Management of venous outflow complications after liver transplantation

Liver transplantation can be complicated by stenosis of the hepatic venous or inferior vena cava outflow. Venous outflow stenosis occurs at rates of 1 to 6% depending on the type of anastomosis. Stenoses can develop acutely as a result of technical problems or can present much later after the transplant due to intimal hyperplasia or perianastomotic fibrosis. Common clinical presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, and occasionally variceal bleeding. Treatment can generally be accomplished via a transjugular approach, but percutaneous transhepatic access may be needed when the anastomosis cannot be catheterized from the jugular access. Angioplasty can achieve technical success in restoring anastomotic patency in close to 100% of cases, but restenosis is frequent. Repeat angioplasties may be needed. In adults and pediatric patients with adult sized hepatic veins, stenting may be a better option. Resolution of clinical signs and symptoms is seen in 73 to 100% of cases. Major complications are uncommon, with stent migration being one of the more difficult complications to manage.     

股浅静脉第一对瓣膜包窄术治疗原发性深静脉瓣膜功能不全

目的　评估应用股浅静脉第一对瓣膜包窄术治疗原发性深静脉瓣膜功能不全的疗效。方法　经下肢静脉顺逆行造影 ,提示倒流程度为 2～ 4级的 5 4例原发性深静脉瓣膜功能不全患者中的 32例深静脉显著增粗 ,但瓣膜瓣叶的游离缘并未严重受损的病人进行股浅静脉第一对瓣膜包窄术。结果　疗效良好 2 9条静脉 ,占 90 .6 % ,好转者 3条静脉 ,占9 4% ,全部病人症状消失 ,溃疡愈合 ,多普勒超声示静脉无明显血液倒流。结论　对原发性深静脉瓣膜功能不全的患者 ,只要瓣膜瓣叶并未严重受损 ,不论其倒流程度如何 ,都可采用瓣膜包窄术     

Diagnosis and treatment of central venous access-associated infections

This paper provides readers with a basic understanding of the types of central venous access-associated infections as well as appropriate diagnostic techniques. Preventive measures are the most effective way to reduce rates of catheter-associated infection and are discussed in detail. Diagnosis and treatment of each type of infection are reviewed for nontunneled central venous catheters, tunneled dialysis catheters, and venous access ports. Readers should be able to employ the methods described in this paper to reduce the rate of central venous access-associated infections at their hospitals.     

内镜下静脉交通支离断治疗下肢静脉性溃疡15例

目的　探讨内镜下静脉交通支离断术治疗下肢静脉性溃疡的可行性及疗效。方法　 15例共 16条下肢静脉曲张伴有交通支功能不全、浅静脉倒流和静脉性溃疡 ,行内镜深筋膜下交通支离断术 ,并同时行大隐静脉高位结扎、分段剥除术。结果　术后静脉性溃疡 17～ 34(2 5 .5± 14 .1)d愈合 ,浅静脉曲张消失。结论　内镜下静脉交通支离断术治疗下肢静脉性溃疡方法简便、术前准备时间短、疗效满意、并发症少 ,具有一定的临床应用价值。     

动脉化静脉皮瓣静脉瓣膜演化的实验研究

为了解动脉化静脉皮瓣中静脉瓣膜对血流的影响及其组织结构的演经,以家兔为实验动物设计制作了以与股动脉吻合的股静脉为供血血管,隐动脉为回流血管的动脉化静脉皮瓣模型,进行组织学、免疫组化和超微结构的检测。结果发现,附着于管壁的静脉瓣膜纤维组织在对血流压力的过程中出现“疲劳性”损伤、断裂,静脉瓣膜顺血流方向开放,逐渐与下方静脉管壁贴合。提示高压、快速的动脉血流对静脉瓣膜有“重塑”作用。     

Venous congestion associated with developmental venous anomaly: Findings on susceptibility weighted imaging

A case of venous congestion associated with developmental venous anomaly (DVA) in a 5‐year‐old girl who presented with acute deterioration of consciousness is reported. Susceptibility‐weighted imaging revealed abnormal structures connected to the central collector of a DVA, which were not shown on other sequences. These structures were considered to be presumably thrombosed medullary veins. J. Magn. Reson. Imaging 2008;28:1506–1509. © 2008 Wiley‐Liss, Inc.     

Physiological Characteristics of Champion Synchronized Swimmers

In brief: Data on body composition, metabolic responses to a maximal treadmill run, postexercise blood lactate, pulmonary function, flexibility, and isokinetic work were obtained in 13 champion synchronized swimmers. Metabolic responses to a maximal tethered swimming test were obtained on four of the subjects. The synchronized swimmers were similar to nonathletic women in percent fat(24.0) and were only slightly different in V o₂ max(43.2 ml· kg^?1-min^?1). The postexercise blood lactate of 101.7 mg/100 ml was comparable to values reported for female competitive swimmers. Results suggest that success in synchronized swimming is not heavily dependent on aerobic capacity, although participants in solo and duet events tended to have higher Vo₂ max values.     

Silicone rubber catheter venography using standard angiographic techniques

Single- and double-lumen silicone rubber central venous catheters were subjected toin vitro destructive testing. Using this data we devised a clinical technique for the detection of central venous thrombosis incorporating mechanical injection of the catheters, serial filming, and magnification radiography. In 20 patients studied, thrombosis was detected in 12 and extravasation in 3. Two partially occluded catheters burst during forceful injection. Our technique demonstrated the presence and extent of thrombosis at the cathetel tip more clearly than did other venographic methods and has been especially useful in assessing the results of thrombolytic therapy.     

门静脉和肝静脉系统MRA增强扫描价值的评估

 采用多平面屏气、二维、TOF序列血管成像技术,对59例患者的常规MRA与其中28例患者的增强MRA影像进行分析,比较两者的信号强度与影像质量.评估增强MRA扫描门静脉和肝静脉系统的影像质量与应用价值.影像整体质量评分为不能诊断、差、中等、优、特优,相应评分0～4级.对门静脉主干、门静脉左右支、肝静脉左中右支、脾静脉进行信号强度的测量,所得数据用均数±标准差((x)±s)表示.结果为增强MRA的信号强度与常规MRA信号强度无显著统计学差异(P>0.05).增强MRA血管影像的整体综合评分(优+特优级=75%)高于常规MRA评分(67.74%).增强MRA血管边缘清晰、分支多,优于常规MRA.但由于动静脉同时显影,会使门静脉及肝静脉的观察受影响.门脉高压患者的影像优于门脉系统正常者.     

How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns

The internal jugular veins are considered to be the main pathways of cerebral blood drainage. However, angiographic and anatomical studies show a wide anatomical variability and varying degrees of jugular and non-jugular venous drainage. The study systematically analyses the types and prevalence of human cerebral venous outflow patterns by ultrasound and MRI. Fifty healthy volunteers (21 females; 29 males; mean age 27±7 years) were studied by color-coded duplex sonography. Venous blood volume flow was measured in both internal jugular and vertebral veins in the supine position. Furthermore, the global arterial cerebral blood volume flow was calculated as the sum of volume flows in both internal carotid and vertebral arteries. Three types of venous drainage patterns were defined: a total jugular volume flow of more than 2/3 (type 1), between 1/3 and 2/3 (type 2) and less than 1/3 (type 3) of the global arterial blood flow. 2D TOF MR-venography was performed exemplarily in one subject with type-1 and in two subjects with type-3 drainage. Type-1 drainage was present in 36 subjects (72%), type 2 in 11 subjects (22%) and type 3 in 3 subjects (6%). In the majority of subjects in our study population, the internal jugular veins were indeed the main drainage vessels in the supine body position. However, a predominantly non-jugular drainage pattern was found in approximately 6% of subjects.This study was presented in part as an oral presentation at the 8th Meeting of Neurosonology and Hemodynamics, Alicante, Spain, 18–21 May 2003.     

经皮肝穿刺肝静脉造影对Budd－Chiari综合征的诊断价值

作者对８２例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征患者进行了９７次经皮肝穿刺肝静脉造影。病人年龄８～５７岁，男５３例，女２９例。所有病人术前均进行下腔静脉造影和Ｂ超检查。结果表明，经皮肝穿刺肝静脉造影可明确显示主肝静脉阻塞部位、程度及侧支循环状态，对Ｂｕｄｄ－Ｃｈｉａｒｉ综合征诊断和分型具有重要意义。作者详细讨论了该方法对本病的诊断、治疗方案的选择及自然预后和手术效果判断的价值。     

中心静脉血、肘静脉血与混合静脉血血气指标值相关性研究

目的比较中心静脉血和肘静脉血血气值与混合静脉血正常血气值的相关性。方法监测54名马拉松赛业余选手(活动组)赛前的动脉血、肘静脉血血气和30名无心肺疾患的术后病人(静息组)全麻拔管前动脉血、中心静脉血和肘静脉血血气。比较肘静脉血、中心静脉血血气值与混合静脉血正常血气值的相关性。结果 84名被测者动脉PO2和PaCO2均正常;肘静脉血PO2均值30.1 mmHg(1 mmHg=0.133 kPa)低于混合静脉血氧分压(P vO2)23%,低于中心静脉PO218%左右。结论混合静脉血、中心静脉血和肘静脉的血气三者具有一定的相关性,在无条件监测PvO2时可用中心静脉或肘静脉血气值作参考。     

经皮胃冠状静脉栓塞术联合部分脾栓塞术在门静脉高压症治疗中的应用

目的探讨一种联合介入术式在治疗门脉高压症中的地位与作用。方法对30例高危门脉高压患者随机分组,A组15例行经皮胃冠状静脉栓塞术(PTVE)联合部分脾栓塞术(PSE),B组15例行单纯PSE术,术前、术后分别采用多普勒超声检查门静脉侧支循环情况,对两组进行比较。结果两组脾功能亢进均得到缓解,联合术式患者曲张静脉全部得到栓塞,A组术前、术后门脉内径无明显变化,术后血流速度减慢,血流量降低(P<0.05),奇静脉内径变小(P<0.01),血流量下降(P<0.01),血流速度降低(P<0.01);B组门脉管径变小,流速降低,流量下降(P<0.01),但奇静脉管径无明显改变,流速降低,流量下降。两组奇静脉血流量下降幅度有明显差异(P<0.01),两组随访13～16个月,B组出现食管胃底曲张静脉破裂出血2例,继发性门脉血栓形成1例,而A组未再出现食管胃底曲张静脉破裂出血,但出现门脉高压性胃肠病(PHG)2例(均有胃镜证实)。结论联合术式能有效治疗门脉高压食管胃底曲张静脉破裂出血和脾功能亢进,该方法操作相对简单,侵袭性小,尤其适用于肝功能差难以耐受外科分流及断流手术的患者,具有临床推广价值。     

二维多普勒超声诊断肢体静脉血栓的价值及标准拟定(附148例分析)

目的：进一步探讨静脉血栓的超声特征及诊断价值。材料和方法：１４８例四肢静脉血栓患者行二维彩色多普勒超声检测，其中５２例同时行血管造影检查。拟定了周围静脉血栓的超声诊断标准，即超声的直接征象和间接征象。结果：超声诊断符合率为９２３％，血栓检出率、定位准确率、血管压缩试验及压迫试验阳性率分别为９０４％、９０４％、９４２％和９２３％。结论：研究表明超声对此病有较高的诊断价值，在观察多部位多血管血栓以及对病情和治疗效果的随访观察方面优于血管造影。     

烧伤后并发下肢静脉血栓12例临床分析

目的:探讨烧伤患者并发下肢静脉血栓形成的原因和治疗方法。方法:对5年内烧伤并发下肢静脉血栓形成的患者进行总结分析。结果:5年内烧伤患者1345例,其中有12例烧伤患者并发下肢静脉血栓形成,经治疗后均痊愈。结论:对烧伤并发下肢静脉血栓形成的患者应早诊断、早治疗。     

Duplex guided foam sclerotherapy plus compression for the treatment of chronic venous ulcer

Background and objective

Venous ulcers are the most severe and debilitating sequel of chronic venous insufficiency (CVI) and venous hypertension. They account for nearly 80% of all lower extremity ulcers, with an overall prevalence of approximately 1–2%. The majority of these patients are otherwise healthy individuals suffering from chronic ulceration during the most productive period of life.

Objective

The aim of this work is to prospectively evaluate the using of foam sclerotherapy guided by duplex ultrasound for injection of incompetent perforators to treat venous ulcer.

Materials and methods

This study was done on forty patients who were referred to management of chronic venous ulcer. All patients were subjected to: pre-treatment evaluation, Ankle brachial pressure index and venous duplex scan.

Results

As regards healing of leg ulcers in the 40 patients under this study: At 1, 3, and 6 months after treatment: 5 ulcers (12.5%), 28 ulcers (70%) and 38 ulcers (95%), respectively had healed completely 3 ulcers had recurred (8%) during the follow up period.

Conclusions

Compared to surgical intervention, the relative freedom from serious complications and its evident success, make this the first line treatment for venous ulcer.     

Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.