scholarly journals The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Eileen C Gajo ◽  
Clifford J Kavinsky ◽  
Joshua Murphy ◽  
Hussam S Suradi
Keyword(s):  
Varicose Veins ◽  
Amorphous Material ◽  
Arterial Occlusion ◽  
Paradoxical Embolism ◽  
Transient Ischaemic Attacks ◽  
Arterial Circulation ◽  
Venous Circulation ◽  
First Case ◽  
Paradoxical Emboli ◽  
In Transit

Abstract Background  Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this procedure. This case provides pathologic evidence of this concept. Case summary  A 66-year-old female presented with syncope after undergoing varicose vein sclerotherapy. A computed tomography angiography of the head and neck in the emergency room revealed an occluded right distal M1 middle cerebral artery. Clot retrieval was performed with final pathology revealing amorphous material consistent with an exogenous agent, polidocanol foam, which was used for the patient’s vein sclerotherapy. A transthoracic echocardiogram and transoesophageal echocardiogram showed a PFO, which was ultimately closed percutaneously. Discussion  In a quarter of the population, lack of closure of the intrauterine interatrial shunt leads to the existence of a PFO. This direct communication between the atria provides an anatomical conduit for paradoxical emboli and eventually infarction of affected tissues. While a paradoxical embolism is an uncommon cause of acute arterial occlusion, it can have catastrophic sequelae. Historically, the presence of an arterial thrombus from the venous circulation has been difficult to establish unless the thrombus is visualized in transit through a PFO. Complications from vein sclerotherapy have been reported in the literature and include transient ischaemic attacks and strokes, however, this is the first case to provide pathological proof of a paradoxical embolism, which ultimately resulted in percutaneous closure of the PFO.

Caught in Transit. A Case of Paradoxical Embolism in Patient With a PFO: The Role of Obstructive Sleep Apnea

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 343A
Author(s):  
Shafik Boyaji ◽  
Lorenzo Zaffiri ◽  
Elizabeth Steensma ◽  
Imad Bagh ◽  
Giovanni Castellucci ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Paradoxical Embolism ◽  
Obstructive Sleep ◽  
In Transit

Leg Varices Originating from the Pelvis: Diagnosis and Treatment

Vascular ◽  
2007 ◽  
Vol 15 (2) ◽  
pp. 70-78 ◽  
Author(s):  
Milka Greiner ◽  
Geoffrey L. Gilling-Smith
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Varicose Veins ◽  
Diagnosis And Treatment ◽  
Repeat Surgery ◽  
Recurrent Reflux ◽  
Venous Circulation ◽  
Platinum Coils

This article reports the investigation and treatment of 24 women presenting with recurrent lower limb varicosities secondary to reflux within the pelvic venous circulation. Diagnosis based on selective retrograde pelvic phlebography enabled precise identification and classification of sites of incompetence. A total of 74 veins were treated by embolization with platinum coils and glue prior to repeat surgery to the lower limb veins. At 4-year follow-up, signs of stasis had disappeared in all patients. Repeat phlebography revealed no evidence of recurrent reflux at the sites of treatment. One patient developed recurrent varices due to incomplete embolization of incompetent pelvic veins. Endovascular occlusion of incompetent pelvic veins is an effective treatment for varicose veins secondary to pelvic venous incompetence.

Patent Foramen Ovale Device Closure in a 27 Years Old Young Lady with Cryptogenic Ischaemic Stroke - First Case Report from Bangladesh

2021 ◽  
Vol 13 (2) ◽  
pp. 227-234
Author(s):  
AQM Reza ◽  
Aparajita Karim ◽  
Mahmood Hasan Khan ◽  
Kazi Atiqur Rahman ◽  
Md Aliuzzaman Joarder ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Patent Foramen Ovale ◽  
Incidental Finding ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Coagulation Therapy ◽  
First Case ◽  
Treatment Paradigm ◽  
Meta Analyses

A patent foramen ovale (PFO) is highly prevalent in patients with strokes of unknown cause or cryptogenic strokes (CSs). It has been remained an unsolved question as to whether a PFO should be closed or not to prevent recurrent strokes in patients diagnosed with cryptogenic stroke (CS). A paradoxical embolism through a PFO is pointed as a leading cause of CS, especially in younger patients with low risk factors for stroke. It also remains an unsolved matter on type of anti-coagulation therapy, which would be better for patients with CS and a PFO. In addition, surgical and transcutaneous closure of a PFO has been proposed for the secondary prevention of stroke in patients with CS with PFO. Several randomized controlled trials have been conducted in recent years to test whether a PFO closure gives a significant benefit in the management of CS. Many investigators believed that a PFO was an incidental finding in patients with CS. However, meta-analyses and more recent specific trials have eliminated several confounding factors and possible biases and have also emphasized the use of a shunt closure over medical therapy in patients with CS. Therefore, these latest studies can possibly change the treatment paradigm in the near future. We are reporting a case of cryptogenic ischaemic stroke in middle cerebral artery territory due to paradoxical embolism through a PFO which was successfully closed with a device solely by a Bangladeshi Consultant & his team first time in Bangladesh. Cardiovasc. j. 2021; 13(2): 227-234

Neovascularization in Restoration of Continuity of the Rat Femoral Vein following Surgical Interruption

1987 ◽  
Vol 2 (1) ◽  
pp. 1-5 ◽  
Author(s):  
G.M. Glass
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Histological Studies ◽  
Venous Circulation ◽  
Main Vein

Recurrence of varicose veins after surgical treatment by ligation and transection has been usually attributed to development of varicosity in veins collateral to the transected vessels. Early studies reported regeneration of the great saphenous vein at the site of previous transection. The present study in the rat was undertaken to determine whether restoration of normal venous circulation in a limb after surgical interruption of the main vein develops through enlargement of collateral veins or by restoration of continuity of the interrupted vein as a result of neovascularization at the site of ligation. Following ligation in continuity or ligation and surgical transection of the rat common iliac or femoral vein, phlebographic, surgical exploratory and histological studies showed restoration of its continuity through newly formed vessels. These findings suggest that in recurrence of varicose veins the roles of neovascularization and of collateral veins deserve further investigation.

scholarly journals INTRACARDIAC THROMBUS IN TRANSIT AND RISK OF PARADOXICAL EMBOLISM

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2138
Author(s):  
Alexander Gong ◽  
Kristen Burton
Keyword(s):  
Paradoxical Embolism ◽  
Intracardiac Thrombus ◽  
In Transit

CHIVA, ASVAL and related techniques – Concepts and evidence

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 42-45 ◽  
Author(s):  
Sarah Onida ◽  
Alun H Davies
Keyword(s):  
Minimally Invasive ◽  
Varicose Veins ◽  
Disease Process ◽  
Chronic Venous Disease ◽  
Treatment Modalities ◽  
Venous Disease ◽  
Invasive Treatment ◽  
Venous Circulation ◽  
Underlying Pathophysiology

Chronic venous disease (CVD) is a highly prevalent condition with significant effects on patients’ quality of life. Despite this, the underlying pathophysiology of venous disease still remains unclear. Two schools of thought exist, explaining the development and propagation of venous disease as an “ascending” and “descending” process, respectively. The descending theory, stating that CVD is secondary to proximal disease (e.g. saphenofemoral/saphenous incompetence), is the most widely accepted when planning treatment aiming to remove or destroy the junction or truncal veins. The ascending theory, describing the disease process as developing in the lower most part of the leg and propagating cranially, aims to re-route the venous circulation via minimally invasive interventions. Classically, superficial venous insufficiency has been treated with the removal of the incompetent trunk, via open surgery or, increasingly, with endovenous interventions. Minimally invasive treatment modalities aiming to preserve the saphenous trunk, such as CHIVA and ASVAL, may also play an important role in the treatment of the patient with varicose veins.

Introduction: Venous brain circulation disorders

2009 ◽  
Vol 27 (5) ◽  
pp. E1 ◽  
Author(s):  
Hiroyuki Nakase
Keyword(s):  
Arterial Occlusion ◽  
Focus Of Attention ◽  
Cerebral Injury ◽  
Brain Circulation ◽  
Imaging Technologies ◽  
Good Outcome ◽  
Modern Imaging ◽  
Venous Circulation ◽  
Venous Disorders

Brain ischemia by arterial occlusion has been a focus of attention for decades, and cerebral venous disorders have been an underestimated condition of potentially good outcome if diagnosed and treated promptly. Recently, there has been considerable interest in cerebral injury following cerebral venous circulation disorders because diagnosis has improved as our understanding of the diseases and modern imaging technologies have advanced.

Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer

Vascular ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 375-377 ◽  
Author(s):  
Hayley M Moore ◽  
Tristan RA Lane ◽  
Ian J Franklin ◽  
Alun H Davies
Keyword(s):  
Saphenous Vein ◽  
Local Anaesthetic ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Ulcer ◽  
Venous Ulceration ◽  
First Case ◽  
Mechanochemical Ablation ◽  
Cannulation Technique ◽  
Endovenous Treatment

We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation.

Sarcoma of the mitral valve causing coronary arterial occlusion in children

2001 ◽  
Vol 11 (5) ◽  
pp. 539-542 ◽  
Author(s):  
Doff B. McElhinney ◽  
David F. Carpentieri ◽  
Nancy D. Bridges ◽  
Bernard J. Clark ◽  
J. William Gaynor ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Left Coronary Artery ◽  
Myogenic Differentiation ◽  
Arterial Occlusion ◽  
Left Ventricular ◽  
Orthotopic Heart Transplantation ◽  
Cardiac Tumors ◽  
Primary Tumors ◽  
First Case

Primary tumors of the cardiac valves are rare. One of the most common reasons that left-sided cardiac tumors come to clinical attention is embolization to the systemic circulation. We present two children who suffered left coronary arterial occlusion due to embolization of a sarcoma of the mitral valve. A 6-year-old female who had been admitted to the hospital after cerebrovascular embolization of a fragment of sarcoma of the mitral valve experienced sudden cardiovascular collapse due to occlusion of the left coronary artery. She was placed on extracorporeal membrane oxygenation, and underwent coronary embolectomy and resection of the tumor from the mitral valve and its tendinous cords. Left ventricular function did not improve, and she underwent orthotopic heart transplantation. On follow-up 32 months after transplant, the patient is well, with no evidence of recurrence of or metastasis from the tumor. The tumor arose from the leaflets and tendinous cords of the mitral valve, and was composed grossly of multiple white nodules. Histopathologic evaluation disclosed fragments composed predominantly of peripheral spindle cells in an extensive fibromyxoid stroma. The mildly pleomorphic cells of the tumor gradually blended with adjacent pieces of the mitral valvar leaflet and tendinous cords. Immunohistochemical studies revealed strong staining for vimentin, smooth muscle actin, muscle specific actin, and myoglobin, suggesting myogenic differentiation. The other patient was a 2½-year-old female who died suddenly at home. Grossly and histologically, the tumor was essentially identical to the first case, and there was a 3 cm string-like extension passing into the orifice of the left coronary artery. To put the cases in context, we compare them with other descriptions of this rare type of tumor.

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