C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome

Preliminary application of three-dimensional venography and fusion navigation technique in May-Thurner syndrome

OBJECTIVE

The purpose of this study was to report a technique for intraprocedural guidance of endovascular iliac vein stenting procedures using three-dimensional (3D) venography images as an overlay on live biplanar fluoroscopy.

METHODS

Using 3D venography and a fusion navigation technique, percutaneous transluminal angioplasty and stent placement were performed to evaluate the feasibility of using 3D venography images and the fusion navigation technique to treat MTS compared with traditional digital subtraction angiography. The general epidemiologic data (ie, age, gender), clinical manifestations (ie, major symptoms, affected extremity, CEAP [clinical, etiology, anatomy, pathophysiology] classification, comorbidity, stenosis rate), intraoperative findings (ie, stent type, stent count, stent to inferior vena cava distance, procedure time, radiation dose, contrast agent dosage), and postoperative recovery were obtained and analyzed.

RESULTS

A total of 30 consecutive patients with symptomatic MTS from our institution were enrolled in the present study. Of the 30 patients, 12 (group A) were treated using 3D venography images and fusion navigation and 18 (group B) were treated with two-dimensional venography images during endovascular management. Significant differences were observed between the two groups with respect to the procedure time (64.42 ± 4.35 minutes vs 76.61 ± 3.47 minutes; P = .04), radiation dose (2152 ± 124.7 mGy vs 2561 ± 105.6 mGy; P = .02), and contrast agent dosage (71.42 ± 4.87 mL vs 86.17 ± 4.14 mL; P = .03).

CONCLUSIONS

3D venography and its fusion navigation technique can improve prediction of the coverage area of the stent. Its use can also shorten the procedure time and reduce the contrast agent dose and radiation exposure, making it a valuable tool for both the diagnosis and the treatment of symptomatic MTS.

[Application of iliac vein molding and stent implantation through the ipsilateral great saphenous vein approach in daytime treatment mode]

OBJECTIVE

To explore the feasibility and recent efficacy of iliac vein molding and stenting in daytime treatment mode in patients with iliac vein stenosis.

METHODS

Medical records of iliac vein molding and stenting performed in the ipsilateral great saphenous vein approach conducted from February 2017 to March 2022 were retrospective reviewed. There were 21 cases, 6 males and 15 females. Age ranged from 37 to 79 years [(62.5 ± 10.2) years]. The stenosis in the 21 limbs simply involved the common iliac veins in 16 patients, 2 patients had the simple and external iliac veins, and both the total and external iliac veins in 3 patients. Both iliac vein molding and iliac vein stenting were performed through the ipsilateral great saphenous vein approach. The patients with simple iliac vein stenosis with great saphenous vein valve insufficiency also underwent radiofrequency closure of great saphenous vein and flexural vein sclerosis therapy simultaneously. Regular postoperative direct oral anticoagulants therapy and stress therapy were followed. All the patients were hospitalized for less than 24 h.

RESULTS

All the 21 patients operations were successful (the success rate was 100%), without any intraoperative complications. Immediate postoperative complications were puncture point bleeding in 1 case. The bandage gauze was completely wet. The bleeding was stopped after 5min of recompression. All the patients were hospitalized for less than 24 h. Follow-up results: The 3-month follow-up rate after operation was 100%. Absolute effective 18 cases (18/21, 85.7%). Relatively effective(postmentation still after surgery, but with less extent) in 3 cases (3/21, 14.3%). The iliac vein stents were unobstructed, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment. The 6-month follow-up rate after operation was 71.4%(15/21). Of these, 14 cases (14/15, 93.3%) were absolutely effective. Relatively effective(postmentation still after surgery, but with less extent) in 1 case (1/15, 6.7%). The iliac vein stents were no restenosis or obstruction, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment.

CONCLUSION

The interventional treatment technique of iliac vein stenosis is feasible in the daytime treatment mode, with clear advantages and satisfactory recent efficacy.

Clinical observations in treatment of lower extremity varicose veins with trigger points acupuncture

OBJECTIVES

To observe the effect of the acupuncture of myofascial trigger points (MTrPs) in the treatment of lower extremity varicose veins (LEVVs).

METHODS

Overall, 260 patients with LEVVs participated in this study. LEVVs were selected based on diagnostic criteria of Clinical, Etiology, Anatomy, and Pathophysiology levels 2-5 and classified into six types on the basis of their anatomical positions. The MTrPs in the lower extremities were localized in accordance with the classification of LEVVs and treated by MTrPs acupuncture combined with self-massage and self-stretching. The interval between each treatment was 2 weeks to 1 month, depending on needling pain tolerance of each patient. An in-house evaluation was used to estimate the proportion of varicose veins in the lower limbs and their accompanying symptoms. The treatment effect was evaluated before each treatment and at 1-year follow-up.

RESULTS

The mean evaluation score of LEVVs before the treatment course was 3.66 ± 1.19. After the course, this reduced to 1.18 ± 0.97, with the following response rates: 85% for excellent and good and 15% for medium. After 1-year follow-up, the mean evaluation score of all patients was 1.11 ± 0.92, with the following response rates: 87% for excellent and good, and 13% for medium.

CONCLUSIONS

In some patients, MTrP acupuncture could cure LEVVs and its accompanying symptoms. These LEVVs are probably caused by fascia tension as a pre-pathology induced by the MTrPs.

Evaluation of 3-dimensional rotational venography for the diagnosis of non-thrombotic iliac venous lesion

Background

The purpose of this study was to determine the technical feasibility and safety of 3D rotational venography (3D-RV) in the diagnosis of non-thrombotic iliac vein lesions compared with traditional 2D-digital subtraction angiography (2-DSA).

Methods

The general epidemiological data (including age, gender), clinical manifestations (including major symptom, affected extremity, CEAP classification, comorbidity, stenosis rate), and intra-operative findings (iliac vein indentation position, collateral circulation, procedure time, X-rays dose, contrast agent dosage) of 61 NIVL patients who were assessed by 3D-RV and traditional 2-DSA between October 2018 to October 2022 were obtained and analyzed.

Results

A total of 61 consecutive patients with symptomatic NIVL from our institution were enrolled in this study. With the aggravation of iliac vein stenosis, the proportion of indicators such as contralateral formation and iliac vein compression indentation reflecting the severity of compression under 3D-RV reconstruction increased significantly. Also, significant differences were observed between the 3D-RV and 2-DSA groups concerning procedure time (10.56 ± 0.09 s vs. 12.59 ± 0.37 s; p < 0.01), X-ray dose (41.25 ± 0.21 mGy vs. 81.59 ± 1.69 mGy; p < 0.01) and contrast agent dosage (21.48 ± 0.24 mL vs. 33.69 ± 0.72 mL; p < 0.01). Contralateral iliac vein imaging (p = 0.002), pelvic collateral vein imaging (p = 0.03), and external iliac vein indentation (p = 0.001) were found to influence the severity of iliac vein compression.

Conclusion

3D-RV can display dynamic stereo image information of NIVL, augmenting the information obtained from traditional 2-DSA. Contralateral iliac vein imaging, pelvic collateral vein imaging, and external iliac vein indentation can be used to evaluate the severity of iliac vein compression to some extent.

Age related changes in mitochondrial function and new approaches to study redox regulation in mammalian oocytes in response to age or maturation conditions

Mammalian oocytes are long-lived cells in the human body. They initiate meiosis already in the embryonic ovary, arrest meiotically for long periods in dictyate stage, and resume meiosis only after extensive growth and a surge of luteinizing hormone which mediates signaling events that overcome meiotic arrest. Few mitochondria are initially present in the primordial germ cells while there are mitogenesis and structural and functional differentiation and stage-specific formation of functionally diverse domains of mitochondria during oogenesis. Mitochondria are most prominent cell organelles in oocytes and their activities appear essential for normal spindle formation and chromosome segregation, and they are one of the most important maternal contributions to early embryogenesis. Dysfunctional mitochondria are discussed as major factor in predisposition to chromosomal nondisjunction during first and second meiotic division and mitotic errors in embryos, and in reduced quality and developmental potential of aged oocytes and embryos. Several lines of evidence suggest that damage by oxidative stress/reactive oxygen species in dependence of age, altered antioxidative defence and/or altered environment and bi-directional signaling between oocyte and the somatic cells in the follicle contribute to reduced quality of oocytes and blocked or aberrant development of embryos after fertilization. The review provides an overview of mitogenesis during oogenesis and some recent data on oxidative defence systems in mammalian oocytes, and on age-related changes as well as novel approaches to study redox regulation in mitochondria and ooplasm. The latter may provide new insights into age-, environment- and cryopreservation-induced stress and mitochondrial dysfunction in oocytes and embryos.