1
|
Parsi K, De Maeseneer M, van Rij AM, Rogan C, Bonython W, Devereux JA, Lekich CK, Amos M, Bozkurt AK, Connor DE, Davies AH, Gianesini S, Gibson K, Gloviczki P, Grabs A, Grillo L, Hafner F, Huber D, Iafrati M, Jackson M, Jindal R, Lim A, Lurie F, Marks L, Raymond-Martimbeau P, Paraskevas P, Ramelet AA, Rial R, Roberts S, Simkin C, Thibault PK, Whiteley MS. Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants. Phlebology 2024:2683555241260926. [PMID: 39046331 DOI: 10.1177/02683555241260926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. OBJECTIVES To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. METHODS An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. RESULTS Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. CONCLUSION Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.
Collapse
Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | | | - Andre M van Rij
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher Rogan
- Interventional Radiology Society of Australasia (IRSA), Camperdown, NSW, Australia
- Department of Medical Imaging, Sydney Adventist Hospital, Sydney, NSW, Australia
- Macquarie University Hospital, Sydney, NSW, Australia
| | - Wendy Bonython
- Faculty of Law, Bond University, Gold Coast, QLD, Australia
| | - John A Devereux
- University of Queensland Law School, University of Queensland, Saint Lucia, QLD, Australia
| | | | - Michael Amos
- Department of Anaesthesiology, Concord Hospital, Sydney, NSW, Australia
| | - Ahmet Kursat Bozkurt
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Department of Cardiovascular Surgery, Istanbul University, Istanbul, Turkie
| | - David E Connor
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Alun H Davies
- European College of Phlebology, Rotterdam, The Netherlands
- Vascular Surgery, Imperial College London, Charing Cross and St Mary's Hospital, London, UK
| | - Sergio Gianesini
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, University of Ferrara, Ferrara, Italy
| | | | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anthony Grabs
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Vascular Surgery, St Vincent's Hospital, Sydney, NSW, Australia
| | - Lorena Grillo
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, University of Medical Sciences (UCIMED), San Jose, Costa Rica
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - David Huber
- Art of Vein Care, Wollongong, NSW, Australia
| | - Mark Iafrati
- American Venous Forum (AVF), East Dundee, IL, USA
- Vanderbilt University Medical Center, Vanderbuilt University, Nashville, TN, USA
| | - Mark Jackson
- Australian and New Zealand Society for Vascular Surgery(ANZSVS), Melbourne, VIC, Australia
- Department of Vascular Surgery, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Ravul Jindal
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular Surgery, Fortis Hospital, Mohali, India
| | - Adrian Lim
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Fedor Lurie
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Jobst Vascular Institute, Toledo, OH, USA
- Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Marks
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Brighton Day Surgery, Adelaide, SA, Australia
| | - Pauline Raymond-Martimbeau
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Dallas Non-Invasive Vascular Laboratory and Vein Institute of Texas, Dallas, TX, USA
| | | | | | - Rodrigo Rial
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Vascular and Endovascular Surgery, University Hospital HM Madrid, Torrelodones, Spain
| | | | - Carlos Simkin
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Clínica Simkin, Buenos Aires, Argentina
| | - Paul K Thibault
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Central Vein and Cosmetic Medical Centre, Newcastle, NSW, Australia
| | - Mark S Whiteley
- The College of Phlebology, Guildford, UK
- The Whiteley Clinic, Guildford, UK
| |
Collapse
|
2
|
Liu G, Clarke JL, Oomens D, Vicaretti M, Daly T, Cho TH, Mohan I. Termination of the great saphenous vein at variable levels. VEINS AND LYMPHATICS 2022. [DOI: 10.4081/vl.2022.10786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The assessment of the saphenofemoral junction (SFJ) is important in the diagnosis and treatment of venous reflux of the great saphenous vein (GSV). In the clinical practice of venous medicine, the SFJ is used to represent the region at which the saphenous arch connects with the common femoral vein (CFV). A number of notable variations of the SFJ have been documented, and rare variable courses of the GSV have been described recently. Our case study reports two unusual GSV terminations. In both cases, the SFJ was located below the confluence of the profunda femoris vein (PFV) with the femoral vein (FV). Case 1 showed the SFJ was formed by the GSV and FV; whereas case 2 showed the PFV was joined by the GSV after a transposition with the FV. Anatomical variations of the SFJ are rare; however, they are increasingly diagnosed with the use of duplex ultrasound. The identification of SFJ variants warrants a safe endovenous procedure and prevents surgical complications.
Collapse
|
3
|
Kachare M, Jaisinghani P, Kulkarni S. Evaluation of anomalies of major veins of the superficial venous system of lower limb in adults on color doppler: An observational study. Phlebology 2022; 37:662-669. [DOI: 10.1177/02683555221114545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the incidence of anomalies in the superficial venous system in lower limb. Method Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. Result (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. Conclusion Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research.
Collapse
Affiliation(s)
- Manohar Kachare
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, India
| | - Pooja Jaisinghani
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, India
| | - Sanjay Kulkarni
- Department of Surgery, Bharati Vidyapeeth Deemed University, Sangli, India
| |
Collapse
|
4
|
Apruzzi L, Bilman V, Ardita V, Favia N, Saracino C, Chiesa R, Baccellieri D. Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein. Phlebology 2021; 37:48-54. [PMID: 34505545 DOI: 10.1177/02683555211045191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. METHODS This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. RESULTS A total of 60 limbs (73.3% women, mean age 54.7 ± 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 ± 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 ± 2.3 days vs. OS 14.2 ± 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. CONCLUSION MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS.
Collapse
Affiliation(s)
- Luca Apruzzi
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Ardita
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Favia
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Concetta Saracino
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | |
Collapse
|
5
|
Valesky EM, Mendoza E, Brenner E. Vena giacomini – so klein und unscheinbar? PHLEBOLOGIE 2021. [DOI: 10.1055/a-1304-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungIn Giacominis Erstbeschreibung (1873) wurde über eine Vene berichtet, die über die Fossa poplitea zum dorsalen Oberschenkel (ohne in die V. poplitea einzumünden) weiter nach medial zieht, um in die V. saphena magna zu münden. Seither wurden zahlreiche weitere Mündungstypen (auch mit Einmündung in die V. poplitea) publiziert. Im klinischen Alltag erfährt diese Vene hingegen nur wenig Beachtung. Die Wahrscheinlichkeit, eine Insuffizienz der V. giacomini nachzuweisen, ist v. a. bei simultanem Vorliegen einer insuffizienten V. saphena parva um das knapp 12-Fache erhöht. Man unterscheidet 2 Refluxtypen der V. giacomini. Beim retrograden Reflux gelangt venöses Blut über die V. saphena magna, die Beckenvenen oder die Perforansvenen des Oberschenkels in die V. saphena parva. Beim wesentlich selteneren anterograden Reflux kommt es zu einem paradoxen (aufsteigenden) Reflux in der V. giacomini während der muskulären Diastole. Eine ausschließlich V.-saphena-fokussierte chirurgische Therapie ohne Berücksichtigung der Refluxtypen kann möglicherweise in einer Überbehandlung des Patienten enden und sollte im Zeitalter der therapeutischen Vielfalt und eines möglichst venenerhaltenden Vorgehens vermieden werden.Aufgrund der anatomischen Enge der Fossa poplitea und der in der Vergangenheit zunehmend an Beliebtheit gewonnenen endoluminal-thermischen Verfahren ist die Kenntnis der topografischen Anatomie insbesondere zur Vermeidung von neurologischen Komplikationen von essenzieller Bedeutung.
Collapse
Affiliation(s)
- Eva Maria Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Deutschland
| | | | - Erich Brenner
- Institut für Klinisch-Funktionelle Anatomie, Department für Anatomie, Histologie und Embryologie, Medizinische Universität Innsbruck, Österreich
| |
Collapse
|
6
|
Kachlík D, Varga I, Báča V, Musil V. Variant Anatomy and Its Terminology. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56120713. [PMID: 33353179 PMCID: PMC7766054 DOI: 10.3390/medicina56120713] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022]
Abstract
Variant anatomy, which is an integral part of anatomical science, is related to abnormalities in the human body structure. Our understanding of variant anatomy is based on thousand years of anatomical experience. These abnormalities generally do not interfere with the function of the human body and do not typically manifest as pathological nosological units. However, under certain conditions, these abnormalities can worsen existing pathological states or even evoke new ones. Understanding variant anatomy is a basic skill not only of mere anatomists, but also of clinicians who work in fields involving both diagnostic techniques and therapeutic interventions. To gain and retain a good knowledge of the most frequent and clinically relevant anatomical variations, a simple, clear, and exactly defined nomenclature of variant structures is needed. A list of items comprising variant anatomy, which have been incorporated into the internationally accepted nomenclatures Terminologia Anatomica (1998) and Terminologia Neuroanatomica (2017), is described and analyzed. Examples of the most common anatomical variations related to terminology are mentioned, and variant anatomy as a whole and its role in understanding current anatomy are discussed.
Collapse
Affiliation(s)
- David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 15006 Prague, Czech Republic;
- Department of Health Care Studies, College of Polytechnics Jihlava, Tolstého 16, 58601 Jihlava, Czech Republic;
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-2-90-119-547
| | - Václav Báča
- Department of Health Care Studies, College of Polytechnics Jihlava, Tolstého 16, 58601 Jihlava, Czech Republic;
| | - Vladimír Musil
- Centre of Scientific Information, Third Faculty of Medicine, Charles University, Ruská 87, 10000 Prague, Czech Republic;
| |
Collapse
|
7
|
Feasibility of a fetal anatomy 3D atlas by computer-assisted anatomic dissection. J Gynecol Obstet Hum Reprod 2020; 49:101880. [PMID: 32755668 DOI: 10.1016/j.jogoh.2020.101880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. STUDY DESIGN For pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specimens were fixed in 10 % formalin, then embedded in paraffin wax and serially sectioned. The histological slices were stained using HES and Masson Trichrome. Protein S-100 and D2-40 markers were used for immuno-labelling. Serial transverse sections were digitalized and manually aligned. Fetal brain slices were obtained from in utero or post-mortem MRI. RESULTS CAAD was performed on 10 fetuses: pelvis was modelised with 3 fetuses of 13, 15 and 24 W G, lower limbs with 2 fetuses of 14 and 15 W G and brain with 5 fetuses aged between 19 and 37 W G. Fetal pelvis innervation was analysed after immunolabelling and nerves appeared proportionally bigger than in adults with the same topography. Lower limbs analysis revealed that nerve development was guided by vascular development: the sciatic nerve along the big axial vein, the saphen nerve along the big saphen vein and the sural nerve along the small saphen vein. Fetal brain study allowed to describe the gyration process and the lateral ventricle development. CONCLUSION CAAD technique provides an accurate 3D reconstruction of fetal anatomy for lower limbs and pelvis but has to be improved for brain model since midline structures were not amendable for analysis. These results need to be confirmed with larger series of specimens at different stages of development.
Collapse
|
8
|
Kubat E, Ünal CS, Geldi O, Çetin E, Keskin A, Karapınar K. Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers. SAO PAULO MED J 2020; 138:98-105. [PMID: 32491084 PMCID: PMC9662839 DOI: 10.1590/1516-3180.2019.0230.r1.06112019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.
Collapse
Affiliation(s)
- Emre Kubat
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Celal Selçuk Ünal
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Onur Geldi
- MD. Attending Physician, Department of Cardiovascular Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
| | - Erdem Çetin
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Aydin Keskin
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Kasım Karapınar
- MD. Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| |
Collapse
|
9
|
Gaye M, Diagne PA, Ndiaye A, Diagne AM, Nazarian S, Ndiaye A. Level and modalities of origin of the small saphenous vein: toward codification of the proximal approach level. Surg Radiol Anat 2019; 41:1451-1454. [PMID: 31501911 DOI: 10.1007/s00276-019-02317-5] [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: 12/15/2018] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The proximal approach to the small saphenous vein (SSV) must be performed according to precise anatomical landmarks to respect the esthetic profile of venous insufficiency surgery. In this work, we propose the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as palpable landmarks from which to easily identify the situation of this vein. METHODS This was a cadaveric dissection study involving 62 members of fresh and embalmed anatomical subjects. We used a horizontal line passing through the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as reference marks. Once the origin of the SSV as dissected, the distances between the saphenous vein and the landmarks were measured. RESULTS We found that the small saphenous vein was often unique. The origin of this small saphenous vein projected, on average, to 4.40 cm from the horizontal passing through the tip of the lateral malleolus and 1.2 cm from the lateral edge of the calcaneal tendon. CONCLUSION These two measurements constitute the orthogonal coordinates for the situation of the small saphenous vein origin.
Collapse
Affiliation(s)
- M Gaye
- Laboratory of Anatomy and Organogenesis, Faculty of Medicine, Pharmacy and Dentistry, University of Cheikh Anta Diop, Dakar, Senegal. .,Department of Thoracic and Cardiovascular Surgery, Fann Hospital, Dakar, Senegal.
| | - P A Diagne
- Department of Thoracic and Cardiovascular Surgery, Fann Hospital, Dakar, Senegal
| | - Aï Ndiaye
- Laboratory of Anatomy and Organogenesis, Faculty of Medicine, Pharmacy and Dentistry, University of Cheikh Anta Diop, Dakar, Senegal
| | - A M Diagne
- Department of Orthopedics and Traumatology, Pikine Hospital, Dakar, Senegal
| | - S Nazarian
- Laboratory of Anatomy, Faculty of Medicine, University of Marseille, Marseille, France
| | - A Ndiaye
- Department of Thoracic and Cardiovascular Surgery, Fann Hospital, Dakar, Senegal.,Laboratory of Anatomy and Organogenesis, Training and Research Unit of Medical Science, University of Assane Seck, Ziguinchor, Senegal
| |
Collapse
|
10
|
Gianesini S, Menegatti E, Sibilla MG, Neuhardt D, Maietti E, Tessari M, Zamboni P. Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment. Phlebology 2019; 34:604-610. [PMID: 30808248 DOI: 10.1177/0268355519833229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.
Collapse
Affiliation(s)
- Sergio Gianesini
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Erica Menegatti
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Maria Grazia Sibilla
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Diana Neuhardt
- Comprehensive Interventional Care Centers, Phoenix, AZ, USA
| | - Elisa Maietti
- Center for Clinical Epidemiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| |
Collapse
|
11
|
Chen P, Chen H, Yang M, Wang X. Secondary lymphedema after high ligation of the great saphenous vein surgery: A case report. Medicine (Baltimore) 2018; 97:e13379. [PMID: 30544409 PMCID: PMC6310514 DOI: 10.1097/md.0000000000013379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022] Open
Abstract
A 56-year-old male patient with secondary lymphedema in a single lower extremity presented to our hospital.He received high ligation of great saphenous vein 3 years ago. Severe infection was observed in affected limb on postoperative day 10, and rapidly progressive pain and erythema spreading to inguinal region. He was diagnosed with secondary lymphedema after 3 years of high ligation of great saphenous vein. Compression treatment was given in affected limb to promote the lymphatic return.The patient was followed up for 3 months now, the edema in right leg showed attenuation compared with before.
Collapse
Affiliation(s)
- Ping Chen
- Department of Vascular Surgery, Yuhuangding Hospital, Qingdao University
| | - Hui Chen
- Department of Basic Research, Yantai Vocational College, Yantai, China
| | - Mu Yang
- Department of Vascular Surgery, Yuhuangding Hospital, Qingdao University
| | - Xuan Wang
- Department of Vascular Surgery, Yuhuangding Hospital, Qingdao University
| |
Collapse
|
12
|
Rodriguez-Acevedo O, Elstner KE, Martinic K, Zea A, Diaz J, Martins RT, Arduini F, Hodgkinson A, Ibrahim N. Hydrodisplacement of sural nerve for safety and efficacy of endovenous thermal ablation for small saphenous vein incompetence. Phlebology 2016; 32:482-487. [DOI: 10.1177/0268355516671233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endovenous radio frequency ablation for small saphenous vein incompetence by and large appears to be superior and safer than conventional open surgery. Small saphenous vein ablation from approximately mid-calf to the point proximally where the small saphenous vein dives into the popliteal fossa is considered to be safe, as the sural nerve is in most cases separated from this segment of the small saphenous vein by the deep fascia. The outcome of the distal incompetent small saphenous vein remains unclear. Efficacy of the endovenous radio frequency ablation can be enhanced by increasing the length of the ablatable small saphenous vein segment. Methodology To optimise endovenous radio frequency ablation outcome, the distal small saphenous vein may be made amenable to ablation if safety of the sural nerve can be assured. The sural nerve was successfully located using duplex ultrasound in 100% of our cohort in this study. The standard entry point for venous access was just above the lateral malleolus. After introduction of the introducer sheath, the radio frequency catheter was advanced proximally; the sural nerve was displaced from the small saphenous vein by approximately 1 cm with the administration of tumescent anaesthesia ( hydrodisplacement). A total of 118 patients underwent extended endovenous radio frequency ablation of 124 incompetent small saphenous vein trunks using the method described. Results Successful extended ablation of the small saphenous vein was achieved in 100% of cases and it was confirmed by duplex scanning at one and six weeks. Two neurological events were recorded during the study: 1. One patient with temporary foot drop lasting for less than 6 h with complete recovery. 2. A second patient with a sural nerve sensory deficit reported by the patient at day 2–3, which remains current at six weeks. Conclusions Extended endovenous radio frequency ablation of the small saphenous vein to optimise length of the ablatable vein segment is feasible with careful identification and hydrodisplacement of the sural nerve. This method is shown to be associated with fewer neurological complications than other methods reported in the literature.
Collapse
Affiliation(s)
| | - Kristen E Elstner
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Kui Martinic
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Aaron Zea
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Jenny Diaz
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Rodrigo T Martins
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Fernando Arduini
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Alexandra Hodgkinson
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Nabeel Ibrahim
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| |
Collapse
|
13
|
Rodriguez-Acevedo O, Elstner K, Zea A, Diaz J, Martinic K, Ibrahim N. The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation. Phlebology 2016; 32:49-54. [PMID: 26826266 DOI: 10.1177/0268355515627262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Neurological complications are well documented in association with both surgical stripping or disconnection and thermal ablation of the small saphenous vein. The sural nerve (medial sural cutaneous nerve) is most vulnerable due to its close relationship to the small saphenous vein. Objective This is a cross-sectional observational study of the sonographic anatomy of 115 Australian patients to determine the course of the sural nerve and its relationship to the small saphenous vein, and to identify its relevance in the thermal ablation of the small saphenous vein. Method Sonographic mapping of the right sural nerve was performed with a Philips L12.5 and Sonosite 10.5 MHz ultrasound machine on 115 patients. The sural nerve was traced proximally from the level of the lateral malleolus to the popliteal fossa in order to measure its distance from the small saphenous vein at four reference points in the lower leg. Results A total of 115 patients were studied (females 82, males 33). The sural nerve was identified in 100% of patients; 64 patients (55.7%) showed usual sural nerve anatomy, while 51 patients (44.3%) demonstrated a range of anatomical variations, including the sural nerve becoming epifascial at a higher point than usual. Conclusion The sural nerve was identifiable on duplex ultrasound in 100% of cases. Classic anatomical relations and the perceived protection of the sural nerve conferred by the deep fascia of the upper calf are unreliable. Preoperative strategies can help to approach and protect the sural nerve in the endovenous ablation setting.
Collapse
Affiliation(s)
- Omar Rodriguez-Acevedo
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Kristen Elstner
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Aaron Zea
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Jenny Diaz
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Kui Martinic
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Nabeel Ibrahim
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Abstract
A thorough understanding of venous anatomy and physiology is foundational to the diagnosis and management of venous disease. Compared with the arterial system, there is significantly greater developmental variation in the venous system. The veins of the lower extremity include the superficial and deep veins, which are defined by their respective relationships to the muscular fascia. Perforating veins traverse the muscular fascia to connect superficial and deep veins. Communicating veins connect veins within the same venous compartment, either deep to deep or superficial to superficial. The deep veins of the lower extremities primarily drain muscles and are encompassed by muscular fascia. The veins located between the skin and the muscular fascia are considered superficial veins. Superficial veins drain the cutaneous microcirculation. The pelvic venous system is a complex transitional outflow pathway between the lower extremities, the pelvic structures, and the inferior vena cava. The terminology used to describe lower-extremity, pelvic, and abdominal vasculature conforms to published international standards.
Collapse
|
15
|
Joh JH, Kim WS, Jung IM, Park KH, Lee T, Kang JM. Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation. Vasc Specialist Int 2014. [PMID: 26217628 PMCID: PMC4480318 DOI: 10.5758/vsi.2014.30.4.105] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2–20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles’ ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Collapse
Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Woo-Shik Kim
- Department of Cardiothoracic Surgery, National Medical Center, Seoul
| | - In Mok Jung
- Department of Surgery, SVU-SMG Boramae Medical Center, Seoul
| | - Ki-Hyuk Park
- Department of Surgery, Daegu Catholic University Medical Center, Daegu
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Jin Mo Kang
- Department of Vascular Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | | |
Collapse
|
16
|
Three-dimensional reconstruction of the lower limb’s venous system in human fetuses using the computer-assisted anatomical dissection (CAAD) technique. Surg Radiol Anat 2014; 37:231-8. [DOI: 10.1007/s00276-014-1350-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/12/2014] [Indexed: 11/25/2022]
|
17
|
Jaworucka-Kaczorowska A, Oszkinis G, Huber J, Wiertel-Krawczuk A, Gabor E, Kaczorowski P. Saphenous vein stripping surgical technique and frequency of saphenous nerve injury. Phlebology 2014; 30:210-6. [PMID: 24906907 PMCID: PMC4390525 DOI: 10.1177/0268355514539316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Saphenous nerve injury is the most common complication after surgical treatment of varicose veins. The aim of this study was to establish its frequency at great saphenous vein long stripping when four methods of surgery were applied. Methods Eighty patients were divided into four groups depending on different stripping methods. Sensory transmission in saphenous nerve and sensory perception of shank were examined before surgery and two weeks, three and six months afterwards with clinical neurophysiology methods. Results In 36% of patients, surgeries caused the injury of saphenous nerve mainly by proximal stripping without invagination (65%, group I). Transmission disturbances ceased completely after three months in patients undergoing distal stripping with invagination (group IV), while in group I they persisted for six months in 35%. Group IV patients were the least injured and group I the most. Conclusion Neurophysiological findings may suggest that distal stripping with vein invagination gives the best saphenous nerve sparing.
Collapse
Affiliation(s)
- Aleksandra Jaworucka-Kaczorowska
- Second Department of Surgery, General and Vascular Surgery Clinic, University of Medical Sciences, Poznań, Poland Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | - Grzegorz Oszkinis
- Second Department of Surgery, General and Vascular Surgery Clinic, University of Medical Sciences, Poznań, Poland
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | | | - Elżbieta Gabor
- Department of Pathophysiology of Locomotor Organs, University of Medical Sciences, Poznań, Poland
| | - Paweł Kaczorowski
- Second Department of Surgery, General and Vascular Surgery Clinic, University of Medical Sciences, Poznań, Poland
| |
Collapse
|
18
|
Auvert JF, Chleir F, Coppé G, Hamel-Desnos C, Moraglia L, Pichot O. [Quality standards for ultrasound assessment of the superficial venous system of the lower limbs. Report of the French Society for Vascular Medicine]. ACTA ACUST UNITED AC 2014; 39:26-46. [PMID: 24448056 DOI: 10.1016/j.jmv.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED The quality standards of the French Society for Vascular Medicine for the ultrasound assessment of the superficial venous system of the lower limbs are based on the two following requirements: technical know-how (mastering the use of ultrasound devices and the method of examination); medical know-how (ability to adapt the methods and scope of the examination to its clinical indications and purpose and to rationally analyze and interpret its results). AIMS OF THE QUALITY STANDARDS To describe an optimal method of examination in relation to the clinical question and hypothesis; to achieve consistent practice, methods, glossary terminologies and reporting; to provide good practice reference points and to promote a high quality process. THEMES OF THE QUALITY STANDARD The three levels of examination. Their clinical indications and goals. The reference standard examination (level 2) and its variants according to clinical needs. The minimal content of the examination report, the letter to the referring physician (synthesis, conclusion and management suggestions) and iconography. Commented glossary (anatomy, hemodynamics, semiology). Technical basis. Ultrasound devices settings. We discuss of use of Duplex ultrasound for the assessment of the superficial veins of the lower limbs in vascular medicine practice.
Collapse
Affiliation(s)
- J-F Auvert
- 8, boulevard de l'Europe, 28100 Dreux, France.
| | - F Chleir
- 113, avenue Charles-de-Gaulle, 92200 Neuilly, France; Hôpital Américain de Paris, 92200 Neuilly, France
| | - G Coppé
- 8, rue Edouard-Robert, 91290 Arpajon, France
| | - C Hamel-Desnos
- Hôpital privé Saint-Martin, 18, rue des Rocquemonts, 14050 Caen, France
| | - L Moraglia
- 47, cours du Médoc, 33300 Bordeaux, France
| | - O Pichot
- 7, rue Lesdiguières, 38000 Grenoble, France
| | | |
Collapse
|
19
|
Abstract
OBJECTIVE To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return. METHODS In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. RESULTS The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein. CONCLUSION The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.
Collapse
Affiliation(s)
| | - Claude Gillot
- URDIA Anatomy Research Unit, Paris Descartes University, Paris
| |
Collapse
|