segment has been the common femoral vein; the disease resulted in luminal compromise and extremity swelling. We report here on a case of adventitial cystic disease of the left external iliac vein that was initially misdiagnosed as deep vein thrombosis in a 68-year-old man who presented with a painless swelling of his left leg.

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.

Color Doppler Ultrasound in Chronic Venous Insufficiency

PURPOSE: To analyse Doppler findings in patients with chronic venous insufficiency, and evaluate the usefulness of color Doppler ultrasonography. MATERIALS AND METHODS: Thirty-seven limbs in 29 patients were evaluated with color Doppler ultrasound for suspected chronic venous insufficiency. To determine luminal patency and valvular competence, the venous system was examined; more than 1 sec of reflux flow during Valsalva maneuver and after release of distal compression in the popliteal vein indicated incompetence. RESULTS: Venous insufficiency was seen in 30 cases (81%), and was Superficial in 14 (38%), deep in eight (21.5%), and combined in eight (21.5%). In seven limbs (19%), veins were normal. Six cases of insufficiency, four of which were deep, were combined with deep venous thrombosis. CONCLUSION: In cases of chronic venous insufficiency, color Doppler ultrasound is useful for defining the exact site of venous incompetence and evaluating venous luminal patency.