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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
Gallbladder Compression of the Inferior Vena Cava Resulting in Extensive Venous Ulcers of the Lower Limbs
No full textDelayed Upstream Migration of an Iliac Stent
No full textIntroductionStent migrations are described after peripheral endovascular treatments. We report a case of an unusual iliac stent movement after a successful angioplasty.ReportAn occlusive distal intimal flap after aorto-iliac endoarterectomy was successfully fixed by stenting of the left external iliac artery. One month later, the patient was readmitted due to contralateral limb acute ischemia. Angiography revealed a right iliac artery thrombosis due to upstream stent migration from the left external iliac artery into the right common iliac artery. The patient underwent a combined surgical and endovascular rescue technique.ConclusionTurbulent and pulsatile flow, associated with wall remodelling may explain this unexpected complication
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
Ex Vivo open reconstruction of hilar renal artery aneurysms: a silngle-center experience
No full textNegative pressure dressing for the prevention of wound complications after aortic surgery.
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