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Hihara M, Hikiami R, Mitsui T, Kakudo N, Kuro A, Kusumoto K. Rare cases requiring emergency procedures while harvesting a free forearm flap: report of two cases. J Surg Case Rep 2021; 2021:rjab435. [PMID: 34616542 PMCID: PMC8489968 DOI: 10.1093/jscr/rjab435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022] Open
Abstract
The free forearm flap is considered safe to harvest and is still extremely useful for reconstruction after head and neck tumor resection. We experienced two uncommon cases, in which an emergency procedure was required during reconstructive surgery after resection of head and neck cancer. Case 1 suffered persistent hand blood flow insufficiency long after the flap was placed in the oral cavity. Case 2 had an anomalous cutaneous vein of the forearm that was a drainage vein of the flap. For risk management during free flap surgery, preparing multiple venous transplant options in advance is fundamental.
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Affiliation(s)
- Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Rina Hikiami
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan
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Waele JJD, Calle PAA, Vermassen FEG. Thrombosis of an Aneurysm of the Basilic Vein Upper Extremity Venous Aneurysm. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. J. De Waele
- Departments of Surgery, University Hospital Ghent, Ghent, Belgium
| | - P. A. A. Calle
- Departments of Emergency Medicine, University Hospital Ghent, Ghent, Belgium
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Kuntz S, Lejay A, Georg Y, Thaveau F, Chakfé N. Management of upper extremity aneurysms: a systematic review. INT ANGIOL 2020; 39:161-170. [PMID: 32052949 DOI: 10.23736/s0392-9590.20.04307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this paper is to provide recommendations for diagnosis and management of arterial or venous aneurysms of the upper extremity. EVIDENCE ACQUISITION A systematic review of the Medline and Cockrane databases was performed from 1988 to 2019 by a combined strategy of MeSh terms. EVIDENCE SYNTHESIS One-hundred-forty-four publications were identified: 111 addressing arterial aneurysms and 33 addressing venous aneurysms. A total of 162 cases of arterial aneurysms, mostly brachial aneurysms (34.0% of cases) and 40 cases of venous aneurysms, mostly located in the forearm (60.0% of cases) were reported. For both types of aneurysms, most common presentation was the perception of a mass (56.3% for arterial one and 87.5% for venous one), but thromboembolic complication (46.7%), paresthesia (16.5%) or rupture (6.4%) could be observed in the setting of arterial aneurysms, while arm swelling (27.5%), neurological symptoms (12.5%), pulmonary embolism (10.0%) or rupture (2.5%) could occur in the setting of venous aneurysms. DUS was performed as first imaging modality for both settings, followed but CTA and MRA, especially in arterial aneurysms, to evaluate distal emboli and surrounding vasculature. Surgical treatment was mostly based on excision of the aneurysms with revascularization for arterial aneurysms (77.2%) and resection without reconstruction for the venous one (85.0%). Complications occurred in 10.5% of the cases of arterial aneurysms, none occurred after venous aneurysm resection. CONCLUSIONS Prompt diagnosis and appropriate preoperative imaging are mandatory in order to offer the best treatment modality. Open resection with revascularization seems to be the treatment of choice for arterial aneurysms, although endovascular procedures became more popular. Venous aneurysms require excision without revascularization.
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Affiliation(s)
- Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France - .,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France.,Department of Physiology, University Hospital of Strasbourg, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.,European Research Group on Prostheses Applied to Vascular Surgery (GEPROVAS), Strasbourg, France
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Weeks JK, Strauch RJ, Virk RK, Wong TT. Cephalic venous aneurysm in the wrist. Clin Imaging 2018; 52:310-314. [PMID: 30218972 DOI: 10.1016/j.clinimag.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/15/2018] [Accepted: 07/04/2018] [Indexed: 11/26/2022]
Abstract
Venous aneurysms are benign vascular lesions usually located in the neck, lower extremity, and abdomen, but rarely in the upper extremity. There may be a mistake or delay in diagnosis because they are uncommon. We report a case of a healthy 54-year-old man who had a cephalic venous aneurysm in his wrist that grew slowly over 20 years. The diagnosis was made on MRI and confirmed with excisional surgery. Radiologists should consider venous aneurysms in the differential when evaluating soft tissue masses as they will often be the first to make the correct diagnosis.
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Affiliation(s)
- Joanna K Weeks
- Department of Radiology, New York-Presbyterian Hospital at Columbia University, 622 West 168th St., MC-28, New York, NY 10032, USA
| | - Robert J Strauch
- Department of Orthopedic Surgery, New York-Presbyterian Hospital at Columbia University, 622 West 168th Street, PH 11-1119, New York, NY 10032, USA
| | - Renu K Virk
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital at Columbia University, 630 West 168th Street, PH Stem 15-124, New York, NY 10032, USA
| | - Tony T Wong
- Department of Radiology, New York-Presbyterian Hospital at Columbia University, 622 West 168th St., MC-28, New York, NY 10032, USA.
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Hosokawa Y, Yoneda K, Nakai K, Moriue J, Kubota Y. Completely Thrombosed Venous Aneurysm in Great Saphenous Vein. Ann Dermatol 2013; 25:268-70. [PMID: 23717033 PMCID: PMC3662935 DOI: 10.5021/ad.2013.25.2.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yoichiro Hosokawa
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kozo Yoneda
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kozo Nakai
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Junko Moriue
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuo Kubota
- Department of Dermatology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Irwin C, Synn A, Kraiss L, Zhang Q, Griffen MM, Hunter GC. Metalloproteinase expression in venous aneurysms. J Vasc Surg 2008; 48:1278-85. [PMID: 18971037 DOI: 10.1016/j.jvs.2008.06.056] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 06/20/2008] [Accepted: 06/22/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although recognized with increasing frequency, the pathogenesis of venous aneurysms (VA) remains poorly understood. We evaluated 8 patients with 10 VA for the presence, localization and activity of metalloproteinases (MMPs). METHODS Tissue specimens from VA (n=8), normal saphenous vein (NSV n=7) and varicose veins (VV n=7 were compared by histology and immunohistochemistry (IHC). Histologic sections were stained with H&E, Movats pentachrome and toluidine blue, and IHC specimens with antibodies to CD68, MMP2, MMP9, and MMP13. Protein expression and enzyme activity were determined by Western immunoblotting and zymography. RESULTS Three of 4 patients with popliteal VA presented with edema and leg pain and the remaining patient with deep venous thrombosis (DVT) and pulmonary embolism (PE). The 5 popliteal VA were treated by; excision and reanastomosis (n=2) lateral venorrhaphy (n=2) and spiral saphenous vein graft (n=1). The 3 patients with 4 upper extremity VA had discomfort over a compressible mass. Two of the VA were excised and the remaining patients aneurysm ruptured spontaneously. The mesenteric VA, an incidental finding at laparotomy was excised. Thrombus was present in 2 popliteal, 1 upper extremity and in the mesenteric aneurysm. Histologically, VA and VV were characterized by fragmentation of the elastic lamellae, loss of smooth muscle cells (SMCs) and attenuation of the venous wall when compared to NSV. Varicose veins and VA also demonstrated increased expression of MMP-2, MMP-9 and MMP-13 in endothelial cells (ECs), SMCs and adventitial microvessels compared to NSV. Both pro-MMP-2 and pro-MMP-9 were detected by zymography in VA,VV and NSV but only MMP-2 activity was demonstrable. CONCLUSIONS The structural changes in the venous wall in addition to the increased expression of MMP-2, MMP-9 and MMP-13 in VA compared to NSV and VV suggests a possible causal role for these MMPs in their pathogenesis.
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Affiliation(s)
- Chance Irwin
- Division of Vascular Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Min SI, Jung IM, Chung JK, Heo SC, Ahn YJ, Hwang KT, Choi YH, Chang MS, Ha J, Kim SJ. A nontraumatic, noniatrogenic pseudoaneurysm of the cephalic vein presenting as an upper arm mass. Ann Vasc Surg 2008; 22:575-8. [PMID: 18462917 DOI: 10.1016/j.avsg.2008.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 01/15/2008] [Accepted: 02/13/2008] [Indexed: 10/21/2022]
Abstract
We report a case of pseudoaneurysm of the cephalic vein which was diagnosed in a 13-year-old boy who presented with a superficial mass in the right upper arm. The patient had no history of trauma, venipuncture, or intravenous drug addiction. Ultrasonic examination revealed a defect in the anterior wall of the cephalic vein and a surrounding vascular pool which included the inner thrombus. The mass was easily peeled off and completely excised after ligation of the afferent and efferent cephalic vein. Pathologic examination revealed it to be a pseudoaneurysm of the cephalic vein. This may represent the first case of venous pseudoaneurysm in the English-language medical literature without causative preceding events. Clinical features, including etiology, diagnosis, treatment, and complications, of this extremely rare lesion are also discussed.
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Affiliation(s)
- Sang Il Min
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, South Korea
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Ghekiere O, Galant C, Vande Berg B. Intravenous pyogenic granuloma or intravenous lobular capillary hemangioma. Skeletal Radiol 2005; 34:343-6. [PMID: 15565332 DOI: 10.1007/s00256-004-0860-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Revised: 08/18/2004] [Accepted: 08/18/2004] [Indexed: 02/02/2023]
Abstract
Lobular capillary hemangioma is a vascular neoplasm that commonly occurs as a cutaneous tumor. When it involves the skin and mucosal surfaces, ulceration and suppuration may occur, hence the classic term of pyogenic granuloma. Intravenous pyogenic granuloma is a rare solitary form of lobular capillary hemangioma that usually occurs in the veins of the neck and upper extremities. We report the ultrasonographic and magnetic resonance imaging findings of a pyogenic intravenous granuloma localized in the right cephalic vein. The imaging and pathological findings and the differential diagnoses are discussed.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Cliniques Universitaires St. Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Menon KR, Schilders E, O'Connor P, Gibbon WW. Traumatic false aneurysm of a saphenous vein tributary in a cricketer. Am J Sports Med 2003; 31:1017-8. [PMID: 14623675 DOI: 10.1177/03635465030310060501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Kavitha Ravindra Menon
- Department of Orthopaedics and Trauma, Bradford Teaching Hospitals, Bradford, United Kingdom
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Abstract
This is a report of a 71-year-old woman who presented with a superficial soft tissue mass in the antecubital fossa. Excision was undertaken under local anaesthesia. The lesion proved to be a primary aneurysm of the basilic vein. Reviewing the literature we found only a few previous reports of primary venous aneurysms in the upper extremities.
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Krinsky G, Johnson G, Rofsky N, Shapiro R, Yang B, Weinreb J. Venous aneurysms: MR diagnosis with the "layered gadolinium" sign. J Comput Assist Tomogr 1997; 21:623-7. [PMID: 9216771 DOI: 10.1097/00004728-199707000-00019] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our goal was to present MR findings in venous aneurysms and introduce the "layered gadolinium" sign as an ancillary diagnostic finding. METHOD Gadolinium-enhanced MR images of three patients with retroperitoneal venous aneurysms were retrospectively reviewed. Prior to MRI, venous aneurysm had been suspected clinically in only one patient. Surgical correlation was available in one patient. A phantom was constructed and imaged to investigate the cause of the layered gadolinium sign. RESULTS A gradation of signal intensity, the layered gadolinium sign, was observed in three patients with venous aneurysms on postcontrast T1-weighted images. The anterior portion of the aneurysms demonstrated high signal intensity separated by a sharp interface from the low signal intensity posterior region. Unenhanced time-of-flight MR venography, color Doppler, and duplex sonography failed to demonstrate flow in the patient with surgical proof. CONCLUSION The layered gadolinium sign may be helpful in the diagnosis of venous aneurysm and in differentiating these masses from solid neoplasms.
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Affiliation(s)
- G Krinsky
- Department of Radiology, New York University Medical Center, New York 10017, USA
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