Adventitial Cystic Disease of the Femoral Vein: Report of a Case

Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.     

Adventitial cystic disease of the femoral vein in a 5-year-old boy mimicking deep venous thrombosis

Adventitial cystic disease of the vein is a rare vascular anomaly with 32 reported cases. A 5-year-old boy initially presented with painless leg swelling. He was misdiagnosed with deep vein thrombosis and treated with 3 months of warfarin. When swelling failed to improve, a magnetic resonance venogram showed a mural cystic lesion of the left common femoral vein. In the operating room, the cyst was excised, relieving the obstructive effect and restoring flow. The swelling resolved within days. This is the first reported case of adventitial cystic disease of the vein occurring in a pediatric patient.     

Simple screening method for deep vein thrombosis by duplex ultrasonography using patients’ active maximum ankle dorsiflexion

We hypothesized that venous obstruction by deep vein thrombosis (DVT) only slightly augments venous outflow from lower limbs by active ankle movements. If our hypothesis is true, we thought that we could develop a new screening method for DVT using duplex ultrasonography. Subjects were 22 lower limbs of 11 patients who gave informed consent for venography after total hip or knee arthroplasty. Around postoperative 19.0 days (range 15–32 days), we measured the ratios, called flow ratios, of the peak flow signal with active maximum ankle dorsiflexion and that at rest using duplex ultrasonography in the bilateral femoral veins. On the same day, we then performed bilateral venography. Thrombosis was detected in 5 of the 22 lower limbs. The mean flow ratios with and without DVT were 1.18 (range 1.0–1.3) and 3.31 (range 1.8–4.8), respectively. The flow ratios with DVT were significantly lower than those without DVT. Pain or difficulty performing active maximum ankle dorsiflexion was not observed in any of the operated or unoperated lower limbs during the ultrasound examination. In conclusion, ultrasonographic measurement of flow ratios may become a simple screening method for DVT in lower limbs without the pain or difficulty of performing active maximum ankle dorsiflexion.     

低分子量肝素预防股静脉置管后血栓形成的临床疗效

目的：观察低分子量肝素预防股静脉置管术后深静脉血栓形成的效果。方法122例下肢深静脉置管患者随机分为治疗组（63例）和对照组（59例）。治疗组每日皮下注射低分子量肝素5000IU,对照组采取下肢主被动活动等常规预防方法。观察2组深静脉血栓的发生率及治疗组治疗前后凝血功能及血小板有无变化。结果治疗组有7例出现深静脉血栓,对照组有15例出现,2组间差异具有统计学意义（P〈0．05）。治疗组治疗前后APTT、PT、INR、PLT均无显著差异。结论股静脉置管术后使用低分子量肝素可以有效预防下肢深静脉血栓形成。     

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目的研究下肢深静脉瓣膜外成形术的临床应用价值。方法自2001年1月至2002年10月，四川省人民医院选择经静脉造影或彩色多普勒检查确诊为原发性下肢静脉瓣膜功能不全的37条患肢行静脉瓣膜外成形术。结果31条患肢随访6个月至2年，疗效良好者30条，轻度肿胀1条。经彩色多普勒检查，均无返流。结论深静脉瓣膜外成形术方法简便，不需阻断、切开深静脉，只要操作正确，术后并发症少，是治疗原发性下肢深静脉瓣膜功能不全的首选术式。     

左髂静脉受压与左下肢深静脉血栓的相关性研究

目的 用计算机断层扫描(CT)评估下肢深静脉血栓形成(deep vein thrombosis,DVT)患者和正常人群的左髂静脉(LCIV)短径和狭窄率,并探讨其与左下肢DVT的相关性.方法 回顾性分析19例右下肢DVT、60例左下肢DVT病例和218例正常人的CT影像结果,测量和计算左髂静脉受压综合征(iliac vein compression syndrome,IVCS)短径和狭窄率.采用多因素回归分析LCIV短径和狭窄率与左下肢DVT发生的相关性.结果 对照组51.8％人群LCIV受压率＞50％,24.3％LCIV受压率＞70％;女性LCIV短径[(4.7±2.7)mm]明显小于男性[(6.6±3.3)mm,P＜0.01)].左下肢DVT组LCIV短径[(2.4±1.0)mm]明显小于对照组[(5.4±3.1) mm,P＜0.01)]和右下肢DVT组[(6.2±1.8)mm,P＜0.01],其LCIV狭窄率[(78±8)％]明显高于对照组[(49±25)％,P＜0.01)]和右下肢DVT组[(38±21)％,P＜0.01)].LCIV短径每减少1 mm,左下肢DVT发生的相对危险度OR值为2.69(P＜0.001,95％ CI为1.91 ～3.77);LCIV狭窄率每增加10％,左下肢DVT发生的OR值为2.78(P＜0.001,95％ CI为1.95～3.96).当LCIV狭窄率＞75％时,左下肢DVT发生风险增加10.12倍;当LCIV短径＜2.5 mm时,左下肢DVT发生风险增加13.57倍.结论 LCIV受压是左下肢DVT发生的独立危险因素;LCIV明显受压患者,是左下肢DVT高危人群.     

Adventitial Cystic Disease of the Popliteal Vein: Report of a Case

Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease seen mainly in arteries. It is very unusual for these cystic masses to develop in a vein. We report the case of a 56-year-old woman with leg swelling caused by ACD arising in the popliteal vein. The swelling appeared after a long period of standing. Magnetic resonance imaging (MRI) showed a popliteal cystic mass and venography showed disrupted venous flow. We resected the cyst wall without venous reconstruction, after which venous blood flow normalized and her symptoms subsided. To our knowledge, this is only the third documented case of ACD arising in the popliteal vein. A misdiagnosis could easily have been made, since the mass was not obvious on physical examination and the only symptom was intermittent swelling. Thus, it is important to be aware of ACD as a possible diagnosis when examining patients with a swelling in the leg.     

股浅静脉瓣膜外修复成形术后血流动力学动态变化74例分析

目的检测股浅静脉瓣膜外修复成形术后血流动力学动态变化 ,以分析其治疗下肢深静脉瓣膜功能不全的疗效。方法回顾性分析原发性下肢深静脉瓣膜功能不全 74例 ( 96条肢体 )的资料 ,利用流速剖面图彩超和空气体积描记仪分别于术前、术后 1、3个月及 1年进行血流动力学指标检测并进行统计学分析。结果全组术后静脉返流量、灌注指数、静脉功能不全评分指标于术后 1、3个月、1年均较术前显著降低 (P <0 0 1)。而射血分数、剩余容积分数均值于术后 3个月、1年较术前明显改善 (P <0 0 1)。溃疡愈合率达 78 8% ( 2 6 /33) ,术后 93 6 %的肢体各种症状体征消失和明显缓解。结论股浅静脉瓣膜外修复成形术可显著改善血流动力学状况 ,对治疗原发性下肢深静脉瓣膜功能不全及静脉性溃疡有确切疗效     

Doppler demonstration of cystic vein dilatation secondary to portal vein thrombosis

Summary High-resolution duplex ultrasound was used to demonstrate vascular dilatation in the gallbladder wall in eight patients with portal vein thrombosis. Gallbladder thickening, combined with a higher incidence of gallstone disease in patients with chronic hepatic disease can be misinterpreted as acute cholecystitis. The Doppler is helpful in detecting the vascular cause of the gallbladder wall thickening thus helping to reduce the frequency of inappropriate cholecystectomy.     

Adventitial cystic disease of the external iliac vein presenting with deep venous thrombosis. A case report

Adventitial cystic disease of the venous system is a rare occurrence with only 8 reported cases in the world literature. The most commonly involved segment has been the common femoral vein, resulting in luminal compromise and presenting with extremity swelling. Painless swelling of the right lower extremity in a 37-year-old man was diagnosed as iliofemoral thrombosis by duplex examination. Thrombolysis revealed smooth luminal defects of the external iliac vein, which prompted surgical exploration. Iliofemoral thrombectomy exposed multiloculated adventitial cysts of the distal external iliac vein. The preferred surgical intervention in the literature has been transadventitial or transluminal evacuation of the mucoid cysts with removal of cystic wall. These are excellent options when there is no associated venous thrombosis, wall thickening, or persistent venous stenosis after drainage. This is the first reported case associated with deep venous thrombosis. In this situation resection of the involved segment followed by venous reconstruction might be the preferred option.     

自制多侧孔溶栓导管经腘静脉入路治疗下肢深静脉血栓

目的探讨采用自制多侧孔溶栓导管经腘静脉入路留置溶栓的方法治疗下肢深静脉血栓的可行性及有效性。方法分析96例采用腘静脉顺行法穿刺留置导管溶栓治疗的下肢深静脉血栓患者的临床资料,通过治疗前后健、患肢周径差,静脉通畅率及静脉通畅评分等指标评价临床疗效。结果 96例患者介入手术技术成功率100%,术后经过5~14天留置导管溶栓后血栓大部分溶解,下肢肿胀消退;在手术及治疗过程中无严重并发症发生,溶栓治疗结束后双下肢周径差≤1.5cm,术后静脉通畅评分较术前明显改善[(9.71±2.42)分vs(3.41±1.92)分,Z=1.72,P0.05)],静脉通畅率为(71.42±14.13)%。82例患者通过3~12个月的随访,平均随访(5.11±3.33)个月,通过超声及临床症状体征的评估,介入治疗的有效率为95.12%(78/82)。结论采用经腘静脉入路留置自制溶栓导管是治疗下肢深静脉血栓的有效方法,成功率较高、术后并发症较少,其中远期效果有待进一步随访观察。     

Adventitial cystic disease of the popliteal artery treated by bypass graft utilizing the short saphenous vein: A case report

IntroductionAdventitial cystic disease is relatively rare vascular disease, frequently occurred in the popliteal artery. No definitive treatment has been established yet.Prentation of caseA 53-year-old woman presenting intermittent claudication of the right leg was diagnosed as adventitial cystic disease of popliteal artery. Percutaneous balloon dilation yielded an immediate recurrence. The disease was successfully treated by bypass grafting utilizing the short saphenous vein to replace the part of the popliteal artery containing the adventitial cyst. No postoperative complication was found six months after surgery.DiscussionComparing to a great saphenous vein, a short saphenous vein as a material of bypass graft has a significant advantage, as only a single surgical field is necessary.ConclusionWe propose that bypass graft surgery employing a short saphenous vein is worth considering as a treatment of adventitial cystic disease at the popliteal artery.     

老年股骨颈骨折患者关节置换术前深静脉血栓形成的发生率

目的 探讨老年股骨颈骨折患者关节置换术前深静脉血栓形成(DVT)的发生情况. 方法 2007年1月至9月收治175例Garden Ⅲ、Ⅳ型老年股骨颈骨折患者,均拟行关节置换术,其中男51例,女124例;年龄60～90岁,平均73.5岁.术前不同时间接受双下肢静脉彩超检查以筛查DVT.彩超检查时探头的压迫不能使静脉管腔塌陷是诊断DVT的主要标准. 结果除去6例明显延迟就诊(＞2周)患者外,其余169例患者骨折发生至超声检查的等待时间平均为4.6 d(3～6d).本组DVT的总发生率为18.3%(32/175).骨折后第3～6天检测的DVT发生率分别为13.3%(4/30)、20.4%(10/49)、19.6%(10/51)、17.9%(7/39),6 d后的DVT发生率为16.7%(1/6).男性组DVT发生率为17.6%(9/51),女性组为18.5%(23/124).60～69岁组DVT发生率为15.7%(8/51),70～79岁组为18.7%(17/91),≥80岁组为21.2%(7/33).以骨折发生至超声检查时间、性别、患者年龄为分组依据分别进行比较,各组间DVT发生率差异均无统计学意义(P值分别为0.950、0.889、0.807). 结论老年股骨颈骨折患者等待关节置换手术期间有较高的DVT发生率,超过48 h的患者应常规术前筛查并采取相应预防措施以降低围手术期风险.     

4例髂股血管外膜囊肿的临床分析

目的 探讨髂股血管外膜囊肿的临床特征、治疗及预后.方法 回顾性分析2017年3月至2019年6月济宁医学院附属医院血管外科诊治的4例髂股血管外膜囊肿患者的临床资料.男性2例,女性2例;年龄54～82岁,中位年龄61岁.分析其就诊资料和临床特点.结果 3例患者为股总静脉外膜囊肿,均表现为下肢肿胀.1例为髂股动脉外膜囊肿,...     

Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report

Deep venous thrombosis (DVT) is an important cause of disability and mortality after major orthopedic surgery. The roles of perioperative treatment and prevention of DVT in patients with femoral neck fractures who require major surgery have not yet been well explored in Chinese clinical practice. Here we report a case of calf muscular venous thrombosis in a 55-year-old woman with femoral neck fracture before surgery. Preventive and treatment measures including the administration of heparin sodium, application of venous foot pump and placement of inferior vena cava filter were taken. The condition of the patient was stable during the perioperative period and the surgery was successful. Besides, postoperative examination showed that the femur healed well and the functional recovery was satisfactory. Our results suggest that femoral neck fracture patients combined with DVT can receive surgery after accurate preoperative assessment and proper preoperative treatment.     

经大隐静脉入路行导管溶栓治疗急性下肢深静脉血栓的可行性

目的评估经大隐静脉入路行急性下肢深静脉血栓置管溶栓治疗的可行性。方法收集70例急性下肢深静脉血栓患者,随机分为A、B两组,A组为实验组(n=35),采用大隐静脉入路置管溶栓,B组为对照组(n=35),采用传统腘静脉入路置管溶栓。评估A、B两组患肢的消肿率、溶栓率、并发症发生率、手术时间。结果 70例均为单侧下肢急性深静脉血栓,A、B两组的患肢消肿率分别为(80.11±4.02)%、(81.70±6.13)%,差异无统计学意义(F=0.723,P=0.89);溶栓率分别为(84.91±3.40)%、(87.72±4.73)%,差异无统计学意义(F=0.685,P=0.71);手术时间分别为(3.91±0.74)min、(4.31±1.13)min,并发症发生率分别为2.86%(1/35)、5.71%(2/35),差异均无统计学意义(P均0.05),A组1例出现隐神经损伤,B组2例并发腘窝血肿。结论经大隐静脉入路置管溶栓治疗急性下肢深静脉血栓可行,可作为常规腘静脉入路的有益补充。     

用犬三种股静脉移植方法修复股动脉对比研究

目的 比较三组移植方法的效果,旨在推广应用于临床。方法 分三组,Ａ组１０只犬,２０根股血管,１０根肱血管,股（肱）静脉外套螺纹人造血管;Ｂ组１０只犬,２０根股血管,股静脉外套平滑人造血管,Ｃ组１０只犬,２０根股血管,股静没有外套人造血管。结果 术后１８０ｄ进行检查。血管造影,Ａ组２８根血管通畅,Ｂ组２０根血管通畅,Ｃ组６根血管明显狭窄,其余未见血管显影。光学显微镜检查,Ｂ组管壁增殖增厚最少,其次是     

Cockett综合征并发深静脉血栓形成的腔内治疗

目的 总结Cockett综合征并发下肢深静脉血栓形成腔内综合治疗的疗效.方法 2009年10月至2011年9月年对85例Cockett综合征并发下肢深静脉血栓形成患者先进行导管溶栓(catheter-directed thrombolysis,CDT)治疗,5～7d后复查造影,对狭窄或闭塞的髂静脉段进行球囊扩张或联合置入支架,术后配合抗凝、溶栓、静脉活性药物、循序气压等治疗,以及穿着医用弹力袜.结果 85例患者中共置入永久滤器6例,CDT治疗后髂静脉的通畅率为67.2％.单纯球囊扩张36例,联合支架置入49例.所有病例均未发生症状性肺栓塞,无出血及死亡病例.随访79例(92.94％),其中67例行血管彩超检查,12例行CT血管成像检查.随访时间6～24个月,平均(16±8)个月,18月通畅率为94.94％ (75/79).下肢深静脉血栓复发4例(5.06％),其中2例为滤器置入术后.症状体征情况:静脉性跛行患者24例(30.38％);患肢不同程度水肿41例(51.9％);足踝皮肤色素沉着5例(6.33％);患肢浅静脉曲张4例(5.06％);无并发皮炎、浅静脉炎及溃疡病例.结论 CDT联合腔内血管成形术治疗Cockett综合征并发下肢深静脉血栓形成是一种安全、有效、微创的治疗方法.     

经小隐静脉插管导管溶栓治疗下肢深静脉血栓形成

目的 探讨经小隐静脉途径置管直接溶栓治疗急性混合型下肢深静脉血栓形成的临床应用价值. 方法分析2005年6月至2007年3月收治的37例急性混合型下肢深静脉血栓形成患者的资料,均经小隐静脉穿刺置溶栓导管插入深静脉血栓,微泵持续推注尿激酶(149±71)万IU直接溶栓.以静脉造影结果的静脉通畅评分和静脉通畅率评价疗效.结果 全组患者溶栓后症状明显改善,与溶栓前比较,静脉通畅评分差异有统计学意义(Z=-5.330,P＜0.01),静脉通畅率改善50%±15%,无严重并发症.本组37例,随访22例随访时间6～18个月,平均(12±4)个月,复查静脉造影.按随访时间6～12个月、13～18个月分两组,结果与溶栓前比较.6～12个月组,静脉通畅评分改善有统计学意义(Z=-3.545,P＜0.01),静脉通畅率为58%±13%;13～18个月组,静脉通畅评分改善有统计学意义(Z=-2.201,P＜0.05),静脉通畅率为68%±20%.结论 经小隐静脉置管直接溶栓治疗急性混合型下肢深静脉血栓形成,是一种安全,可行的治疗方法.