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Bertino FJ, Hawkins CM. Contemporary management of extracranial vascular malformations. Pediatr Radiol 2023; 53:1600-1617. [PMID: 37156889 DOI: 10.1007/s00247-023-05670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Vascular malformations are congenital vascular anomalies that originate because of disorganized angiogenesis, most commonly from spontaneous somatic genetic mutations. The modern management of vascular malformations requires a multidisciplinary team that offers patients the gamut of medical, surgical, and percutaneous treatment options with supportive care. This manuscript discusses the standard and contemporary management strategies surrounding extracranial vascular malformations and overgrowth syndromes.
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Affiliation(s)
- Frederic J Bertino
- Department of Radiology, Interventional Radiology Section, NYU Langone Health/NYU Grossman School of Medicine, 2nd Floor Radiology-Tisch Hospital, 550 First Avenue, New York, NY, 10016, USA.
| | - C Matthew Hawkins
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Fluss G, Cranwell V, Rao A, Lee JS, Elshafey R, Wallack M, Finlay D. Covid-19 Delta variant resulting in multi system thromboembolic disease. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100101. [PMID: 35784811 PMCID: PMC9222409 DOI: 10.1016/j.avsurg.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022]
Abstract
Infection with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2/Covid-19) has been correlated with micro and macrovascular thrombosis. Reports have discussed localized thrombosis leading to ischemia, we report a case of diffuse systemic thromboembolism resulting in limb ischemia and organ damage from Covid-19 despite prompt anticoagulation. A 60-year-old unvaccinated male with a history of asthma, diabetes mellitus and coronary artery disease, presented with shortness of breath and right lower extremity pain. The patient was found to be Covid-19 Delta variant positive. CTA and transthoracic echocardiogram showed diffuse thromboembolic disease affecting the left ventricle, right kidney and bilateral lower extremities.
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Kalinin RE, Suchkov IA, Klimentova ÉA, Shanaev IN. [Clinical anatomy of deep femoral vessels in the area of femoral triangle]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:17-23. [PMID: 33825724 DOI: 10.33529/angio2021107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The purpose of this study was to specify the anatomy of the deep femoral artery and deep femoral vein within the femoral triangle. MATERIAL AND METHODS The study was based on the data of anatomical dissection of vessels in the area of the upper third of the femur (20 specimens ) and ultrasonographic duplex angioscanning of patients undergoing routine examination of the vascular system (40 patients, 50 lower extremities). Ultrasonography was performed using linear and convex transducers (frequency 3-13 and 3-5 MHz). RESULTS In the majority of cases, the deep femoral artery originated from the common femoral artery: in 100% of cases in anatomical dissection and in 98% according to the findings of ultrasound duplex angioscanning. Two trunks of the deep femoral artery were revealed in 14% of cases. The findings of ultrasound duplex angioscanning and those of anatomical dissection demonstrated a high origin of the deep femoral artery in 8% and 10% of cases, respectively. In the majority of cases, the deep femoral artery originated from the posterior surface of the common femoral artery: in 46% of cases on ultrasound duplex angioscanning and in 60% of cases in anatomical dissection; along the posterior lateral surface: in 36% according to the data of ultrasound duplex angioscanning and in 40% on dissection. The origin of the deep femoral artery from the medial surface of the common femoral artery was encountered in 8% cases and in 6% of cases was associated with formation of an atypical saphenofemoral junction. One patient was found to have the origin of one of the trunks of the deep femoral artery from the anterior surface of the common femoral artery. Two trunks of the deep femoral vein were revealed in 84% of cases. The proximal trunk flowed into the femoral vein from the lateral surface immediately beneath the ostium of the deep femoral artery, and the distal trunk - 1-1.5 cm lower from the posterior medial side of the femoral vein. CONCLUSION The knowledge of variant anatomy of deep femoral vessels is very important for decreasing the risk of iatrogenic lesions during surgical manipulations and false-negative results of diagnostic manipulations. If possible, it is always necessary to preoperatively assess variant anatomy of deep femoral vessels (real-time assessment of topography of vessels by means of ultrasound duplex angioscanning, preoperative marking of vessels).
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Affiliation(s)
- R E Kalinin
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I A Suchkov
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - É A Klimentova
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I N Shanaev
- I.P. Pavlov Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
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Asnake ZT, Fishman TJ, Sun L, Salabei JK. Recurrent Venous Thromboembolism in a Patient with Klippel-Trenaunay Syndrome Despite Adequate Anticoagulation with Warfarin. Cureus 2020; 12:e7576. [PMID: 32391225 PMCID: PMC7205377 DOI: 10.7759/cureus.7576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare genetic condition defined by capillary malformation, venous malformation, and soft tissue and bony overgrowth. Due to venous malformations, individuals are predisposed to intravascular coagulopathy leading to thrombosis and thromboembolism. However, anticoagulating these patients long-term remains a challenge because of the presence of capillary malformations that increase bleeding risk. We present a rare case of a 30-year-old Caucasian male with KTS and history of gastrointestinal bleeding who has been on anticoagulation since the age of 7 and has had three different inferior vena cava filters placed during his lifetime. At presentation, he had dyspnea with stable vital signs. His prothrombin time/international normalized ratio was 37.3 and 3.2, respectively and chest computed tomography showed bilateral segmental pulmonary embolism (PE). He was treated with heparin drip and his home anticoagulation was switched from warfarin to apixaban at the time of discharge for better anticoagulation optimization. KTS is a condition associated with venous thromboembolic complications that can be difficult to manage. PE should remain on the top of the list of differential diagnoses in patients with KTS presenting with dyspnea even if laboratory findings suggest an alternate diagnosis.
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Affiliation(s)
- Zekarias T Asnake
- Internal Medicine, University of Central Florida College of Medicine, Hospital Corporation of America (HCA) North Florida Division, Gainesville, USA
| | - Troy J Fishman
- Internal Medicine, University of Central Florida College of Medicine · Hospital Corporation of America (HCA) North Florida Division, Gainesville, USA
| | - Liang Sun
- Internal Medicine, University of Central Florida College of Medicine · Hospital Corporation of America (HCA) North Florida Division, Gainesville, USA
| | - Joshua K Salabei
- Internal Medicine, University of Central Florida College of Medicine · Hospital Corporation of America (HCA) North Florida Division, Gainesville, USA
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Significance of Partial or Complete Thrombosis of the Common and Deep Femoral Vein in Patients With Deep Vein Thrombosis. Eur J Vasc Endovasc Surg 2019; 58:570-575. [PMID: 31477519 DOI: 10.1016/j.ejvs.2019.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim was to assess the anatomical distribution of acute deep venous thrombosis (DVT) with a focus on iliofemoral DVT, and, in particular, to characterise thrombus in the common femoral vein (CFV) and the deep femoral vein (DFV). METHODS A one year prospective study including patients older than 18 years of age with an acute first time DVT according to ultrasound examination at one of three university hospitals in Copenhagen, Denmark. Thrombus location and extent were registered and divided into five segments: calf veins; popliteal vein; femoral and deep femoral vein; common femoral vein; and iliac veins and/or the inferior vena cava. Thrombus appearance of the CFV and the DFV (partial or occlusive) was examined in detail. RESULTS Acute DVTs were identified in 203 extremities in 200 patients (58% male). The median age of the patients was 68 years (range 19-92 years), and left-sided DVT was observed in 56%. Iliofemoral DVT was present in 54 (27.0%) patients. Thrombus involving the CFV but not the iliac veins (CFV group) was seen in 28 patients; the remaining 26 had involvement of the iliac veins (iliac group). Thrombus in the CFV was more likely to be occlusive in the iliac group than in the CFV group (77% vs. 4%; p < .001). Thrombus in the DFV was more often occlusive in the iliac group than in the CFV group (81% vs. 11%; p < .001). The DFV was free of thrombus in 12% of patients in the iliac group and in 64% of those in the CFV group. CONCLUSION The presence of occlusive thrombus in the CFV and/or in the DFV pointed to a DVT also involving the ipsilateral iliac veins. Thrombosis of the deep leg veins extending into the CFV below the inguinal ligament was more likely to be partial in the CFV, mainly due to inflow from the DFV.
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Mampuya FK, Steinberg WJ, Raubenheimer JE. Risk factors and HIV infection among patients diagnosed with deep vein thrombosis at a regional/tertiary hospital in Kimberley, South Africa. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1432135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- FK Mampuya
- Faculty of Health Sciences, Department of Family Medicine, University of the Free Sate , Bloemfontein, South Africa
| | - WJ Steinberg
- Faculty of Health Sciences, Department of Family Medicine, University of the Free Sate , Bloemfontein, South Africa
| | - JE Raubenheimer
- Faculty of Health Sciences, Department of Biostatistics, University of the Free Sate , Bloemfontein, South Africa
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Repella TL, Lopez O, Abraham CZ, Azarbal AF, Liem TK, Mitchell EL, Landry GJ, Moneta GL, Jung E. Characterization of profunda femoris vein thrombosis. J Vasc Surg Venous Lymphat Disord 2018; 6:585-591. [PMID: 29681458 DOI: 10.1016/j.jvsv.2018.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/16/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The incidence of and risk factors for profunda femoris vein (PFV) thrombosis are poorly characterized. We prospectively identified patients with PFV deep venous thrombosis (DVT) to characterize the demographics and anatomic distribution of proximal DVT in patients with PFV DVT. METHODS A prospective study was conducted of patients at a tertiary care university hospital with DVT diagnosed by venous duplex ultrasound scanning between June 2014 and June 2015. DVT patients were categorized as having PFV involvement (yes or no), and the anatomic distribution of other sites of ipsilateral venous thrombi was further stratified to determine whether there was external iliac vein (EIV), common femoral vein (CFV), or femoropopliteal vein (FPV) DVT. Demographic characteristics of the patients were compared between groups, PFV DVT vs proximal DVT without PFV DVT. RESULTS Of 4584 lower extremity venous duplex ultrasound studies performed, 398 (8.7%) scans were positive for proximal DVT from 260 patients; 23.1% of patients with DVT (60/260) had DVT involving the PFV. Of 112 patients who had CFV DVT, 55 (49.1%) also had ipsilateral involvement of the PFV. Of 60 patients with PFV DVT, 55 (91.7%) had involvement of the ipsilateral CFV. Patients in the PFV DVT group were more likely to have a history of a hypercoagulable disorder (26.7% vs 14.5%; P = .029) and a history of immobility (58.3% vs 42%; P = .026) compared with those with proximal DVT without PFV DVT. There were no differences in smoking, recent surgery, personal or family history of DVT, other medical comorbidities, inpatient status, or survival. There was no difference in laterality of DVT between the PFV DVT and proximal DVT without PFV DVT groups (35% vs 41.5% left, 35% vs 33.5% right, 30% vs 25% bilateral; P = .619). There was a higher proportion of PFV DVT with EIV involvement (21.7% vs 2.5%; P < .00001) and a higher proportion of PFV DVT with CFV + FPV involvement (65.0% vs 19%; P < .00001) compared with proximal DVT without PFV DVT. There was no difference in survival between the PFV DVT and proximal DVT without PFV DVT groups. CONCLUSIONS Patients with PFV thrombosis tend to have more thrombus burden with more frequent concurrent DVT in the EIV and FPV. Patients with PFV DVT are also more likely to have a history of hypercoagulable disorder and immobility. Ultrasound protocols for assessment of DVT should include routine examination of the PFV as a potential marker of a more virulent prothrombotic state.
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Affiliation(s)
- Tana L Repella
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore.
| | - Olga Lopez
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Cherrie Z Abraham
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Amir F Azarbal
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Timothy K Liem
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Erica L Mitchell
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Gregory J Landry
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Gregory L Moneta
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Enjae Jung
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Ore
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Aurshina A, Ascher E, Hingorani A, Salles-Cunha SX, Marks N, Iadgarova E. Clinical Role of the “Venous” Ultrasound to Identify Lower Extremity Pathology. Ann Vasc Surg 2017; 38:274-278. [DOI: 10.1016/j.avsg.2016.05.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Abstract
Purpose: This study aimed to determine whether deep vein thrombosis (DVT) predominantly occurred on a particular side in the pelvic and lower extremity veins. Materials and Methods: Among 259 consecutive patients with leg swelling, 65 were confirmed to have DVT in the pelvis and lower extremities, and enrolled in this study. The serum levels of initial D-dimer, antithrombin III, tissue plasminogen activator, factor VIII, proteins C and S, anticardiolipin antibodies immunoglobulin (Ig) G and IgM and lupus anticoagulant were measured and analyzed retrospectively. Lower extremity venous system was divided into 11 anatomic segments on each side, and thrombotic involvement in each segment was recorded to determine the laterality of thrombotic involvement for each patient. The presence of thrombus in a specific vein was assigned using a Thrombus Scoring System (TSS) score of 1. Predominant direction was determined based on the TSS score for each side. Results: Left-side predominat DVT (57%) was most frequent. Patients with both-side equivalent DVT had the highest total TSS score (P=0.022). The predominant side was significantly different between men (right 44.1%) and women (left 74.2%) (P=0.022). Patients with both-side equivalent DVT had the highest mean age (69.3±9.9 years) as well as the highest mean levels of initial D-dimer (13.8±20.7 μg/mL) and anticardiolipin antibody IgM (13.4±22.8 MPL) indicating increased coagulability. Conclusion: In the current study, left-side predominant DVT is most frequent in pelvis and lower extremities, and this phenomenon is more apparent in women. And both-side equivalent DVT is associated with the most advanced age and hypercoagulability.
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Affiliation(s)
- Ha Song Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kwon Park
- Department of Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
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Ndzengue A, Rafal RB, Balmir S, Rai DB, Jaffe EA. Klippel-trenaunay syndrome: an often overlooked risk factor for venous thromboembolic disease. Int J Angiol 2013; 21:233-6. [PMID: 24293983 DOI: 10.1055/s-0032-1328969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a congenital condition redefined by Oduber et al (2008) by the coexistence of vascular malformations and disturbed soft tissue or bony growth, including hypertrophy or hypotrophy in the same or opposite sides of the body. The anomalies may involve part of a limb, a whole limb, a limb girdle, or a hemibody. Vascular malformations may involve veins, capillaries, or lymphatics although venous or capillary malformations are essential for the diagnosis. Associated venous anomalies include dysplasia, valvular malformations, and varicosities. Congenital venous anomalies are often associated with disturbances of blood flow and should be considered as prothrombotic states. However, such anomalies are not considered in Wells scores and used to determine the risk for venous thromboembolism (VTE). We present the case of a male with unrecognized crossed dissociated form of KTS and unsuspected VTE. The pathophysiology and the treatment of VTE in KTS are discussed. We suggest physicians to be aware of KTS and that its recognition in a critically ill patient should prompt consideration for appropriate prophylaxis for high-risk category for VTE. Dedicated duplex sonography should be obtained if VTE is suspected. We also suggest a modification of the Wells scores to reflect the association of KTS and VTE.
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Affiliation(s)
- Albert Ndzengue
- Department of medicine, Interfaith Medical Center, Brooklyn, New York
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Oduber CEU, Young-Afat DA, van der Wal AC, van Steensel MAM, Hennekam RCM, van der Horst CMAM. The persistent embryonic vein in Klippel–Trenaunay syndrome. Vasc Med 2013; 18:185-91. [DOI: 10.1177/1358863x13498463] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Klippel–Trenaunay syndrome (KTS) is a congenital malformation syndrome with prominent vascular anomalies. A persistent embryonic vein (PEV) may be located on the affected leg(s) of patients with KTS. Our understanding of PEVs of the legs is limited and their nomenclature is confusing. The objective of this study was to obtain further insight in the prevalence, nomenclature and etiology of PEVs of the legs in KTS and to propose a standardized description of anomalous leg veins in KTS. We investigated 70 KTS patients for the presence of PEVs (lateral marginal vein, LMV) of the legs by duplex ultrasonography. We performed histopathological analysis of a surgically excised PEV (LMV) of a typical KTS patient, and we conducted an extensive literature study. Duplex ultrasonography showed LMVs in 12/70 (17.1%) patients. The terms used to describe PEVs in the leg are quite variable, while indicating only two types: lateral marginal vein (LMV) and persistent sciatic vein (PSV). The histology of the excised LMV showed remarkable similarity with that of varicose veins found in the general population. In conclusion, the prevalence of LMVs in our KTS cohort is 17.1%. Two PEVs can be found in the legs and we propose nomenclature based on anatomical criteria, thereby using only the terms persistent lateral marginal vein and persistent sciatic vein, combined with the patency of the deep venous system. We hypothesize that PEVs are most likely caused by a genetic defect leading to abnormal venous pattern formation, which is further supported by our histopathological findings.
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Affiliation(s)
- Charlène EU Oduber
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Maurice AM van Steensel
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Raoul CM Hennekam
- Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands
- Clinical and Molecular Genetics Unit, Institute of Child Health, Great Ormond Street Hospital for Children, UCL, London, UK
| | - Chantal MAM van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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