Clinical, ultrasonographic and histological findings in varicose vein surgery

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease's clinical severity or reflux in the SFJ on a Doppler ultrasound.

RESUMO OBJETIVO Este estudo tem como objetivo correlacionar os dados demográficos, os diferentes graus clínicos da insuficiência venosa crônica (Ceap), com achados ultrassonográficos de refluxo da junção safenofemoral (JSF) e os achados anatomopatológicos do segmento proximal da veia safena magna (VSM) extraído de pacientes com insuficiência venosa crônica (IVC) primária submetidos à safenectomia magna para correção de varizes dos membros inferiores. MÉTODO Estudo prospectivo de 84 pacientes e 110 membros submetidos à safenectomia magna para o tratamento de varizes de membros inferiores, correlacionando a sua classificação clínica Ceap, presença de refluxo na JSF ao ultrassom Doppler e alterações histopatológicas. Comparamos ainda os achados histopatológicos da VSM proximal retirada dos pacientes com IVC com grupo controle de VSM normal retirada de cadáveres. RESULTADOS Média de idade dos pacientes foi maior nos Ceaps avançados quando comparado Ceap C2 (46,1 anos) com C4 (55,7 anos) e C5-6 (66 anos), e pacientes C3 (50,6 anos) com C5-6. A espessura da parede da VSM normal (média de 839,7 micrômetros) foi significativamente menor do que das VSM varicosas (média de 1.609,7 micrômetros). As análises de correlação da presença do refluxo em JSF com a classificação clínica ou achado histopatológico não demostraram ser estatisticamente significativas. CONCLUSÕES Quanto maior a idade, mais avançada é a classificação clínica da IVC dos pacientes. A espessura da parede da crossa da VSM é maior nos pacientes com IVC e essas alterações não se correlacionam com a classificação clínica da doença ou com a presença de refluxo na JSF ao ultrassom Doppler.

Estudo experimental de reconstrução da veia femoral com enxerto tubular do bipolímero de cana-de-açúcar / Experimental study of femoral vein reconstruction with sugarcane biopolymer tubular graft

RESUMO Objetivo: avaliar, através de dopplerfluxometria, de venografia, de histologia e de evolução clínica, o uso de enxertos tubulares de biopolímero de cana-de-açúcar (BP) na reconstrução de veias femorais em cães. Métodos: oito cães adultos foram submetidos à reconstrução de veia femoral, à esquerda com enxerto tubular de BP e à direita com veia autóloga. No período pós-operatório, os animais foram submetidos à avaliação clínica e dopplerfluxometria das veias femorais. Após 360 dias, os cães foram reoperados e submetidos à flebografia das veias femorais com contraste iodado. Os segmentos das veias femorais contendo os enxertos foram retirados e enviados para avaliação histopatológica. Resultados: os cães não apresentaram hemorragia, hematoma, infecção da ferida operatória ou edema dos membros operados. Um animal apresentou dilatação venosa superficial na região inguinal esquerda. A flebografia realizada 360 dias após a primeira cirurgia demonstrou que três (37,5%) enxertos de BP e sete (87,5%) do grupo controle (C) estavam pérvios. Na avaliação histopatológica foi encontrada uma reação inflamatória com neutrófilos e linfócitos na superfície externa de ambos os grupos. Na camada íntima de revestimento dos enxertos e na camada externa nos dois grupos, foi encontrada fibrose. Conclusão: com base nos resultados obtidos com o modelo experimental utilizado, conclui-se que a BP apresenta potencial para ser utilizado como enxerto tubular para revascularização venosa, porém novas pesquisas precisam ser realizadas para confirmar a sua eficácia na revascularização de veias de médio e grande calibre, o que poderia permitir o seu uso na prática clínica.

ABSTRACT Objective: to evaluate, through Doppler flowmetry, venography, histology and clinical evolution, the use of sugarcane biopolymer (BP) tubular grafts in the reconstruction of femoral veins in dogs. Methods: we submitted eight adult dogs to femoral vein reconstruction, on the left with BP tubular graft and on the right with autologous vein. In the postoperative period, the animals underwent clinical evaluation and femoral vein Doppler flowmetry. After 360 days, we reoperated the dogs and submitted them to femoral vein phlebography with iodinated contrast. We removed the segments of the femoral veins containing the grafts and sent them for histopathological evaluation. Results: the dogs did not present hemorrhage, hematoma, surgical wound infection or operated limb edema. One animal had superficial venous dilatation in the left inguinal region. Phlebography performed 360 days after the first surgery showed that three (37.5%) BP grafts and seven (87.5%) grafts from the control group (C) were patent. In the histopathological evaluation, we found an inflammatory reaction, with neutrophils and lymphocytes on the external surface of both groups. In the intimal layer of the grafts and in the outer layer in the two groups, we observed fibrosis. Conclusion: based on the results obtained with the experimental model used, BP presents potential to be used as a tubular graft for venous revascularization. However, new research must be performed to confirm its efficacy in the revascularization of medium and large diameter veins, which could allow its use in clinical practice.

Pulmonary embolism and stroke associated with mechanical thrombectomy / Embolia pulmonar e AVC isquêmico associado à trombectomia mecânica

Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy...

A trombectomia mecânica tem a vantagem de levar à rápida remoção dos trombos. Permite a desobstrução venosa e a redução do tempo de infusão de trombolíticos. A aspiração dos trombos pode levar a complicações, principalmente embolia pulmonar e hemólise. Algo que não está definido é a validade do uso de filtros de veia cava durante a trombectomia, com o objetivo de evitar a TEP maciça. Os autores relatam um caso de embolia pulmonar maciça associada a AVC isquêmico, em uma paciente que apresentava forame oval patente. Não havia o diagnóstico prévio da PFO. A paciente evoluiu com insuficiência respiratória e déficit neurológico logo após a trombectomia. Neste caso, questiona-se o valor da trombectomia para o tratamento da trombose venosa proximal, devido aos riscos deste procedimento. Os autores discutem sobre a necessidade de filtro de veia cava e sobre a pesquisa de forame oval nos pacientes que serão submetidos à trombectomia...

Adventitial Cystic Disease of the Femoral Vein: a Case Report with the CT Venography

Fewer than 20 cases of adventitial cystic disease of the vein have been reported in the worldwide literature. This small number of reported cases may be due not only to the disease's low incidence, but also to the difficulty in making the proper diagnosis. Many techniques have been used to investigate this disease, but venography has been the traditional diagnostic tool. In this report we present a case of adventitial cystic disease that was well demonstrated by CT venography.

In vivo visualization of bonghan ducts inside blood vessels of mice by using an Alcian blue staining method.

An in vivo method using Alcian blue (AB) was developed for visualizing floating threadlike tissues inside blood vessels of mice. These novel structures called intravascular Bonghan ducts (IBHDs) are considered as extension of acupuncture meridians. For in vivo imaging of IBHDs, AB solution (pH 7.4) that stains mucopolysaccharides like hyaluronic acid was used. After injecting AB solution into the femoral vein of a mouse, the threadlike structures, stained deep blue, inside the inferior vena cava. The histological results, such as hematoxylin, eosin, and AB staining, show the compositions of the cells and the extracellular matrix in the IBHD. Further studies are needed to investigate their physiological functions, especially in relation with those of other circulatory systems.

Unilateral lower limb oedema in pregnancy.

A 21 years old lady was admitted with severe pain and swelling of left lower limb in a pregnancy of 34 weeks of period of gestation. On examination there was pitting oedema of the whole left lower limb with extreme tenderness. Doppler USG of left femoral vein showed a thrombus in the process of recanalisation and no significant flow was demonstrated inside the lumen and USG for foetoplacental profile showed a single live foetus of gestational age 34 weeks. The case was diagnosed as deep venous thrombosis in pregnancy. She was treated with heparin injection 5000 unit subcutaneously twice daily throughout pregnancy along with antibiotics. In spite of proper management she developed extensive ulceration in left lower limb. She delivered normally a healty male child after induction with oxytocin dirp. The postpartum period was uneventful. Throughout this period heparin was continued and she was referred to surgery department for skin grafting.

Leiomyosarcoma of femoral vein in an adult

A middle aged female presented with a swelling in the groin on the left side. On examination, it was an oval mildly tender firm mass, adherent to underlying structures and extending into the pelvis with pulsatility and bruit. It was diagnosed as leiomyosarcoma of femoral vein on fine needle aspiration cytology and selective left common iliac and common femoral angiography of the lesion. En-bloc wide excision of the mass including the femoral vessels was carried out with saphenous vein graft interposition for restoration of vascular continuity for both vessels. Femoral nerve was sacrificed for tissue clearance. The defect was large and led to permanent limp and walk with a support. The lady was followed up for two years. She was found to have no local recurrence or detectable metastases

Psoas Abscess Presenting with Femoropopliteal Vein Thrombosis

Psoas abscess is an uncommon condition with vague clinical presentation. It generally has an insidious onset and before the advent of computed tomography, few cases were reported in the medical literature. We report the case of a middle aged diabetic woman who presented with left leg swelling. Doppler ultrasound revealed thrombosis of the popliteal vein and a collection in the left groin. Computed tomography confirmed the presence of a large left iliopsoas abscess extending to the anterior compartment of the thigh complicated with thrombosis of the superficial femoral and popliteal veins. We suggest that an iliopsoas abscess should be excluded when an immunocompromised patient presents with deep vein thrombosis

Diagnosis of deep vein thrombosis in the leg by using colour coded duplex sonography

Deep Vein Thrombosis [DVT] is regarded rare in Asia. There is no documentation of the incidence of DVT in Pakistan. Clinical diagnosis of Deep Vein Thrombosis is inaccurate. Venography is the most reliable method of diagnosis, but it has several disadvantages. Many noninvasive diagnostic methods have therefore been developed in the past decade. Of these only duplex sonography has comparable accuracy. We studied 100 cases of suspected DVT by using, color coded duplex sonography. We report the results of a prospective study in patients with suspected deep vein thrombosis evaluated by both color coded Doppler sonography and venography. We conclude that color coded duplex sonography is a highly accurate, simple, non-invasive method for detecting femoropopliteal thrombosis. Additional venography is not necessary. Its value in diagnosing isolated calf vein thrombosis remains to be established

Verdades y errores en el diagnóstico tomográfico de las trombosis venosas / Computed tomographic dianosis of the venous thrombosis

El propósito de este trabajo es subrayar los signos de trombosis venosa evidente en los estudios tomográficos, revisando a la vez los posibles errores de diagnóstico y sus causas. Se presentan 10 casos, estudiados por TC en trombosis venosas en diferentes localizaciones. Los signos constantes son:1)aumento del diámetro del vaso afectado; 2)aumento del espesor de su pared, y 3)reforzamiento de la misma al incorporarse el contraste. Los signos más inconstantes son 1)hipodensidad intraluminal correspondiente al trombo en sí mismo; 2)presencia de circulación colateral; 3)manguito de partes blandas perivenoso (periflebitis) y 4)aire en el interior del trombo en el caso de que se trate de un trombo séptico. Esta imagen es independiente del sitio y causa del fenómeno. La TC posee una alta sensibilidad y especificidad en este tipo de patología prácticamente sin diagnósticos diferenciales a tener en cuenta ante imágenes en las cuales se registren los parámetros ya enunciados. La RMI y más recientemente marcación con radioisótopos parecen promisorios, no obstante faltaría agregar experiencia a lo ya elaborado. Por el momento pensamos que la TC cumple en forma eficaz, rápida y poco costosa el objetivo diagnóstico, a lo que se deberá agregar la ventaja del descubrimiento casual del fenómeno en estudios solicitados por otros motivos