How to avoid and manage iatrogenic femoral arteriovenous fistulae?

Iatrogenic femoral arteriovenous fistula [AVF] is one of the most frequent complications of percutaneous vascular intervention. We report 3 cases of iatrogenic AVF; one followed coronary angiography and stent implantation and the other two followed permcath insertion for hemodialysis. A review of these cases and of the relevant literature showed that most of these iatrogenic AVF originated below the bifurcation of the common female artery [CFA], which indicates that an excessively distal puncture site is a possible anatomic explanation for the formation of iatrogenic AVF. All the cases were managed successfully by open surgery

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery [May and Thurner syndrome] is a well-known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy

Histological assessment of the long saphenous vein in normal and varicose veins

Varicose veins occur due to weakness of the vein wall as a result of structural problems. Conflicting results were recorded about these problems concerning collagen fibers, elastin and smooth muscle cells content. This study aimed to clarify the structural abnormalities of varicose veins [with and without valvular incompetence]. Sixty specimens of long saphenous veins were obtained from 30 patients of both sexes [10 with normal and 20 with varicose veins]. Two specimens were taken from each vein about 3-4 cm from the saphenofemoral junction and were processed for histological [light and electron microscope] and immunohistochemical studies. Using the image analyzer, contents of collagen, elastin and smooth muscle cells, in addition to intimal and medial thickness, were measured and analyzed statistically. Light microscopic examination revealed significant increase in intimal and medial thickness and collagen content of media. Elastin content and smooth muscle optical density were significantly decreased in varicose veins compared to normal veins. There was no sign difference between varicose veins with and without saphenofemoral valve incompetence. Electron microscopic examination showed marked degenerative changes in intima and media as well as the adventitia of varicose veins. The structural changes associating varicose veins included intimal, medial and adventitial changes, disturbance in the connective tissue components and smooth muscle cells. These findings supported the theory of primary weakness of the vein wall as a cause of varicosity