Deep Femoral Vein Research Articles

CT Angiographic Evaluation of Congenital Anastomoses between Femoropopliteal Vein and Deep Femoral Vein: Types and Incidence.

To evaluate congenital anastomotic channels between femoropopliteal veins and deep femoral veins with the use of computed tomographic (CT) venography. CT venography of 488 limbs in 244 patients (105 men; mean age, 61 y; age range, 18-96 y) performed between January 2016 and December 2016 was retrospectively evaluated. The presence or absence of anastomotic channels (> 3 mm in diameter) connecting a femoropopliteal vein to a deep femoral vein was determined, and the observed channels were classified based on their location and course. Two types of anastomotic channels were observed in 32 patients (13%): a persistent sciatic vein (PSV) in 24 limbs of 15 patients (6%) and a retrofemoral channel (RFC) in 22 limbs of 19 patients (8%). A PSV anastomosed with the popliteal vein in the popliteal fossa, coursed posterior to the adductor magnus muscle, and drained into the deep femoral vein. An RFC anastomosed with the femoral vein at the level of the adductor hiatus, coursed posterior to the femoral shaft, and drained into the deep femoral vein. PSVs and RFCs were of similar size or larger than adjacent femoropopliteal veins in 50% (12 of 24) and 22% of limbs (4 of 22), respectively. Anastomotic channels connecting a femoropopliteal vein to a deep femoral vein are not a rare variation and may have an important role in collateral venous drainage of the lower extremities.

2563 When Considering a Broad Differential to Diarrhea and Joint Pain: Don't Forget About Whipple's Disease

INTRODUCTION: Whipple's disease (WD) is a rare systemic disease caused by bacteria Tropheryma whipplei and commonly overlooked as a diagnosis. CASE DESCRIPTION/METHODS: A 42-year-old man presented to the ED for intolerance chronic of diarrhea, lower extremity swelling, paresthesia, migratory monoarticular arthralgia, and weakness. Over 2 years he lost 60-pounds and had early satiety, intermittent dysphagia, and decreased concentration. Physical exam was remarkable for a scaphoid abdomen with mild diffuse tenderness, knee joint tenderness, lower extremity strength 4/5. Labs abnormalities: hemoglobin 6.5 g/dL, albumin 1.9, 25-OH vitamin D 5 ng/mL (nml > 30 ng/mL), CRP 25.4 mg/L. Bilateral lower extremity ultrasound showed a blood clot in the right deep femoral vein and bilateral baker's cysts. Colonoscopy and EGD examinations were unrevealing. Histologic exam of duodenum biopsies showed dilated fat vacuoles and a positive periodic acid-Schiff (PAS) stain confirming Whipple's Disease. Cerebrospinal fluid was negative and cognitive changes improved with electrolyte replacement. He was treated with a 14-day course of intravenous ceftriaxone followed by Bactrim doubled-strength twice a day. After intravenous antibiotics, the diarrhea resolved and he regained weight. DISCUSSION: WD most commonly affects men (86%), farmers (35%), and those with occupational exposure to soil or animals (66%). Transmission is thought to be fecal-oral since sewage workers are more prevalent carriers. Common symptoms are weight loss, arthralgia, diarrhea, and abdominal pain. Arthralgia is the sentinel symptom preceding others by ∼6 years. Less common include skin hyperpigmentation, endocarditis, and CNS symptoms (severe disease). Three diagnostic tests exist: PAS-staining, PCR of the 16S ribosomal RNA of T. whipplei, and immunohistochemistry (IHC) via rabbit anti-T. whippleiantibodies. Diagnostic criteria include: 1) small intestine biopsies positive on PAS stain for bacillus material in the lamina or 2 positive tests from other origins. Initial testing is done with EGD and duodenal biopsies submitted for PAS staining and PCR testing ± IHC. If extraintestinal symptoms, PAS staining and PCR testing ± IHC on tissue or fluid samples. CSF should be tested by PCR in all cases. After diagnosis, treatment starts with a 2-week course of IV of antibiotics (4 weeks if CNS infection or endocarditis) followed by one year of Bactrim. Relapse occurs in 17-35%, years later.

2475 Polycystic Liver Disease Causing Inferior Vena Cava Compression and Venous Thromboembolism

INTRODUCTION: Polycystic Liver Disease (PLD) is a rare disorder that can be diagnosed in patients with greater than 10 fluid filled-cysts identified on imaging. PLD is associated with two genetic disorders autosomal dominant polycystic liver disease and autosomal dominant polycystic kidney disease. Since PLD is uncommon, it is difficult to study both the natural history of the disease and treatment modalities. We present a case of a massive hepatic cyst in a 95-year-old patient with polycystic liver disease that led to inferior vena cava compression and venous thromboembolism. CASE DESCRIPTION/METHODS: A 95-year-old male with past medical history of colon cancer status-post resection twenty-five years ago, with no subsequent recurrence and hemorrhagic hepatic cyst, two months prior, presented for evaluation of abdominal distension, lower extremity edema and shortness-of-breath. Physical exam was remarkable for a firm distended abdomen with hepatomegaly and bilateral lower extremity pitting edema. Laboratory evaluation showed a hemoglobin of 8.6 mg/dL, with a baseline hemoglobin of 8.0 mg/dL on prior admission. An abdominal CT scan showed numerous hepatic cysts with an enlarging right hepatic lobe cyst, measuring 25 × 25 × 30 cm, with interval resolution of blood products within the cyst, and an incidentally noted pulmonary embolism in the right lower lobe. The size of the cyst led to compression of the inferior vena cava and displacement of the right kidney. Ultrasound revealed that it was multiseptated in nature. Image-guided drainage and catheter placement was performed, revealing 5.7 liters of clear brown fluid. Cytologic evaluation revealed no evidence of malignancy and aerobic and anaerobic cultures showed no growth. A duplex ultrasound of the lower extremities exhibited acute thrombus of the left deep femoral vein and sluggish flow throughout all vessels. Given the patient's prior hemorrhage, anticoagulation was contraindicated and an inferior vena cava filter was placed. At the time of filter placement, the cyst had decreased in size and sclerotherapy was performed. The patient felt substantial improvement in his dyspnea and abdominal distension and was discharged home with plans for sclerotherapy as an outpatient. DISCUSSION: PLD is a rare disorder which makes the natural history difficult to define. Our case further clarifies the association of PLD with external compression of the inferior vena cava. It adds data to the literature by illustrating the complication of venous thromboembolism.

Significance of Partial or Complete Thrombosis of the Common and Deep Femoral Vein in Patients With Deep Vein Thrombosis

The aim was to assess the anatomical distribution of acute deep venous thrombosis (DVT) with a focus on iliofemoral DVT, and, in particular, to characterise thrombus in the common femoral vein (CFV) and the deep femoral vein (DFV). A one year prospective study including patients older than 18 years of age with an acute first time DVT according to ultrasound examination at one of three university hospitals in Copenhagen, Denmark. Thrombus location and extent were registered and divided into five segments: calf veins; popliteal vein; femoral and deep femoral vein; common femoral vein; and iliac veins and/or the inferior vena cava. Thrombus appearance of the CFV and the DFV (partial or occlusive) was examined in detail. Acute DVTs were identified in 203 extremities in 200 patients (58% male). The median age of the patients was 68 years (range 19-92 years), and left-sided DVT was observed in 56%. Iliofemoral DVT was present in 54 (27.0%) patients. Thrombus involving the CFV but not the iliac veins (CFV group) was seen in 28 patients; the remaining 26 had involvement of the iliac veins (iliac group). Thrombus in the CFV was more likely to be occlusive in the iliac group than in the CFV group (77% vs. 4%; p<.001). Thrombus in the DFV was more often occlusive in the iliac group than in the CFV group (81% vs. 11%; p<.001). The DFV was free of thrombus in 12% of patients in the iliac group and in 64% of those in the CFV group. The presence of occlusive thrombus in the CFV and/or in the DFV pointed to a DVT also involving the ipsilateral iliac veins. Thrombosis of the deep leg veins extending into the CFV below the inguinal ligament was more likely to be partial in the CFV, mainly due to inflow from the DFV.

Analysis of effect by different air pressure treatment time on prevention of deep venous thrombosis of the lower extremity in severe chronic bedridden patients

Objective To explore the effect of different air pressure treatment time on preventing deep vein thrombosis in severe chronic bedridden patients. Methods This is a prospectie, randomized and controlled study. A total of 120 patients with severe chronic bedridden were randomly divided into normal group and experimental group 1, group 2, with 40 cases in each group. The normal group received 30 min every time, and group 1 received 1h,and group 2 received 2h. To observe the incidence of DVT within 15 days, the blood flow velocity of deep femoral vein before and after the first treatment, and the incidence of deep tissue injury. Results There was no significant difference in the incidence of DVT among the three groups (P> 0.05), but the incidence of DVT in test group 1 was 5.0% (2/40), 2.5% (1/40) and 12.5% (5/40) compared with the conventional group. Compared with before treatment, the blood flow velocity of deep femoral vein in the three groups increased significantly after treatment (t=1.475、t=2.881、t=4.027, all P < 0.05), but after treatment, the blood flow velocity of deep femoral vein in the conventional group (20.41±1.37) ml/s, the experimental group 1 and the experimental group 2 were (22.39±2.22) ml/s and (22.51±1.73) ml/s, respectively, which were significantly faster than that of the conventional group. There were significant differences (t= 3.086、t= 3.662, all P < 0.05).(3) The incidence of deep tissue injury in experimental group 2 was 20.0% (8/40), which was 2.5% (1/40) and 5.0% (2/40) higher than that in conventional group and experimental group 1 respectively (χ2=6.135、χ2=4.114, all P<0.05). Conlousion On the basis of conventional barometric therapy, it can be extended to 1 h/time, 3 times/d, which can significantly increase the blood flow velocity of deep femoral vein, reduce the incidence of DVT, and do not increase the incidence of skin pressure injury in patients with chronic bed-rest. It is worth popularizing and applying in clinic. Key words: Air pressure treatment; Severe chronic bedridden; Deep vein thrombosis

Catheter laser ablation of superficial veins of the lower extremities in the symptomatic treatment of venous reflux − comparison of the immediate results of two types of laser generators

ntroduction: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers. Methods: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (5−25 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) – used to operate on 630 patients – with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients. Results: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations. Conclusion: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser abla- tion of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

The deep femoral artery as a inflow source for distal reconstruction

Purpose of the study. To improve the treatment outcomes of patients with occlusion-stenotic lesions of the femoral-popliteal-tibial segment, long-term results of the profundafemorispopliteal autologous vein bypass surgery have been studied.&#x0D; Material and methods. In the surgical clinic of A. Novak Regional Clinical Hospital during the last 10 years has been performed 300 isolated profundoplasty at chronic limb ischemia. In 16 patients with deep femoral popliteal autologous vein bypass, a distal segment of arteria profunda femoris was used as the «tidal» artery, which varied from 0,51 to 0,63 in diameter (0,58 cm in average).&#x0D; Results. In the immediate and long-term follow-up period, no thrombosis of profunda femoris popliteal autologous vein shunt was observed in 5 years. The ankle-brachial pressure index after surgery increases almost twice and approaches 0,9 on posterior tabial artery. The mean profunda popliteal collateral index score decreased to 0,301 ± 0,099 in all patients after surgery. Ifwecomparethequalityoflifeafterprofunda femoris popliteal autologous vein reconstruction, it should be noted that the quality of life in our patients before the operation was 21,8 ± 4,9 points, after the operation − 45,6 ± 4,9 points.&#x0D; Conclusion. Profundafemorispopliteal autologous vein bypass by a length of up to 15 cm provides blood supply to the limb with stenoticocclusive lesions of the femoral-popliteal-tibial segment, with the passage of at least one artery of the leg and the arteries of the pedis.

Restoration of the donor site in face transplant through reconstruction and printing in third dimension: a form of donor dignity

Introduction: Face transplantation (CT) is a complex and innovative treatment that restores function, aesthetics and allows the social reintegration of patients with severe facial deformities (1). TC involves not only the development of anatomy-surgical techniques, but also the manufacture of a mask congruent with the donor site. Our experience in the manufacture of the mask with a third dimension (3D) technology for the dignification of the donor is presented. Presented at the 3rd World Congress of the UNESCO Chair for Teaching and Research in Digital Anatomy Paris Descartes at Egas Moniz University Institute - Almada, Portugal. Materials and methods: Stereo photometry technology was used, combining the obtention of geometric and photogrammetry calculations. With this, the donor site was scanned in a fraction of a second. Subsequently, various softwares were used, the surface mesh was calculated and a 3D model was generated. It was printed on PLA and ABS materials. Once the physical model was obtained, it was defined artistically. 24 hours later, the “mask” was placed on the donor site. Results: With the use of stereo photometry, the completion times were reduced from 2.5 hours to 1 minute to obtain the model, and 10 minutes to obtain the 3D printing file. The total time was 24 hours, also allowing a process of minimizing invasion for the 3D scanning of the donor site. A mask of punctual proportion was obtained to the donor site while retaining facial features. Figure 1. A,D) 3D facial reconstruction with stereophotometry technique. B,E) Representation of the 3D file optimized for 3D printing. The orange line shows the thickness of the printing layer. C) 3D printed donor site prosthesis, PLA material, unpainted. F) Final prosthesis. G) Donator of facial tissues. H) Dignification of cadaver with 3D printed mask. Figure 2. Venous arcades of the semi-membranosus muscle, bypassing the Hunter canal by their lower arcades (blue dots) connected into the popliteal vein (P) and their higher arcades (green dots) connected into the deep femoral vein.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations.

MEDICOLEGAL AND CLINICAL ASPECTS OF PERIPHERAL VASCULAR INJURIES: A RETROSPECTIVE STUDY

Background: Vascular trauma is one of the devastating types of injuries whether accidental or intentional. Despite this fact, there is an obvious deficiency in the educational sessions for vascular surgeons concerning the appropriate medicolegal dealing with such injuries. Aim: To report the experience of vascular limb trauma highlighting the medicolegal and clinical findings. Methods: A 5-years retrospective study with a follow up period of 1.5 years studying the data of peripheral vascular injuries at three specialized trauma centers with special emphasize on the cause, the type, and the outcome of this trauma in relation to sociodemographic factors. Obtained data were statistically analyzed using the SPSS computer program (version 23). Results: This study included 350 trauma patients (287 males and 63 females) who presented with peripheral vascular injuries. The patients’ age ranged from 50 years. There was a significant association between the age and the circumstances of trauma. The most encountered causative mechanisms were traffic accidents (45.7%) and firearms (21.7%). There was no significant association between outcome and age (p = 0.114) or circumstances of trauma (p = 0.208). There was a highly significant association between the outcome and the duration of hospital stay (p < 0.001). Lower limb injuries were higher in frequency than upper limb injuries (n = 286 and 123) respectively. Upper and lower limbs arterial injuries had a significantly higher frequency rate than the venous injuries. Ulnar artery and brachial vein injuries were the most frequently encountered upper limb arterial and venous trauma, while the femoral artery and the deep femoral vein were the most commonly affected lower limb vessels. Bone injuries were the most frequently accompanying injuries. (44.6% of total cases). Conclusion: As any sort of injury may possess medical and lawful perspectives, medicolegal investigations have to take the crown’s position when studying trauma cases, going hand in hand with the clinical aspect.

Effect of Etiology and Inflow on Outcomes of Endovascular Recanalization for Nonmalignant Inferior Vena Cava Occlusion

The aim of this study was to determine factors affecting outcomes of inferior vena cava (IVC) recanalization for nonmalignant obstruction, with focus on venous inflow and etiology of IVC occlusion. Data from consecutive patients undergoing IVC recanalization between January 2001 and December 2017 were retrospectively reviewed. Patients were grouped by etiology of IVC obstruction, including post-thrombotic (PT), retroperitoneal fibrosis (RPF), and hypoplasia (HP). Patency of the femoral, deep femoral, and great saphenous veins was evaluated; the venous inflow was graded, assigning a point to each for stenosis or occlusion, for a total possible unilateral score of 3 and a composite score of 6. A score of 6 indicated no inflow stenosis or occlusion, whereas a score of 0 indicated disease of all 6 inflow veins. Primary outcomes included primary, primary assisted, and secondary patency rates. There were 114 patients during the 18-year period (64% male; mean age, 42 ± 15 years). Etiology was PT in 96 (84%), RPF in 5 (5%), and HP in 13 (11%) patients. Clinical, Etiology, Anatomy, and Pathophysiology classes included 3, 4a, 4b, 5, and 6 in 23, 17, 3, 11, and 23 patients, respectively. Forty-four (38%) patients had an IVC filter, all of whom had PT etiology, and 33 (29%) had a thrombophilia. Inflow grading was 6 in 20 (18%), indicating no disease; 4 in 36 (32%); and 3 or less in 32 (30%). There was no mortality related to the procedure. Periprocedural complications occurred in 11% of patients. Median follow-up was 15.2 months (interquartile range, 6.4-35.8 months; maximum, 141.6 months). Kaplan-Meier analysis of primary, primary assisted, and secondary patency in the entire cohort at 1 year and 5 years was 78%, 85%, and 95% and 66%, 85%, and 95%, respectively. Early failures occurred in 12 PT, 2 HP, and 0 RPF patients (P = .94) No factors studied, including female sex, etiology of IVC occlusion, or thrombophilia, affected patency (P > .05). Median venous inflow in PT, RPF, and HP was 4, 5.5, and 5, respectively. Patients with grade 0 to 3 had patency rates similar to those of patients with grade 4 to 6 (P > .05). Presence of an IVC filter crushed aside during IVC stenting did not adversely affect stent patency. Midterm results of endovascular recanalization are excellent regardless of the etiology of IVC occlusion. This cohort was predominantly PT with small numbers of RPF and HP, resulting in insufficient statistical power to demonstrate the effect of venous inflow on patency.

Anatomic Dissection of the Femoral Vein at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm; 7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%; as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.

Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p < 0.001). The common femoral vein (CFV) was affected in 71.7% of cases. The superficial femoral vein (SFV) was affected in 71.7% of cases. The popliteal vein was affected in 67.4%. The deep femoral vein was affected only in 17.4%. Both CFV and SFV were affected together in 47.8% of cases. Both SFV and popliteal vein were affected together in 50% of cases. The majority of DVT cases (71.1%) were in the acute stage. This study revealed an essential relationship between the acute stage of DVT and distension of the affected veins (p < 0.001) (OR 20.667, 95% CI 3.826 - 111.633). It also detected a significant relationship between the acute stage and absence of venous blood flow (p < 0.001) (OR 90.667, 95% CI 8.303 - 990.114). Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

A numerical analysis of the effects of the lower-limb prosthetic socket on muscle atrophy of the residual limb

Muscle atrophy of the residual limb after lower-limb amputation is a disadvantage of amputees' rehabilitation. To investigate the biomechanics mechanism of muscle atrophy of the residual limb, we built a finite element model of a residual limb including muscle, skeletons and main vessels based on magnetic resonance images of a trans-femoral amputee, and studied the biomechanics effects of the socket of the lower-limb prosthesis on the soft tissue and vessels in the residual limb. It was found that the descending branch of the lateral femoral circumflex artery suffered the most serious constriction due to the extrusion, while that of the deep femoral artery was comparatively light. Besides, the degree of the constriction of the descending branch of the lateral femoral circumflex vein, femoral vein and deep femoral vein decreased in turn, and that of the great saphenous vein was serious. The stress-strain in the anterior femoral muscle group were highest, while the stress concentration of the inferior muscle group was observed at the end of the thighbone, and other biomechanical indicators at the inferior region were also high. This study validated that the extrusion of the socket on the vessels could cause muscle atrophy to some degree, and provided theoretical references for learning the mechanism of muscle atrophy in residual limb and its effective preventive measures.

Reverse Lemierre\u2019s syndrome: a case report

We present the case of a 60-year-old diabetic who had acute-onset shortness of breath that was preceded by bilateral thigh and hip pain. He was initially admitted for septic arthritis with community-acquired pneumonia. His respiratory complaints resolved, but he continued to have thigh pain. Ultrasound of the lower limbs showed thrombosis of the deep veins of the thigh and MRI showed a collection in the right thigh suggestive of pyomyositis with thrombosis in deep veins abutting the collection. Contrast enhanced CT (CECT) chest showed multiple peripherally located pneumatoceles and cavities in both the lungs suggestive of septic emboli. Here, we present a case of pyomyositis of thigh muscles causing Deep vein thrombosis (DVT) and septic pulmonary emboli (reverse Lemierre’s syndrome).

Isolated proximal greater saphenous vein thrombosis and the risk of propagation to deep vein thrombosis and pulmonary embolism

ObjectivesGreater saphenous vein (GSV) thrombosis is concerning due to its close proximity to the deep femoral vein. This study sought to identify the risk of propagation to deep vein thrombosis (DVT) or pulmonary embolism (PE) among patients with isolated proximal GSV superficial thrombosis and describe provider practice patterns related to treatment.Materials and methodsThis is an Institutional Review Board-approved retrospective multi-center study. Patients presented to one of three possible emergency departments in a large health system. About 21,716 patients were queried through the electronic medical record. Ninety-five patients or 0.4% of study subjects met inclusion criteria of isolated proximal GSV thrombosis. Forty-five patients were excluded, leaving a final data set of 40 patients. Investigators recorded radiology impressions, patient demographics, past medical history, DVT/PE risk factors, and treatment plans. Propagation of GSV thrombosis to DVT/PE was also noted. Follow-up methods included chart review, primary care physician follow-up, and direct, scripted patient follow-up phone calls. Descriptive statistics were applied to study subjects using SAS for Windows, version 9.3.ResultsThree patients (7.5%) had progression of GSV thrombosis to DVT/PE. Twenty percent of patients without malignancy were treated with anticoagulation compared to 14% of those with preexisting malignancy upon initial diagnosis of isolated GSV thrombosis. Forty-five percent of patients were prescribed some type of supportive therapy to aid in the treatment of GSV thrombosis.ConclusionIsolated proximal GSV thrombosis, while uncommon, may frequently progress to DVT or PE. Our work suggests clinicians should consider anticoagulation for isolated GSV thrombosis.

Stent Extension below the Common Femoral Vein in Extensive Chronic Iliofemoral Venous Obstructions

PurposeTo analyze whether primary venous stent placement into 1 dominant inflow vein peripheral to the common femoral vein (CFV) confluence is feasible. Materials and MethodsRetrospective review was performed of 14 consecutive patients who underwent primary venous stent placement into veins peripheral to the CFV between 2013 and 2016. Mean patient age was 49 years; 6 (43%) patients were women. All patients had successful deep venous stent placement with brisk contrast flow through the stent. Patients had primary percutaneous stent placement when postthrombotic changes extended peripherally to the femoral confluence but a trabeculation-free area in the deep femoral vein (DFV) could be identified. Based on imaging findings, the DFV had to be considered the prominent inflow vein with normal anatomy. Femoral vein, DFV, and collateral inflow were minimally impaired owing to postthrombotic scarring or trabeculations. ResultsPrimary, assisted primary, and secondary patency rates were 92% at a median follow-up of 481 d (range, 411–792 d). Venous Clinical Severity Score decreased from a mean of 8.9 to 6.4 (P = .03). The Villalta scale decreased from a mean of 11.7 to 4.3 (P = .003). Before intervention, venous claudication was present in 92% and remained in 38% after intervention (P = .016). ConclusionsStent placement through the femoral confluence into a dominant inflow vein is a promising option in a carefully selected group of patients.

Profilaxis of pulmonary embolism with transfascial thrombosis

The aim — to substantiate indices to surgery prophylaxis of pulmonary embolism related to transfascial thrombosis in the inferior vena cava system.Materials and methods. The results of examination and surgery treatment of 125 patients with transfascial thrombosis have been analyzed, patients were admitted to surgical diseases department of Novak clinical hospital of Transcarpathia region in the period from 1995 to 2014. These were 47 (37.6 %) men and 78 (62.4 %) women. The age of the patients ranged from 16 to 83 years, the mean age was 53 ± 2.5 years. The frequency of transfascial thrombosis among the total number of treated patients (n = 1601) for acute varicotromboflebitis during the mentioned period was 7.8 % of cases. Patients underwent laboratory and instrumental examination, ultrasound Doppler and ultrasound duplex scanning (Aloka­3500, Japan; My Lab­50, Italy; HDI­1500 ATL­Philips; Ultima Pro­30, z.one Ultra, Zonare Medical Systems Inc., USA).Results and discussion. In 62 (49.6 %) patients, the proliferation of thrombotic process on the deep venous system was observed in the area of sapheno­femoral junction with the transition on the common femoral vein, the length of floating part of the thrombotic masses varied from 1.5 to 7.5 cm, on average 4.2 ± 0.7 cm. In 54 (87.1 %) patients, when spreading the floating top of thrombotic masses beyond the boundaries of sapheno­femoral junction of 3 cm length, thrombectomy was performed through the large subcutaneous vein orifice at the height of Valsalva test. 8 (12.9 %) patients underwent a venotomical section of the general femoral vein for thrombectomy. In 20 (16.0 %) patients, the spread of thrombotic process on the deep venous system was observed in the region of sapheno­popliteal junction with the transition to the popliteal vein. The length of floating part the thrombotic mass in spreading through the sapheno­popliteal junction varied from 1.5 to 5.5 cm, on average of 3.3 ± 0.5 cm. In 15 (75.0 %) patients it was possible to perform the thrombectomy from the popliteal vein through the orifice of the small subcutaneous vein. In 5 (25.0 %) patients were performed the venotomy of popliteal vein during thrombectomy. The transition of thrombotic lesion through the perforated veins of the shin was detected in 43 (34.4 %) patients. In this case, the localization of the top thrombotic masses in the shin veins was observed in 7 (16.3 %), in the leaf veins — in 16 (37.2 %), in the popliteal veins — in 17 (39.5 %) and in the surface popliteal veins — in 3 (7.0 %) patients. In 7 patients with localization on the top of thrombotic masses in the perforated vein, thrombectomy was performed from the perforated vein during the compression of the calf muscles and the ligation of the perforated vein. In 7 patients the ligation of the popliteal vein below the fall of the small subcutaneous vein was performed in order to prevent pulmonary embolism for the transition of thrombotic masses through the perforated veins on the shin. In 26 patients an open thrombectomy from the popliteal vein or the calf venous sinus with venotomy followed by ligation of affected venous sinuses was performed. In 3 patients with the spreading the process on popliteal and superficial femoral veins, the ligation of the superficial femoral veins below the fall of issue of the deep femoral vein was performed.Conclusions. In order to prevent the pulmonary thrombosis, the volume of surgical intervention should be extended. Patients with transfascial thrombosis, regardless the surgery redicality, should be treated as in the case of deep vein thrombosis.

Characterization of profunda femoris vein thrombosis

ObjectiveThe incidence of and risk factors for profunda femoris vein (PFV) thrombosis are poorly characterized. We prospectively identified patients with PFV deep venous thrombosis (DVT) to characterize the demographics and anatomic distribution of proximal DVT in patients with PFV DVT. MethodsA prospective study was conducted of patients at a tertiary care university hospital with DVT diagnosed by venous duplex ultrasound scanning between June 2014 and June 2015. DVT patients were categorized as having PFV involvement (yes or no), and the anatomic distribution of other sites of ipsilateral venous thrombi was further stratified to determine whether there was external iliac vein (EIV), common femoral vein (CFV), or femoropopliteal vein (FPV) DVT. Demographic characteristics of the patients were compared between groups, PFV DVT vs proximal DVT without PFV DVT. ResultsOf 4584 lower extremity venous duplex ultrasound studies performed, 398 (8.7%) scans were positive for proximal DVT from 260 patients; 23.1% of patients with DVT (60/260) had DVT involving the PFV. Of 112 patients who had CFV DVT, 55 (49.1%) also had ipsilateral involvement of the PFV. Of 60 patients with PFV DVT, 55 (91.7%) had involvement of the ipsilateral CFV. Patients in the PFV DVT group were more likely to have a history of a hypercoagulable disorder (26.7% vs 14.5%; P = .029) and a history of immobility (58.3% vs 42%; P = .026) compared with those with proximal DVT without PFV DVT. There were no differences in smoking, recent surgery, personal or family history of DVT, other medical comorbidities, inpatient status, or survival. There was no difference in laterality of DVT between the PFV DVT and proximal DVT without PFV DVT groups (35% vs 41.5% left, 35% vs 33.5% right, 30% vs 25% bilateral; P = .619). There was a higher proportion of PFV DVT with EIV involvement (21.7% vs 2.5%; P < .00001) and a higher proportion of PFV DVT with CFV + FPV involvement (65.0% vs 19%; P < .00001) compared with proximal DVT without PFV DVT. There was no difference in survival between the PFV DVT and proximal DVT without PFV DVT groups. ConclusionsPatients with PFV thrombosis tend to have more thrombus burden with more frequent concurrent DVT in the EIV and FPV. Patients with PFV DVT are also more likely to have a history of hypercoagulable disorder and immobility. Ultrasound protocols for assessment of DVT should include routine examination of the PFV as a potential marker of a more virulent prothrombotic state.

The emergency simulation with the help of four-layer hidden Markov model

The object of research is the process of selecting a synergistically determined pair for the elements of complex systems in the design, manufacture or repair. One of the most problematic places in the selection is the need to numerically evaluate the result of combining the elements, taking into account the explicit, additive properties of elements and hidden manifestations of the pair that are unusual for the elements alone (emergence). Lack of accounting for emergence can significantly distort the apparent picture of the processes taking place in systems, which makes many existing models of such processes inadequate. During the research, methods of extracting information from arrays known, hidden for direct observation were used. In particular, four-layer hidden Markov models with an additional hidden layer were used. The models were trained by the Baum-Welch method, adapted to work with an additional layer. As training samples used data obtained as a result of statistical processing of information available for object monitoring, expert assessments, as well as data obtained in the world's computer networks. The test of the method and model on real medical and technical objects confirms their clinical and technical effectiveness. In particular, thanks to this in the medical industry: in the medical industry, the incidence of thromboembolism of the branches of the pulmonary artery and deep veins of the thigh and lower leg are decreased by 65 %; frequency of postoperative bleeding is decreased by 43 %; by 36 % the total number of drug-related medicines aimed at correcting the blood coagulation system is decreased. In the technical field, the test results confirm the increase in the service life of rubber-metal shock absorbers by 14.5 %. This is due to the fact that the proposed method has a number of features, in particular, for the first time in its evaluation of emergence a four-layer hidden Markov model is used. The results obtained in the work make it possible to propose a general scheme of an intellectual decision support system in the selection of a synergistically determined pair of elements for complex systems of various purposes.