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Chronic Venous Disease
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
How would you assess for deep venous obstruction?“I would place the ultrasound probe over the common femoral vein and look for normal phasic flow with respiration. If this a flat aphasic pattern, this would suggest upstream venous obstruction. However, this is a specialist area. If the clinical assessment and ultrasound findings suggested a deep venous problem I would refer the patient for a formal departmental duplex assessment.”
The VANISH-2 Study: A Randomized, Blinded, Multicenter Study to Evaluate the Efficacy and Safety of Polidocanol Endovenous Microfoam 0.5% and 1.0% Compared with Placebo for the Treatment of Saphenofemoral Junction Incompetence
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Results There were statistically significant improvements for both the 0.5% and 1.0% treatments groups compared with placebo. Overall, there was a 64% reduction in symptoms in the treatment groups compared with 22% in the placebo group (p < 0.0001). Statistically significant improvement in appearance was also noted in the 0.5% and 1.0% treatment groups. Elimination of SFJ reflux and/or complete occlusion of the GSV was achieved in 83% and 86% of patients who received PEM 0.5% and PEM 1.0%, respectively. No cerebrovascular events or anaphylactic shock occurred. Thrombotic adverse events occurred in 10.4% of patients. Thrombus extension into the common femoral vein occurred in nine patients (3.9%). None were occlusive. There were six proximal deep vein thromboses (2.6%), seven distal deep vein thromboses (3%), and two patients had gastrocnemius thrombi. Half of the patients received anticoagulation and the remainder were managed with nonsteroidal anti-inflammatory medications and/or compression and observation. There were no differences in the outcome between patients who were treated or not treated with anticoagulation. All patients were followed until their thrombi resolved or stabilized (median 29 days). No pulmonary emboli were noted.
Venous Thrombosis
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Gary E. Raskob, Russell D. Hull
A relatively high proportion (10 to 30%) of patients undergoing hip or knee surgery develop venous thrombosis of the popliteal or femoral venous segments,19–23 whereas only 3 to 5% of patients undergoing elective general surgery develop proximal vein thrombosis.22,24–26 In general surgical patients, venous thrombosis usually originates in the calf,5,16,17,22,24–26 and when proximal vein thrombosis occurs, it usually results from proximal extension of calf vein thrombosis. In contrast, approximately 20% of deep vein thrombi in patients who have hip surgery are localized to the femoral vein close to the site of surgery (Figure 1) and originate as isolated events.18–22
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique
Published in Journal of Obstetrics and Gynaecology, 2023
Fong Lien Kwong, Miski Scerif, Jason KW Yap
Surgical technique: We start by identifying the anterior superior iliac spine and pubic tubercle to map the course of the inguinal ligament. We then palpate the femoral artery to identify its location and a handheld Doppler may be used in obese women. Situated on its medial side in the femoral triangle is the femoral vein and the latter is joined on its medial side by the saphenous vein at the saphenofemoral junction. We make a 3-4cm incision inferior to and parallel to the inguinal ligament. The incision extends over the femoral vein and slightly above the saphenous vein (Figure 1). Radiolocalisation of the SLN was achieved after identifying and excising the node with the highest signal count using a handheld gamma counter. The groin was re-examined and dissection continued until there was no residual radioactivity. All histological specimens were analysed using ultrastaging with immunohistochemistry. Ipsilateral unilateral inguinal SLN biopsies were conducted for lateral tumour and bilateral excisions for central tumours. The long saphenous vein was preserved in all cases.
Femoral venous haemostasis in children and young adults using the ‘figure‐of‐eight’ suture technique
Published in Acta Cardiologica, 2022
Yasemin N. Dönmez, Hayrettin Hakan Aykan, Kutay Sel, İlker Ertuğrul, Derya Duman, Ebru Aypar, Dursun Alehan, Tevfik Karagöz
The survival rate for children and adolescents with congenital heart disease (CHD) is increasing with the advance and progression in interventional treatment options and surgical procedures, with more patients reaching adult age. In CHD, interventional treatment methods have gained importance in recent years and interventional techniques (transcatheter closure of atrial/ventricular septal defect or patent ductus arteriosus; balloon angioplasty; transcatheter pulmonary valve replacement) have replaced surgery in some areas [1]. Owing to an increase in the number of interventions in a single patient and a decrease in intervention age, large sheaths are required for vascular access. In addition, recurrent catheterisation may be required prior to staged reconstructive heart surgery for residual defects and repaired surgery [2]. Appropriate haemostasis of the femoral vein plays an important role in the prevention of femoral vein thrombosis and the development of other vascular complications. We report our experience with the ‘figure-of eight’ suture technique in children and adolescents, with the aim of providing femoral haemostasis in those procedures requiring large or multiple femoral venous sheaths. In addition, we describe a novel method to ensure stabilisation of the sheaths to the central catheter sheath via the Seldinger technique.
Intravenous leiomyomatosis—a case report
Published in Journal of Obstetrics and Gynaecology, 2021
A. Z. Zaidi, I. Hawley, J. Zaidi
A pelvic ultrasound and a MRI confirmed the existence of large uterine fibroid, with a probable ureteric obstruction to the right kidney. A colour Doppler ultrasound scan revealed a right, common femoral and femoral vein thrombosis, respectively. An inferior vena cava filter was inserted, and she was not anticoagulated in view of the severe anaemia. A laparotomy with a view to a hysterectomy with conservation of both ovaries was performed without complication. The pathology report identified there was a large fibroid measuring 100 × 100 × 90 mm distorting the endometrial cavity. The surface was pale and homogenous with a focal area of necrosis measuring 30 mm. On microscopy, benign leiomyoma was identified with infarction type necrotic areas. At the periphery there were few vascular luminae containing mature smooth muscle tissue, confirming the diagnosis of benign leiomyoma (BL) with intravenous leiomyomatosis (IVL) (Figure 1).