Endovascular infrainguinal in situ saphenous vein bypass: a multicenter preliminary report.

The ideal operative approach for infrainguinal in situ bypass grafting would render the saphenous vein (SV) valves incompetent while occluding venous tributaries from within the SV: an endovascular in situ SV bypass. Forty-six femoropopliteal-tibial in situ bypasses were performed in part by the endovascular occlusion technique. Valvulotomy was accomplished with a retrograde "cutter" valvulotome, and endoluminal cannulation of 84 SV tributaries was performed with a shape memory metal alloy (nickle-titanium), electronically steerable catheter under angioscopic surveillance. Sixty-nine SV tributaries (82%) were totally occluded and 15 (18%) were partially occluded with platinum occlusion coils. Twelve coils that "recoiled" into the SV lumen were retrieved uneventfully. The valvulotomes caused six SV perforations that were repaired without consequence. Intraoperative fluoroscopy confirmed coil placement and verified venous tributary occlusion, as well as SV graft patency. During short-term follow-up (mean 9.2 months; range 1 to 15 months), all patients have undergone ultrasonography of the in situ bypasses. All 69 of the SV tributaries that occluded initially have remained occluded and 84% (39/46) of the in situ bypasses have remained patent. This study demonstrates that an electronically steerable nitinol catheter can be used safely to occlude venous tributaries from within the SV. Endovascular occlusion of SV tributaries may ultimately obviate the need for long incisions the length of the leg, thus reducing wound-related problems and shortening recuperation.     

Extraluminal endoscopic-assisted ligation of venous tributaries for infrainguinal in situ saphenous vein bypass: a preliminary report

In an attempt to obviate the need for an incision the length of the leg during in situ saphenous vein bypass, a minimally invasive operation using ‘laparoscopic techniques’ was developed. At operation, standard incisions were made over the proximal femoral artery/vein and the saphenous vein at the distal popliteal artery level. An angioscopic valvulotome was used to perform valvulotomy under direct vision. After valvulotomy, a distention balloon system was used to form a ‘pocket’ into which a laparoscope was inserted. Trocars were then inserted under direct vision and the saphenous vein dissected and side branches individually clipped. After occlusion of the venous side branches, proximal and distal arterial anastomoses were performed in the standard fashion. This minimally invasive operation using laparoscopic techniques precludes the need for a long leg incision and saphenous vein dissection, except at the proximal and distal arterial anastomoses. Copyright © 1996 The International Society for Cardiovascular, Surgery.     

Delayed exposure to pulsatile shear stress improves retention of human saphenous vein endothelial cells on seeded ePTFE grafts

Since significant loss of endothelial cells (ECs) from the surface of a seeded prosthetic graft occurs after implantation, improved cell retention following exposure to flow should increase the likelihood of long-term success with this technology. An in vitro pulsatile flow circuit was developed to study the effects of two variables on cell retention: cell density at the time of seeding and postseeding incubation time. Fibronectin-coated ePTFE grafts (4 mm x 5 cm) were seeded with human saphenous vein ECs at two densities, confluent (1 x 10(5) cells/cm2) or subconfluent (2 x 10(4)), and incubated in vitro for varying time intervals (90 min, 1, 3, or 7 days). Test grafts were exposed to 90 min of pulsatile flow in an in vitro flow circuit, then fixed, and stained, and in situ cell counts (cells/cm2) were determined for nine representative fields per graft. Paired control grafts were treated identically but were not exposed to flow. Cell retention was calculated using the formula: % retention = cells/cm2 perfused graft divided by cells/cm2 control graft. Grafts exposed to flow 90 min after seeding demonstrated significantly lower cell retention when compared to later time points. When cells were seeded at confluent density, maximal retention (92 +/- 3%) occurred 24 hr after seeding. Prolonged culture of cells seeded on ePTFE grafts at confluent density resulted in increased cell loss. In contrast, on grafts seeded at subconfluent density, retention improved as cells grew to confluence (16 +/- 4.5% initially to 82 +/- 7% at 7 days).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of cardioplegic solutions and their components on human saphenous vein contractility.

Cardioplegic solution administration into the vein graft is an established method to ensure cardioplegic distribution beyond coronary artery stenoses. The ultrastructural demonstration of severe endothelial damage after cardioplegic exposure suggests that intravenous cardioplegic administration can contribute to early and late graft thrombosis. The direct effect on human saphenous vein contractility of three cardioplegic solutions and their components was compared. A solution with 30 mmol/L K+ and 82 mmol/L Na+ produced intense venoconstriction. Lowering the potassium level to 10 mmol/L and increasing the sodium level to 92 mmol/L reduced its vasoconstricting action. A third solution with 16 mmol/L K+, 16 mmol/L Mg2+, and lidocaine caused venodilatation. Analysis of the single component effects showed that high potassium level, low sodium level, and the addition of lidocaine produced concentration-dependent vasoconstriction. High magnesium concentration resulted in vasodilatation. The present data suggest that cardioplegic solution composition may cause marked vasomotor effects on saphenous vein and thus influence its endothelial integrity. In the search for an "ideal solution" to the cardioplegic controversy, a venoconstrictor infusate should be avoided to improve patency rates of coronary artery bypass grafts.     

骨梗塞1例报告

患者,男,34岁,水泥工,因右小腿肿痛20d就诊。20前右内踝出现一约0.3cm×0.3cm的包块,压痛,未引起重视,3d后包块消失。于入院前1周,右小腿及踝部肿胀、疼痛而收住我科。入院查体:右小腿中下段内侧沿大隐静脉走行皮肤呈红色,皮温略高,压痛不明显,可触及条索状改变。血常规:WBC5.1×109/L,HGB187g/L,PLT99×109/L,右下肢动静脉B超所见:右下肢股、腘、胫后、大隐、小隐静脉及动脉未见异常。X线片示:右侧胫骨中上段髓腔外后侧见条状不规则密度增高影,边界毛糙,长约10cm,该段髓腔变窄,右腓骨骨质未见异常(见图1)。诊断:①右胫骨中段骨梗塞;…     

Infrainguinal reconstruction with arm vein,lesser saphenous vein,and remnants of greater saphenous vein: A report of 257 cases

Purpose: The purpose of this study was to evaluate the results of infrainguinal reconstructions with arm vein, lesser saphenous vein, and remnants of greater saphenous vein (ectopic vein grafts). Methods: The records of 222 patients who underwent 257 bypasses were retrospectively reviewed. Most of the grafts were placed for rest pain or tissue loss (88%) and were secondary reconstructions (70%) to the infrapopliteal level (90%). Single-length vein grafts were constructed in 66% of cases, whereas 34% were composite vein grafts. Results: Secondary graft patency was 70%, 52%, and 43% at 1, 3, and 5 years. Single-length grafts had significantly better patency rates at all intervals: 78% versus 56% at 1 year (p = 0.001), 60% versus 39% at 3 years (p = 0.004), and 52% versus 29% at 5 years (p = 0.002). The limb salvage rate was 69% at 5 years. Conclusions: Ectopic vein grafts with primarily arm vein are an acceptable alternative for infrainguinal reconstruction in the absence of suitable ipsilateral greater saphenous vein. (J VASC SURG 1994;20:451-7.)     

Metabolism of prostaglandins in human saphenous vein

The described methodology allows for analysis of metabolism of the prostaglandin PGH₂ in subcellular fractions (microsomes) obtained from human saphenous veins. Prostacyclin (PGI₂) synthetase as identified by its stable breakdown product 6-keto-PGF_1a is present in human saphenous vein. Thromboxane A₂ is absent. The enzymatic formation of PGE₂ was demonstrated by the addition of glutathione (GSH) indicating the presence of an active PGE₂ isomerase. The data suggest that the enzymatic endoperoxide-metabolizing pathways in human saphenous vein microsomes are prostacyclin synthetase and prostaglandin E isomerase. It is suggested that the ability of the vein graft to produce prostacyclin and PGE₂ may contribute to short- and long-term graft patency.     

Transluminal coronary angioplasty during saphenous coronary bypass surgery: a preliminary report.

A previously described balloon tipped dilatation catheter has been used during revascularization surgery to dilate lesions which potentially could limit the runoff of the saphenous bypass grafts. A total of 34 lesions were dilated in 25 patients. Restudy of 12 patients (15 lesions) demonstrated positive results and no clinically significant complications. These preliminary results suggest an important role for transluminal coronary dilatation in the operative treatment of coronary artery disease.     

Primary leiomyosarcoma of the great saphenous vein: A case report

Introduction and importanceVascular smooth muscle sarcomas are rare neoplasms that comprise less than 2% of all leiomyosarcomas. These malignancies usually originate in the inferior vena cava, with a limited number of cases affecting the great saphenous vein. Due to the limited reports on these sarcomas, epidemiologic data remains insufficient.Case presentationWe report the case of a 67-year-old Hispanic female that presented with an asymptomatic growing mass in her right thigh. She was managed with an En bloc resection under the impression of a smooth muscle vascular sarcoma. The diagnosis was confirmed after histopathologic evaluation.Clinical discussionVascular leiomyosarcomas remain a rare and challenging diagnosis. They usually present as a slowly growing mass that is initially asymptomatic. High clinical suspicion and a comprehensive radiologic evaluation, including magnetic resonance imaging, are crucial. Histopathological evaluation is essential for diagnostic confirmation. Surgical excision remains the treatment of choice, with radiation therapy mostly considered for local disease control. Postsurgical surveillance is necessary every three months to monitor for signs of recurrence.ConclusionPhysicians should remain aware of the nonspecific presentation of leiomyosarcomas and the importance of a comprehensive diagnostic approach. Early diagnosis and adequate management are fundamental elements in the treatment of these aggressive tumors.     

Effects of pulsatile perfusion upon left ventricular function

This study compares the effects of pulsatile and nonpulsatile perfusion upon myocardial contractility. After 2 hr of ventricular fibrillation, control animals demonstrated a 37% decrease in left ventricular force, a 48% decrease in left ventricular compliance, and an increase in endomyocardial water content. On the other hand, after 2 hr of ventricular fibrillation, animals undergoing pulsatile perfusion had no significant change in ventricular diastolic compliance and only a 14% decrease in left ventricular force. The results of this study show that the addition of pulsatile perfusion minimized the deleterious effects of ventricular fibrillation upon myocardial contractility.     

Primary leiomyosarcoma of the great saphenous vein: case report.

OBJECTIVE: To describe a case of primary leiomyosarcoma of the great saphenous vein. PATIENT RECORD: A 59-year-old Chinese lady presented with two painful lumps in the right thigh in the line of the great saphenous vein. At surgery, in September 2004, two tumors in the right great saphenous vein above the knee were excised with the intervening normal vein. Histopathological studies confirmed both masses as leiomyosarcoma. Radiotherapy was given postoperatively. The patient has been followed-up for 300 days after surgery with no evidence of local or distant metastasis. CONCLUSION: Leiomyosarcoma of the great saphenous vein can exist at more than one site. Tumor resection and radiotherapy was associated with good patient prognosis.     

Leiomyoma of the greater saphenous vein: a case report and review of the literature

Greater saphenous vein tumors are exceedingly rare, whether benign or malignant. Leiomyoma is one of the benign vascular tumors that can present as a localized mass; however, the diagnosis cannot be made clinically. Multiple radiologic imagings are usually required, as well as histological examination, to make a definitive diagnosis. This tumor is treated by wide excision along with a normal portion of the vessel, and the recurrence rate is very low. We describe the case of a patient with great saphenous vein leiomyoma.     

Aneurysm of the small saphenous vein presenting as a popliteal mass: a case report.

This report describes an aneurysm in the superficial small saphenous vein in a 44-year-old woman who presented with a popliteal mass. A venous aneurysm in this area is rare but should be among the differential diagnoses for a popliteal mass for optimal treatment and outcome.     

Material and structural characterization of human saphenous vein

Saphenous vein patch rupture after carotid endarterectomy is an infrequent but devastating complication. This study was undertaken to evaluate the material and structural properties of fresh human saphenous veins to understand the causes of this complication. Segments of saphenous veins were obtained from 22 patients from vein harvested during coronary artery bypass surgery. Ninety-three specimens, oriented in both circumferential (n = 45) and longitudinal (n = 48) directions, were prepared from the available vein segments for testing. Specimens were mounted on specially designed grips and then subjected to uniaxial tension testing. For each specimen the following material and structural parameters were determined: vessel diameter, tensile stiffness, failure and ultimate forces, and tensile modulus, failure stress, and strain. The physical properties of specimens evaluated in longitudinal orientations and thus limit the inherent strength of the vein. The physical properties of circumferentially tested vein specimens were negatively correlated to age, female gender, diabetes, and hypertension. The data obtained in this investigation suggest that age, hypertension, as well as diabetes and gender may adversely influence the circumferential tensile strength of human saphenous veins used as patch grafts.     

Effects of pulsatile perfusion on the immunogenicity of renal allografts.

The results in 190 consecutive perfused cadaver renal transplants failed to show a detrimental effect of long-term perfusion. In a controlled study in mongrel dogs, those receiving transplants preserved by pulsatile perfusion for 24 or 48 hr had equal or better survival than those receiving grafts preserved by cold storage or unpreserved grafts. In addition, kidneys preserved for 24 hr by perfusion showed functional abnormalities similar to those preserved as long by cold storage and those transplanted as fresh grafts. It can be concluded that pulsatile perfusion as a means of preservation does not adversely affect long-term function and does not increase the effective immunogenicity of renal allografts.     

Aneurysm of aortocoronary saphenous vein graft: case report and literature review

True aneurysms of aortocoronary saphenous vein bypass grafts are a relatively rare complication of bypass surgery, but because the complications of thrombosis, embolization, or rupture are potentially fatal, this condition requires immediate surgical intervention. We describe a 78-year-old man who had undergone coronary bypass 15 years previously and who presented with a saphenous vein graft that was severely degenerated and aneurysmally enlarged throughout its course, measuring as much as 5 to 6 cm in certain locations. Redo coronary artery bypass grafting using the right and left internal thoracic arteries and resection of the aneurysm were performed. We also present a review of the literature regarding diagnosis, management, and treatment of this condition.