左髂股静脉平滑肌瘤一例

患者 男,43岁。左下肢肿胀3月余入院。体检：左下肢肿胀明显,触之皮温较左侧略高,髌骨上10cm处左侧大腿较对侧周径增粗4cm,膝下5cm处增粗约2cm,左足背动脉搏动尚可。下肢静脉超声（外院）：示左下肢髂静脉血栓形成。左侧髂股静脉造影：（正位片）于髂外静脉远端、与股静脉交界处管腔内可见一直径2cm左右类圆形充盈缺损,边界清,对比剂可从侧旁通过,呈杯口样改变,示静脉腔内肿物（图1）,侧位片示髂股静脉腔呈鸟嘴样充盈缺损改变。     

64层螺旋CT下肢静脉造影诊断静脉畸形骨肥大综合征1例

患者女,15岁。生后见右下肢皮色呈紫红色改变,无搔痒不适,4年前右小腿无明显诱因出现静脉曲张;双下肢等长,双侧股动脉、动脉、胫后动脉及足背动脉搏动正常,双下肢肢围测量:髌骨下缘下15cm处右侧肢围较对侧粗3cm,踝上10cm处右侧较对侧粗4cm。右下肢深静脉彩色多普勒超声:右下肢静脉局限性狭窄,浅静脉曲张。X线平片:双下肢骨质结构未见明显异常,右侧软组织较对侧增粗,其内可见迂曲的浅静脉影。双下肢静脉CTV表现:右侧股静脉及静脉未见对比剂充盈,右大隐静脉较对侧明显增粗,小腿深静脉经增粗迂曲的穿静脉与大隐静脉相通;右侧下肢皮下脂…     

飞行员多发血管畸形一例

一、临床资料 患者,男性,39岁,教练机-8飞行员,飞行时间3 570 h.患者因入睡困难2个月余,胸痛1个月就诊.入院查体：左侧上肢血压：104/70 mmHg（1 mmHg＝0.133 kPa）,右侧上肢血压：134/76 mmHg,双侧收缩压相差30 mmHg,左锁骨上窝可闻及收缩期血管杂音.行颈部血管超声检查：双侧椎动脉起始处走行变异,均于C5水平人横突孔（图1,见封四）;右侧椎动脉代偿性增宽,内径约0.41 cm,左侧椎动脉纤细,内径约0.08 cm.彩色及频谱多普勒检查显示：右侧椎动脉内血流通畅,峰值流速72.5 cm/s,左侧椎动脉血流呈反向血流信号（图2,见封四）,峰值流速39.1 cm/s;左侧锁骨下动脉狭窄处呈花色血流信号,收缩期峰值流速347 cm/s.     

大网膜移植术治疗髂股静脉血栓综合征54例

1989年7月～1997年4月,我们采用带蒂大网膜移植治疗髂股静脉血栓综合征54例,效果良好。1　临床资料1.1　一般情况　本组54例,男40例,女14例;年龄20～64岁,平均37岁。左侧38例,右侧16例。均有患肢表浅静脉扩张及明显肿胀,膝关节上15cm处两侧大腿周径相差4～12cm,平均5.4cm;膝关节下10cm处两侧小腿周径相差2～7cm,平均3.5cm。44例沿股静脉走行处有压痛,41例小腿以下皮肤有色素沉着,22例踝区有溃疡。站立位测踝区静脉压10～15kPa,平均13.5kPa。术前均常规行超声多普勒及顺行下肢深静脉造影检查,21例术前行核素静脉显像检查,均提示髂股静脉及远…     

下肢静脉造影方法的改进──经皮股腘静脉置管造影术的临床应用

下肢静脉高压是外科常见的疾病，发病率很高。近年来由于血管外科的迅速发展，更新了传统理论，在诊断上获得令人瞩目的成果。在新理论指导下，我科1990年以来共诊治40例下肢静脉高压患者，其中8例10肢做了经皮静脉造影术，定位检测下肢深静脉瓣膜功能，并指导临床工作，取得了满意效果。1临床资料与造影方法1．1临床资料8例中男7例，女互例。平均年龄46（33～57）岁。平均病程7（1～20）年。临床表现：下肢浅静脉曲张6例，肢体肿胀9肢，胀痛10肢，足靴区色素沉着伴溃疡2肢。8例均行下肢静脉顺行造影，结果示深静脉全程通畅，静脉外径1cm以…     

踝泵运动对下肢静脉血流动力学影响的研究

目的通过研究不同时长、不同角度的踝泵运动对下肢静脉血流动力学变化的影响,探讨促进下肢静脉回流的最佳踝泵运动模式,以便提高下肢静脉血栓预防效果。方法采用前瞻性研究,根据纳入及排除标准选取健康人18名,依次进行两种踝泵运动模式(舒适角度的踝泵运动和最大角度的踝泵运动)及每种模式下的3个运动时长(5、10、15min),根据同一人不同的踝泵运动模式,分为A组(舒适角度的踝泵运动)和B组(最大角度的踝泵运动),每组18例。Philips IU22彩超,探头频率5～10MHz,检测腘窝处腘静脉在静息状态、5、10、15min各个时长的血管内径、收缩期最大血流速度、血流平均速度、每分钟血流量。结果 A组组内比较:踝泵运动各时长血管内径均大于静息状态,但差异无统计学意义(P0.05);踝泵运动各时长每分钟血流量均大于静息状态,差异有统计学意义(P0.05)。B组组内比较:5、10、15min的最大角度踝泵运动血管内径值、每分钟血流量均数显著高于静息状态,差异有统计学意义(P0.05),其中10min时的每分钟血流量均数最高,高于其他各个时长,差异有统计学意义(P0.05)。A组和B组比较:B组中5、10、15min每分钟血流量均显著高于A组,差异有统计学意义(P0.05); B组在5min和10min时血管内径值大于A组,差异有统计学意义(P0.05); 10min时B组的收缩期最大血流速度、血流平均速度大于A组,差异有统计学意义(P0.05);而在5、15min时A、B组差异无统计学意义(P0.05)。结论踝泵运动可有效促进血液回流,防止静脉血栓,10min时长最大角度踝泵运动促进下肢静脉回流的效果最好;老年体弱多病无力的患者,5～10min舒适角度下的踝泵运动不失为预防下肢深静脉血栓的一个重要预防措施。     

直接法多层螺旋CT静脉造影诊断下肢深静脉血栓简

目的：探讨直接法多层螺旋CT静脉造影（MSCTV）诊断下肢深静脉血栓的临床应用价值。方法直接法多层螺旋CT（MSCT）下肢静脉造影17例,同期均行彩色多普勒超声血流显像（CDFI）检查。直接法MSCTV检查后,所得图像经处理后传送至工作站进行多平面重建（MPR）、最大密度投影（MIP）、表面遮盖（SSD）及容积再现（VR）重建。结果直接法MSCTV检查显示13例存在下肢深静脉血栓（DVT）,彩色多普勒超声检查显示10例,2例髂静脉及1例胫腓静脉血栓彩色多普勒超声未能检出。直接法MSCTV上DVT主要表现为静脉腔内造影剂充盈缺损、静脉节段性不显影、栓塞静脉远端扩张及其周围侧支循环静脉迂曲扩张、周围软组织肿胀、皮肤增厚。结论直接法MSCT能清晰显示DVT形成的部位、范围、侧支静脉情况及病变血管周围的解剖结构,对彩色多普勒超声不易检出的盆腔及小腿深静脉栓塞也能清晰显示,可以作为下肢深静脉血栓检查的常规方法。     

彩色多普勒超声在诊断下肢深静脉血栓形成后继发性动静脉瘘形成中的临床价值

目的探讨彩色多普勒超声血流显像在诊断下肢深静脉血栓形成后深静脉血管腔内多发动静脉瘘形成的临床价值。方法收集下肢深静脉血栓腔内继发性动静脉瘘患者59例,行双侧下肢深静脉彩色多普勒超声检查,对确定的病变位置和范围,测量最大流速,阻力指数。结果本组59例病例中累及髂外静脉者18例,股总静脉15例,股浅静脉12例,腘静脉7例,肌间静脉6例,其中1例发生于浅静脉血管腔内,病变血管血栓再管化率低于10%,血管阻力指数为0.33～0.48。结论下肢深静脉血栓形成后深静脉血管腔内多发动静脉瘘形成在彩色多普勒超声现象中具有特征性表现,是诊断本病的首选影像学检查方法。     

下肢静脉造影分析静脉曲张术后复发原因

目的：探讨下肢静脉曲张术后复发的原因。材料和方法：回顾性分析1997年1月至2001年12月诊治的83例（89例）下肢静脉曲张术后复发病例资料，静脉顺行造影池解下肢深、浅静脉和交通支瓣膜功能。结果：静脉造影显示深静脉瓣膜功能不全59．55％（53／89），交通支瓣膜功能不全64．04％（57／89），大隐静脉主干残留19．10％（17／89），深静脉血栓形成后遗症14．61％（13／89），静脉发育异常1．12％（1／89）。结论：下肢静脉曲张是深、浅静脉和交通支静脉功能不全的共同临床表现，术前静脉造影可明确疾病性质，从而选择正确的手术方式，避免术后复发。     

下肢静脉曲张的X线影像分析

目的 评价下肢静脉造影对下肢静脉曲张的诊断价值。方法 收集了llO例（192条）下肢静脉曲张经顺行静脉造影的X线表现。结果 原发性下肢深静脉瓣膜功能不全143条（占74％），交通静脉瓣膜功能不全13条（占7％），单纯下肢浅静脉功能不全25条（占13％），下肢深静脉血栓形成及其后遗症11条（占6％）。结论 下肢静脉造影是诊断下肢静脉曲张既实用又可靠的方法。     

Gold-195m: a steady-state imaging agent for venography that gives blood velocity measurement

Gold-195m has found applications in first-pass studies for investigating both right and left ventricular activity as well as lung transit. Owing to its reasonably short half-life of 30 sec we have found it particularly useful for imaging leg veins up to and including the inferior vena cava. Its short half-life prevents recirculation activity from appearing, so continuous perfusion into a superficial foot vein and application of ankle tourniquets yield a steady-state image of the deep veins, with particularly good resolution. Its decay pattern along a vessel is very sensitive to blood velocity, so measurement of activity at various points on a vein in a computer static image can give velocity values that reveal abnormalities due to partial or complete thrombosis. The radiation dosimetry of 195mAu used in this way is lower than contrast and technetium-99m macroaggregated albumin [( 99mTc]MAA) venography, making it particularly useful for investigating deep vein thrombosis (DVT) in pregnancy.     

下肢远端静脉动脉化治疗缺血性糖尿病足

目的：探讨缺血性糖尿病足的治疗.方法：对26例（29肢）腘动脉以下广泛性闭塞或狭窄,采用膝关节下静脉动脉化,7肢为近端动脉重建后远端静脉动脉化.其中浅静脉型11（大隐静脉6,大隐＋小隐3,小隐2）肢,深静脉型18（胫腓干12,胫后3,胫腓静脉成形后3）肢.结果：经3月～10年随访,除2肢半足截肢外,均保存了肢体功能.结论：该手术对肢体缺血症状解除快,对静脉回流影响小,可分期完成也可一期完成,适应证广.     

The effect of posture and positive pressure breathing on the hemodynamics of the internal jugular vein

BACKGROUND: Mathematical and mechanical models of cerebral circulation indicate that the resistance of the collapsed internal jugular veins limits cerebral blood flow during high acceleration (+Gz) and that positive pressure breathing (PPB) restores cerebral blood flow by elevating blood pressure and preventing collapse of the vein. The effect of acceleration and PPB on the jugular resistance and flow can be estimated by documenting changes in the lumen area and blood velocity. METHODS: The right internal jugular vein was imaged with vascular ultrasound in supine and seated human subjects exposed to 0-50 mm Hg of PPB. For each of the PPB posture combinations the vein was imaged at four locations along the length; resistance and flow were calculated using Poiseuille flow approximation. RESULTS: For the supine subjects, the lumen area, just above the inferior bulb, was 1.0 +/- 0.49 cm2, the estimated resistance was 0.13 +/- 0.07 x 10(-3) mm Hg x cm(-3) x min(-1), and the estimated blood flow was 931 +/- 477 cm3 x min(-1). In the sitting position, the lumen narrowed to 0.11 +/- 0.07 cm2, the resistance increased to 6.3 +/- 4.9 x 10(-3) mm Hg x cm(-3) x min(-1), and the blood flow dropped to 372 +/- 194 cm3 x min(-1). However, the vessel of a sitting subject can be completely reopened with PPB of 30 mm Hg or higher, and the resistance can be brought to supine levels. CONCLUSIONS: The results demonstrate that the internal jugular vein collapses with transition from supine to sitting position. This implies a significant increase in resistance which is inversely proportional to the square of the lumen area. However, the collapse can be prevented with sufficiently high PPB.     

下行性静脉造影在诊断下肢深静脉瓣膜功能不全中的价值(附43例造影资料分析)

1987年9月至1989年9月对43例44条临床有不同程度静脉慢性功能不全表现的患者进行了下行性深静脉造影检查,除1例瓣膜功能正常外,其余42例43条均有程度不同的瓣膜功能障碍,其中23例24条合并浅静脉曲张。造影诊断准确、可靠,能明确显示静脉病变类型,从而选择有效的治疗措施。其中对拟作静脉重建手术者尤为重要。通过造影确认大隐静脉曲张常是一种临床症状,更新不明原因下肢肿胀及浅静脉曲张的概念。     

下肢静脉功能不全患者临床症状与超声表现的相关性

目的探讨下肢静脉功能不全患者临床症状与下肢深、浅静脉及交通静脉超声改变的关系.资料与方法73例下肢静脉功能不全患者按照 CEAP分类标准进行临床症状分级,应用彩色多普勒超声观察患者下肢深、浅静脉及交通静脉的表现,并分析其与患者临床症状分级的相关性.结果超声显示伴有溃疡发生的 C5级患者反流节段总数为(3.5±0.3)条,交通静脉数目和内径分别为(3.5±0.8)条、(5.5±1.2)mm.下肢静脉反流节段总数、交通静脉数目及大隐静脉、股浅静脉、交通静脉内径与患者临床症状分级呈正相关(r =0.36、0.52、0.58、0.54、0.66, P <0.05).结论下肢静脉功能不全患者临床症状受深、浅静脉及交通静脉共同影响,特别是交通静脉病变在下肢皮肤病变中起重要作用.     

Dual-VENC 4D Flow MRI Can Detect Abnormal Blood Flow in the Left Atrium That Potentially Causes Thrombosis Formation after Left Upper Lobectomy

Purpose: The purpose of the current study was to clarify the blood flow pattern in the left atrium (LA), potentially causing the formation of thrombosis after left upper lobectomy (LUL). The blood flow in the LA was evaluated and compared between LUL patients with and without thrombosis. For the evaluation, we applied highly accelerated 4D flow MRI with dual-velocity encoding (VENC) scheme, which was expected to be able to capture slow flow components in the LA accurately.Methods: Eight volunteers and 18 patients subjected to LUL underwent dual-VENC 4D Flow MRI. Eight patients had a history of thrombosis. We measured the blood flow velocity and stasis ratio (proportion in the volume that did not exceed 10 cm/s in any cardiac phase) in the LA and left superior pulmonary vein (LSPV) stump. For visual assessment, the presence of each collision of the blood flow from pulmonary veins and vortex flow in the LA were evaluated. Each acquired value was compared between healthy participants and LUL patients, and in LUL patients with and without thrombosis.Results: In LUL patients, blood flow velocity near the inflow part of the left superior pulmonary vein (Lt Upp) and mean velocity in the LA were lower, and stasis ratio in the LA was higher compared with healthy volunteers (Lt Upp 9.10 ± 3.09 vs.13.23 ± 14.19 cm/s, mean velocity in the LA 9.81 ± 2.49 vs. 11.40 ± 1.15 cm/s, and stasis ratio 25.28 ± 18.64 vs. 4.71 ± 3.03%, P = 0.008, 0.037, and < 0.001). There was no significant difference in any quantification values between LUL patients with and without thrombosis. For visual assessment, the thrombus formation was associated with no collision pattern (62.5% vs. 10%, P = 0.019) and not with vortex flow pattern (50% vs. 30%, P = 0.751).Conclusion: The net blood flow velocity was not associated with the thrombus formation. In contrast, a specific blood flow pattern, the absence of blood flow collision from pulmonary veins, correlates to the thrombus formation in the LA.     

MR-angiography of veins in the lower extremities]

Phase contrast MR-angiography (MRA) of veins in the lower extremities was performed in 10 healthy volunteers and 2 patients with deep vein thrombosis of the lower extremities. In all volunteers, MRA demonstrated bilateral large saphenous veins, femoral veins and popliteal veins. Deep veins in the leg were visualized in only 3 out of 20 legs examined, but with compression of the thigh they were visualized in 4 out of 7 legs subjected to compression. In patients with deep vein thrombosis, obstruction of the femoral veins and development of the collateral veins were clearly visualized. It is concluded that MRA may be a valuable technic for the evaluation of the veins patency in the lower extremities.     

经大隐静脉插管栓塞术治疗下肢静脉曲张的临床价值

目的评价X线监视下经导管注入无水乙醇治疗下肢静脉曲张的远期疗效及安全性。资料与方法对69例(78条患肢)下肢静脉曲张患者行穿刺或切开内踝上方大隐静脉插入导管,在X线及对比剂监视下注入无水乙醇栓塞治疗。结果 75条(96.%)患肢均一次性栓塞成功;75条患肢于术后7天～3个月多普勒超声显示栓塞的大隐静脉未探及血流信号。随访3～55个月(平均31.2个月),术后3～7天曲张的静脉均塌陷,2～3周临床症状明显减轻或消失,7条小腿溃疡于术后4～6周愈合。13例(18.8%)术后出现咳嗽、胸闷,5～10 min内消失;7条患肢(9.0%)术后肢体出现迟发性感觉异常,2～3周内恢复正常;31条(39.7%)患肢术后第2天出现轻度肿胀,1～2周内均消失;3条(3.8%)患肢于术后12个月内出现小腿浅静脉局限性轻度曲张,无1例深静脉血栓等严重并发症发生。结论经大隐静脉插管注入无水乙醇治疗下肢静脉曲张安全、并发症少,远期疗效肯定;有望成为下肢静脉曲张新的治疗方法之一。     

Predictors of Thrombosis in Hepatic Vasculature during Microwave Tumor Ablation of an In Vivo Porcine Model

PurposeTo evaluate and model the risk of in vivo thrombosis in each hepatic vessel type during hepatic microwave ablation as a function of vessel diameter, velocity, and vessel-antenna spacing.Materials and MethodsA single microwave ablation antenna was inserted into a single porcine lobe (n = 15 total) adjacent to a hepatic artery, hepatic vein, or portal vein branch. Conventional ultrasound and Doppler ultrasound were used to measure the vessel diameter, blood flow velocity, and vessel-antenna spacing. A microwave ablation zone was created at 100 W for 5 minutes. Thrombus formation was evaluated on ultrasound performed immediately after the procedure. Logistic regression was used to evaluate the predictive value of vessel diameter, blood flow velocity, and vessel-antenna spacing on vascular thrombosis.ResultsThrombosis was identified in 53% of portal veins, 13% of hepatic veins, and 0% of hepatic arteries. The average peak blood flow rate of the hepatic artery was significantly greater than the average peak blood flow rate of the hepatic vein and portal vein. Peak blood flow velocity < 12.45 cm/s, vessel diameter < 5.10 mm, and vessel-antenna spacing < 3.75 mm were strong predictors of hepatic vein thrombosis. However, these individual factors were not predictive of the more common portal vein thrombosis.ConclusionsHepatic arteries do not appear to be at risk for thrombosis during microwave ablation procedures. Portal vein thrombosis was more common than hepatic vein thrombosis during microwave ablation treatments but was not as predictable based on vessel diameter, flow velocity, or vessel-antenna spacing alone.     

Distribution of thrombi in acute lower extremity deep venous thrombosis: implications for sonography and CT and MR venography

OBJECTIVE: Our objective was to determine the typical distribution of thrombi in acute lower extremity deep venous thrombosis as a means of evaluating the validity of imaging techniques that only include the common femoral and popliteal veins, but not the superficial femoral vein. MATERIALS AND METHODS: The results of 2704 lower extremity venous sonograms, obtained in 2026 consecutive patients over a 4-year interval, were reviewed retrospectively. The distribution of acute deep venous thromboses across various lower extremity venous segments was analyzed for this population, which consisted of both symptomatic and asymptomatic patients. RESULTS: Of 2704 lower extremities studied with duplex sonography, acute deep venous thrombosis was identified in 269 (9.9%). Of these 269 cases, acute deep venous thrombosis was isolated to the superficial femoral vein in 60 (22.3%). The remaining 209 cases (77.7%) showed thrombus that extended into the common femoral or popliteal veins (or both). CONClUSION: An abbreviated imaging study that evaluates only the common femoral and popliteal veins would fail to identify more than 20% of lower extremity acute deep venous thromboses in a population like ours. Although evaluation of the superficial femoral vein requires additional time and resources, evaluation of this segment may prevent a substantial number of thrombi from being missed.