External Vein Research Articles

Are the Fe-rich-clay veins in the igneous rock of the Kansas (USA) Precambrian crust of magmatic origin?

The North American Mid-Continent rift (MCR) is a 1.1 Ga aborted rift, which has recently become an area of intense focus for energy resource exploration following the report of H2 emissions. To document the nature of the producing rocks, we conducted a multi-scale study on preserved drill-core samples from the DR1-A well located in the same area as the H2-producing wells in Kansas. We showed that this well reaches an unmapped part of the MRS composed of fayalite-bearing monzo-diorites in which we identified atypical veins of iddingsite, a complex mixing of Fe-rich phyllosilicates. Combining scanning and transmission electron microscopy (SEM and TEM) with scanning transmission X-ray microscopy (STXM) allowed us to differentiate at least two types of sub-micro-meter Fe-rich veins. A central reduced vein cutting the fayalite, other mafic minerals, the plagioclase, and to a lesser extent the alkali feldspar, contains a complex mix of serpentine, chlorite, and mica. Furthermore, a border vein, with a higher degree of Fe-oxidation, is found to be contained only within the fayalite. This external vein mainly contains iron and silicon, together with a few percent of potassium and calcium, and can be divided into two sub-veins composed of Fe3+-rich interstratified chlorite-smectite and Fe3+-rich serpentine in direct contact with the fayalite. Textures and microstructures of these phyllosilicates suggest that they have crystallized from a late magmatic and differentiated fluid, which precipitation produced the central vein together with the exsolution of an H2O-enriched fluid phase. This exsolved fluid, chemically far from equilibrium with the fayalite, appears to have induced a deuteric alteration of the fayalite, leading to the crystallization of the external veins enriched in ferric iron. These observations bring new perspectives on the history of formation of iron-rich clay minerals, which may, somehow, be related to H2 production.

Топографическая анатомия плечевого сплетения и возможности эндоскопического доступа (кадаверное исследование)

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

External Support for Saphenous Vein Grafts in Coronary Artery Bypass Surgery

Intimal hyperplasia and subsequent saphenous vein graft failure may have significant adverse clinical effects in patients undergoing coronary artery bypass surgery. External support of saphenous vein grafts has the potential to prevent vein graft dilation and hence slow the rate of intimal hyperplasia and increase long-term vein patency. To determine efficacy, as measured by intimal hyperplasia, and safety of an external saphenous vein graft support device in patients undergoing a coronary bypass graft procedure. This within-patient randomized, open-label, multicenter study was conducted at 17 Cardiothoracic Surgical Trials Network centers in North America. Between January 2018 and February 2019, 224 patients with multivessel coronary artery disease undergoing isolated bypass surgery were enrolled. For each patient, 1 of 2 vein grafts was randomized to receive external support or no support. External vein graft support or no support. The primary efficacy end point was intimal hyperplasia area assessed by intravascular ultrasound at 12 months postrandomization for each study graft. Secondary confirmatory end points were lumen diameter uniformity assessed by angiography and graft failure (≥50% stenosis) by quantitative coronary angiography. Major cardiac and cerebrovascular events were collected through month 12. Among 224 patients (mean [SD] age, 65.8 [8.3] years; 178 [79.5%] male), 203 (90.6%) were eligible for intravascular ultrasound, of which 85 (41.9%) had at least 1 study graft occluded or severely diseased at 12 months (55 supported, 56 unsupported). After imputation of data missing because of graft occlusion or severe disease, the estimated mean (SE) intimal hyperplasia area was 5.11 (0.16) mm2 in supported grafts and 5.79 (0.20) mm2 in unsupported grafts (P = .07). In a sensitivity analysis of 113 patients with both grafts imaged, the mean intimal hyperplasia area was 4.58 (0.18) mm2 and 5.12 (0.23) mm2 in supported and unsupported grafts, respectively (P = .04). By 12 months, 5 patients (2.2%) died and 16 patients (7.1%) experienced a major cardiac or cerebrovascular event. The 12-month difference in intimal hyperplasia area between supported and unsupported grafts did not achieve statistical significance. Cumulative mortality and major cardiac or cerebrovascular events rates were similar to those in other randomized coronary artery bypass trials. Further investigation to assess the effect of external graft support devices on long-term graft patency and clinical outcomes is warranted. ClinicalTrials.gov Identifier: NCT03209609.

Laparoscopic management of external iliac vein injury

A 57-year-old white woman was referred to our division for incomplete surgically staged endometrial cancer. She was taken to the operating room for laparoscopic surgical staging. Incidental right external vein injury occurred during pelvic lymphadenectomy. Video 1 shows an incidental thermal full thickness injury of right external iliac vein and repairing it laparoscopically during a pelvic lymphadenectomy procedure. A 3 mm laceration to the right external iliac vein occurred while right pelvic lymphadenectomy (Figure 1). After immediate clamping of the injury site with graspers, the laceration on the right external iliac vein was primarily repaired by use of a running intracorporeal 4-0 polypropylene suture (Figure 2). The insufflation pressure was increased to 20 mmHg for the duration of primary repair for 60 seconds to limit the hemorrhage. The patient was not obese and her body mass index (BMI) was 24.

Reno-iliac intrasystem anastomoses of the inferior vena cava

The study objective is to describe the anastomoses between the left renal and iliac veins in the inferior vena cava system and to classify these anastomoses.Materials and methods. From 2015 to 2020, 340 men with varicose veins of the pelvic organs and bilateral varicocele were examined. Delayed imaging for 10–30 s with phlebotesticulography of 157 patients allowed us to study in more detail the vascular venous x-ray anatomy of the scrotum and various options for collateral circulation.Results. The data obtained by us during phlebography allowed us to offer our own classification of anastomoses between the left renal vein and the common iliac vein in the inferior vena cava system (reno-iliac intrasystemic anastomoses of the inferior vena cava): 1) through the vein of the vas deferens (v. ductus deferens), 2) through the cremasteric vein (v. cremasterica), 3) through the external testicular vein (v. testicularis externa). In addition to the classification, the terms for specific types of anastomoses are also proposed by us for the first time and do not have a name in the medical scientific literature. A new definition of the term “venous anastomotic node (nodus venarum anastomoticus) of the testis and its appendage” is proposed, which describes the anatomical relationship between the 4 veins: the internal testicular vein, external testicular vein, vena cremasterica and veins of the vas deferens. A new term is proposed “pseudo-varicocele” that defines the compensatory expansion of the internal testicular vein during normal antegrade blood flow through it.Conclusion. In this work, we give an X-ray anatomical description of the development of various types of collateral circulation in the system of the inferior vena cava between the left renal vein and iliac vessels in various types of arteriovenous conflicts of both the upper (nutcracker syndrome, posterior nutcracker syndrome) and the lower level (May–Thurner syndrome).

The Superior Ophthalmic Vein: Anatomical Perspective for Transvenous Access to the Cavernous Sinus.

The anatomical characteristics of the superior ophthalmic vein (SOV), which is crucial when performing craniofacial surgeries and transvenous access to the cavernous sinus, have not been documented. The present study aimed to explore them using magnetic resonance angiography (MRA). A volumetric, phase-contrast MRA was performed in 74 outpatients not bearing vascular or tumorous pathologies in the face, orbit, and cavernous sinus. The entire course of the SOV was delineated in 46 patients (62%), for 76% on the right side and 83% on the left. These SOVs consistently showed a characteristic morphology with a laterally coursing proximal segment and a medially coursing distal segment. The latter segment was connected to the angular, supraorbital, supratrochlear, facial, and external nasal veins that were inconsistently delineated. The angular vein was tortuous in 51% of the patients on the right and 53% on the left. The morphology of the proximal part of the SOV was also variable and involved a tortuous segment in 11% of the patients on the right and in 7% on the left. Furthermore, in 4 patients (8.7%), a fenestration was found in the right SOVs. Inconsistent tributaries of the SOV, tortuous angular vein, and possible tortuous segment and fenestration of the SOV can make orbital transvenous access to the cavernous sinus difficult.

Central Venous Obstruction-Induced Intracranial Hypertension in Hemodialysis Patients: An Underrecognized Cause of Elevated Intracranial Pressure.

Central venous obstruction (stenosis or occlusion) is common in patients with renal failure on hemodialysis and may be associated with intracranial hypertension (IH). Causes include vein injury from an endoluminal device, lumen obstruction from a device or thrombus, external vein compression, and high venous flow leading to vein intimal hyperplasia. A combination of high venous flow and central venous obstruction can lead to intracranial venous hypertension, impaired cerebrospinal fluid (CSF) resorption, and subsequent IH. We conducted a search of the English literature using the Ovid MEDLINE Database and PubMed, with a focus on reports involving IH and central venous obstruction in the setting of hemodialysis. We reviewed CSF flow dynamics, the risk factors and causes of central venous obstruction, and the evaluation, management, and outcomes of central venous obstruction-induced IH. Twenty-four cases of IH related to central venous obstruction in hemodialysis patients were identified. Twenty patients had headaches (83.3%) and 9 had visual symptoms (37.5%). The brachiocephalic vein was the most common site of stenosis or occlusion (20/24, 83.3%). Twenty-one patients (87.5%) had resolution of IH with treatment. Two patients died from complications of IH (8.3%). Central venous obstruction-induced IH is likely underrecognized by clinicians and mimics idiopathic IH. Hemodialysis patients with IH should be screened with computed tomography venography of the chest. Optimal treatment is with vascular intervention or a CSF diversion procedure and can help prevent vision loss from papilledema or nervous system damage. Medical management may be appropriate in mild cases or as a bridge to definitive interventional treatment. Increased awareness among clinicians has potential to facilitate the timely diagnosis of this treatable condition with potential for good neurologic and visual outcomes.

Functional remodeling of an electrospun polydimethylsiloxane-based polyether urethane external vein graft support device in an ovine model.

Saphenous vein graft (SVG) failure rates are unacceptably high, and external mechanical support may improve patency. We studied the histologic remodeling of a conformal, electrospun, polydimethylsiloxane-based polyether urethane external support device for SVGs and evaluated graft structural evolution in adult sheep to 2 years. All sheep (N = 19) survived to their intended timepoints, and angiography showed device-treated SVG geometric stability over time (30, 90, 180, 365, or 730 days), with an aggregated graft patency rate of 92%. There was minimal inflammation associated with the device material at all timepoints. By 180 days, treated SVG remodeling was characterized by minimal/nonprogressive intimal hyperplasia; polymer fragmentation and integration; as well as the development of a neointima, and a confluent endothelium. By 1-year, the graft developed a media-like layer by remodeling the neointima, and elastic fibers formed well-defined structures that subtended the neo-medial layer of the remodeled SVG. Immunohistochemistry showed that this neo-media was populated with smooth muscle cells, and the intima was lined with endothelial cells. These data suggest that treated SVGs were structurally remodeled by 180 days, and developed arterial-like features by 1 year, which continued to mature to 2 years. Device-treated SVGs remodeled into arterial-like conduits with stable long-term performance as arterial grafts in adult sheep.

Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFast™ procedure: Influence of BMI and CEAP class.

Purpose Endovascular ablation of the great saphenous vein has been proposed as a less invasive alternative to conventional ligation and stripping of varicose veins. Outcomes of patients treated with the radiofrequency ablation ClosureFast™ system over an eight-year period from a single-center were evaluated. Methods Three-year follow-up data included duplex ultrasound scan, complication rate, and questionnaires to assess patients' QOL, level of pain, and days off work. Results A total of 1080 consecutive patients (49.5 ± 18.6 years, 72% female, mean body mass index: 25.44 ± 4.1 kg m-2) underwent radiofrequency ablation for incompetent saphenous veins in a single institution. Occlusion of the great saphenous vein was obtained in 98.6% and 93.8% cases at the end of the procedures and within 36 months, respectively. Only three deep venous thromboses and minor complications occurred in this series throughout the first week from the procedure. A decrease of the external vein diameter, equal to 72.7% and 31.1% of the pretreatment diameter, was observed at 1 week and 36 months, respectively. The average Aberdeen Varicose Vein Questionnaire score improved from 18.06 ± 9.47 before treatment to 11.56 ± 10.23 at 12 months, with no significant differences in the subsequent follow-up. SF-36 QOL scores significantly improved after the procedure in all domains, while there were no changes over time. Patients reported a prompt return to normal daily activities (1.5 ± 0.7 days) and work (3.1 ± 1.9 days). Body mass index influenced QOL scores, while it did not affect great saphenous vein diameter reduction during the follow-up. On the contrary, Clinical Etiologic Anatomic Pathophysiologic class significantly influenced both great saphenous vein diameter reduction after the treatment and QOL scores within 36 months. Conclusion Results of this retrospective monocentric, large patients study suggest that radiofrequency ablation of the great saphenous vein may be a safe and efficient alternative to conventional surgery.

Bone Undifferentiated Pleomorphic Sarcoma – A Case Report

Bone sarcomas are a rare group of tumors arising mostly in the extremities, being the undifferentiated pleomorphic sarcoma (UPS), also known as malignant fibrous histiocytoma, the most common. UPS exhibits a wide spectrum of clinical behavior and a diagnosis challenge. We report a clinical case of a proximal humeral UPS that presented with a non-recognized pathological fracture, initially treated with open reduction and internal fixation. Suboptimal postoperative management of the patient, leading to a diagnosis delay, occurred related to its hematoid transformation, a variant of aggressive high-grade sarcoma associated with a worse prognosis. Pulmonary embolic complication, external axillary vein compression, rapidly tumor growth and diffuse metastization were some characteristics. Abrupt disease development makes important to recognize the clinical features of those tumors, so better outcomes can be obtained.

Obturator Internus Muscle Endometriosis with Nerve Involvement: a Rare Clinical Presentation

Study ObjectiveTo describe our surgical approach in a rare case of deep infiltrating endometriosis of the obturator internus muscle with obturator nerve involvement. DesignA step-by-step surgical explanation using video and literature review (Canadian Task Force Classification III). SettingEndometriosis can be pelvic or rarely extrapelvic and is classically defined as the presence of endometrial glands and stroma outside the uterine cavity [1,2]. Pain along the sensitive area of the obturator nerve, thigh adduction weakness and difficulty in ambulation are extremely rare presenting symptoms [2–4]. PatientWe report a case of a 32-year-old patient who presented with cyclic leg pain in the inner right thigh radiating to the knee caused by a cystic endometriotic mass in the obturator internus muscle with nerve retraction. The patient provided informed consent to use the surgical video. Institutional review board approval was obtained. InterventionsPelvic magnetic resonance imaging was performed and confirmed a nodular lesion of about 2.3 cm with high signal on T1WI and T2WI and without fat suppression on T2FS inside the right obturator internus muscle, suggesting an endometriotic lesion (Fig. 1). Surgical removal of the mass was performed using the laparoscopic approach. A normal pelvic cavity was found, and the retroperitoneal space was dissected. A mass located within the right obturator internus muscle, below the right iliac external vein, behind the corona mortis vein, and lateral to the right obturator nerve was identified. The whole region was inflamed, and the nerve was partially involved. Dissection was performed carefully with rupture of the tumor, releasing a chocolatelike fluid (Fig. 2), and the cyst was removed. Pathology examination was consistent with endometriosis. Patient improvement was observed, with pain relief and improved ability for right limb mobilization. No recurrence of endometriosis was found at the follow-up visit 6 months later. Measurements and Main ResultsThe obturator nerve is responsible for motor and sensitive innervation of the joins and internal muscles of thigh and knee as well as the innervation of skin in the internal thigh. Pain along the sensitive area of the obturator nerve at the time of menstruation, thigh adduction weakness, difficulty ambulating, or paresthesia can be presenting symptoms with the involvement of the obturator nerve [5]. Besides paresthesia, our patient presented all the symptoms. The suspected diagnosis of obturator internus muscle endometriosis with retraction of the obturator nerve was confirmed by laparoscopic surgery and pathological examination of the excised tissue. To our knowledge, only 4 cases of endometriosis involving the obturator nerve have been described (according to MEDLINE searched in January 2017) [5–8]. The laparoscopic approach provided an excellent access to the retroperitoneal space, allowing fine dissection of the obturator nerve and the surrounding structures with complete removal of the cystic mass. ConclusionWe report a rare case of endometriosis with a single mass located inside the right obturator internus muscle with neuronal involvement of the obturator nerve. The fundamental role of laparoscopy was clearly demonstrated for the diagnosis and treatment of our patient.

TCTAP C-238 Balloon Angioplasty of Long Segment of Inferior Vena Cava and Bilateral Common and External Veins

TCTAP C-238 Balloon Angioplasty of Long Segment of Inferior Vena Cava and Bilateral Common and External Veins

Orbital venous pattern in relation to extraorbital venous drainage and superficial lymphatic vessels in rats.

The purpose of this study was to demonstrate the normal and variant anatomy of extraorbital and intraorbital venous drainage together with retroorbital communication, and determine the lymphatic drainage from the superficial orbital region with a potential outlet of lymphatic vessel into the venous bloodstream. The study of the venous system was carried out on 32 Wistar rats by using corrosion casts methods and radiography, while the lymphatic system was studied in 12 Wistar rats following ink injection. Superficially, orbital veins are connected with extraorbital veins running through angular vein of the eye and the superficial temporal vein, and via the pterygoid plexus with the maxillary vein, which provide readily accessiblecommunication routes in the spreadofinfection. The extent of intraorbital and periorbital venous drainage was ensured by the dorsal and ventral external ophthalmic vein through the infraorbital vein, which together formed the principal part of the ophthalmic plexus. Venousdrainageofthe eyeballwas carried out mainly by the vortex veins, ciliary veins and internal ophthalmic vein. The highest variability, first presented by differences in structural arrangement and formation of anastomoses, was observed within the ventral external ophthalmic vein (22 cases) and the medial vortex vein (10 cases). Four vortex veins, one vein in each quadrant of the eye, were observed in rats. The vortex vein located on the ventral side of the eyeball was occasionally found as two veins (in four cases) in the present study. The lymphatic vessel from the lower eyelid entered into the mandibular lymph centre, and from the upper eyelid entered into the superficial cervical lymph centre, but both drained into the deep cranial cervical lymph node. The direct entry of lymph entering the veins without passing through lymph nodes was not observed.

Pulmonary Embolism and Uterine Venous Plexus Thrombosis in the Postpartum Period

Pregnancy is associated with an increased risk of venous thromboembolism, which includes pulmonary embolism (PE) and deep vein thrombosis. The incidence of venous thromboembolism is estimated at 0.76 to 1.72 per 1,000 pregnancies, which is four times higher than that in non-pregnant women [1]. The incidence of PE in the postpartum period is much higher than during pregnancy [2]. There are few reports on uterine vein thrombosis, consisting mostly of cases involving thrombi in external and internal iliac veins [3]. Uterine venous plexus thrombosis (UVPT) is a rare diagnosis. Sudden death linked to pulmonary thromboembolism (PTE) in the presence of UVPT without deep vein thrombosis in the lower extremities is even more uncommon. We report a case of sudden, unexpected death due to acute PTE associated with UVPT in a postpartum woman.

Asymmetric Superior Ophthalmic Vein Thrombosis due to Sepsis Induced by a Deep Neck Infection

Superior ophthalmic vein thrombosis is one of the early signs of cavernous sinus thrombosis. It is characterized by ipsilateral proptosis, ptosis, chemosis, limitations of ocular muscle movement and normal fundus findings. In this article, we present a case of bilateral asymmetric superior ophthalmic vein thrombosis due to sepsis developed from a deep neck infection from a parotid gland abscess. A 49-year-old male patient presented to our emergency department with a history of progressive left neck swelling, ocular pain and conjunctival injection, ptosis, proptosis, and diplopia on his right eye. He had limitations of his extraocular muscle movement in all directions of his right eye, especially abduction and adduction limitations with no midline crossing. It was revealed that the patient was in a septic condition at the emergency department. The findings revealed a diffuse parotid gland abscess and left external carotid vein thrombosis. An incision was performed and drainage was done on next day of the ER visit. His bilateral cavernous sinus yielded a decreased enhancement on the CT scan signifying thrombophlebitis. His right superior ophthalmic vein was filled with a thrombus. The left superior ophthalmic vein was also filled with a thrombus. An orbital MRI also revealed both an ophthalmic vein engorgement due to the thrombus and an enhancement around the extraocular muscle with infiltration. A blood culture test concluded the presence of Staphilococcus auerus, a gram positive microorganism. The patient was maintained on intravenous antibiotics over his admission. After discharge, the proptosis and limited motion of the extraocular muscle dissipated. However, diplopia at the primary position remained. Septic thrombosis of the cavernous sinus is rare but a potentially detrimental condition that demands careful consideration and suspicion when dealing with a patient with an acute neck inflammation. Early recognition and prompt administration of broad spectrum intravenous antibiotics is important because isolated septic superior ophthalmic vein thrombosis is rare.

Hematologiczne i biochemiczne parametry krwi koni uzytkowanych sportowo i rekreacyjnie

The study was conducted to determine and compare the resting values of haematological and biochemical blood indices in clinically healthy horses competing in show jumping and used for leisure activities. The experiment included twenty adult horses of Polish half-bred and Wielkopolska breed which were subjected to a daily training programme typical of their type of use. Blood samples were collected at rest before feeding from the jugular external vein. Show jumpers had higher (P < 0.05) red blood cell count, haematocrit value and haemoglobin concentration as well as the serum level of total protein, albumin, α2- and γ-globulin, HDL and iron. The level of β-globulin, magnesium and activity of creatine kinase were significantly higher in recreationally used horses. There were no differences in the values of red blood cell parameters (MCV, MCH, MCHC), number of leucocytes and the percentage of their respective kinds, platelets, concentration of urea, creatinine, glucose, triglycerides, total cholesterol, LDL, activity of AST, ALT, LDH and in the content of Na, K, Cl, P, Ca between the tested groups. The results of the present study indicate that the type of training influences some of the resting haematological and biochemical indices in adult horses. Horses used for show jumping have higher aerobic capacity and show a more beneficial lipid profile compared to horses used for recreation.

Jugular vein reconstruction by longitudinal constriction suture venoplasty and microvascular anastomosis

Objective To seek a new method for reconstructing bilateral intemrnal jugular vein invaded by metastasis lymph node in advanced oral cancer patients. Methods A combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions. Results Postopera-tive follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60% (3/5). Conclusion Microvascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.

Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion

Nonthrombotic iliac vein lesions are an active area of research. The advantages of intravascular ultrasound (IVUS) imaging include allowing the exact localization of these lesions. We chose to use IVUS to explore the anatomical location of nonthrombotic iliac vein lesions (NIVLs) and correlate it with clinical findings. Over the course of 7 months, we performed 217 iliofemoral IVUS-assisted studies in 141 women and 76 men. The average ± standard deviation age of examined population was 68 ± 14 years (range, 22-96 years). We used IVUS intraoperatively to measure and record the area of the involved iliofemoral veins. The measurement of stenosis was compared with the adjacent nonstenotic iliofemoral veins. If >50% cross-sectional area or diameter reduction was found by IVUS imaging, it was treated with appropriate balloon size (range 10 × 40 to 16 × 60) and stent (12-to 24-mm diameter × 40-to 90-mm length). We used the Boston Scientific Mobile Cart System IVUS to perform these measurements. We identified 233 lesions: 115 in left lower extremity (LLE) and 118 in the right lower extremity (RLE). The CEAP scores in the LLE were C1: 0; C2: 35; C3: 40; C4: 15; C5: 20; and C6: 6; with the most common site being the proximal common iliac vein in 37.4% (20.86% females and 16.5% males). The CEAP scores in the RLE were C1: 0; C2: 31; C3: 42; C4: 14; C5: 23; and C6: 7; and the most common site was in the middle external iliac vein in 31.35% (20.4% females and 11.01% males). The least common site of the NIVL in the LLE was in the distal external iliac vein in 2.6% (2.6% females and 0% males). In the RLE, the least common site of NIVL was also in the distal external vein 7.62% (5.93% females and 1.69% males). No correlation between age, laterality, gender, or CEAP score were noted. This analysis gives an insight into understanding the anatomical location of the NIVL, which is often an undiagnosed cause of lower extremity venous diseases. Despite multiple questions yet to be answered, the results give an insight to clinicians and researches to guide their treatment and research.

Apprentissage des techniques microchirurgicales vasculaires sur un modèle animal

IntroductionThe aim of this study was to assess the progress of an operator, during microsurgical training, on a bilateral carotid revascularization in the rat. Material and methodsIn this prospective study, nine rats underwent bilateral carotid revascularization. An end-to-end graft of the right carotid artery by the facial vein and an end-to-side bypass of left carotid artery by the jugular external vein were performed. Anastomoses were carried out with 10/0 thread, based on the technique of the symmetric bi-angulation. At the end of procedure, a permeability test was performed on each anastomosis. Duration of survival of the animal, permeability of anastomosis, and evolution of the operating periods during the training were collected and respectively analyzed with a Fisher's and Student's t tests. In cases of procedure success, anastomoses were remotely controlled and a brain dissection was performed in order to seek a possible ischemia due to carotid clamping. In the event of failure, the rat was sacrificed and anastomoses were opened in order to establish the cause of thrombosis. ResultsTwo thirds of the revascularization procedures were successful. A total of 83.3% of the anastomoses were patent. Of the six rats preserved for remote evaluation of anastomoses, three died. Remotely controlled anastomoses remained all permeable. No cerebral ischemia, associated with carotid clamping (approximately 45minutes), was highlighted by brain dissection. With the growing experience of the operator, an improvement in results in mastery of the technique was objectively observed. Operative durations were reduced between the beginning and the end of the training: −54minutes (P=0.001). ConclusionMicrosurgical laboratory training seems to be essential in order to acquire the dexterity, ease and experience necessary for performing microsurgical procedures in humans.

The venous system of the human foetal spinal cord. Scanning electron microscope of vascular corrosion casts.

The investigation was carried out on 16 human foetal cadavers at the age of 17-23 weeks from the time of conception. The foetal vascular system was injected with the synthetic resin MERCOX CL-2R and analysed in scanning electron microscope.The vascular system of the foetal spinal cord was studied. The foetal vascular system was characterised by high variability concerning the number, course and localisation of blood vessels. It contained numerous anastomoses with the internal spinal venous plexuses, which included anterior and posterior radicular veins. Large arteries running on the surface of the spinal cord are accompanied by the homoname veins. The venous system of the investigated foetuses was divided into 2 categories of veins: internal veins responsible for the drainage of blood from the central area, that is central and peripheral veins coming radially to the surface of the spinal cord and external veins, which form the venous system of the surface of the spinal cord. The venous system of the foetal spinal cord was also examined as to the presence of the valves.