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Chronic deep venous disease
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
Most patients are managed by conservative measures.3, 4 Treatment for reflux in superficial veins is frequently sufficient to relieve deep venous load. Deep vein valve surgery is reserved for patients with severe complications in whom compression treatment and superficial vein ablation, where feasible, has failed to resolve the problem. Surgery to restore deep vein valve function is restricted to a few specialist centres since the indications are few, the techniques are demanding and the results are uncertain.
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
Unlike the lower extremity, the veins of the pelvis have few valves to restrict the direction of venous outflow. In a cadaver study of 200 gonadal veins, single bicuspid valves were noted in 62% of left-sided veins and 48% of right-sided veins. The ovarian vein valve is located just prior to its termination point.9 However, there are no valves within the uterine veins. The internal iliac veins also share this paucity of valves. LePage and colleagues studied 79 internal iliac venous systems in 42 cadavers. The common iliac vein was formed by the confluence of the external iliac vein with single internal iliac veins in 73% and dual internal iliac veins in 27%. Valves were identified in only 10.1% of the main trunks of the internal iliac veins and in only 9.1% of the secondary branches.10 In the absence of valves, the rich anastomotic networks allow blood to flow in alternative directions during periods of relative venous overload, such as that which may occur during pregnancy or in the setting of venous reflux.
Venous anatomy and pathophysiology
Published in Helane S Fronek, The Fundamentals of Phlebology: Venous Disease for Clinicians, 2007
What about the supine position? Varicose vessels that bulge when the patient is standing may collapse when the patient is supine, but duplex ultrasound readily demonstrates that the veins are not empty of blood. Both varicose and normal vessels contain a significant volume of blood with the legs extended in the supine position. A bulging varicosity that has a diameter of 2 cm in the standing position may have a diameter of 1 cm in the supine position and of 0.5 cm or less when the legs are elevated as high as possible. With such a patient in the supine position, injection of 1 cm3 of a 3% solution leads to a final concentration of approximately 1.7% at a distance of 1 cm and a concentration of about 0.6% at a distance of 5 cm (2 inches). This supine technique limits dilution enough to allow successful sclerosis of large vessels using detergent solutions, so long as sufficient concentrations and volumes of sclerosants are injected. The only problem is that if an injection of sclerosant at a high initial concentration is made directly into a perforating vessel, so that sclerosant flows directiy into the deep system, dilution within the deep vessel will still permit zone 1 and 2 endothelial injury for a short distance within the deep vein. This can lead to deep vein valve damage and chronic venous insufficiency, to DVT, and to lifethreatening pulmonary embolism.
Complications in robotic urological surgeries and how to avoid them: A systematic review
Published in Arab Journal of Urology, 2018
Rafael Rocha Tourinho-Barbosa, Marcos Tobias-Machado, Adalberto Castro-Alfaro, Gabriel Ogaya-Pinies, Xavier Cathelineau, Rafael Sanchez-Salas
A steep Trendelenburg position and pneumoperitoneum can result in increased intracranial pressure (ICP), reduction of cerebral oxygenation and ultimately in cognitive dysfunction, especially in elderly patients. Although ∼15% of patients can present ICP at >20 mmHg, abnormal neurological signs are a rare event. Internal jugular vein valve incompetence may play a role in cognitive impairment after surgery [19]. Because monitoring ICP during robotic surgery with an invasive intracranial device is not feasible, measurement of optic nerve sheath diameter by ultrasonography appears as a novel and non-invasive technique to assess ICP [20]. Drugs, such as dexmedetomidine, have been studied in an effort to reduce the risk of cognitive dysfunction.
The effects and molecular mechanism of heat stress on spermatogenesis and the mitigation measures
Published in Systems Biology in Reproductive Medicine, 2022
Yuanyuan Gao, Chen Wang, Kaixian Wang, Chaofan He, Ke Hu, Meng Liang
Varicocele is considered the most common pathogenic factor of male sterility. In clinical practice, the conventional treatment is to correct varicocele, including surgical varicocelectomy and radiographic venous embolization (Agarwal et al. 2012). Varicocele refers to the obstruction of venous blood flow due to the abnormal development of the internal spermatic vein valve or local anatomical factors, which lead to the dilatation of the scrotal venous plexus, causing stasis or ‘warm’ blood to return to the spermatic vein. Impairments in countercurrent heat exchange thus contribute to increased testicular temperature in patients with varicocele (Paick and Choi 2019).
Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
M Machin, S Salim, M Tan, S Onida, AH Davies, J Shalhoub
Endovenous treatments for PTS include balloon venoplasty and venous stenting. Open surgical approaches to restoring venous return include venous bypass, endophlebectomy and patch venoplasty, with creation of arteriovenous fistula being a strategy for maintaining venous patency. Prevention of venous reflux can be undertaken through segmental vein valve transfer/transposition, valvuloplasty (internal or external) and neo-valve reconstruction (e.g. Maleti). Endovenous and surgical techniques can be combined in hybrid endovenous interventions.