The effect of pregnancy on the lower-limb venous system of women with varicose veins.

OBJECTIVES: to assess the effect of pregnancy on the lower-limb venous system of women with varicose veins. Design a longitudinal prospective study of 11 pregnant women, with varicose vein disease. METHODS: eleven pregnant women with varicose veins were recruited as part of a larger study. Veins were assessed in both lower limbs using colour-flow duplex scanning at a 75 degrees head-up tilt. The diameter and velocity and duration of reflux were measured in each vein at 12, 20, 26, 34, 38 weeks gestation and 6 weeks postpartum. RESULTS: eleven women had reflux and varicose veins demonstrated at first scan. All veins dilated with increasing gestation. This was maximal in the superficial system, reaching significance (p相似文献   

Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report.

A 35-year-old woman presented with severe left leg swelling and pain after a spontaneous abortion of a 20-week fetus. Duplex ultrasound imaging confirmed venous thrombosis of the left iliac, common femoral, superficial femoral, deep femoral, greater saphenous, posterior tibial, and popliteal, peroneal, and soleal veins. A computed tomography scan showed large uterine fibroids that were completely compressing the distal inferior vena cava and both ureters, with associated hydronephrosis. A magnetic resonance venography showed the inferior vena cava proximal to the mechanical obstruction was free of thrombosis but was dilated at 27 mm in the suprarenal location. A hysterectomy was performed and an 8-pound uterus was removed. Intraoperative ultrasound of the inferior vena cava showed a patent crescent shaped vein with no thrombus and adequate venous blood flow. Pathology of the uterus showed a large leiomyoma with necrosis. Her lower extremity symptoms resolved.     

Ungewöhnliche Ursache einer peripheren Lungenembolie

Aneurysms of popliteal veins are a rare but silent danger that may involve pulmonary embolism. This case report is of a 63-year-old woman with a venous aneurysm of the left popliteal vein who suffered pulmonary embolism twice during treatment with phenprocoumon. Three days after resection she suffered an embolism of the left popliteal vein. Follow-up at 12 months with duplex showed no signs of thrombosis.     

Importance of valvular incompetence after acute deep venous thrombosis.

The color Doppler scanner was used to analyze acute deep venous thrombosis in 14 patients. A thrombus was found in the superficial femoral vein in 4 patients and in the superficial femoral and popliteal veins in 6 patients; a popliteal occlusion was found in 4 patients. All 14 patients were treated with intravenous heparin followed by at least 3 months of warfarin therapy. Patients were re-examined between 24 and 48 months. Six patients were symptomatic; 8 were asymptomatic. Five patients had occluding thrombus in the distal popliteal vein; major competent collateral channels developed from the proximal superficial femoral vein, and they remained asymptomatic. Three patients whose superficial femoral veins recanalized without valvular incompetence were asymptomatic. Valvular incompetence was observed in all of the symptomatic patients. Patients with persistent popliteal occlusion and collateral channels have fewer symptoms than patients with valvular incompetence in the superficial femoral and popliteal veins.     

Lower extremity calf thrombosis: to treat or not to treat?

Seventy-five patients with isolated calf vein thrombi were prospectively monitored with sequential duplex scans at 3- to 4-day intervals. Twenty-four patients (32%) propagated and 11 of these 24 (46%) into the popliteal or larger veins of the thigh. Sex, age, obesity, trauma, estrogen use, malignancy, varicose veins, smoking, surgery, and activity level were not predictive for proximal propagation. Proximal soleal vein thrombi had the highest incidence in both propagating and non-propagating groups. Thrombus extent and bilateral involvement were not predictive of propagation. Five percent (4 of 75 patients) had highly probable ventilation perfusion scans as their initial indication for duplex scanning. Deep vein thrombosis isolated to the calf is not a benign problem. If anticoagulant therapy is contraindicated, the progress of the thrombus can be followed by duplex scanning.     

Venous reflux patterns in the popliteal fossa.

Incompetent veins in the popliteal fossa were assessed with duplex ultrasound in 123 legs of 104 patients. In 91 cases the venous reflux was the result of a single incompetent vein draining into the deep system. In 32 cases duplex ultrasound demonstrated a combination of incompetent veins. With the exception of 3 patients duplex scanning accurately localised the incompetent veins and their "junctions" with the deep system. In 48 legs the reflux signal, detected in the surface vein, extended back beyond the "junction" into a proximal segment of the popliteal vein or superficial femoral vein; in most cases the distal popliteal vein remained competent. Six distinct venous reflux patterns were identified in the popliteal fossa, which seemed to correlate with the severity of related clinical symptoms.     

Renal replacement therapy via popliteal vein for exhausted vascular access in emergency: A case report

A 59 year-old man was admitted as his left antecubital arterio-venous fistula was thrombosed, and hemodialysis could not be succeeded for the last two sessions. It was a brachio-basilic fistula without transposition, which also required thrombectomy 8 months ago, and had been created 18 months before. He had multiple catheter insertions during the period of 6 years. Following the failed catheter insertions from both jugular and femoral veins, an ultrasound-guided venography via the left popliteal vein demonstrated the intact left popliteal and femoral vein with well-developed collaterals at the level of occluded left iliac vein. A temporary hemodialysis catheter was placed through the popliteal vein with an antegrade manner under ultrasound guidance in prone position, which effectively worked during hemodialysis sessions afterwards. Transposition of basilic vein was performed. Following the wound recovery, arterialized basilic vein has started to be used effectively for hemodialysis, and the popliteal catheter was displaced.     

Nature and management of duplex abnormalities encountered during infrainguinal vein bypass grafting

Purpose: This study was undertaken to evaluate the application of duplex scanning during infrainguinal vein grafting procedures to verify vein conduit preparation, anastomotic patency, and graft hemodynamics.Methods: Between 1991 and 1995, 275 infrainguinal vein bypasses (in situ, 114; reversed, 82; nonreversed translocated, 48; spliced alternative/arm vein, 31) to the popliteal (n = 116) or an infrageniculate artery (n = 159) were scanned during surgery for sites of color Doppler flow abnormality. Duplex-detected defects were graded with peak systolic velocity and velocity ratio criteria. Sites that demonstrated highly disturbed flow (peak systolic velocity >180 cm/sec, velocity ratio >2.4) were immediately revised by direct repair, patch angioplasty, or interposition grafting.Results: Intraoperative duplex scanning prompted revision of 50 abnormalities in 43 of the 275 grafts (16%), including 32 vein and seven anastomotic stenoses, nine vein segments with platelet thrombus, and two bypasses with low flow. The intraoperative revision rate was lowest (p < 0.02) for reversed saphenous vein bypasses (7%) compared with other grafting techniques (in situ, 20%; nonreversed translocated, 15%; spliced alternative vein, 23%). The revision rates of popliteal and tibial bypasses were similar (14% vs 17%). A normal result shown by intraoperative scan (235 bypasses) was associated with a low 90-day thrombosis (0.4%) and revision (2%) rate, whereas six of 15 grafts (40%) with residual and 13 of 25 grafts (52%) with unrepaired duplex abnormalities required corrective procedures (p < 0.001). One graft failed within 3 months (secondary patency rate, 99%).Conclusions: Intraoperative duplex scanning accurately predicted the technical adequacy of infrainguinal vein grafts and was particularly useful in assessing bypasses constructed with valve lysis techniques or alternative veins. Early graft revisions indicated by duplex monitoring for thrombosis or stenosis were the result of a progression of residual defects and platelet thrombus formation rather than inadequate graft run-off flow. (J Vasc Surg 1996;24:430-8.)     

下肢深静脉功能不全诊治的实验与临床研究

目的 寻找下肢深静脉瓣膜包窄术最佳环包材料,了解彩超对深静脉瓣膜功能不全的诊断价值和Ｇｕｏ静脉膜功能。方法 （１）观察３０条实验犬以自体大隐静脉片、自体阔筋膜和人造血管片作深静脉膜包窄术的效果;（２）对７８例彩超与经Ｇｕｏ静脉插管造影结果对比;（３）观察正常人与患者Ｇｕｏ静脉瓣膜血液动力学变化。结果 自体阔筋膜和大隐静脉逐渐挛缩呈纤维化瘢痕增生,而膨胀聚四氟乙烯人造血管的形态和结构无明显变化;彩超     

The role of popliteal vein incompetence in the diagnosis of saphenous-popliteal reflux using continuous wave doppler.

INTRODUCTION: continuous wave Doppler (CWD) has good discriminatory power at the groin in the assessment of saphenous femoral junction (SFJ); however, it is not as accurate as duplex ultrasound scanning (DUS) in the popliteal fossa for assessment of saphenous popliteal junction (SPJ) in patients with primary short saphenous vein incompetence. AIM: the aim of this study was to compare the findings of CWD with those of DUS at the SPJ and assess the role of popliteal vein incompetence in the accuracy of CWD. METHOD: prospective study of consecutive patients presenting to a vein clinic requiring a duplex scan of their SPJ. Each patient was examined by one surgeon using CWD and by one radiologist using DUS. Each observer was unaware of the other's findings. Additional information on the competence of the popliteal vein on DUS was also recorded. RESULTS: some 171 limbs in 128 patients with varicose veins were studied. One hundred and sixteen limbs had reflux at SPJ on CWD whilst 55 did not. Their mean age was 54 (range 18-85). Female to male ratio was 3:1. Spearman's rank correlation between CWD and DUS has 0.49 (p =0.0001). CWD has a sensitivity of 92% and specificity of 53% (PPV=62%, NPV=89%, accuracy=70%). Twenty-nine limbs had an incompetent popliteal vein (IPV). Of those, 12 limbs also had incompetence on CWD and competence on DUS at the SPJ, which represent 28% of the total number of limbs with these findings (n =43). CONCLUSION: CWD is sensitive in detecting incompetence at SPJ, though its specificity is low. In this study 17% (n =29) of all patients had incompetence of popliteal vein. Up to 25% ( n =12) of patients with SPJ incompetence on CWD (Doppler +) and competence on DUS (duplex -) had incompetence of the underlying popliteal vein, which may explain the low specificity. The presence of SPJ incompetence on CWD should be confirmed on DUS prior to surgery.     

DUPLEX ULTRASOUND ASSESSMENT OF THE VENOUS STATUS OF THE SWOLLEN LEG

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only. and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty-two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two-thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swelling.     

Extent of thrombus evaluated in patients with recurrent and first deep vein thrombosis

OBJECTIVES: The objective of this retrospective study was to document the extent of thrombus in patients with recurrent and first deep vein thrombosis (DVT). Patients and Methods: A total of 864 patients with DVT of the leg were enrolled in the study. They were divided into two groups: patients with recurrent DVT (n = 233) of the leg, and patients with first DVT of the leg (n = 631). In both groups the extent of the thrombus was evaluated by duplex scanning, contrast venography, or magnetic resonance imaging. Thrombus involving veins distal to the popliteal vein was classified as distal DVT, whereas involvement of the popliteal vein and proximal was classified as proximal DVT. RESULTS: We could demonstrate that involvement of proximal segments (CEAP anatomic classification 1-9) occurred significantly more often in patients with recurrent DVT than in patients with the first DVT (P <.001). The incidence of pulmonary embolism (PE) and the clinical symptoms of PE were equally distributed between patients with recurrent DVT and those with first DVT (P >.05). Only one patient died as a consequence of PE in our patient sample. CONCLUSIONS: In our experience, patients with recurrent DVT have a higher frequency of proximal DVT. Nevertheless, the incidence of PE is similar in patients with recurrent and those with first DVT.     

A survey of physicians' knowledge and management of venous thromboembolism

A review of all patients diagnosed with venous thromboembolism (VTE) at an academic medical center from 1996 to 1998 revealed a wide variation in management and subsequent patient outcomes and a 30% increase in utilization of the vascular laboratory from the previous 2-year period. The purpose of this study was to determine physicians' knowledge and management strategies before the implementation of integrated care pathways for VTE. Mail surveys were sent to 650 physicians covering 3 academic medical centers. The disciplines targeted were from those physicians who had previously referred patients for any VTE screening examination. One-hundred and twenty-eight physicians (20%) completed the survey. Only 12% of the physicians were able to correctly identify all of the veins routinely imaged as either deep or superficial veins. Fifty-nine percent of the physicians incorrectly identified the superficial femoral vein of the thigh as a superficial vein, and 23% believed the popliteal vein to be a superficial vein. Only 17% of the respondents correctly classified the tibial-peroneal veins as deep veins. Approximately 70% of the physicians stated that they would not treat symptomatic isolated calf vein thrombosis, and, of those, only 42% said that they would obtain serial duplex scans to monitor for proximal propagation. Physicians underestimated the charges for all diagnostic screening tests, and only 14% were able to correctly identify the range of charges for a venous duplex scan. This survey of physicians demonstrated a lack of basic knowledge regarding lower extremity venous anatomy, charges for the different diagnostic tests used to diagnose VTE, and, most importantly, current treatment standards for VTE.     

Femoral venous reflux abolished by greater saphenous vein stripping

Preoperative venous duplex scanning has revealed unexpected deep venous incompetence in patients with apparently only varicose veins. Acting on the hypothesis that the deep vein reflux was secondary to deep vein dilation caused by reflux volume, the following was done. Between July 1990 and April 1993, 29 limbs in 21 patients (16 females) were examined by color-flow duplex imaging to determine valve closure by the method of van Bemmelen. Instrumentation included high-resolution ATL-9 venous interrogation using a pneumatic cuff deflation stimulus of reflux in the standing, nonweight-bearing limb. All limbs showed greater saphenous vein reflux. Twenty-nine showed superficial femoral vein reflux and of these three showed popliteal vein reflux. Duplex testing was performed by a certified vascular technologist whose interpretation was blinded as to the results of clinical examination and grading of the severity of venous insufficiency. Surgery was performed on an outpatient basis under general anesthesia using groin-to-knee removal of the greater saphenous vein by the vein inversion technique of Van Der Strict. Stab avulsion of varicose tributary veins was accomplished during the same period of anesthesia. In 27 of 29 limbs with preoperative femoral reflux, that reflux was abolished by greater saphenous stripping. In patients with popliteal reflux both femoral and popliteal reflux was abolished. Improvement of deep venous hemodynamics by ablation of superficial reflux supports the reflux circuit theory of venous overload. Furthermore, preoperative evaluation of venous hemodynamics by duplex scanning appears to provide useful pre- and postoperative information regarding venous insufficiency in individual patients.Presented at the Twelfth Annual Meeting of the Southern California Vascular Surgical Society, Coronado, Calif, September 17–19, 1993.     

The place of duplex scanning for varicose veins and common venous problems.

Duplex scanning has become the 'gold standard' for confirming reflux and demonstrating anatomy in cases of lower limb venous disease. However, the large numbers of patients presenting with varicose veins (or with skin changes and ulcers) mean that routine use of duplex is impractical, and this investigation has still not become well established in many hospitals. In order to determine the proportion of patients likely to require duplex scanning (and other special tests-photoplethysmography and ascending venography) we reviewed a consecutive series of 201 patients referred to the vascular clinic of a district general hospital with 283 symptomatic limbs affected by varicose veins and/or skin changes and ulcers. Patients were examined clinically and with hand-held Doppler. Duplex scanning was then requested to check for reflux in the popliteal fossa and to examine the groin and residual long saphenous vein in some cases of recurrent varicose veins. Duplex scanning was required in 51 (18%) limbs, venography in 8 (3%), and photoplethysmography in only one limb. In total, special tests were needed in 60 (21%) limbs. Subsequently, 198 (70%) limbs were referred for surgery. We would now (in 1996) duplex scan every case with popliteal fossa reflux and most recurrences. Had all these been scanned, then 79 (28%) would have had special tests. This knowledge should help in planning the implications of a duplex scanning service for varicose veins, skin changes and ulcers.     

Iatrogenic arteriovenous fistula following endovenous laser therapy of the short saphenous vein

Short saphenous vein incompetence is present in up to 20% of patients with varicose veins. Studies looking at the success and complication rates associated with endovenous laser ablation of the short saphenous vein included only a small number of patients. The authors report the case of a 51-year-old woman presenting with a painful right leg edema. She had a history of previous endovenous laser ablation of the right and left great saphenous veins and right short saphenous vein. Duplex scan was performed and showed an arteriovenous fistula between branches of the popliteal artery and vein. Surgical ligation of the fistula was performed. At 8-month follow-up, the patient remains asymptomatic.     

The phlebographic pattern of acute leg thrombosis within a defined urban population.

The incidence of thrombosis during one year in a defined population of 263 144 city inhabitants has been studied with a new method based upon acute phlebography of all patients with the slightest symptoms of the disease. The roentgenographic pattern of the acute thrombosis has been studied and the size of the individual thrombus has been compared with the duration of the symptoms. The incidence of thrombosis was found to be 0.9 per mille per year. No correlation was found between the size of the thrombus and the duration of the symptoms. The thrombus had its origin in the calf veins in 89% of the patients and its origin in a vein at a higher level in 10% of the patients. In patients with a thrombus confined to the calf veins the contrast medium always entered the deep crural veins. When the calf vein thrombosis had an extension to the popliteal vein or still higher up the contrast medium bypassed the deep crural veins in more than 75% of the patients.     

B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement

A prospective study of the accuracy of real-time B-mode ultrasonography in detecting deep venous thrombosis in the femoral and popliteal veins of the lower extremity was conducted on a consecutive series of patients who had had a total hip replacement. Ascending venography was used as a diagnostic standard. One hundred and forty-three patients had ultrasound studies of both lower extremities and a venographic study of the operatively treated lower extremity at an average of 7.6 days postoperatively. The two tests were done within twenty-four hours of each other. Both ultrasonography and venography were done on 152 extremities. Two paired studies were excluded from the analysis of results because the ultrasound scans could not be interpreted. In 131 extremities, both diagnostic tests were negative for proximal thrombosis. Eight extremities had isolated thrombosis of a vein in the calf that was detected only by venography. In nineteen extremities, old or fresh thrombosis was diagnosed by venography. In four extremities, an old thrombosis of the superficial femoral vein was detected by both studies. In four of the extremities that had a new thrombus in the common femoral vein and in nine that had a new thrombus in the superficial femoral vein, abnormal findings on ultrasound scans correlated with those on venograms. There were two false-negative ultrasound scans and one false-negative venogram. The sensitivity, specificity, and accuracy of ultrasonography were 89, 100, and 99 per cent for the diagnosis of thrombosis of the proximal veins of the lower limb and 63, 100, and 93 per cent for the diagnosis of thrombosis when the entire venous system of the limb was included.(ABSTRACT TRUNCATED AT 250 WORDS)     

A popliteal venous aneurysm with deep venous thrombosis in the contralateral calf: report of a case

Although a popliteal venous aneurysm is a rare entity, it is an important cause of pulmonary embolism (PE), which is occasionally life-threatening. We herein report a case of a popliteal venous aneurysm with deep venous thrombosis (DVT) in the contralateral calf. A 65-year-old male, who presented with sudden onset palpitation and dyspnea, was transferred to our hospital. Enhanced computed tomography revealed PE and a venous aneurysm of the left popliteal vein. The popliteal venous aneurysm was saccular and had an intramural thrombus. Furthermore, duplex scanning detected DVT in the contralateral calf. The patient underwent a tangential aneurysmectomy with lateral venorraphy. The surgery and postoperative course were uneventful. The PE and calf DVT disappeared with perioperative anticoagulant therapy. It is recommended that, in the treatment of popliteal venous aneurysms, special attention should be given to the condition of the venous vessels of the contralateral leg, because this can influence the therapeutic strategy.     

Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the sapheno-femoral junction after five years.

OBJECTIVE: To investigate whether the results of duplex examination 1 year after sapheno-femoral junction (SFJ) ligation might be helpful in predicting long-term results after 5 years. PATIENTS AND METHODS: Follow-up data concerning patients operated on for primary or recurrent varicose veins of the great saphenous vein were studied 1 year and 5 years after surgery, focusing on the thigh and groin region. Clinical examination was undertaken to detect recurrent thigh varicose veins. The site of SFJ ligation was carefully screened for any signs of neovascularisation by duplex ultrasound. Sensitivity, specificity, positive and negative predictive value of the 1-year duplex scan were calculated, based upon the outcome of a further duplex scan 5 years following surgery. RESULTS: A total of 100 limbs were studied: 50 limbs operated on for primary varicose veins and 50 limbs for recurrent varicose veins. The 1-year duplex ultrasound of the SFJ ligation site had a sensitivity of 80%, a specificity of 91%, a positive predictive value of 70% and a negative predictive value of 95% in assessing the 5 year recurrence rate. CONCLUSION: A postoperative duplex scan of the SFJ 1 year after varicose vein surgery to the great saphenous vein predicts which patients are most likely to have a good outcome 5 years after surgery. The 1-year duplex scan is a reliable diagnostic tool for future studies evaluating the effect of new methods of treating sapheno-femoral incompetence.