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BACKGROUND: The recipient vessel choice is very important when performing free-flap breast reconstructions. Usually, the concomitant vein of the recipient artery is anastomosed, and mismatches in the diameter are occasionally observed. We consider the thoracoepigastric vein (TEV) as a potential useful recipient vein. The use of the TEV is not a novel technique. It has been used by surgeons for free-flap anastomoses in the axillary region, but usually as an anastomotic site for the second vein. However, anatomical findings such as TEV diameter, its deficiency rate, and influence on mastectomy are not clear. In this study, computed tomography (CT) was performed to evaluate the use of the TEV as a recipient vein for breast reconstruction. METHODS: The medical records of patients who underwent breast reconstruction with free-flap transfer were retrospectively evaluated. In most cases, CT was performed using a tissue expander inserted after mastectomy. The TEV was considered suitable if its diameter on the mastectomy side was >1 mm and the vertical distance from the most distal slice level where the TEV could be seen at the third costal cartilage height of the parasternal region was <50 mm. RESULTS: Sixty-six sides of 33 patients were evaluated. The mean age of the patients was 49.3 ± 5.1 years. The TEV was used in five flaps. TEV diameters were not significantly different between the left and right sides (1.85 ± 0.53 vs. 1.82 ± 0.6, respectively, p = 0.836). On the mastectomy side, eight (25%) TEVs were injured, but only three (8.6%) were considered unavailable. On the healthy side, 96.4% TEVs were available. CONCLUSIONS: TEVs may be a good choice as vein anastomosis targets for breast reconstruction with a free flap because of their relatively large vessel diameter. TRIAL REGISTRATION: UMIN-CTR: R000061573.
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Colgajos Tisulares Libres , Mamoplastia , Mastectomía , Tomografía Computarizada por Rayos X , Humanos , Mamoplastia/métodos , Femenino , Persona de Mediana Edad , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Estudios Retrospectivos , Adulto , Tomografía Computarizada por Rayos X/métodos , Mastectomía/métodos , Anastomosis Quirúrgica/métodos , Venas/diagnóstico por imagen , Venas/cirugía , Venas/anatomía & histología , Neoplasias de la Mama/cirugíaRESUMEN
Chronic venous disease is a vascular disorder characterized by impaired venous return and a progressive dysfunction of the venous system. Pathological reflux can occur due to abnormal dilation and weakening of the vein wall. The circulatory system is a natural structure in which physical laws, such as the law of closed containers and gravity, operate. The malfunctions in the system also adhere to these laws of nature. This article explains how the principles of fluid dynamics apply to the flow of blood in the veins of the legs. I am discussing the principles of Pascal's law, Torricelli's law, Bernoulli's law, and Poiseuille's law, and how they are relating to the anatomy and physiology of the venous system.
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Hemodinámica , Hidrodinámica , Extremidad Inferior , Modelos Cardiovasculares , Flujo Sanguíneo Regional , Venas , Humanos , Extremidad Inferior/irrigación sanguínea , Venas/fisiopatología , Venas/diagnóstico por imagen , Velocidad del Flujo Sanguíneo , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/diagnóstico por imagen , Enfermedad CrónicaRESUMEN
Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.
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Soluciones Esclerosantes , Escleroterapia , Malformaciones Vasculares , Humanos , Escleroterapia/efectos adversos , Soluciones Esclerosantes/efectos adversos , Soluciones Esclerosantes/administración & dosificación , Malformaciones Vasculares/terapia , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/fisiopatología , Resultado del Tratamiento , Venas/diagnóstico por imagen , Venas/anomalías , Venas/fisiopatología , Radiografía Intervencional/efectos adversos , Flebografía , Punciones , FemeninoRESUMEN
Overgrowth syndromes, particularly within the PIK3CA-related overgrowth syndrome (PROS) spectrum, are commonly associated with venous anomalies. The anomalies include spongiform venous malformations and persistent embryonic veins, such as the lateral marginal vein (of Servelle). The anomalous veins pose a significant risk of thromboembolic disease and should be occluded, preferably earlier in life. A thorough understanding of the conditions, anatomy, and interdisciplinary treatment of these complex anomalies is essential for optimal management. This review explores the clinical and imaging diagnosis of overgrowth syndromes and techniques for assessing and treating associated venous anomalies, particularly the endovenous closure of anomalous veins.
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Fosfatidilinositol 3-Quinasa Clase I , Malformaciones Vasculares , Venas , Humanos , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/terapia , Fosfatidilinositol 3-Quinasa Clase I/genética , Venas/anomalías , Venas/diagnóstico por imagen , Venas/cirugía , Fenotipo , Resultado del Tratamiento , Predisposición Genética a la Enfermedad , Procedimientos Endovasculares , Valor Predictivo de las Pruebas , Síndrome , Flebografía , MutaciónRESUMEN
Objective: To analyze the anatomical characteristics of the adrenal veins through adrenal venography to improve the success rate of adrenal venography (AVS). Methods: This study was a cross-sectional study. Patients who were diagnosed with primary aldosteronism and underwent AVS from January 2019 to October 2023 at the First Affiliated Hospital of Dalian Medical University were included. Adrenal vein imaging was collected from the enrolled patients. We performed statistical analysis on the adrenal vein orifice position, inflow angle, and adrenal venography morphology. The adrenal venous orifice was defined as the location where the catheter was placed at the end of the calm inhalation. Spearman correlation analysis was used to explore the relationship between the positions of bilateral adrenal vein orifices and body mass index (BMI). Results: A total of 282 patients with successful bilateral AVS and complete bilateral adrenal vein imaging were enrolled, of whom 57.1% (161/282) were male and the age was (53.3±10.7) years old. The orifice of the left adrenal vein was located between the middle segment of the 11th thoracic vertebra and the upper segment of the 2nd lumbar vertebra. The inflow angle relative to the position of the orifice was all leftward and upward. The orifice of the right adrenal vein was located between the upper segment of the 11th thoracic vertebra and the lower segment of the 1st lumbar vertebra, and 91.1% (257/282) had a rightward and downward angle of inflow relative to the position of the orifice. The position of the adrenal vein orifices on both the left (r=0.211, P<0.001) and right (r=0.196, P=0.001) showed positive correlation with BMI. The position of the right adrenal vein orifice also increased with the position of the left adrenal orifice (r=0.530, P<0.001). The most common adrenal venography morphology on the right side was triangular (36.5%, 103/282), while the most common venography morphology on the left side was glandular (66.3%, 187/282). Conclusions: The anatomical morphology of adrenal veins are diverse. Being familiar with the morphological characteristics of the adrenal vein and identifying the adrenal vein accurately during surgery has important clinical value in improving the success rate of AVS.
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Glándulas Suprarrenales , Hiperaldosteronismo , Flebografía , Venas , Humanos , Hiperaldosteronismo/diagnóstico por imagen , Masculino , Glándulas Suprarrenales/irrigación sanguínea , Glándulas Suprarrenales/diagnóstico por imagen , Estudios Transversales , Persona de Mediana Edad , Femenino , Venas/diagnóstico por imagen , Venas/anatomía & histología , Flebografía/métodos , AdultoRESUMEN
BACKGROUND: Among low-flow vascular malformations, venous malformations are relatively frequent. The pathological patterns vary in severity and are generally characterized by dilated vessels and low-flow blood that over time can organize into phleboliths. Sometimes small capillary and/or lymphatic vessels may be associated, micro- and/or macro-shunts may form alone or in different combinations, and finally adipose tissue may be interposed between the malformed vessels. Magnetic resonance imaging (MRI) is a crucial examination for confirming venous malformations because it can accurately identify different features of the lesions. OBJECTIVE: The aim of our study was to compare MRI and histopathological findings of venous malformations in children to assess the possibilities and limitations of MRI. MATERIALS AND METHODS: In a retrospective study, two observers independently evaluated the contrast-enhanced MRI of 26 children with venous malformations. Several radiological parameters were considered and compared with histopathological findings. The agreement between the interobserver radiological evaluation and between histopathological and radiological diagnosis was verified using Cohen's kappa. RESULTS: MRI interobserver agreement was excellent for micro-shunts and good for the remaining findings. The radiological-pathological agreement was perfect for the presence/absence of phleboliths and of macro-shunts and almost perfect for the presence of intralesional adipose tissue, lymphatic component, and micro-shunts. CONCLUSION: MRI in venous malformations can detect the presence of phleboliths, adipose tissue, and lymphatic components with excellent accuracy and good to excellent interobserver agreement. Furthermore, MR angiography can detect micro-shunts in simple and combined venous malformations with substantial agreement with histopathological findings.
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Imagen por Resonancia Magnética , Malformaciones Vasculares , Humanos , Niño , Masculino , Femenino , Preescolar , Malformaciones Vasculares/diagnóstico por imagen , Lactante , Adolescente , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Reproducibilidad de los Resultados , Venas/diagnóstico por imagen , Venas/anomalías , Venas/patología , Medios de Contraste , Sensibilidad y Especificidad , Variaciones Dependientes del ObservadorRESUMEN
BACKGROUND: Dialysis access is a fundamental procedure performed by vascular surgeons. Commonly, upper extremity access is utilized via a brachiobasilic fistula (BBF) or brachiocephalic fistula (BCF). BCF is preferred due to ease compared to BBF without documented improved function. Few studies compare patency outcomes between BBF and BCF over time. Our goal was to evaluate the difference in outcomes between BBF and BCF. METHODS: This is a retrospective review of patients with BCF or BBF between 2019 and 2022. Patients were split by procedure: BCF and BBF. Data collected included demographics, vein size, tunneled catheter, and previous access. Primary outcomes included primary patency (PP), primary assisted patency (PAP) and secondary patency (SP). Secondary outcomes included 30-day complications, access abandonment, interventions and mortality. Linear regression, Kaplan-Meier, and log-rank test were performed. RESULTS: Our study had 184 patients, 109 (59%) with BCF and 75 (41%) with BBF. There were no differences in demographics except for body mass index and vein size (BBF: 4 vs. BCF: 3.6 mm, P = 0.020). There was no difference in PP at 1 year (41% vs. 47%, P = 0.547) or SP at 2 years (73% vs. 84%, P = 0.058) in BBF versus BCF. However, PAP was significantly greater in BCF (80% vs. 67%, P = 0.030) at 1 year. Secondary outcomes revealed no difference in wound complications (1% vs. 0%, P = 0.408), access abandonment (35% vs. 28%, P = 0.260), or number of interventions (1 vs. 1, P = 0.712) in BBF versus BCF. Mortality was significantly greater in the BBF patients (19% vs. 6%, P = 0.005). On adjusted analysis, BBF had 43 min longer operative time (P < 0.001) and 22 cc greater blood loss (P < 0.0001). CONCLUSIONS: In this single center review comparing BBF and BCF, no difference was seen between BBF and BCF in terms of PP or SP. Even with larger vein size, BBF did not confer a benefit in long term patency or access abandonment. Additionally, BBF did not confer decreased procedures to maintain patency and BBF had greater operative length and blood loss, as well as mortality. We believe this study demonstrates that for patients who must use an upper extremity location, when the cephalic vein is satisfactory, using the cephalic vein is preferred as it does not negatively impact long-term patency.
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Derivación Arteriovenosa Quirúrgica , Arteria Braquial , Diálisis Renal , Grado de Desobstrucción Vascular , Humanos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Derivación Arteriovenosa Quirúrgica/mortalidad , Estudios Retrospectivos , Masculino , Femenino , Factores de Tiempo , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Arteria Braquial/fisiopatología , Arteria Braquial/cirugía , Arteria Braquial/diagnóstico por imagen , Factores de Riesgo , Oclusión de Injerto Vascular/fisiopatología , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/terapia , Extremidad Superior/irrigación sanguínea , Venas/fisiopatología , Venas/cirugía , Venas/diagnóstico por imagenRESUMEN
BACKGROUND: To study and compare the effects of venoactive drug (VAD) therapy and ovarian vein embolization or resection (OVE or OVR, accordingly) on the levels of vasoactive peptides and cytokines in patients with pelvic venous disorders (PeVDs). METHODS: The study included 70 consecutive female patients with PeVD symptoms, such as chronic pelvic pain (CPP), dyspareunia, dysuria, and vulvar varicosities. Based on the results of clinical examination and duplex ultrasound of the pelvic veins, the patients were allocated to the VAD therapy (n = 38) or OVE/OVR (n = 32). Additionally, the enzyme-linked immunosorbent assay tests were performed to determine levels of calcitonin gene-related peptide (CGRP), substance P (SP), interleukins 6 and 8 (IL-6, IL-8) and monocyte chemotactic protein-1 (MCP-1) after a 2-month course of VAD therapy and at 3 months after OVE/OVR. RESULTS: The VAD therapy was associated with a significant decrease in CPP in 84% of patients with PeVD and isolated lesions of the parametrial veins (PVs) and uterine veins (UVs). VAD had no significant effect on the pelvic venous reflux. No changes in the CGRP, SP, IL-6, IL-8, and MCP-1 levels were detected after treatment. At 3 months after OVE or OVR, all patients with PeVD and combined lesions of the ovarian veins (OVs), PVs and UVs reported almost complete relief of CPP. Along with elimination of reflux in ovarian veins, the disappearance of reflux in PVs and UVs was noted. A decrease in the CGRP and SP levels was observed (0.7 ± 0.1 ng/mL and 0.12 ± 0.02 ng/mL before treatment; 0.5 ± 0.12 ng/mL and 0.09 ± 0.06 ng/mL after treatment, respectively; all P < 0.05). No changes in cytokine levels were revealed. CONCLUSIONS: Treatment with VAD is associated with the CPP relief, but has no significant effect on the CGRP, SP, IL-6, IL-8, and MCP-1 levels. OVE/OVR results in the CPP relief, elimination of the pelvic venous reflux and a significant decrease in the CGRP and SP levels, but does not change cytokine levels.
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Citocinas , Ovario , Dolor Pélvico , Pelvis , Venas , Humanos , Femenino , Persona de Mediana Edad , Adulto , Ovario/irrigación sanguínea , Ovario/efectos de los fármacos , Citocinas/sangre , Venas/diagnóstico por imagen , Venas/efectos de los fármacos , Venas/fisiopatología , Resultado del Tratamiento , Dolor Pélvico/tratamiento farmacológico , Dolor Pélvico/etiología , Dolor Pélvico/sangre , Pelvis/irrigación sanguínea , Embolización Terapéutica/efectos adversos , Biomarcadores/sangre , Factores de Tiempo , Insuficiencia Venosa/tratamiento farmacológico , Insuficiencia Venosa/sangre , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Anciano , Neuropéptidos/sangre , Ultrasonografía Doppler Dúplex , Sustancia P/sangre , Estudios ProspectivosRESUMEN
BACKGROUND: Determination of vessel resection in patients with pancreatectomy after neo-adjuvant chemotherapy remains controversial. The recently introduced computed tomography-based vascular burden index presents a potential solution to this challenge. This study aimed to evaluate the model performance for the prediction of vascular resection and pathological invasion. METHODS: Patients who underwent surgery after neo-adjuvant chemotherapy were included. Two independent reviewers measured the vascular tumour burden index around the adjacent artery (AVBI), and vein (VVBI). The area under the curve was compared to assess the predictive capacity of vascular burden index values and their changes for vascular resection and pathological vascular invasion. RESULTS: Among 252 patients, 179 and 73 had borderline resectable and locally advanced pancreatic cancer, respectively. Concurrent vessel resection and pathological vascular invasion were observed in 121 (48.0 %) and 42 (16.6 %) patients, respectively. In all patients, the VVBI (area under the curve: 0.872) and AVBI (0.911) after neo-adjuvant therapy significantly predicted vessel resection. In patients with vascular resection, the VVBI after neo-adjuvant chemotherapy (0.752) and delta value of the AVBI (0.706) demonstrated better performance for predicting pathological invasion of the resected vein. The regression of the AVBI and VVBI was an independent prognostic factor for survival (hazard ratio: 0.54, 95 % confidence interval: 0.34-0.85; P = 0.009) CONCLUSIONS: Regressed VVBI on serial computed tomography scans is useful for predicting vein resection and pathological venous invasion before surgery. The delta value of the AVBI may therefore be helpful for predicting pathological arterial invasion after neo-adjuvant chemotherapy.
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Terapia Neoadyuvante , Invasividad Neoplásica , Pancreatectomía , Neoplasias Pancreáticas , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patología , Neoplasias Vasculares/secundario , Carga Tumoral , Quimioterapia Adyuvante , Adulto , Venas/patología , Venas/diagnóstico por imagen , Valor Predictivo de las Pruebas , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
Venipuncture for blood collection is frequently delegated to medical or nursing students, while their individual skills depend on the quality of teaching. The aim of this study was to evaluate the use of a near infrared imaging (NIR) system on the visualization of veins and its potential benefit for the education of medical personnel. Participants answered a questionnaire following standardized venipuncture for blood sampling with the help of an NIR device. Vein visibility with the NIR device and its ability to facilitate venipuncture were examined. Visibility of veins was significantly better with the NIR, and its direction was clearly delineated. Sixty-nine percent of the participants stated that they felt more secure with venipuncture after using the NIR device. Patients' individual factors limited the visibility of veins. The adjuvant use of an NIR system for venipuncture improves participants' subjective skills through visualization of veins and their direction.
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Flebotomía , Estudiantes de Enfermería , Humanos , Femenino , Hospitales Universitarios , Masculino , Adulto , Competencia Clínica , Venas/anatomía & histología , Venas/diagnóstico por imagen , Encuestas y Cuestionarios , Hospitales de EnseñanzaRESUMEN
Residual intravenous foreign bodies following hand trauma are relatively rare; only a few previous reports of this situation are available. It has been reported that foreign bodies often migrate to the heart and atrium dextrum. Herein, we report a recent case of needle breakage in the dorsal vein of the hand that was removed with lignification using an intraoperative C-arm fluoroscopy machine and tape tourniquet to avoid proximal movement during removal. The mandate should be to remove within the capacity allowed so that rare cases and terrible complications can be avoided. The case was seen at The Yanji City, Jilin Province, China at the Yanbian University Hospital emergency at February 20, 2023.
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Cuerpos Extraños , Agujas , Humanos , Agujas/efectos adversos , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Masculino , Traumatismos de la Mano/cirugía , Fluoroscopía , Venas/lesiones , Venas/diagnóstico por imagen , Venas/cirugía , Administración IntravenosaRESUMEN
BACKGROUND: Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. MATERIALS AND METHODS: Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. RESULTS: The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. CONCLUSION: This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.
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Derivación Arteriovenosa Quirúrgica , Hiperplasia , Neointima , Diálisis Renal , Humanos , Derivación Arteriovenosa Quirúrgica/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Neointima/patología , Hiperplasia/patología , Inmunohistoquímica , Adulto , Insuficiencia del Tratamiento , Factores de Tiempo , Insuficiencia Renal Crónica/patología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Fallo Renal Crónico/terapia , Fallo Renal Crónico/patología , Fallo Renal Crónico/complicaciones , Oclusión de Injerto Vascular/patología , Oclusión de Injerto Vascular/etiología , Grado de Desobstrucción Vascular , Antígeno Ki-67/metabolismo , Antígeno Ki-67/análisis , Biomarcadores/análisis , Biomarcadores/metabolismo , Venas/patología , Venas/diagnóstico por imagen , Remodelación VascularRESUMEN
INTRODUCTION: Ultrasound is used for peripheral intravenous (PIV) cannulation in patients with difficult landmark-guided IV access in the Emergency Department. Distal-to-proximal application of an Esmarch bandage on the target limb has been suggested as a method for increasing vein size and ease of cannulation. METHODS: This study was a single-blinded crossover randomized controlled trial comparing basilic vein size under ultrasound with use of an Esmarch bandage in addition to standard IV tourniquet ("tourniquet + Esmarch") compared to use of a standard IV tourniquet alone. Participant discomfort with the tourniquet + Esmarch was also compared to that with standard IV tourniquet alone. RESULTS: Twenty-two healthy volunteers were used to measure basilic vein size with and without the Esmarch bandage. There was no difference in basilic vein size between the two groups, with a mean diameter of 6.0 ± 1.5 mm in the tourniquet + Esmarch group and 6.0 ± 1.4 mm in the control group, p = 0.89. Discomfort score (from 0 to 10) was different between the groups, with a mean discomfort score of 2.1 in the tourniquet + Esmarch group and 1.1 in the standard IV tourniquet alone group (p < 0.001). CONCLUSIONS: This study showed that the use of an Esmarch bandage does not increase basilic vein size in healthy volunteers but is associated with a mild increase in discomfort.
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Cateterismo Periférico , Estudios Cruzados , Voluntarios Sanos , Torniquetes , Venas , Humanos , Masculino , Femenino , Adulto , Método Simple Ciego , Venas/anatomía & histología , Venas/diagnóstico por imagen , Cateterismo Periférico/métodos , Vendajes , Adulto Joven , Ultrasonografía Intervencional/métodos , Persona de Mediana EdadRESUMEN
OBJECTIVE: To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Venous Disorder (PeVD). METHODS: We performed a retrospective cohort review assessing population, intervention, comparison, and outcomes (PICO) for women undergoing PVE for PVR January 2017-January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52). The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data. RESULTS: 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal, 25.3% (48/190) postmenopausal and menopausal status not documented 1% (2/190). 10.1% (19/188) were nulliparous (average age 34 years; range 20-55 years). There was a statistically significant improvement in all symptoms and in the appearance of varicosities on TVDUS post-PVE (P < 0.05) of the ovarian vein plexus, uterus plexus, arcuate veins, vaginal wall, peri-urethral, peri-anal, haemorrhoids, labial and proximal thigh. The locations of veins requiring embolisation having demonstrated reflux were analysed; 82.8% (154/186) underwent embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (P > 0.05). No significant complications such as coil migration were observed. CONCLUSIONS: PVE is an effective treatment for pelvic pain due to PeVD and its diagnosis should not be limited to multiparous women of childbearing age, as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal.
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Embolización Terapéutica , Pelvis , Insuficiencia Venosa , Humanos , Estudios Retrospectivos , Embolización Terapéutica/efectos adversos , Persona de Mediana Edad , Femenino , Adulto , Resultado del Tratamiento , Factores de Riesgo , Pelvis/irrigación sanguínea , Insuficiencia Venosa/terapia , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Adulto Joven , Várices/terapia , Várices/diagnóstico por imagen , Várices/fisiopatología , Medición de Riesgo , Factores de Tiempo , Flujo Sanguíneo Regional , Venas/diagnóstico por imagen , Venas/fisiopatologíaRESUMEN
BACKGROUND: This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions. METHODS: Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected. RESULTS: Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012). CONCLUSION: These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
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Verde de Indocianina , Mamoplastia , Colgajo Perforante , Humanos , Mamoplastia/métodos , Persona de Mediana Edad , Femenino , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Adulto , Estudios Prospectivos , Angiografía/métodos , Anciano , Arterias Epigástricas/trasplante , Anastomosis Quirúrgica/métodos , Colorantes , Venas/cirugía , Venas/diagnóstico por imagen , Neoplasias de la Mama/cirugíaRESUMEN
Accurate cannulation of the adrenal vein is challenging during adrenal venous sampling (AVS) because of the variations in adrenal vein anatomy. This study aimed to investigate the adrenal venous morphology in Chinese and improve the success rate of AVS. A total of 221 participants with primary aldosteronism (PA) who underwent AVS were enrolled. Compare the morphology among subgroups divided according to sex, body mass index (BMI), and with or without adenoma. The success rate of right, left, and bilateral AVS was 98.60%, 97.20%, and 96.85%, respectively. The triangular pattern was the most common (39.37%) on the right side, while the glandlike pattern (70.14%) on the left. The proportion of adrenal venous morphology varies among patients with different sexes (χ2 = 21.335, P < .001), BMI (χ2 = 10.642 P = .031), and with or without adenoma (χ2 = 10.637, P = .031) on the right side, and the male, obese and adenoma group showed a higher proportion of glandlike pattern than triangular pattern. If only dependent on computed tomography, 9.05% of patients incorrectly diagnose the dominant side, 14.48% of patients would have inappropriate surgery meanwhile 25.34% of patients would miss the surgical opportunity. In conclusion, the most common types of right and left adrenal venous morphology were triangular pattern and glandlike pattern, respectively. Sex, BMI, and the presence of adenoma affected right adrenal venous morphology. Adequate knowledge of the adrenal venous morphology is critical for improving the success rate of AVS and making an appropriate treatment for PA.
Asunto(s)
Glándulas Suprarrenales , Hiperaldosteronismo , Venas , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/sangre , Masculino , Femenino , Glándulas Suprarrenales/irrigación sanguínea , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Persona de Mediana Edad , Adulto , China/epidemiología , Venas/diagnóstico por imagen , Venas/patología , Índice de Masa Corporal , Tomografía Computarizada por Rayos X/métodos , Adenoma/patología , Adenoma/diagnóstico , Estudios Retrospectivos , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Although the usefulness of lymphaticovenous anasotmosis (LVA) for lymphedema has been reported, it is difficult to determine where the LVA is to be performed, especially for inexperienced surgeons. This study aimed to establish a map of the LVA site. METHOD: A total of 105 limbs from 64 patients who underwent lower limb LVA were retrospectively reviewed. Multi-lymphosome indocyanine green (ICG) lymphography (in 35 patients) and lymphatic ultrasound (in all patients) were performed preoperatively and the incision site was determined where dilated lymph vessels and appropriate veins were located in close proximity. The LVA location was identified using a post-operative photograph. Additionally, the degree of lymphatic degeneration at the LVA site was recorded based on the normal, ectasis, contraction, and sclerosis type (NECST) classification. RESULT: A total of 206 skin incisions were analyzed. Among them, 161 (75.9%) were medial and 45 (21.2%) were lateral. Among the 85 sites on the calf, 52 (61.2%) were medial and 33 (38.8%) were lateral. Among the 117 sites on the thigh, 106 (90.6%) were medial and 11 (9.4%) were lateral. As the severity of lymphedema progressed, the probability of performing LVA on the lateral calf increased. Among the 202 locations where LVA was performed on the thigh and lower leg, ectasis type was found in 164 sites (81.2%). CONCLUSION: We established an LVA map of the legs based on multi-lymphosome ICG lymphography and lymphatic ultrasound data. Using this LVA map, surgeons can easily predict the location of lymph vessels, thereby improving the success rate of LVA.
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Anastomosis Quirúrgica , Verde de Indocianina , Vasos Linfáticos , Linfedema , Linfografía , Humanos , Linfografía/métodos , Linfedema/diagnóstico por imagen , Linfedema/cirugía , Vasos Linfáticos/diagnóstico por imagen , Vasos Linfáticos/cirugía , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anastomosis Quirúrgica/métodos , Anciano , Adulto , Ultrasonografía/métodos , Colorantes , Extremidad Inferior/cirugía , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/irrigación sanguínea , Venas/diagnóstico por imagen , Venas/cirugía , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: Contrast-enhanced ultrasound (CEUS) is useful in mapping lymphatic vessels in upper limb lymphedema; this study was aimed to evaluate its efficiency in lower limb lymphedema and investigate whether magnetic resonance lymphangiography (MRL) enhance the efficiency of CEUS. METHODS: This retrospective study enrolled 48 patients with lymphedema undergoing lymphaticovenous anastomosis (LVA) surgery who received MRL and/or CEUS in addition to conventional indocyanine green (ICG) lymphangiography. The number of anastomotic sites and the duration per site (DPS) for LVA surgery were described and compared. RESULTS: Among the 48 patients subjected to analysis, it was observed that 12 (25%), 20 (41.67%), and 16 (33.33%) of them received ICG, ICG+CEUS, and ICG+CEUS+MRL, respectively. The ICG+CEUS group demonstrated a significant increase in the number of LVAs (median, 5; range, 4-7), compared with the ICG group (median, 2; range, 1-4) (P < .001). Moreover, the ICG+CEUS+MRL group exhibited a higher number of LVAs (median, 8; range, 7-8.25) compared with both the ICG+CEUS and ICG groups (P < .001). For lower limb lymphedema, the ICG+CEUS+MRL group displayed an elevated number of LVAs (median, 8; interquartile range, 7-9) (P = .003), in contrast to the ICG group (median, 3; interquartile range, 1.75-4.25). Furthermore, the DPS in the ICG+CEUS+MRL group (median, 50.56; interquartile range, 48.13-59.29) (P = .005) exhibited a remarkable decrease when compared with the ICG group (median, 131.25; interquartile range, 86.75-198.13]). CONCLUSIONS: MRL-CEUS fusion demonstrates superior performance in the identification of lymphatic vessels for lymphedema.
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Anastomosis Quirúrgica , Medios de Contraste , Verde de Indocianina , Vasos Linfáticos , Linfedema , Linfografía , Imagen por Resonancia Magnética , Valor Predictivo de las Pruebas , Humanos , Femenino , Linfedema/cirugía , Linfedema/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Vasos Linfáticos/cirugía , Vasos Linfáticos/diagnóstico por imagen , Linfografía/métodos , Adulto , Medios de Contraste/administración & dosificación , Anciano , Verde de Indocianina/administración & dosificación , Resultado del Tratamiento , Imagen Multimodal , Venas/cirugía , Venas/diagnóstico por imagen , Ultrasonografía , Adulto JovenRESUMEN
With the development of biometric identification technology, finger vein identification has received more and more widespread attention for its security, efficiency, and stability. However, because of the performance of the current standard finger vein image acquisition device and the complex internal organization of the finger, the acquired images are often heavily degraded and have lost their texture characteristics. This makes the topology of the finger veins inconspicuous or even difficult to distinguish, greatly affecting the identification accuracy. Therefore, this paper proposes a finger vein image recovery and enhancement algorithm using atmospheric scattering theory. Firstly, to normalize the local over-bright and over-dark regions of finger vein images within a certain threshold, the Gamma transform method is improved in this paper to correct and measure the gray value of a given image. Then, we reconstruct the image based on atmospheric scattering theory and design a pixel mutation filter to segment the venous and non-venous contact zones. Finally, the degraded finger vein images are recovered and enhanced by global image gray value normalization. Experiments on SDUMLA-HMT and ZJ-UVM datasets show that our proposed method effectively achieves the recovery and enhancement of degraded finger vein images. The image restoration and enhancement algorithm proposed in this paper performs well in finger vein recognition using traditional methods, machine learning, and deep learning. The recognition accuracy of the processed image is improved by more than 10% compared to the original image.
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Algoritmos , Dedos , Procesamiento de Imagen Asistido por Computador , Venas , Humanos , Dedos/irrigación sanguínea , Dedos/diagnóstico por imagen , Venas/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Identificación Biométrica/métodos , AtmósferaRESUMEN
Forensic identification using vein patterns in standard colour images presents significant challenges due to their low visibility. Recent efforts have employed various computational techniques, including artificial neural networks and optical vein disclosure, to enhance vein pattern detection. However, these methods still face limitations in reliability when compared to Near-Infrared (NIR) reference images. One of the biggest challenges of the studies is the limited number of available datasets that have synchronised colour and NIR images from body limbs. This paper introduces a new dataset comprising 602 pairs of synchronised NIR and RGB forearm images from a diverse population, ethically approved and collected in Auckland, New Zealand. Using this dataset, we also propose a conditional Generative Adversarial Networks (cGANs) model to translate RGB images into their NIR equivalents. Our evaluations focus on matching accuracy, vein length measurements, and contrast quality, demonstrating that the translated vein patterns closely resemble their NIR counterparts. This advancement offers promising implications for forensic identification techniques.