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Management of pelvic congestion syndrome and perineal varicosities
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Venographic criteria suggestive of a diagnosis of PCS include: (1) reflux in the ovarian vein; (2) uterine venous engorgement; (3) congestion of the ovarian plexus; (4) filling of pelvic veins across the midline; and/or (5) filling of vulvovaginal thigh varicosities.19 Brisk and extensive filling of collateral lumbar veins can also be indicative of the syndrome (Figure 59.3). Although the absolute diameter of the ovarian vein has been used as a criterion for pelvic venous congestion syndrome, it is now recognized that PCS is a disorder of venous flow, independent of venous diameter.8 The diagnosis is most firmly established in the presence of free reflux in the left ovarian vein, cross-pelvic flow through smaller collateral veins, and drainage of the left pelvis through the right internal iliac vein.26 If labial or vaginal varicose veins are present but renal and pelvic venography fail to identify the presence of reflux or large pelvic varicose veins, direct stick venography through an accessible external varicose may be of value.
The Bladder (BL)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
First lumbar vein: The lumbar veins accompany the lumbar arteries and drain blood from the posterior body wall and the lumbar vertebral venous plexuses. The first and second lumbar veins drain into the ascending lumbar vein. The ascending lumbar veins feed into the azygous venous system. The lumbar veins communicate with the epidural venous plexus within the vertebral column.
Lateral Pelvic Lymph Node Dissection in Low Rectal Cancer
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The external iliac artery is exposed and secured using a vessel loop or tape. By exposing the medial aspect of the psoas major muscle, the fat tissue between the external iliac artery and the psoas major is dissected and the obturator nerve is identified. Care should be taken not to damage the fifth lumbar vein that drains into either the inferior vena cava or the external iliac vein (Figure 6.13.2).
Outcome of sentinel lymph node biopsy in patients with clinically non-metastatic renal cell carcinoma
Published in Scandinavian Journal of Urology, 2018
Teele Kuusk, Roderick De Bruijn, Oscar R Brouwer, Jeroen De Jong, Maarten Donswijk, Kees Hendricksen, Simon Horenblas, Katarzyna Jóźwiak, Warner Prevoo, Renato A Valdés Olmos, Henk G Van Der Poel, Bas WG Van Rhijn, Esther M Wit, Axel Bex
The rapid systemic progression described in patients with isolated LN metastases [15] and the pattern of supradiaphragmatic drainage in our previous imaging study [8] adds to the hypothesis that, in a proportion of patients, lymphatic spread of tumour cells may result in subsequent systemic metastases due to lympho-venous connections [9]. Five patients out of six with at least one interaortocaval SN receiving radiotracer drainage from the tumour developed thoracic metastases. This pattern supports a previously reported hypothesis that tumours with interaortocaval drainage drain straight into the TD, which connects to the subclavian vein [12]. Lymphatic drainage from the kidney revealing interaortocaval connections with the thoracic cavity has been reported in early cadaver studies of lymphatic drainage from the kidney by Parker [27] and others, who observed lymphatic drainage from the kidney to the TD without intervening LN [9,11]. However, additional direct local lympho-venous connections that may cause hematogenous metastases through anastomoses between regional LN and adrenal and lumbar veins have been postulated [9].
Inferior vena cava reconstruction with a superficial femoral vein graft after resection of a venous leiomyosarcoma
Published in Acta Chirurgica Belgica, 2021
Ovidiu Tirnavean, Christophe Van Bellinghen, Luc Monfort, Bruno Coulier, Michel Buche, Spiridon Papadatos, François Buche, Pierre-Yves Etienne
The contrast abdominal CT scan (Figure 4) confirmed a small residual permeability of the inferior vena cava, and the extension of the tumor assuming essentially endoluminal location of the lesion with anyway a relative obstruction of the renal veins, demonstrated by presence of varicose veins in the peripheral fat of the renal compartments; light venous hypertrophy was also described at the level of the ascendant lumbar veins and of the azygos system.
Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience
Published in Arab Journal of Urology, 2020
Thekke Adiyat Kishore, Gregory Pathrose, Vishnu Raveendran, Arvind Ganpule, Gagan Gautam, Abhishek Laddha, Ginil Kumar Pooleri, Mahesh Desai
The da Vinci® Si (Intuitive Surgical, Sunnyvale, CA, USA) was used in two institutions, while the other two utilised the da Vinci Xi system. The patients were positioned in left lateral decubitus position. Initially, a 12-mm camera port was inserted ~6 cm lateral to the midline ~3 cm above the umbilicus after creating a pneumoperitoneum. Two 8-mm robotic instrument ports were inserted 8 cm cephalic and caudal to the camera port. The fourth robotic port was inserted 5 cm superolateral to the iliac spine. The 5-mm port for liver retraction and two assistant ports (10 and 5 mm) were also inserted. In institutions were the da Vinci Xi was used, four ports were placed in a linear fashions lateral to rectus sheath at a distance of 6–8 cm. The liver, colon and duodenum were mobilised to gain access to the interaortocaval region. The lumbar veins were clipped to facilitate IVC mobilisation. The renal arteries were ligated with Hem-o-lok clips (Telflex Surgical, Wayne, PA, USA) in the interaortocaval region. The IVC was circumferentially dissected proximal and distal to the renal vein and vascular tourniquets were applied. The left renal vein was then isolated. Doppler ultrasonography was used to delineate the extent of the thrombus and also to assess any remaining vascular supply to the kidney (Figure 1(a)). Bulldog clamps were applied in a sequential manner on the infrarenal IVC, left renal vein and suprarenal IVC. A cavotomy was performed and the thrombus extracted. In cases where the thrombus extended into the intrahepatic portion, a few short hepatic veins were divided to obtain adequate space for the application of the bulldog clamps (Figure 1(b)). In one patient, there was a small area of IVC wall infiltration adjacent to the renal vein that necessitated resection of the IVC. In an instance were bland thrombus was encountered in the infrarenal IVC, a Fogarty catheter was used to extract the thrombus. The cavotomy was closed with 6–0 Gore-Tex suture in a continuous manner. The kidney with the tumour and adrenal gland was then mobilised all around. The ureter was dissected out and divided. The specimen was removed through a Pfannenstiel incision.