Deep Femoral Vein Research Articles

The Effect of Botulinum Toxin B Pretreatment to the Blood Flow in the Microvascular Anastomosis

Although multiple factors can lead to free flap failure, vessel-related accidents are the most important. Many methods have been developed (both intraoperative and postoperative) to prevent vessel-related complications. In this article, we study the effects of a "preoperative treatment" using botulinum toxin B that could enhance the velocity and blood flow of vascular pedicles and decrease vascular accidents. Ten Sprague-Dawley rats were pretreated with botulinum toxin type B at the perivascular area of the femoral vessel. Ten other rats were injected with saline as a control group. After 3 days, pedicle diameter and the peak mean frequency of blood in the pedicle were measured using laser Doppler flowmetry, and the peak mean blood velocity was calculated. We performed a "pedicle division and reanastomosis" operation to compare changes in vessel diameter and peak mean blood velocity. Vessel diameter was significantly increased in the botox-pretreated group for both veins and arteries. A comparison of the deep femoral vein and artery blood velocities showed that the peak mean velocity was significantly higher in the botox group. The average increase in blood velocity was significantly larger in the botox group. Botulinum toxin B is helpful by influencing the microvascular environment through an increase in the blood velocity of the pedicle.

Anatomy of the veno-muscular pumps of the lower limb

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. In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. 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. 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.

Relative Importance of Iliac Vein Obstruction in Patients with Post-Thrombotic Femoral Vein Occlusion.

Patients with femoral vein occlusion rapidly develop collateral flow through the deep femoral vein, an embryonic collateral. In contrast, iliac vein collateralization is sparser and functionally poorer. It is not uncommon to have femoral vein occlusions associated with iliac vein obstruction even though the former is often more readily apparent venographically, while the latter may remain occult. We examined if percutaneous stent correction of iliac vein obstruction associated with femoral vein occlusions would yield symptomatic relief.

Variations in Lower Limb Deep Venous Anatomy in Latvia

Summary Introduction. During the last several decades there have been many new methods introduced for the treatment of lower limb chronic venous insufficiency (laser, foam, subendothelial and thermal coagulation methods). Venous system of lower limbs often presents anatomic variations including venous duplications. Knowledge of venous system variations in the lower limb area is of particular importance due to correct interpretation of imaging in relation to deep vein thrombosis (DVT). There was only a small number of studies published on anatomic variations of venous system in the lower limbs. To the best of our knowledge there have been no previous studies on anatomic variations of lower limb deep venous system performed in Latvia. Aim of the study. To retrospectively review of 216 patients (432 lower limbs) phlebograms in order to establish deep venous system anatomic variations in Latvian population and compare our results to other publications. Materials and methods. Retrospective analysis of 432 lower limb phlebograms performed at Pauls Stradins Clinical University Hospital (Riga, Latvia) of 216 patients treated in different ortopedic centers of Latvia during 2009 and 2012. Assessment made using DICOM Synedra view personal software. Study protocol was developed for definition of veins and assessment of phlebogram images in accordance with anatomic definitions used in previous studies. Two independent radiologists assessed data. Visualised duplications in the deep venous system of both lower limbs in patients were registered (common iliac vein, external iliac vein, common femoral vein, femoral vein, deep femoral vein, popliteal vein). Blood vessels have been listed as single, double or triple / complex. The presence of DVT was recorded upon assessment of phlebograms. Statistical analysis performed using SPSS 20.0 software (IBM). Parametric data comparison performed using Student t-test and ANOVA. Non-parametric data comparison performed using chi-square and Mann Whitney tests. Data comparison type was assessed using Kolmogorova-Smirnovs test. The results are presented as the average ± standard deviation. Results. Retrospective analysis of 432 lower limb phlebograms was performed in 216 patients. Average age of the patients was 34.4 years (range 19-90). 101 patients were female (47%) and 115 (53%) were male with no statistical venous variation differences found between two genders, which is explained by both age and gender (p > 0.05). Analysis of calf vein, popliteal vein and femoral venous variations provided a strong correlation between larger number of duplications in one limb and possibility of such variations in the other limb of the same patient (all p < 0.001). Conclusion. We conclude that there are frequent anatomic variations in SFV and popliteal veins seen in Latvian population. All patients included in this study had high DVT risk, much higher than in the average Latvian population. In almost every sixth Latvian person there is some form of deep veins hypoplasia found.

Preexisting Deep Venous Thrombosis in the Peroneal Vein of a Free Vascularized Fibular Graft

Sir: The reported prevalence of preoperative deep venous thrombosis in patients with advanced malignancy ranges from 8 to 16 percent.1,2 The peroneal vein is a common site for deep venous thrombosis to develop3; however, we have rarely encountered deep venous thrombosis when harvesting free vascularized fibular grafts. However, we recently found a preexisting deep venous thrombosis in the peroneal vein of a free vascularized fibular graft harvested to reconstruct the distal femur. A 68-year-old man with spindle-cell sarcoma of the left distal femur underwent wide resection of the femur and immediate reconstruction with liquid nitrogen–treated autograft and a free vascularized fibular graft. Forty days earlier, an excisional biopsy had been performed under general anesthesia. Before resection, the left leg had been asymptomatic, and the D-dimer level had been normal (0.6 µg/ml). The free vascularized fibular graft was harvested without a tourniquet from the ipsilateral leg. The peroneal artery and two accompanying veins were transected just distal to the bifurcation of the posterior tibial vessels. After transection, we found a firm thrombus in the lumen of the larger peroneal vein (Fig. 1). The smaller peroneal vein was patent and without thrombus. After bone fixation at the recipient site, the peroneal artery was anastomosed to the deep femoral artery, and the patent peroneal vein was anastomosed with a venous coupler to a branch of the deep femoral vein. After revascularization, we attempted to remove the thrombus of the larger peroneal vein under an operating microscope; however, the thrombus was partially organized and could not be removed from the lumen (Fig. 2). Therefore, we trimmed the peroneal vein back to the bifurcation of the soleus branches to leave only healthy lumen. This peroneal vein was then anastomosed by hand to the deep femoral vein. Vigorous venous return through the vein was observed. The postoperative course was uneventful. The patient was treated with heparin until the seventh postoperative day.Fig. 1: Harvested vascular pedicle of the fibula. There was a partially organized thrombus (arrowhead) in one of the peroneal veins.Fig. 2: Appearance of the thrombus (arrow) under an operating microscope.To our knowledge, only a few cases of preexisting deep venous thrombosis in the peroneal vein of a free vascularized fibular graft have been reported.4,5 Taghinia et al. reported a similar case at the time of mandibular reconstruction but successfully transferred the flap by using the soleus branch as an alternative drainage route.4 Jacobson et al. reported two similar cases at the time of head and neck reconstruction; however, the flaps could not be transplanted because the peroneal veins were diffusely occluded.5 The cause of the deep venous thrombosis in the present case could not be definitively determined; however, we suspect the deep venous thrombosis developed after the excisional biopsy, when the patient was restricted to bed rest with the knee immobilized for 5 days. The nature of the thrombus, which was incompletely organized, is consistent with the time course. We believe that preoperative examination for possible deep venous thromboses in the peroneal veins is advisable when the free vascularized fibular graft is harvested from a limb with a history of surgery or trauma. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Shimpei Miyamoto, M.D. Division of Plastic and Reconstructive Surgery National Cancer Center Hospital Tokyo, Japan Masahide Fujiki, M.D. Minoru Sakuraba, M.D. Division of Plastic and Reconstructive Surgery National Cancer Center Hospital East Kashiwa, Japan

Allergy and Other Risks of Ultrasound Gel: Recognition and Alternative Coupling Agents

We recently encountered a patient who required urgent leg venous ultrasound. The patient warned us of a previous severe allergic reaction to ultrasound gel, an uncommon problem without a defined prevalence (according to our searches for literature on PubMed, Google Scholar, and uptodate.com ). The reaction was so severe that he permitted ultrasound only if an alternative agent could be used. We recalled both that allergy to gel is possible and that mineral oil could be used as a coupling agent in such cases and purchased a bottle on the spot while the patient waited. The clinical flexibility of switching to an alternative coupling agent turned out to be potentially life-saving because the patient was found to have an extensive deep venous thrombosis of the common femoral, femoral, deep femoral, popliteal, and gastrocnemius veins. This case report details this patient's course; reviews the potential adverse effects of ultrasound gel, proven and theoretical; demonstrates the excellent imaging characteristics of a large number of alternative coupling agents that we tested on our patient as well as another subject; and describes strategies for prevention and management of adverse effects. Although isolated case reports were found by literature search regarding use of alternative ultrasound coupling agents, we have found no review article or study evaluating as many agents as we have.

Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects

Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as "lower type persistent sciatic vein". Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.

Application of inferior vena cava filter in patients with tumor thrombus secondary to malignant renal tumor

Objective To summarize the experience of implantation of inferior vena cava (IVC) filter for pulmonary embolism prevention during radical nephrectomy and IVC thrombus resection for malignant renal tumor.Methods Total 20 patients with malignant renal tumor and IVC tumor thrombus were performed IVC filter implantation via superior vena caval approach (right internal jugular vein) or right femoral vein approach from January 2008 to April 2011,including Tempofilter (B.Braun Medical Inc,USA) in 8 cases,Cook Tulip (Cook company,USA) in 7 cases and Aegisy temporary IVC filter (Shenzhen,China) in 5 cases.The filter was inserted at the morning of surgery or 1-11 days prior to nephrectomy under local anesthesia.Radical nephrectomy was performed in 4 cases,including 1 T4N0M0 (tumor thrombus level grade Ⅲ),1 T3bN2M0 (grade Ⅱ),and 2 T3cN0M0 (grade Ⅳ).Laparotomy and biopsy were done in 2 cases whose tumors were T4N2M0 (grade Ⅱ),and radical nephrectomy plus IVC thrombus resection were done in the other 14 cases.IVC filters were removed 1-14 days after operation in 18 cases or remain indwelling in 2 cases.The methods of filter implantation,technique of nephrectomy and IVC thrombus resection and complications were discussed.Results There were no complications related to the filter implantation or intraoperative pulmonary embolism occurred.The intraoperation blood transfusion were required in 10 patients (50％),and amount ranged from 500-5000 ml,with mean (1930 ± 1405) ml.Incompletely IVC control and unrecongnized venous branches such as lumbar veins were the important risk factor of blood loss.Postoperative acute renal failure and deep femoral vein thrombosis occurred in 1 patient.Pulmonary embolism occurred in 1 case in the day of IVC filter removed.All these postoperative complications were relative with bland thrombus and cured by conservative methods such as anticoagulation.Conclusions The IVC filter is effective in preventing pulmonary embolism during resection of renal tumor and IVC tumor thrombus.It could be insert and removal easily and securely,and appropriate for level ＞0 thrombus,especially for those who has bland thrombus and venous branches.Hemorrhage was the most frequent perioperative complication.The complete clamping of the IVC Inferior or superior to tumor thrombus,or keeping the vein branches from divulsion can decrease blood loss. Key words: Kidney neoplasms; Malignant; Thrombosis; Inferior vena cava, filter

Indications for stenting during thrombolysis

The most important vein segment to thrombolyse after deep venous thrombosis (DVT) is the outflow tract meaning the iliofemoral vein. Iliofemoral DVT is defined as DVT in the iliac vein and the common femoral vein. Spontaneous recanalization is less than 50%, particularly on the left side. The compression from adjacent structures, predominantly on the left side is known as the iliac vein compression syndrome. Therefore, it is essential that supplementary endovenous procedures have to be performed in case of persistent obstructive lesions following catheter-directed thrombolysis. Insertion of a stent in this position is the treatment of choice facilitating the venous flow into an unobstructed outflow tract either from the femoral vein or the deep femoral vein or both. The stent, made of stainless steel or nitinol, has to be self-expandable and flexible with radial force to overcome the challenges in this low-pressure system. The characteristics of the anatomy with external compression and often a curved vein segment with diameter difference make stent placement necessary. Ballooning alone has no place in this area. The proportion of inserted stents varies in the published materials with catheter-directed thrombolysis of iliofemoral deep venous thrombosis.

Complicated case of infected graft following endovascular treatment of internal iliac artery aneurysm – explantation and autologous reconstruction using deep femoral vein

Objective: Infection of endovascular grafts are rare with rates of 0.3 – 0.8% for EVAR and 1.4 – 4.8% for TEVAR. In the light of the constantly increasing absolute number of grafts being implanted and a reintervention rate of approx. 20%, a significant number of graft infections can be anticipated. Therapeutic options in that case rely on the established principles of septic vascular reconstruction, however, we propagate complete removal of prosthetic material and autologous reconstruction.

Unusual communication of profunda femoris vein with the popliteal vein in the middle of the popliteal fossa

Profunda femoris vein (PFV) rarely forms a direct communication with the lower end of the femoral vein (FV) or popliteal vein (PV). During regular dissections for medical undergraduates, we came across a rare anatomical variation of PFV in the right lower limb of an 80-year-old female cadaver. PFV commenced from the PV just above its formation by the union of anterior and posterior tibial veins. It traversed the popliteal fossa on the lateral side of the popliteal artery and entered into the adductor canal after piercing the adductor magnus muscle. Finally, it emptied into the FV in the lower part of the femoral triangle. Furthermore, the PV had a small caliber than that of PFV. Deep veins of leg are the common site for formation of thrombosis. In terms of diagnosis and operative procedures, the location of thrombosis in the deep veins of lower limb is clinically of great importance. Thus detailed knowledge of the anatomical variation reported here is useful during diagnosis and treatment of deep vein thrombosis.

"The Pending Oedema Symptom of the Thigh" at Thrombosis of the Deep Femoral Vein

The presence of oedema on a segment of the limb is a typical clinical sign of thrombosis (thrombophlebitis) of the main veins of the limb. The oedema of the limb is typically located lower than the level of venous occlusion, starting from the foot and then progresses in cranial direction. The deep femoral vein is rarely affected by thrombosis. However, when the deep femoral vein is the singular vein affected by thrombosis, its clinical presentation is “the pending oedema symptom of the thigh”. The symptom is characterized with presence of oedema at the posterior-medial muscle group of the thigh and subcutaneous tissue from the knee to the upper 1/3 of the thigh. This oedema is in contrast with absence of oedema of the foot, shank and anterior-lateral muscle group of the thigh. The purpose of this paper is to analyze the contribution of the peculiarities in the topographic anatomy of the venous blood vessels which accompany the deep femoral artery for occurrence of the thrombosis in this venous segment, as well as for disappearance of the oedema during the convalescence. The functional state of the deep femoral vein is of great importance to the venous haemodynamics of the limb. The results of the anatomical analysis of the literature data showed that the three main veins which accompany the branches of the deep femoral artery have some anatomical peculiarities which are very important for the haemodynamics in these venous segments.

Veins of the lower limbs – anatomy and new terminology

Background: In the last years, an important development in the diagnostic procedures and treatment of venous disease of the lower limbs has been achieved. Due to the lack of anatomic names for some of the clinically relevant veins, different clinical eponyms were introduced. Recently, an international consensus on the nomenclature of leg veins was accepted to simplify the communication and to minimize the risk of mistreatment. Authors of this article reviewed new literature on he veins of the lower limbs and compared the new terminology with the old one. Conclusions: Through the systematic review of superficial, deep and perforant veins, authors point out the altered and newly introduced names of the veins. The majority of changes refer to the names of superficial veins and perforators. The use of clinical eponyms is discouraged and descriptive terms designating location of the veins are preferred instead. The nomenclature of the deep veins has not been changed much. The term deep femoral vein, already in use in clinical practice was introduced, whereas the use of clinical term superficial femoral vein was discouraged. The most important changes in vein nomenclature are summarized in the table.

Meso-Rex Shunt Using Deep Femoral Vein Conduit: First Report

The Meso-Rex shunt (MRS) procedure was first described in 1992 by de Ville et al. for the treatment of extra-hepatic portal vein obstruction (EHPVO) in paediatric liver transplant patients (1). This technique provides more physiological relief of portal hypertension compared to the porto-systemic shunts, which can lead to long-term complications such as hyperammonaemia and hepato-pulmonary syndrome (2). Different conduits as autologous and cryopreserved veins or prosthetic grafts have been previously reported (3–7). We present herein the first case of a MRS using the autologous deep femoral vein in a 17-year-old female patient affected by EHPVO from unknown reasons.

Great saphenous vein transposition to the popliteal vein (the May-Husni procedure).

A 55-year-oldmale long distance runner had been bothered by venous claudication for 8 years. He previously sustained a tibial plateau fracture complicated by a deep venous thrombosis. He was no longer able to compete in longdistance races because of severe swelling and pain from the knee down. Before his injury, he had completed thirteen 100-mile ultra-marathons. Venous ultrasound imaging demonstrated segmental occlusion and incompetence of the left femoral and popliteal veins. An ascending and descending venogram demonstrated the femoral, popiteal, and tibial veins to have partial occlusions and incompetence due to chronic deep venous thrombosis (A). The patient was a suitable candidate for transposition of the saphenous vein into the popliteal vein (May-Husni procedure) to alleviate venous outflow obstruction. The operation was conducted through a vertical incision at the distal thigh. The great saphenous vein (GSV) and proximal popliteal vein were exposed through the same incision. After heparinization, a thigh tourniquet was inflated to provide a bloodless field, the popliteal vein was opened longitudinally, some old recanalized thrombus was excised, and an end-to-side anastomosis was performed between the GSV and the popliteal vein (PV) using running 6-0 monofilament suture (B and C [CFV, Common femoral vein; DFV, deep femoral vein]). After an uneventful postoperative course, the patient was discharged fully anticoagulated. A computed tomography (CT) venogram at 14 months showed widely patent popliteal-saphenous anastomosis with preferential flow of contrast into the transposed GSV (Cover). The patient currently reports no symptoms of venous claudication.

Bilateral Deep Femoral Vein Thrombosis

Introduction Deep vein thrombosis (DVT) is a major national health problem, especially among the critically ill and elderly. Most clinically significant DVTs involve the proximal veins of the lower limb, particularly the iliac, common femoral, femoral, and popliteal veins. Case Study We report a 53-year-old man sent to our vascular laboratory for ultrasound examination of the lower extremities to investigate the cause of nonpitting edema in both lower extremities. The ultrasound examination revealed isolated bilateral thrombosis in the deep femoral veins. Conclusion This is the first reported case of bilateral isolated deep femoral vein thrombosis.

Deep Venous Thrombosis and Pulmonary Embolism Caused by an Intravascular Synovial Sarcoma of the Common Femoral Vein

Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism. Physical and radiological examinations showed besides the thrombosis a tumor arising from the right common femoral vein involving the bifurcation of the common femoral artery. At surgery, en block resection of the tumor including the deep femoral vein and arterial bifurcation was done with an arterial reconstruction using a synthetic graft. Histopathological examination revealed an intravascular SS of the common femoral vein. The mainstay of curative therapy is complete surgical resection of all tumor manifestations with negative histological margins.

C0376 Venous thrombosis revealing a multiple myeloma

Background: It is now established well that the intestinal chronic inflammatory disease are associated to a venous significant risk of venous thromboembolism (MTV). Global prevalency of venous thromboembollism during these affections would be about 6% and the risk of venous thromboembolic events would bemultiplied by 3,5. A pulmonary embolism is found in the autopsy in near 40%des death during these affections. The incidence of the MTV seems particularly raise during the first five years following the diagnosis. But it rarely precedes the disease. We report two cases of venous thrombosis revealing a crohn‘s disease Results: Case report 1 : We report the case of a 46-year-old patient , operated 3 months ago for a microlithiasic cholecystitis complicated with an angiocholitis and with cephalic pancreatitis stage B of Balthazar and hospitalized for pain and functional disability of the left lower limb evolving for 4 days. The venous doppler echography of lower limbs showed an aspect in favour of a thrombophlebitis of the left deep and superficial femoral veins as well as the external and primitive iliac homolaterales veins. There were no signs of pulmonary embolism. Risk factors of thromboembolic disease : recent surgery, venous insufficiency and obesity (BMI upper to 30). Physical examination did not found signs in favour of a neoplasy or of a Behcet'disease. The dosage of the tumoral markers was normal. The patient was treated by heparinotherapy and antivitamine K with good evolution. Seven months later, the patient presented proctorrhagia of weak to average abundance with a diarrhea at the rate of 3 saddles / day. Hemodynamic state was correct and there was an overdose in antivitamin K. We thus completed by a colonoscopy showing a fragile congestive mucous membrane strewed with fine ulcerations in sigmoid. Within the pathological mucous membrane, it exists zones of normal mucous membrane with variable-sized going from 1 cm to a 3–4 cms. The rectum was less affected with a normal mucous membrane. The biopsies were in favour of a disease of crohn in push of average intensity. The patient was treated handled by Mesalazine. Case report 2 We report the case of a 30-year-old patient, with past history of recidivant deep venous thrombophlebitis since 1999 (5 episodes of thrombosis in 8 years) and buccal aphtosis. Risk factors of thromboembolic disease : proteine C deficiency, obesity (BMI upper to 36). Physical examination did not found signs in favour of a neoplasy or of a Behcet'disease. A crohn's disease was diagnostsed at colic biopsy in 2002 in front of digestive signs. A subtotal colectomy with ileorectal anastomose was underwent for right colic stenosis. She was treated by purinethol because of intolerance to imurel. Comment: The arisen of venous thrombosis during a crohn's disease is frequent. Sometimes, it can precede or reveal the disease as it is the case of our patients. Numerous arguments of physiopathological order plead for a specific role of the inflammation in the thrombotic complications: numerous studies described, so, during the pushes of MICI a state of hypercoagulability, associated with a certain degree of endothelial dysfunction, of platelet activation and hypofibrinolysis. A systematic search for this medical affection by the practice of a colonoscopy with biopsiy is imperative in case of venous thrombosis especially in the presence of a suggestive digestive symptomatology or in case of negativity of the aetiologic balance assessment.

Preparation of Polymer-Based Magnetic Resonance Imaging Contrast Agent to Visualize Therapeutic Angiogenesis

The objective of this study was to design and prepare a new contrast agent of magnetic resonance (MR) imaging for the evaluation of therapeutic angiogenesis. Diethylenetriaminepentaacetic acid (DTPA) residue of a chelator was chemically introduced to dextran with a molecular weight of 74,000 (dextran-DTPA). Cyclic peptide containing an arginine-glycine-aspartic acid (RGD) sequence (cyclic RGD) with an inherent affinity for the α(v)β(3) integrin was then introduced to dextran-DTPA (Cyclic RGD-dextran-DTPA). Gd(3+) was added to cyclic RGD-dextran-DTPA to prepare a dextran-based MR contrast agent (Cyclic RGD-dextran-DTPA-Gd). Cyclic RGD-dextran-DTPA-Gd had affinity for cells expressing the α(v)β(3) integrin and showed a higher longitudinal relaxivity compared with DTPA-Gd of an MR contrast agent clinically used. Right femoral, external iliac, and deep femoral and circumflex arteries and veins were surgically ligated to prepare a mouse model of hindlimb ischemia. A laser Doppler analysis and histological evaluation confirmed that hindlimb ischemia healed naturally and was accompanied by angiogenesis, while α(v)β(3) integrin was expressed in the ischemic-angiogenic region without any treatment. Mice at 7 days after vascular ligation were used as an angiogenesis model. When intravenously injected into mice with hindlimb ischemia, cyclic RGD-dextran-DTPA accumulated in the ischemic-angiogenic region and showed the MR ability to detect the ischemic-angiogenic region. It is concluded that cyclic RGD-dextran-DTPA-Gd is a promising material for evaluation of therapeutic angiogenesis.

Leiomyosarcoma of the Deep Femoral Vein. A Rare Cause of Venous Obstruction in Lower Limbs and an Alternative Diagnosis to Chronic Venous Thrombus

Primary venous leiomyosarcoma of the extremities is an uncommon, but aggressive, tumoral entity with a high rate of local recurrence and early hematogenous metastasis. In the present article, we report a case of leiomyosarcoma of the vena profunda femoris. This pathology causes deep venous thrombosis-like symptoms. No improvement in lower limb status and a significant and progressive increase in the diameter of the vein as seen using ultrasonography could indicate tumor disease. Particular care must be taken to avoid biopsies due to the possible dissemination. We must complete the medical study with imaging techniques, and the tumor must be removed as soon as possible for histopathological diagnosis. After a follow-up of 12 months, there was no evidence of local or metastatic recurrence in our patient.