1/25. Local subcutaneous heparin as treatment for venous insufficiency in replanted digits.In the treatment of venous insufficiency unsuitable for surgical correction in replanted digits, a small ungual window was surgically created to infiltrate subcutaneous heparin in the congested digit. The initial heparin dose was 1000 units. This dose made possible a continuous bleeding during 24 to 48 hours, solely through the ungual window. Further doses were applied based on the degree of congestion of the replanted digit, but usually it was necessary to infiltrate up to 500 units of heparin every 24 to 48 hours until vascular stability was achieved. Three patients were treated with this technique. One opted for quitting the treatment. A replanted thumb suffered venous congestion on the seventh postoperative day and was treated with local subcutaneous heparin for 3 days. A replanted fingertip suffered venous thrombosis 24 hours after surgery and was treated likewise for 18 days. In these two patients, success was attained. blood transfusions were carried out in the latter two, and none had any systemic changes in partial thromboplastin or thrombin time. This treatment is based on the mechanism of action of heparin at high doses but applied only to the congested segment. Besides their anticoagulant effect through antithrombin, high doses of heparin slow platelet aggregation, may induce angiogenesis, and have a longer-than-normal half-life. With the above technique, heparin has been applied to the congested segment at an approximate dose of 33,000 to 40,000 units/kg, and continuous bleeding solely through the ungual window for 24 to 48 hours has been achieved, which has allowed us to save two replanted segments with no complications at all. This method may offer another alternative for the medical treatment of venous insufficiency in replanted segments.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
2/25. Unrecognized internal jugular vein obstruction: cause of fatal intracranial hypertension after tracheostomy?We report an unusual case of fatal intracranial hypertension following tracheostomy due to the obstruction of the internal jugular veins (left side: thrombosis after central venous cannulation, right side: hypoplastic vein) and their collaterals. Principal cerebral outflow through the internal jugular veins can be substituted by the internal and external vertebral vein plexus because blood drains from the brain by two major routes: the internal jugular veins and the vertebral venous plexus. We suggest transcranial color-coded duplex sonography as a simple bedside method to detect patients with significant reduction of venous drainage who are at risk of developing massive cerebral venous congestion as a result of reduced intracranial elastance.- - - - - - - - - - ranking = 1.0082652540151keywords = thrombosis, cerebral (Clic here for more details about this article) |
3/25. Subcutaneous arteriovenous fistulas for dialysis with special emphasis on vascular insufficiency.Ninety-four subcutaneous arterio-venous fistulas were created for haemodialysis in 83 patients. Seventy-one patients eventually received well-functioning fistulas. The most common complication was thrombosis at the suture line. Thus, 8 primary fistulas clotted within 24 hours of surgery and 5 clotted later. Eleven patients were reoperated with a successful result in six. One patient developed arterial insufficiency in the hand with finger ulcerations, probably due to a radial steal syndrome. Four patients got extremely swollen hands and threatening gangraena because of thrombosis of the vein proximally to the anastomosis. Vital capillary microscopy in the patients with vascular insufficiency demonstrated profound changes of the nutritional capillaries which were not seen in control patients with well-functioning fistulas. After closure of the fistulas the edema disappeared and the ulcerations healed rapidly.- - - - - - - - - - ranking = 2keywords = thrombosis (Clic here for more details about this article) |
4/25. Percutaneous prosthetic venous valves: current state and possible applications.The small-intestinal submucosa square-stent bicuspid venous valve has shown the most promising results of all of the artificial venous valves developed. In long-term experimental studies in sheep, 25 valves were placed into the jugular veins and 88% exhibited good function, whereas 12% had decreased function because of valve tilting. Only 4% had partial thrombosis in the tilted valve. Valves also were placed in 3 patients. The bicuspid venous valves remained patent without thrombosis or other complications. Proper sizing and proper placement of the valves was critical to their function. The valve construction needs to be improved to prevent occasional tilting during their deployment.- - - - - - - - - - ranking = 2keywords = thrombosis (Clic here for more details about this article) |
5/25. Thrombosis of aggressive dural arteriovenous fistula after incomplete embolization.We report the cases of three patients diagnosed with dural arteriovenous fistula (DAVF) and cortical venous reflux (CVR). All were treated by transarterial endovascular embolization. Residual shunting and cortical venous drainage continued to be present at the end of the treatment procedure, despite the fact that during endovascular embolization glue penetration into the proximal venous component of the fistula had been achieved. Subsequently, follow-up angiography showed total obliteration of the fistulas and absent associated CVR. The fistulas were no longer opacified, and no additional treatment was performed. We demonstrate that residual aggressive DAVF may progress to total thrombosis if strategic deposition of the glue into the venous side has been achieved. Early follow-up angiogram is recommended prior to a planned complementary surgical approach.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
6/25. iliac vein compression and pulmonary embolism in a long distance runner: computed tomography and magnetic resonance imaging-a case report.iliac vein compression is invoked as the explanation for deep venous thrombosis occurring more often in the left iliofemoral system than the right. The authors report a previously undescribed variant of iliac compression whereby a left iliac arterial aneurysm caused venous compression and resultant thrombosis. In this case the patient suffered a pulmonary embolism without symptoms of lower extremity venous thrombosis.- - - - - - - - - - ranking = 3.9882568290273keywords = thrombosis, embolism (Clic here for more details about this article) |
7/25. Three cases with may-thurner syndrome: a possibly under-reported disorder.The may-thurner syndrome is an acquired stenosis of the left common iliac vein causing left lower leg edema, thigh discomfort, and deep venous thrombosis. This condition was first described by May and Thurner in 1956 in 22% of autopsy series. They concluded that it was the underlying factor for deep venous thrombosis on the left side. Here, we present three young female patients with may-thurner syndrome, but without actual thrombosis. One of these patients was successfully treated with a Wall stent, and the other two patients underwent clinical follow-up with anticoagulant therapy.- - - - - - - - - - ranking = 3keywords = thrombosis (Clic here for more details about this article) |
8/25. venous insufficiency due to chronic traumatic arteriovenous fistula: two case reports.Chronic traumatic arteriovenous fistula (AVF) is a rare complication of vascular injury, and few papers have reported on its consequences to the venous system, that is, venous insufficiency. The author has highlighted this problem with 2 case reports in this case presentation. One patient had recurrent chronic ulcer of the left foot. The other patient developed deep vein thrombosis following repair to the large AVF of the right thigh.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
9/25. Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein.Endovenous laser treatment (EVLT) has become a valuable and safe option in the treatment of varicose veins. Although long-term results are lacking, most patients seem to benefit in the short-term from EVLT. Reported postoperative complications are limited, consisting usually of pain, ecchymosis, induration, phlebitis, or spot skin burn injuries. The most feared complication is an extension of the saphenous thrombus into the femoral vein, with possible pulmonary embolism. Here we report a septic thrombophlebitis after EVLT resulting in a phlegmonous infection of the whole leg that was treated by surgical drainage. Aggressive local therapy and antibiotic treatment resulted in complete resolution of symptoms and eventual satisfactory healing.- - - - - - - - - - ranking = 0.19765136580545keywords = embolism (Clic here for more details about this article) |
10/25. Venous congestive flap salvage with subcutaneous rtPA.Free-flap success has been the rule with technical advancements in microsurgery. Despite improvements, thrombosis and flap loss still occur occasionally. Salvaging a sick flap can be a harrowing experience, even in the most experienced hands. Thrombolysis using intravenous and intra-arterial urokinase, streptokinase, and/or tissue plasminogen activator (rtPA) administered through the flap vascular pedicle has been reported in free-flap salvages. In such situations, success depends on early diagnosis and emergent exploration. Recently, we successfully used rtPA subcutaneously to salvage a venous congested free transverse rectus abdominus myocutaneous (TRAM) flap. Here, we report on that case.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
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