Phlebologie最新文献

Intraoperative angioscopy was applied to evaluate the venous valvular incompetence and perform external valvuloplasty in case of venous reflux. Sixty-seven limbs, 43 cases of primary varicose veins were examined using intraoperative angioscopy and the angioscopic findings of the incompetent venous valves were classified into three types as follows: valves with elongated and atrophic cusps 43 (50%)--type I, values with expanded and depressed commissures 36 (42%)--type II, and valves with perforated cusps or other changes 7 (8%)--type III, according to the angioscopie findings, external valvuloplasty was done in 31 subterminal valves of the long saphenous veins and 7 highest valves of the superficial femoral vein. Our external valvuloplasty consisted of two techniques. The first was the total plication technique for valvular annulus by a running suture of prolene and the second was by the venocuff sleeve of the autogenetic femorofascial band. The degree of plication was decided by angioscopic observation. Postoperative observation periods were from 2 to 28 months. There was no recurrence of varicose veins or prominent venous reflux. The application of intraoperative angioscopy is therefore useful for the choosing appropriate surgical procedures and for the evaluation of venous valvuloplasty.

Unlabelled: The venous confluence syndrome is the clinical consequence of the flows obstruction which are the main tributary of the deep venous system. The cava confluence syndrome is different from the aortic obstruction at the level of its bifurcation. Its causes are congenital abnormality, extrinsic, intrinsic and intramural compression.

Clinical picture: collaterization of the int. vertebral plexus of the Azigos and hemiozygos veins as well as episgastric and thoracic veins, in chronic cases. On the other hand, in acute cases, significant renal insufficiency, ascites and bilateral phlegmasia caerulea make up the clinical picture. In acute stage, surgery requires thrombectomy and endovascular prothesis whereas in chronic stage, surgery will tend to remove the cause with only a palliative action on external symptoms. In both cases, abnormalities bring about a surgical issue.

The authors report two recent observations of thrombophlebitis of the right ovarian vein. The first occurred after a cesarotomy, due to a bigeminal pregnancy, and the second, after a breech delivery. The diagnosis was given when faced to a febrile syndrome and pains of the right flank and confirmed in both cases by an abdominal tomodensimetric examination. In both cases, an enlargement of the lower vena cava thrombosis was observed with a floating clot that reached the renal veins. Both patients underwent a surgery. The latter consisted in both cases in a thrombectomy of the lower vena cava as well as a ligature of the right ovarian vein. In both cases, the evolution was positive, thanks to a remote-control of the lower vena cava via tomodensimetry. This therapeutic procedure and other potential therapies were discussed.

Aim: a 7 F percutaneous cava filter was achieved, developed and tested in a goat. Thanks to its double-spiral original form, it is possible to place and remove it atraumaticaly and percutaneously. PRINCIPLES OF THE FILTER: its diameter, larger than the lower vena cava's (LVC) leads to a flattening of the venous lumen whose flow is intersected by the filter turns, thus creating a netting effect.

Case-report: during 28 months, 40 filters were introduced under fluorscopy in 20 goats. Thanks to 16 embolizations, it was possible to test the effectiveness of the filter against small emboli, with simultaneous cavography and pulmonary angiography in 4 cases. 29 filters were removed by jugular and femoral track, from D0 to D14. 12 goats were sacrificed to investigate histologicaly and macroscopicaly the LVC and control the biocompatibility from the 8th to the 385th day. Clinical and radiological supervision lasted more than one year for 3 goats.

Results: the size of the filter (30, 35, 40 mm) is chosen from the LVC diameter measured by cavography. 30 filters were introduced via jugular vein, 10 via femoral vein. These filters were introduced by catheter 7F thanks to an applicator and placed in correct position in the LVC. RELIABILITY OF THE FILTER: easy percutaneous introduction 7F. Once installed, the filters flatten the LVC; this process is automatically confirmed by cavography, and by scanning in 4 cases. EFFECTIVENESS AGAINST EMBOLI: out of 16 cases, 2 partial failures were observed at the beginning of the experiment (one spiral-fitted filter). Its effectiveness was optimized thanks to the addition of a second spiral which allowed the blocking of over-2 mm clots. PERCUTANEOUS REMOVAL: during the initial removals, partial failures were due to the fragility of the filter and the inflexibility of the extracting material. Successive changes of the shape and the alloy of the filter as well as the development of catheters and extracting materials have led to a sufficient reliability to remove (D0 to D14) the filter in security, by percutaneous tract (9 jugular, 9 femoral) before its clamping on the LVC, on the 15th day. INNOCUOUSNESS: both biological supervision and anatomo-pathological investigation have showed the good tolerance of the filter. In local areas, this atraumatic filter does not wound nor perforate the LVC wall. Histologically, a thickening of the intima is observed. The positive results of this experiment led us to start clinical trials of "DM" filter in human beings.

5 cases of phlegmatia caerula dolens have been observed after the fixation of a cava blocking. You will find below the characteristics of the case reports: Mean age of patients: 69.2, from 55 to 83. Early phlegmatiae caeruleae dolens: 2 cases; late phlegmatiae: 3 cases (3 and 4 years after the cava ligature). Clinical context: advanced age; general state alteration 1 case; artery predisposition: 2 cases; heparin thrombopenia: 1 case. Responsible material: ombrelle de Mobin Uddin: 3 cases; Adams-De Weese's Clip: 2 cases. Current filters are probably less thrombogenous. Nevertheless, these case reports make us aware of the fact that in case of predisposition and/or in case of precary hemodynamic conditions, any factor likely to generate or worsen a venous stasis can originate (immediately or later) a significant thrombosis and, particularly in a few conditions, a phlegmatia caerulea dolens. Consequently, partial cava blocking indications must be seriously taken into consideration and saved for cases in which embolic risk is patent.

The vena cava that has a preferential flattening axis, has also 2 wall sides and 2 borders. The back wall fits closely round on the back vertebral plane and the main colaterals terminate on the borders of the vein. TM echography perfectly analyses the movements of the walls of the vein, as well as the respiratory and auricular movements. In a lying patient, echo-doppler colour shows the expiratory acceleration of the vena cava flow in subrenal area associated with an inspiratory slowing down (as well as for the femoral veins) and the inspiratory acceleration of the flow in suprarenal area associated with an expiratory slowing down. In a standing patient, the vena is cylindrical. When he/she walks on a treadmill, the diameter of the cava seems to be constant, i.e. quasi identical to the aorta's, as fluxes vary in the aorta according to the ventricular contractions and in the LVC according to the patient's gait.

The spermatic vein is tributary at the right of the infra-renal cava mainstem and at the left of the renal vein. It is fitted with an ostium or pre-ostium valvula which is normally tight. In the broad ligament of the uterus, the ovarian vein exchanges plexiform anastomosi with the homolateral or contralateral uterine vein through pre- or retro-uterine arches. The spermatic or ovarian reflux is more frequent on the left. Retrograde venography under cava occlusion is a good means to explore these vessels. The big Azygous vein joins the sub-renal vena cava by two roots. The internal root, which is often slender, perforates vertically the dialitic membrane. The external root, bigger, is the vein in L2; the lateral part of its track takes place in the psoas where it gains veins proceeding from the foramina of the adjacent conjugations. On the left side, the roots of the hemi-Azygos appear most frequently in the left-renal vein. There may be a single root: the external root is the Lejars' arch. The variations of the derivative cavo-cava system represented by the Azygos veins are studied on the anatomical plan. Pathological literature complements this study.

The sub-renal abnormalities of the lower vena cava (LVC) (left LVC, double LVC) are determined by a deterioration of the alteration process of supra-cardinal veins. Though they are rare, it is necessary to look for them during surgery of abdominal aorta in order to lower the risk of iatrogenic venous injuries. You will find below the description of six cases of sub-renal lower vena cava abnormality (3 double LVC, 3 left LVC) associated with an abdominal aorta aneurism (4 non specific aneurisms, 2 inflammations ones) as well as the diagnostic aspects and the technical issues they cause during the reconstruction of a non specific and inflammation aneurism of the abdominal aorta.

Large veins LMS is a rare slow growing malignant tumor originating from smooth muscle cells of the media. The authors report a case of LMS of the left common iliac vein propagating to the Inferior Vena Cava that presented with a left femoral-iliac deep thrombophlebitis. CT scan showed an uneven solid mass approximately 5 cm large within the left side of the pelvis. The mass displaced the left iliac artery and compressed the left iliac vein without a significant cleavage surface between the mass itself and the vascular structures. Location was next to the spine, medially and anteriorily to the psoas muscle. A thrombosis could be noticed within the distal segment of the inferior Vena Cava and within the proximal segment of the left iliac vein. US scan with fine needle biopsy of the mass didn't yield significant information. At surgical exploration a neoplastic mass involving and blocking the left iliac vein was found. Veinotomy performed on the iliac vein and on the distal segment of the Inferior Vena Cava but without infiltration of the vein walls. Surgical treatment consisted of asportation of the neoplastic mass, resection of the left iliac vein and thrombectomy of the Inferior Vena Cava. Histologic examination of the operated specimen revealed a mixoid LMS with vascular origin without involvement of the surrounding lymph nodes. Absence of clinical and radiological signs of relapse eight months after surgery makes further surgical and complementary (drug- and radiotherapy) treatments currently unnecessary.