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Müller JV, Ramires ED, Schimit GTF, Kasuya FVB, Ramires LA. Penetrating injury of the common femoral vein followed by local deep vein thrombosis: A case report. Trauma Case Rep 2024; 50:100985. [PMID: 38464485 PMCID: PMC10924122 DOI: 10.1016/j.tcr.2024.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/12/2024] Open
Abstract
This case report discusses a unique scenario in which a 19-year-old patient with a penetrating wound in the common femoral vein developed deep vein thrombosis in response to life-threatening bleeding. The report highlights our thoughts on managing an isolated truncal venous injury leading to deep vein thrombosis, emphasizing the significance of surgical exploration in vascular trauma and the feasibility of employing non-invasive imaging diagnosis in preoperative planning.
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Dias NH, Gomes DR, de Oliveira ACT, Pellegrini JAS, Boniatti MM. Prognostic value of Doppler waveform analysis of common femoral vein in septic patients: a prospective cohort study. J Ultrasound 2023; 26:871-877. [PMID: 37603258 PMCID: PMC10632248 DOI: 10.1007/s40477-023-00819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES To assess whether there is an association between abnormal common femoral vein (CFV) Doppler waveform and intensive care unit (ICU) mortality in patients with sepsis. METHODS Patients admitted to the ICU with sepsis were included. Pulsed-wave Doppler was performed by examining the CFV in the short axis without angle correction and in the long axis with angle correction. An abnormal CFV Doppler waveform was determined by a retrograde velocity peak (RVP) > 10 cm/s in the long axis or RVP > 50% of the antegrade velocity peak in the short axis. TAPSE < 17 mm was defined as right ventricular (RV) dysfunction. The primary outcome was ICU mortality. RESULTS One hundred and ten patients were included. There was no association between abnormal CFV Doppler waveforms in the long (p = 0.709) and short axes (p = 0.171) and ICU mortality. TAPSE measurements were performed in 16 patients. RV dysfunction was identified in 8 (50.0%) patients. There was no association between the diagnosis of RV dysfunction based on TAPSE measurement and the identification of abnormal CFV Doppler waveforms in the long axis (p = 1.000) and in the short axis (p = 1.000). CONCLUSION Abnormal CFV Doppler waveforms were not associated with ICU mortality in patients with sepsis. Furthermore, in the exploratory analysis, these alterations were not useful in identifying RV dysfunction in these patients.
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Affiliation(s)
- Nathalia Helbig Dias
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | | | | | | | - Márcio Manozzo Boniatti
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Torres-Arrese M, Mata-Martínez A, Luordo-Tedesco D, Casasola-Sánchez GG, Montero-Hernández E, Cobo-Marcos M, Tejeda-Jurado F, Berrocal-Espinosa P, Martínez-Ballester JF, Tung-Chen Y. Role of the Femoral Vein Doppler in Acute Heart Failure Patients: results from a prospective multicentric study. Rev Clin Esp 2023:S2254-8874(23)00054-1. [PMID: 37088380 DOI: 10.1016/j.rceng.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of our study is to define the role of Pulsed-Doppler (PW-Doppler) Ultrasound of the Common Femoral Vein (CFV) in the assessment of dilatation Inferior Vena Cava (IVC), probability of Pulmonary Hypertension (PH), Tricuspid Regurgitation (TR), and Tricuspid annular plane systolic excursion (TAPSE). METHODS This is a prospective two-hospital study in 74 patients admitted with acute heart failure (AHF). We performed PW-Doppler ultrasound of the common femoral vein, Point of Care (POC) cardiac ultrasonography and assessment of the IVC at the time of admission, as well as PW-Doppler and ultrasound of the IVC at hospital discharge. RESULTS The detection of a pulsatile flow (138 scans) had an excellent ROC curve for the detection of IVC greater than 2 cm (AUC 0.931, Sn 95%, Sp 90%, PPV 93%, NPV 94%) with an Odds Ratio (OR) of 211.2 (95% confidence interval 48.13-926.72). The pulsatility of the flow also had the highest performance in the detection of PH (AUC 0.8, Sn 95%, Sp 64%, PPV 84%, NPV 84%) and in the detection of moderate-severe TR (AUC 0.79, Sn 95%, Sp 67%, PPV 88%, NPV 78%). If the flow is continuous, we can reasonably rule out diminished TAPSE (NPV 89%). CONCLUSSION Detection of PW-Doppler flow of the CFV may be an alternative window for the detection of an IVC dilation of 2 cm, significant TR, and the likelihood of high PH in acute heart failure. It also allows us to reasonably rule out dysfunction of the right ventricle in cases of normality in these patients.
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Affiliation(s)
| | | | | | | | | | - Marta Cobo-Marcos
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | | | - Yale Tung-Chen
- Servicio de Medicina Interna, Hospital Universitario La Paz. Departamento de Medicina, Facultad de Medicina, Universidad Alfonso X El Sabio. IdiPAZ, Madrid, Spain.
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Lee JS, Kim SD. Surgical management for adventitial cystic disease of common femoral vein. Asian J Surg 2021; 44:1572-1573. [PMID: 34503872 DOI: 10.1016/j.asjsur.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jong Seok Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
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Labropoulos N, Giuliano KK, Tafur AJ, Caprini JA. Comparison of a nonpneumatic device to four currently available intermittent pneumatic compression devices on common femoral blood flow dynamics. J Vasc Surg Venous Lymphat Disord 2021; 9:1241-7. [PMID: 33540132 DOI: 10.1016/j.jvsv.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare common femoral vein blood flow enhancement during external mechanical compression using the novel, nonpneumatic Recovery Force Health Movement and Compressions (MAC) System (Recovery Force USA, Fishers, Ind), and four currently available intermittent pneumatic compression devices. METHODS The MAC device was compared with the Kendall SCD 700 (Cardinal Health, Dublin, Ohio), Arjo Huntleigh Flowtron ACS900 (Arjo, Malmö, Sweden), ActiveCare+S.F.T. (Zimmer Biomet, Warsaw, Ind), and Circul8 (Ortho8, Rocklin, Calif). Doppler ultrasound measurements for each device were directly obtained from the right common femoral vein by a registered vascular technologist. The peak flow velocity and the time taken to reach the peak were calculated. For the MAC system only, the subjects were asked to walk a minimum of 500 steps while wearing the system, which was then checked for slippage. Leg size measurements were obtained using the noncontact Sigvaris Legreader XT5 (Vialis Ortopedia, Turin, Italy). The MAC device is not yet commercially available, and the present study was a prequel to clinical studies of venous thromboembolism prevention. RESULTS We recruited a broad range of 20 subjects who varied in age (mean ± standard deviation [SD], 50.5 ± 16.2 years), body mass index (mean ± SD, 26 ± 5.5 kg/m2), gender (male, 25%; female, 75%), and right calf circumference (mean ± SD, 37.2 ± 5.5 cm). The peak flow velocity compared with the baseline measurements was significantly greater for the Recovery Force Health MAC System for three (Kendall SCD 700, P = .02; ActiveCare+S.F.T., P = .003; Circul8, P < .001) of the four comparisons. Although the difference was not significant, the Arjo Huntleigh Flowtron ACS900 (SD, 3.4 cm/s) had more measurement variability in the peak flow velocity compared with baseline than did the MAC System (SD, 1.9 cm/s). The MAC had a significantly (P < .001) faster rise time to peak flow compared with the comparison devices. It was the only device to achieve the target peak flow velocity over baseline of at least three times in every body mass index group. Finally, the MAC System met the goal of <2.5 cm of movement after ambulation in 100% of the measurements, with 75% of the measurements showing no movement. CONCLUSIONS The MAC System is a mobile device that remained in place during ambulation and provided more consistent external mechanical compression in the desired range compared with the other three devices included in the present study.
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Moeri L, Lichtenberg M, Gnanapiragasam S, Barco S, Sebastian T. Braided or laser-cut self-expanding nitinol stents for the common femoral vein in patients with post-thrombotic syndrome. J Vasc Surg Venous Lymphat Disord 2020; 9:760-769. [PMID: 32890743 DOI: 10.1016/j.jvsv.2020.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic obstruction of the common femoral vein in patients with post-thrombotic syndrome after iliofemoral or iliocaval deep vein thrombosis has remained a challenge for endovascular treatment. The patency rates and clinical outcomes of laser-cut and braided nitinol stents extending to the common femoral vein have not yet been studied. METHODS From the Swiss and Arnsberg Venous Stent Registries, we included 150 patients with post-thrombotic syndrome (mean age, 44 ± 16 years; 48% women) with laser-cut (n = 101) or braided nitinol (n = 49) stents placed into the common femoral vein across the inguinal ligament. Routine follow-up included duplex ultrasound examinations and assessment of clinical scores. The primary study outcomes were the primary and secondary patency rates at 12 months. RESULTS Overall, the mean number of implanted stents was 2.6 ± 1.7. The proximal stent landing zone was the inferior vena cava in 32 patients (21%), the iliac vein in 106 patients (76%), and the common femoral vein in 5 patients (3%). The primary patency rate was 67.3% (95% confidence interval [CI], 58.0%-76.6%) in the laser-cut group and 86.7% (95% CI, 75.3%-98.1%) in the braided stent group (log-rank, P = .016). The corresponding secondary patency rates were 93.9% (95% CI, 89.2%-98.6%) and 100% (log-rank, P = .10). The median improvement in the Villalta score from baseline to the latest follow-up was 4 points (interquartile range, 2-6 points), without significant differences between the two groups. Symptomatic common femoral vein stent fractures were observed in four patients (4%) with laser-cut stents but in no patient with braided stents. CONCLUSIONS The use of braided nitinol stents for common femoral vein obstruction appeared to be associated with favorable primary patency rates at 12 months compared with laser-cut nitinol stents. Further studies are needed to confirm that braided nitinol stents remain patent and might be less prone to fractures in the long term.
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Affiliation(s)
- Laura Moeri
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Tim Sebastian
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
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Behzadi AH, Khilnani NM, Zhang W, Bares AJ, Boddu SR, Min RJ, Prince MR. Pelvic cardiovascular magnetic resonance venography: venous changes with patient position and hydration status. J Cardiovasc Magn Reson 2019; 21:3. [PMID: 30602387 PMCID: PMC6317255 DOI: 10.1186/s12968-018-0503-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To determine the effect of hydration as well as prone versus supine positioning on the pelvic veins during cardiovascular magnetic resonance (CMR) venography. METHODS Under institutional review board approval, 8 healthy subjects were imaged with balanced steady state free precession, non-contrast CMR venography to measure common and external iliac vein volumes and common femoral vein cross-sectional area in the supine, prone and decubitus positions after dehydration and again following re-hydration. CMR venography from 23 patients imaged both supine and prone were retrospectively reviewed and measurements of common femoral and iliac veins areas were compared using Wilcoxon test. RESULTS Common femoral vein area on CMR venography increased with prone positioning (83 ± 35 mm2) compared to supine positioning (59 ± 21 mm2) (p = 0.02) and further increased with hydration to 123 ± 44 mm2 (p < 0.01). With right and left side down decubitus positioning, the common femoral vein area on dehydration increased from 29 ± 17 mm2 in the ante-dependent position to 134 ± 36 mm2 in the dependent position (p < 0. 001). Similarly, common and external iliac veins increased in volume with prone, 5.4 ± 1.9 cm3 and 5.8 ± 1.9 cm3 compared to supine positioning 4.6 ± 1.8 cm3 and 4.5 ± 1.9 cm3 (p = 0.01) and further increase with hydration to 6.7 ± 2.1 cm3 and 6.3 ± 1.9 cm3 (p = 0.01). CMR venography on patients also demonstrated an increase in mean common femoral vein luminal area from 103 ± 44 mm2 in supine position to 151 ± 52 mm2 with prone positioning (p < 0.001) as well as increases in common and external iliac vein volumes from 6.5 ± 2.6 cm3 and 8.0 ± 3.4 cm3 in the supine position to 7.5 ± 2.5 cm3 and 9.3 ± 3.6 cm3 with prone positioning (p < 0.01). CONCLUSIONS Common femoral and common/external iliac vein size on CMR venography may be affected by position and hydration status. Routine clinical CMR venography of the pelvis could include prone positioning and avoiding dehydration to maximize pelvic vein distension.
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Affiliation(s)
- Ashkan H Behzadi
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Neil M Khilnani
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Weiguo Zhang
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Amanda J Bares
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Srikanth R Boddu
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Robert J Min
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical Center, 416 East 55th Street, New York, NY, 10022, USA.
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Bechsgaard T, Hansen KL, Brandt AH, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Nielsen MB, Jensen JA. Respiratory variability of peak velocities in the common femoral vein estimated with vector flow imaging and Doppler ultrasound. Ultrasound Med Biol 2018; 44:1941-1950. [PMID: 29960752 DOI: 10.1016/j.ultrasmedbio.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
Respiratory variability of peak velocities (RVPV) in the common femoral vein measured with ultrasound can reveal venous outflow obstruction. Pulse wave (PW) Doppler is the gold standard for venous velocity estimation of the lower extremities. PW Doppler measurements are angle dependent, whereas vector flow imaging (VFI) can yield angle-independent measures. The hypothesis of the present study was that VFI can provide RVPV estimations without the angle dependency of PW Doppler for an improved venous disease assessment. Sixty-seven patients with symptomatic chronic venous disease were included in the study. On average, VFI measured a lower RVPV than PW Doppler (VFI: 14.11 cm/s; PW: 17.32 cm/s, p = 0.002) with a non-significant improved precision compared with PW Doppler (VFI: 21.09%; PW: 26.49%, p = 0.08). In a flow phantom, VFI had improved accuracy (p < 0.01) and equal precision compared with PW Doppler. The study indicated that VFI can characterize the hemodynamic fluctuations in the common femoral vein.
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Affiliation(s)
- Thor Bechsgaard
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark.
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Andreas Hjelm Brandt
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Ramin Moshavegh
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen K, Denmark
| | - Pia Føgh
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lotte Klitfod
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Niels Bækgaard
- Department of Vascular Surgery, Rigshospitalet & Gentofte Hospital - Copenhagen University Hospital, Hellerup, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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Shaydakov ME, Diaz JA. Endovascular Today: Give Me a Narrowing in the Venous System, and I Shall Stent It. Eur J Vasc Endovasc Surg 2018; 56:255. [PMID: 30100018 DOI: 10.1016/j.ejvs.2018.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Jose A Diaz
- Department of Surgery, Section of Vascular Surgery, Conrad Jobst Research Vascular Laboratories, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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