A Rare Case of an Aneurysm of the External Iliac and the Common Femoral Vein

1996 ◽  
Vol 11 (1) ◽  
pp. 34-38 ◽  
Author(s):  
N. Labropoulos ◽  
S. K. Volteas ◽  
A. Al Kutoubi ◽  
A. N. Nicolaides ◽  
A. O. Mansfield
Keyword(s):  
Iliac Fossa ◽  
Femoral Vein ◽  
Oral Anticoagulants ◽  
Fistula Formation ◽  
Compression Stockings ◽  
Vein Wall ◽  
Av Fistula ◽  
Common Femoral Vein ◽  
Acute Thrombosis ◽  
The Right

Objective: To report a case of an external iliac – common femoral vein aneurysm and review the literature on the subject. Design: Case report. Setting: Academic Vascular Surgery and Radiology Units, St Mary's Hospital, London, UK. Patients, Interventions and Results: The aneurysm occurred in a 34-year-old woman and was diagnosed with venography, duplex scanning and magnetic resonance venography. It underwent acute thrombosis and, as the thrombus was well organized and extensive, thrombectomy was not possible. The patient was treated with standard heparin followed by oral anticoagulants for 5 months. Thirty months after the operation the right calf remains swollen but soft and non-tender and the patient is currently treated with grade II full-length compression stockings. Since there were no findings of vein compression or malignancy it seems that the formation of the aneurysm resulted from a congenital weakness of the venous wall. Conclusions: The most common presentation of these aneurysms is of a mass of the abdomen or the iliac fossa, while thromboembolism is not uncommon. The main causes are arteriovenous (AV) fistula formation and congenital weakness of the vein wall. For the first the preferred treatment is AV fistula ligation while for the rest ligation with or without vein reconstruction has been successfully used.

EP.FRI.42 REBOA associated iatrogenic AV fistula

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Raghvinder Gambhir ◽  
Charlotte Grainger ◽  
Monica Davies ◽  
Matthew Harris ◽  
Abhilash Sudarsam
Keyword(s):  
Femoral Vein ◽  
Expectant Management ◽  
Paediatric Population ◽  
Balloon Occlusion ◽  
Fistula Formation ◽  
Av Fistula ◽  
Ct Angiogram ◽  
Post Traumatic ◽  
The Right ◽  
Stab Injuries

Abstract Aim To discuss a rarely reported complication of Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a trauma patient with exsanguating haemorrhage. Case description A 15 year old male sustained was brought in as a cod Red, following multiple stab injuries to his Rt thigh. A REBOA was inserted via the contralateral Femoral artery on the scene to control the bleeding. Once proximal and distal control was obtained on the Right leg, the REBOA was deflated and removed. The right leg needed an interposition vein graft and ligation of femoral vein. The patient had received 12 units of transfusion. Post-operative CT-angiogram demonstrated an AV fistula between the Left Profunda femoris artery and Common femoral vein on the side of REBOA insertion. A Duplex scan showed flows of 2600ml/min on duplex and AVF diameter of 2.6mm. It was decided to wait for spontaneously closure as patient underwent rehab. At 6 weeks the AVF flow had reduced to 460ml/min however further expectant management did not lead to spontaneous closure of the AVF and he underwent surgical tie off during his next school holidays 6 months later. Conclusion AV fistula formation as a complication of REBOA insertion has not been reported in paediatric population. It highlights the need for a CT angio after surgical stabilisation. These post traumatic AVFs may need surgical repair if it does not spontaneously close in 3-6 month time.

On the Relationship between Changes in the Deep Veins Evaluated by Duplex Sonography and the Postthrombotic Syndrome 12 Years after Deep Vein Thrombosis

1997 ◽  
Vol 77 (06) ◽  
pp. 1109-1112 ◽  
Author(s):  
U K Franzeck ◽  
I Schalch ◽  
A Bollinger
Keyword(s):  
Femoral Vein ◽  
Compression Therapy ◽  
Venous Ulcer ◽  
Duplex Sonography ◽  
Clinical Findings ◽  
High Rate ◽  
Postthrombotic Syndrome ◽  
Compression Stockings ◽  
Acute Thrombosis ◽  
Superficial Femoral Vein

SummaryIn a prospective study we performed color duplex ultrasonography to evaluate patency and valvular function of previous thrombosed veins 12 years after the acute thrombosis.Normal clinical findings were found in 64% of the patients, mild postthrombotic skin changes in 28%, and marked trophic changes in 5%; only 1 venous ulcer occurred.In 39 patients, 114 initially thrombosed vein segments were evaluated. Thirty-seven of 72 proximal segments were completely recanalized (23 with valvular incompetence) and 21 segments exhibited partial recanalization (19 with valvular incompetence). Superficial femoral vein segments were completely occluded in 19%, however, excellent collateralization was provided via the deep femoral vein. Thromboses of the posterior tibial vein demonstrated a high rate of recanalization with development of valvular incompetence in 52%.Whereas obstruction and valvular incompetence as single factors led to a postthrombotic leg in 8.5% and 33%, respectively, the most frequent cause for the development of the postthrombotic syndrome was the combination of reflux plus obstruction in the deep veins (50%).Compression therapy with elastic compression stockings is recommended for at least 5 years after the acute thrombosis.

Graduated Compression Stockings Reduce the Venous Velocity Augmentation of Foot Pumps

2004 ◽  
Vol 90 (3) ◽  
pp. 142-146
Author(s):  
David Higgs ◽  
Michael Uglow ◽  
Theresa Fail
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Total Hip Arthroplasty ◽  
Femoral Vein ◽  
Randomised Clinical Trial ◽  
Compression Stockings ◽  
Common Femoral Vein ◽  
Impulse System ◽  
The Common ◽  
Graduated Compression Stockings

AbstractThe use of the A-V Impulse System of foot pumps and graduated compression stockings to reduce the incidence of thrombo-embolic disease after total hip arthroplasty is well recognised. It is not known if they have a synergistic effect as all clinical trials have used them in combination.We examined the effect compression stockings had on the ability of the A-V Impulse System to accelerate peak venous velocities in the common femoral vein in ten healthy volunteers using a duplex scanner.The use of foot pumps without stockings produced the greatest increase in peak venous velocity and this was 34% greater than using a foot pump with stockings.It is not known if this difference could account for a reduction in thrombo-embolic episodes and so we propose a randomised clinical trial.

scholarly journals Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease

2018 ◽  
Vol 33 (2) ◽  
pp. 134-137
Author(s):  
SMG Saklayen Russel ◽  
Jubayer Ahmad ◽  
Raju Ahmed ◽  
Jashim Uddin ◽  
Suman Nazmul Hosain
Keyword(s):  
Upper Limb ◽  
Brachial Artery ◽  
Proximal Part ◽  
Fistula Formation ◽  
Axillary Vein ◽  
Av Fistula ◽  
Venous Fistula ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137

Acute Appendicitis Remains a Great Mimicker – The Pitfalls in the Differential Diagnosis and Tactics - A Case Report

2020 ◽  
Vol 13 (1) ◽  
pp. 54-58
Author(s):  
Georgi I. Popivanov ◽  
Marina N. Konaktchieva ◽  
Vladimir V. Vasilev ◽  
Kirien Ts. Kjossev ◽  
Marin B. Penkov ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Neuroendocrine Tumour ◽  
Iliac Fossa ◽  
Femoral Vein ◽  
Vascular Complications ◽  
Final Diagnosis ◽  
Linear Stapler ◽  
Chronic Appendicitis ◽  
The Right

Summary Acute appendicitis (AA) is the most common non-traumatic abdominal emergency. Despite the improved knowledge, experience, and technological advance, its diagnosis remains a challenge. Herein we report an example of a difficult diagnosis of acute appendicitis and comment on the possible pitfalls in the differential diagnosis and surgical tactics. We present the case of a 41-year-old man who had been admitted to another hospital with an initial diagnosis of acute appendicitis and changed to Crohn’s disease (CD). Because of a pelvic abscess, percutaneous drainage had been performed. Thrombosis of the right femoral vein had been diagnosed and treated accordingly. In an improved condition, he was referred for elective operation with a final diagnosis of neuroendocrine tumour based on cytology. At laparotomy, the appendix was found densely adherent to the right external iliac vein with a well-demarcated tumour (1 cm) at the base. Appendectomy with partial resection of the caecum with a linear stapler was performed. The histological examination revealed acute to chronic appendicitis with lymphoid follicle hyperplasia at the base. The case illustrates the necessity for broad differential diagnosis in AA and the possibility of severe vascular complications in complicated AA. Taking a detailed history and CT are of paramount importance for an accurate preoperative diagnosis, especially of CD. All emergency surgeons should also be familiar with the scenario of unexpected findings at laparotomy, especially with the management of CD and the algorithms for treatment of appendiceal malignancies. The mini-invasive drainage of right iliac fossa abscess allows for optimizing the patient’s condition and may help to avoid unnecessary extensive resections.

scholarly journals Endovascular correction of venogenic erectile dysfunction in May–Thurner syndrome (clinical case)

2019 ◽  
Vol 20 (4) ◽  
pp. 45-51
Author(s):  
E. A. Povelitsa ◽  
A. V. Bystrenkov ◽  
A. M. Shesternya ◽  
O. V. Parkhomenko
Keyword(s):  
Erectile Dysfunction ◽  
Clinical Case ◽  
Femoral Vein ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Venous Plexus ◽  
Common Femoral Vein ◽  
Left Common Iliac Vein ◽  
The Right ◽  
Deep Vein

Introduction. Secondary varicose small pelvic veins with the development of chronic venous insufficiency due to obstruction of the magistral venous vessels, in particular, the left common iliac vein and the right common iliac artery (May–Thurner syndrome), occupy a special place in the structure of the causes of venogenic erectile dysfunction (ED).The study objective is to present the clinical case of arteriovenous conflict (May–Thurner syndrome), leading to the development of secondary varicose small pelvic veins in men and venogenic ED, as well as modern methods of its verification and endovascular surgical repair.Clinical case. A clinical case of successful endovascular correction of venogenic ED is presented. The patient is diagnosed with: May– Thurner syndrome. Pelvic varicose disease С3 (according to CEAP Classification). Condition after endovascular balloon angioplasty and stenting of the left common iliac vein. Bilateral varicocele. Condition after bilateral varicocelectomy in 2018. Severe venogenic ED (pathological venous drainage, proximal type, International Index of Erectile Function (v. 5) – 12 points; Er3 according to the Unem Scale) in accordance with the Comprehensive Classification System for Chronic Venous Disorders. On July 24, 2019 endovascular occlusion of the Santorini’s plexus veins was performed with the installation of occlusion spirals in their lumen according to Gianturco. In order to provide visualization of the veins in the Santorini’s plexus, given the impossibility of cannulation of the deep vein of the penis, bilateral symmetrical cannulation of the cavernous bodies of the penis was carried out to perform cavernosophlebography. The left common iliac vein was catheterized according to the Crossover technique. Under phlebography control we ensured that the stent in the common iliac vein passed without signs of loss of its lumen. The internal pudental vein on the left was selectively catheterized. Hydrophilic guidewire was introduced through the veins of the periprostatic plexus into the right internal pudental vein. Selective catheterization of the periprostatic venous plexus was not possible due to pronounced tortuosity, valve flaps of the veins and small diameter of the catheterized veins. It was decided to pass the guidewire further through the right iliac vein system with access to the inferior vena cava. Further, the guidewire was again transferred to the left common iliac vein (double crossover). The left common femoral vein was punctured followed by the placement of 5 Fr introducer sheath according to Seldinger. The guidewire tip was fixed by the loop in the left common iliac vein, then captured and brought out through the introducer in the left common femoral vein. A catheter Сobra15 Fr was inserted through a crossover guide from the left common femoral vein into the right internal iliac vein and further into the periostatic venous plexus. Gradually veins of the Santorini’s plexus were selectively catheterized followed by Gianturco coils embolization.Conclusion. The first choice surgery for verified proximal type ED is endovascular occlusion of the veins in the Santorini’s plexus through the deep vein of the penis, which allows to change the hemodynamics in the penis and provide sufficient erection without resorting to endofalloprosthesis of the penis. Single or double-sided transfemoral access is suggested for patients when access through the deep vein of the penis is rather challenging or absent. 

Monocusp – novel common femoral vein monocusp surgery uncorrectable chronic venous insufficiency with aplastic/dysplastic valves

2008 ◽  
Vol 23 (4) ◽  
pp. 158-171 ◽  
Author(s):  
J C Opie ◽  
T Izdebski ◽  
D N Payne ◽  
S R Opie
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Femoral Vein ◽  
Production Capacity ◽  
Full Thickness ◽  
Hormone Production ◽  
Vein Wall ◽  
Common Femoral Vein ◽  
History Of

Objective Previous reparative valvular surgical options directed at reconstructing damaged common femoral vein (CFV) valves associated with pathological chronic venous insufficiency (CVI) have not succeeded in reliably managing CVI. In consequence, venous valvuloplasty is rare and most patients are managed conservatively. As a result, monocusp surgery was identified as an optional surgical solution for this large underserved patient group. Methods Ulcer patients appear at wound clinics and often experience disappointing results. Monocusp valves were constructed utilizing viable vein wall in 14 operations on 11 patients. These patients were observed for four years to see if such an autogenous vein wall valve might control aggressive symptomatic CVI when faced with unusable valves. Results Long-term follow-up showed that the monocusp valves remained competent at four years. Symptomatic failures have not appeared at this time. Pain, swelling, ulcers and leg congestion were reliably reversed. VEnous INsufficiency Epidemiologic and Economic Study (VEINES) classification (see Abenhaim L, Krux X, VIENES Study collaborators. Angiology 1997;48:59 and Kurz X, Kahn SR, Abenhaim L, et al. Int Angiol 1999;18:83–102) improved over four years from 2.7 ± 0.9 to 0 ( P < 0.001); CEAP classifications (see Kistner RL, Eklof B, Masuda EM. Mayo Clin Proc 1996;71:338–45) improved from grade 4–6 to 0–1 (CEAP is not generally a postoperative grading system, but it can be used to develop some form of qualitative analyses as to intervention effectiveness, i.e. what existed preoperatively no longer exists postoperatively. Its postsurgery use is limited by (C5) classification – history of ulcer, which by definition cannot go below that with a history of ulcer even if the ulcer has been cured). Mean venous reflux scores decreased from 3.8 ± 0.4 to 0.3 ± 0.5 ( P < 0.001). Conclusion Monocusp implantation reliably resolved patient symptoms when unusable CFV valves were encountered. Postoperative CFV reflux is usually undetectable. The monocusp valve exhibits minimal thrombogenicity related to its viability with attendant antithrombotic hormone production capacity and has markedly improved the patient's quality of life. Full thickness monocusp surgery could become widespread with the difficult dysplastic/aplastic CVI patient subset because of its simplicity, repeatability, durability, low complication rate, effectiveness, persistent availability and viability providing nitric oxide synthase and thymomodulin hormone production capacity. The full thickness of vein wall has distinct advantages over other partial thickness valve creation methods because of its long-term vitality. Postoperative coumadin is recommended for six months to minimize risks of deep vein thrombosis and/or pulmonary embolism.

Absence of the right iliac vein and an unusual connection between both common femoral veins

2013 ◽  
Vol 28 (3) ◽  
pp. 162-164 ◽  
Author(s):  
A Yahyayev ◽  
M Bulakci ◽  
E Yilmaz ◽  
A Ucar ◽  
O A Sayin ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Femoral Vein ◽  
Clinical Importance ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Fatty Tissue ◽  
Surgical Interventions ◽  
Common Femoral Vein ◽  
Venous Structure ◽  
The Right

The aim of the study is to report a case of a rare congenital anomaly of the venous system and to emphasize its clinical importance. We describe a case of aplasia of the right common and external iliac veins in a healthy seven-year-old boy who was referred for Doppler ultrasound examination for further evaluation of an abnormal varicosity in the suprapubic region. Colour Doppler ultrasound revealed a dilated, arch-shaped vein. Contrast-enhanced magnetic resonance angiography showed the absence of the right common iliac vein and external iliac vein. It also clearly demonstrated the aberrant venous structure, originating from the right common femoral vein and draining to the left common femoral vein. In conclusion, in our case, the patient's life was threatened because the aberrant venous connection crossing within subcutaneous fatty tissue was not protected from external trauma and possible abdominal surgical interventions. Additional attention should be given to avoid such injuries, which can cause significant haemorrhage.

Use of a VBX balloon expandable stent-graft for management of right brachiocephalic vein stenosis

2021 ◽  
pp. 112972982199883
Author(s):  
Robert G Jones ◽  
Andrew P Willis
Keyword(s):  
Stent Graft ◽  
Haemodialysis Patient ◽  
Fistula Formation ◽  
Brachiocephalic Vein ◽  
Luminal Diameter ◽  
Av Fistula ◽  
Advantages And Disadvantages ◽  
Extrinsic Compression ◽  
The Right ◽  
Vein Stenosis

Here we describe the use of a VBX balloon expandable stent-graft (WL Gore, Flagstaff, AZ, USA) to treat a right brachiocephalic vein stenosis in a haemodialysis patient prior to ipsilateral upper limb arterio-venous (AV) fistula formation. Balloon expandable stent-grafts are unsuitable for treating peripheral fistula stenoses due to their susceptibility of being crushed. The right brachiocephalic vein is both relatively short in comparison to the left and is less susceptible to extrinsic compression and the use of such a device to treat stenosis here allows for very accurate placement and restoration of luminal diameter. The advantages and disadvantages of using these devices in haemodialysis access circuits are also discussed herein, in what we believe to be the first report of the application of a dedicated commercially available balloon expandable stent graft in a haemodialysis patient.

scholarly journals Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

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