1,720,981 research outputs found
Ultrasound guided full mechanical thrombectomy of a floating thrombus in the common femoral vein
Full text linkA Floating Venous Thrombus (FVT) in the deep venous system has a high potential to cause pulmonary embolization. There are no defined criteria for treatments described in the literature, which range from anticoagulation and fibrinolytic treatments, through open or endovascular thrombectomies, to more invasive procedures such as surgical interruption with ligation of the venous system. Catheter-directed thrombolysis is effective for treatment of venous clots, but it is associated with increased risk of bleeding. Mechanical thrombectomy currently represents a valid therapeutic option without the need for lytic therapy and with excellent short and medium-term results. We herein present a technical note through an explicative case of a patient with an FVT located in the left common femoral vein who underwent to percutaneous venous mechanical thrombectomy (ClotTriever, Inari Medical, Irvine, CA, USA) under ultrasound guidance without an intravascular ultrasound check. At the end of the treatment, venography and duplex ultrasound scan showed iliofemoral patency without residual thrombus. No further procedures were needed and the patient was discharged two days post-intervention with oral anticoagulation and compression therapy with stockings
Compensation for external iliac vein hypoplasia via an inherent suprapubic shunt
Full text linkA 13-year-old girl was referred to our vein center by pediatricians owing to hypertrophic superficial venous circulation in her right groin, associated with local heaviness and the presence of two enlarged superficial venous branches emerging from her right medial thigh. The patient had previously undergone numerous examinations to exclude gynecological and gastrointestinal causes. A duplex ultrasound scan revealed reflux in the right common femoral vein with competent femoral valves. Notably, the right great saphenous vein (GSV) did not show significant reflux in the calf, but a severe reflux was detected in the proximal thigh with an enlarged ascending collateral branch directed towards the suprapubic area. In the left limb, duplex ultrasound examination revealed common femoral vein competent valves and modulated flow. Further exploration of the abdomen led to the diagnosis of external iliac vein agenesia. To better define the anatomy, she underwent contrastenhanced magnetic resonance venography, which revealed incomplete agenesis or chronic occlusion of the left external iliac vein with aberrant venous drainage (A/Cover and B). In B, the asterisk (*) represents the left common iliac vein (CIV), and the plus sign (& thorn;) represents the right GSV merging into the left CIV through a suprapubic collateral, owing to complete right CIV agenesis. Two main branches were identified, sprouting from the left common femoral vein, and connecting respectively to the right external iliac vein and right GSV through a suprapubic collateral (C). Venous malformations can manifest as hypoplastic or hyperplastic vessels, leading to obstruction or dilation, depending on the case.1 Embryologically, iliac veins develop from the posterior cardinal veins, which progressively regress and leave remnants like the renal segment of the inferior vena cava and the iliac veins.2 External iliac vein agenesia is typically associated with KlippelTrenaunay syndrome, which shows an incidence of 8%.3,4 However, this young lady did not present with the typical associated triad of varicose veins, asymmetric limb growth, and arteriovenous malformation, increasing the likelihood of isolated left external iliac vein agenesis, presenting with an incidence of less than 0.09%.5 Remarkably, the patient did not show signs of deep vein thrombosis; therefore, she was recommended a conservative treatment using compressive stockings, an
Anterior accessory saphenous vein confluence anatomy at the sapheno-femoral junction as risk factor for varicose veins recurrence after great saphenous vein radiofrequency thermal ablation
No full textBACKGROUND: Varicose veins recurrence rate remained almost unchanged despite the constant technological advancement in its treatment. The aim of this study is to evaluate the variable accessory saphenous vein (ASV) anatomy at the sapheno-femoral junction (SFJ) as a possible risk factor for recurrent varicose vein (RVV) after great saphenous vein (GSV) radiofrequency thermal ablation (RTA). METHODS: Two-hundred consecutive patients affected by chronic venous disease (mean age 52.4±10.3 years; 187 women; CEAP C2-C6; 25.2±1.4), underwent to RTA from 2014 to 2016, at our Institute. Preoperatively all patients underwent duplex-ultrasound scanning, reporting the anatomical site, extension of reflux and the ASV anatomy at the SFJ. Duplex ultrasound and physical examination was performed postoperatively at 1, 6 and 12 months, and yearly thereafter. RESULTS: Patients were divided in two groups based on the anatomical site of reflux: group A (N.=187) including GSV and SFJ, group B (N.=82) including SFJ reflux. There was no preoperative statistical difference between the two groups. At a mean follow-up of 29.7±2.4 months, a freedom from recurrent varicose vein and GSV recanalization was: 100% and 100% at 1 month, 95.9% and 99.1% at 1 year, 93.7% and 96.7% at 3 years, respectively. A higher rate of RVV was documented for patients in group A at 3-year of follow-up (P=0.042). Cox regression analysis found, among five potential predictors of outcome, that direct confluence of ASV in SFJ (HR=1.561; 95% CI: 1.0-7.04; P=0.032) was a negative predictors of 1-year RVV. CONCLUSIONS: Sapheno-femoral junction morphology may affect recurrent varicose veins formation. In particular, a concomitant incompetence of the accessory saphenous vein or its directly confluence into the SFJ could represent an indication to simultaneous treatment by non-surgical techniques (RTA or laser) and avoid surgical ligation
Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture
No full textLate formation of pseudoaneurysm related to stent fracture is rarely described in the literature. We describe a case of spontaneous 8-cm femoral superficial artery pseudoaneurysm rupture that had developed from fracture of a stent implanted 3 years previously. Surgical repair was performed with fractured stent removal and reverse saphenous vein bypass
Dual Endovascular Approach for Post-traumatic Rupture of Left Iliac Vein in Emergent Setting
No full textTraumatic venous injuries are associated with high mortality rates. When they involve the inferior vena cava and iliac veins, prompt treatment is necessary in cases of patient instability. Endovascular treatment of a traumatic injury at the iliac confluence extending to the proximal external iliac vein was performed in a 50-year-old patient following a fall. A GORE Excluder PLC141400 endograft was placed at the bleeding site via percutaneous transfemoral access, combined with simultaneous embolization of the internal iliac vein through right percutaneous jugular access. Effective haemostasis was achieved, along with normalization of blood pressure. Prompt diagnosis and recognition of the condition are vital for achieving blood pressure stabilization and haemostasis in unstable patients
Endovascular treatment of chronic ilio-femoral vein obstruction with extension below the inguinal ligament in patients with post-thrombotic syndrome
Full text linkObjective: This study aimed to evaluate postoperative outcomes of patients with chronic iliofemoral venous out fl ow obstruction and post -thrombotic syndrome (PTS) who underwent endovascular recanalization and stenting across the inguinal ligament. Methods: All consecutive patients with chronic iliofemoral venous out fl ow obstruction and PTS were included in the analysis, from January 2018 and February 2022. Preoperative, intraoperative, and postoperative outcomes were assessed. Primary endpoints analyzed were major adverse events (MAEs) at 30 days and primary patency rate at 2 years of followup. Secondary endpoints assessed were secondary patency rate, target vessel revascularization, and clinical improvement evaluated with the Venous Clinical Severity Score (VCSS) classi fi cation, Villalta scale, and visual analog scale (VAS), respectively. Results: A total of 63 patients (mean age, 48.1 6 15.5 years; female, 61.9%) were evaluated. No intraoperative and 30 -day postoperative complications were documented. The technical success rate was achieved at 100%. Overall, one in-stent occlusion and fi ve in-stent restenosis were detected during follow-up. The primary patency rate was 93.7% (95% con fi- dence interval [CI], 87.8%-99.9%) and 92.1% (95% CI, 85.6%-99%), at 1- and 2 -year follow-up, respectively (Kaplan -Meier analysis). Target vessel revascularization was conducted in two cases, resulting in a secondary patency of 98.4% (95% CI, 95.4%-100%) at 2 years of follow-up. Stent fracture and/or migration were not observed during follow-up. A signi fi cant clinical improvement in the patient's quality of life was documented. The median improvement of VCSS and Villalta scores were 4 (interquartile range, 2-7; P = .001), and 3 (interquartile range, 1.5-5; P = .001) vs baseline at the last follow-up. Overall, pain reduction of 17 mm on the VAS scale was documented at 2 years of follow-up. At multivariate analysis, presence of trabeculation into the femoral vein and deep femoral vein (odds ratio, 1.89; 95% CI, 0.15-6.11; P = .043), and Villalta scale > 15 points at admission (odds ratio, 1.89; 95% CI, 0.15-6.11; P = .043) were predictive for in-stent occlusion during the follow-up. Conclusions: The use of a dedicated venous stent across the inguinal ligament was safe and effective for the treatment of symptomatic iliofemoral venous disease with acceptable primary and secondary patency rates at 2 years of follow-up
The “venous perspective” in Lombardia (Italy) during the first weeks of the COVID-19 epidemic
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Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein
No full textObjective to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. Methods This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. Results A total of 60 limbs (73.3% women, mean age 54.7 +/- 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 +/- 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 +/- 2.3 days vs. OS 14.2 +/- 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. Conclusion MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS
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