Femoral Vein Thrombosis Research Articles

Diagnosis of abdominal mural aortic thrombus following discovery of common femoral artery and vein thrombosis by point-of-care ultrasound.

Acute limb ischemia (ALI) is a limb-threatening and life-threatening disease process. Mural aortic thrombosis (MAT) is a rare cause of ALI. While there is limited evidence on the use of bedside ultrasound for the detection of ALI or MAT, duplex ultrasound remains the standard in the diagnosis and ultimate medical decision-making in patients with acute and chronic limb ischemia. Point-of-care ultrasound may be used in the evaluation of patients with signs and symptoms of this disease entity. This is a case of a 79-year-old female with a complicated medical history, who presented with a pulseless right leg and abdominal tenderness. The patient quickly decompensated requiring intubation for airway protection. A post-intubation arterial blood gas (ABG) was unsuccessfully attempted in the right femoral artery, prompting an ultrasound-guided ABG. On B-mode ultrasound evaluation, echogenic material was visualized in the right common femoral artery without evidence of Doppler flow signal. Additionally, a partially obstructing echogenic material was also noted at the femoro-saphenous vein junction with only partial compressibility by compression sonography. A computed tomography angiography of the aorta was performed indicating extensive infrarenal aortic thrombosis. The patient expired despite the relatively prompt diagnosis, highlighting the importance of early identification of acute arterial occlusion.

Leg Swelling and Mildly Deranged Liver Tests: An Unusual Presentation of a Usual Diagnosis

Question: A 72-year-old woman presented to the hospital with progressively worsening left lower extremity swelling and pain of 1 weeks’ duration. She also reported vague right upper abdominal discomfort, but did not complain of nausea, vomiting, shortness of breath, chest pain, fever, or jaundice. Her past history was significant for hypertension and Meniere disease. She had had no prior surgeries and was a lifetime nonsmoker. Her current medications were hydrochlorothiazide-triamtrene, aspirin, calcium-vitamin D, and a multivitamin. On examination, she had 2+ pitting pedal edema with mild tenderness of left lower extremity. Abdomen was soft and nontender with no palpable organomegaly or mass. The rest of the physical examination was unremarkable. Laboratory tests showed: hemoglobin, 11.8 g/dL; platelets, 277,000/μL; International Normalized Ratio, 1.3; total bilirubin, 1.4 mg/dL; alkaline phosphatase, 279 IU/L; alanine aminotransferase, 39 IU/L; and aspartate aminotransferase, 38 IU/L. Lower extremity ultrasound duplex examination was performed and showed deep venous thrombosis of left femoral vein. CT of the abdomen with oral and intravenous contrast was subsequently obtained (coronal sections; Figure A, B). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. CT of the abdomen with contrast showed multiple simple liver cysts (SLCs) with a large cyst (12.2 × 11.4 × 13.1 cm) in segment IV of liver causing extrinsic inferior vena cava (IVC) compression (black arrow in Figure C) and extensive venous thrombosis extending from the left ileofemoral veins to the IVC (white arrows in Figure D). After initiation of therapeutic anticoagulation with subcutaneous weight-based enoxaparin, the patient underwent percutaneous catheter-guided thrombolysis of IVC and ileofemoral thrombus. Open surgical fenestration of large liver cyst was performed the next day. Pathologic examination of the cyst wall showed cuboidal epithelium with no features of biliary cystadenoma. The patient was discharged on post-operative day 5 on oral warfarin. SLC are the most common nonparasitic cystic lesions of liver estimated to occur in approximately 5% of the population.1Kelly K. Weber S.M. Cystic diseases of the liver and bile ducts.J Gastrointest Surg. 2014; 18: 627-634Crossref PubMed Scopus (10) Google Scholar They are usually asymptomatic, detected incidentally, and do not carry malignant potential. Differential diagnoses of SLC include parasitic cyst, hepatic abscess, and neoplastic cyst. Large cysts can become symptomatic owing to hepatomegaly, mass effect on adjacent organs, or complications like infection, rupture, biliary obstruction, and intracystic hemorrhage. Rarely, a liver cyst can cause extrinsic compression of IVC, which predisposes to thrombus formation by causing venous stasis, as in our patient.2England R.A. Wells I.P. Gutteridge C.M. Benign external compression of the inferior vena cava associated with thrombus formation.Br J Radiol. 2005; 78: 553-557Crossref PubMed Scopus (20) Google Scholar SLCs do not require treatment unless symptomatic. Treatment options include aspiration–sclerotherapy, surgical fenestration, or hepatic resection.3Koperna T. Vogl S. Satzinger U. et al.Nonparasitic cysts of the liver: results and options of surgical treatment.World J Surg. 1997; 21: 850Crossref PubMed Scopus (76) Google Scholar Aspiration–sclerotherapy, although noninvasive, is associated with higher recurrence and complication rates than laparoscopic fenestration, and may be reserved for patients who are poor candidates for surgery and general anesthesia.3Koperna T. Vogl S. Satzinger U. et al.Nonparasitic cysts of the liver: results and options of surgical treatment.World J Surg. 1997; 21: 850Crossref PubMed Scopus (76) Google Scholar

Leiomyosarcoma of the Inferior Vena Cava Level II Including Both Renal Veins: Surgical Approach

A 66 years old male developping an acute lower right limb oedema due to an extended venous thrombosis of the common femoral and iliac veins was diagnosed to have a leiomyosarcoma of the inferior vena cava (IVC) involving both renal veins. The characteristics and management of this level II IVC leiomyosarcoma are discussed with particular attention to the renal vein reconstruction and neo-adjuvant therapy.

Spontaneous retroperitoneal hematoma with deep venous thrombosis of left lower limb managed conservatively

Deep vein thrombosis (DVT) of iliac and femoral veins is a common condition in our clinical practice. Spontaneous retroperitoneal hematoma (SRH) is a relatively rare condition. The occurrence of both DVT and SRH concomitantly is very rare. Many of the times the exact pathology leading to SRH with DVT is unknown. Both conditions being fatal in nature, the management remains very challenging. Here we report a similar case with review of the literature.

Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi

Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation. At 1 week after the procedure, each femoral vein was imaged by color Duplex ultrasound and sent for histologic interpretation for differentiation between EHIT and DVT. Five blinded vascular surgery faculty, two vascular surgery fellows, and three vascular surgery residents reviewed the ultrasound images. Thrombi associated with radiofrequency ablation demonstrated a greater degree of hypercellular response, fibroblastic reaction, and edema (3.42 vs 2.92; 3.75 vs 2.42; 2.83 vs 1.33). Specimens harvested from the iatrogenic-induced DVT swine demonstrated a more prolific response to trichrome staining (3.42 vs 2.67). Evidence of revascularization was found in all of the EHIT specimens but in 33% of DVT specimens. On the basis of histologic findings, the pathologist predicted correct modality 92% of the time. Subgroup analysis comparing paired specimens from each swine failed to demonstrate any marked pathologic differences. Recorded ultrasound images from EHIT and DVT samples were reviewed by fellows, residents, and vascular surgery staff to determine whether clot was stationary or free-floating (n = 111; 93%), evidence of retracted or adherent vein (n = 105; 88%), and absence of color flow (n = 102; 85%). The degree of occlusion (partial vs total) and degree of distention of a visualized vein were least likely to be agreed on by reviewers (n = 95; 79% each, respectively). In subgroup (DVT vs EHIT) analyses, the percentage agreement was greatest among vascular surgery fellows (89% and 92%) compared with residents (82% and 79%) and faculty (78% and 77%). It is possible to differentiate the thrombus origin on pathologic examination but not clinically on ultrasound. Wide variability exists for ultrasound diagnosis of EHIT and de novo DVT. Care must be taken in evaluating post-treatment duplex scans to not assign diagnosis of EHIT when DVT may well be present and extending into the deep venous system. The modulation of collagen production in the treatment of DVT may be helpful in preventing vascular dysfunction and reducing the post-thrombotic changes. Further studies on injury after radiofrequency ablation and laser ablation are needed.

Catheter-Directed Reperfusion Therapy after Unsuccessful Systemic Thrombolysis in a Patient with Evolving Sub-massive Pulmonary Embolism

Thrombolysis in sub-massive pulmonary embolism remains controversial. We present a case of a 52 year old obese male admitted for a 2-week history of dyspnea and swelling of the right leg. On admission, the patient was dyspneic and tachycardic. Venous duplex study showed acute partially occlusive thrombosis of the right femoral vein and totally occlusive thrombosis of the right popliteal vein. Echocardiography revealed a dilated right ventricle with severe pulmonary hypertension (95 mmHg). B-type natriuretic peptide and D-dimer levels were elevated. Computerized tomography (CT) angiogram showed a saddle thrombus in the main pulmonary artery with almost complete obstruction of the proximal left lower lobe segmental artery. Systemic thrombolysis with 100 mg of recombinant tissue plasminogen activator (r-TPA) was given, followed by low molecular weight heparin. Approximately 30 hours after thrombolysis, the patient had recurrence of dyspnea, and became hypoxemic. A repeat CT angiogram of the pulmonary arteries revealed an interval thinning of pulmonary embolus of the main pulmonary artery, interlobar arteries and proximal branches, but the obstruction of the proximal left lower lobe segmental artery was unchanged. Right heart catheterization revealed a pulmonary artery pressure (PAP) of 68/30 mmHg. Pulmonary angiogram showed a large thrombus at the right main pulmonary artery, and total occlusion of the left lower lobe pulmonary artery. Catheter-directed thrombolysis to the pulmonary artery was done with 50 mg of r-TPA, given over 2 hours. An inferior vena cava filter was also inserted. PAP decreased to 50 mmHg after catheter-directed thrombolysis. There was relief of dyspnea, and his heart rate normalized. This case demonstrated the safety and feasibility of systemic thrombolysis followed by catheter-directed thrombolysis in sub-massive pulmonary embolism and deep venous thrombosis done in the local setting.

Efficacy of Prolene 3D patching in tension-free hernioplasty for femoral hernia via femoral approach

A total of 114 cases of femoral hernia undergoing 3D Prolene patching via femoral approach were examined for duration of surgery, length of stay, recurrence, postoperative pain and complications.Among them, 53 cases received both pre- and post-operative Doppler ultrasonic examinations.The vein thrombus, diameter and flow rate of femoral vein were observed to compare with the pre-operative data to learn whether it had difference or not.The operative duration was 13.3 minutes.There was no event of recurrence, compression, stricture or thrombosis of femoral vein. Key words: Hernia, ventral; Reconstructive surgical procedures

Reversible lower limb deep vein thrombosis following haemotoxic snakebite—a case report

Haemotoxic snakebite, presenting with coagulopathy and bleeding manifestations, is quite common. Thrombotic manifestations are infrequently observed. We describe the unusual case of a young male who developed deep vein thrombosis (DVT) of the left lower limb following snakebite, despite an ongoing coagulopathy. Investigations revealed leucocytosis, prolonged 20-minute whole blood clotting time (20'WBCT), prolonged prothrombin time (PT), and activated partial thromboplastin time (aPTT). Doppler study revealed thrombosis of common femoral vein, superficial femoral, and profunda femoris veins. The patient underwent two fasciotomies and received anticoagulation after which patency of the veins was restored. Doppler sonographic imaging in patients with haemotoxic snakebite who present with increasing local swelling may assist with early anticoagulation therapy that has a potential to be limb-saving.

Sudden hearing loss followed by deep vein thrombosis and pulmonary embolism in a patient with factor V Leiden mutation

Objective: Factor V Leiden (FVL) is by far the most prevalent inherited thrombophilic abnormality in Western countries, and this genetic condition has been associated with sudden sensorineural hearing loss (SSHL). Audiologists should be aware that SSHL may be the precursor of life-threatening thromboembolic events, especially in Caucasians who are more likely to be FVL carriers. Design: Case report. Study sample: A 41-year-old male patient. Results: Although this is not the first report of SSHL in a FVL carrier, it is the first to describe SSHL occurring in a heterozygous FVL carrier who — within a month — was also diagnosed with deep vein thrombosis of the left common femoral, saphenous, and popliteal veins, and pulmonary embolism of the left pulmonary artery branch serving the posterior basal segment of the inferior lobe. Conclusions: SSHL is an emergency condition that warrants prompt medical examination and treatment. Hematological investigations should be considered in SSHL patients at least for those with a family history of thrombotic events, and for women on estrogen-progestin therapy or during pregnancy, with a view to providing adequate antithrombotic prophylaxis and reducing the risk of other thromboembolic events.

Clinical outcomes and causes of death in Japanese patients with long-term inferior vena cava filter implants and deep vein thrombosis

Background and purposeWe assessed the causes of death and efficacy of permanent inferior vena cava (IVC) filters for preventing new pulmonary embolisms (PE) in Japanese deep vein thrombosis (DVT) patients with or without PE. Methods and subjectsWe studied the clinical outcomes during the follow-up period of 1 day to 9 years (median: 18 months; mean: 28 months) in 66 of 72 consecutive patients (44 with acute PE, 27 with intrapelvic DVT, and 1 with floating femoral vein thrombosis). Fifty of 66 patients received anticoagulant therapy after the filter placement. ResultsFive patients died within 1 month (median 9 days) after the filter placement: three from recurrence of PE, one from cancer, and one from sepsis. Two of the three patients with recurrence of PE had preexisting intracardiac thrombi in the right atrium or main pulmonary artery before filter implantation. Ten patients died from the underlying disease (cancer: 7; brain hemorrhage: 1; amyotrophic lateral sclerosis: 1; pneumonia: 1) over 1 month after the filter placement (median follow-up period: 21 months). No new symptomatic PE recurrence was observed over 1 month after the filter placement. The 61 patients with long-term follow-up had no deterioration of DVT, and all the 31 patients who underwent multi-slice computed tomography showed no PE recurrence or filter thrombus occlusion, fracture, or migration. ConclusionsUnderlying diseases and preexisting intracardiac thrombi may be the determining factors for the prognosis of DVT patients. Permanent IVC filters with anticoagulant therapy may be effective for preventing death from new PE in Japanese DVT patients.

Deep vein thrombosis in a child with osteoarticular infection: A case report

Acute osteoarticular infections are common in children and rarely complicated with deep vein thrombosis (DVT). This complication can cause significant morbidity and may even be fatal. Herein we report a ten year girl with deep vein thrombosis of left femoral vein who presented initially with septic arthritis of left knee and osteomyelitis of left femur. She required prolonged hospital admission and was managed with surgical debridement, antibiotics and anticoagulation. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 52-55 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9675

Femoral vein thrombosis and subsequent pulmonary embolism after osteosynthesis of femoral trochanteric fracture, a case report

Femoral vein thrombosis and subsequent pulmonary embolism after osteosynthesis of femoral trochanteric fracture, a case report

Venous Thromboembolism and Cancer

Case Presentation 1: A 64-year-old man with prostate cancer who recently underwent radical retropubic prostatectomy presented to the emergency department with sudden-onset exertional dyspnea and chest heaviness. On physical examination, he was tachycardic with a heart rate of 110 beats per minute, normotensive with a blood pressure of 100/76 mm Hg, and hypoxemic with an oxygen saturation of 88% on room air. Left lower extremity edema and calf tenderness were noted. Contrast-enhanced chest computed tomography demonstrated bilateral segmental pulmonary embolism (PE) without right ventricular enlargement. A left lower extremity venous ultrasound documented left femoral, popliteal, and calf deep vein thrombosis. Case Presentation 2: A 70-year-old woman with renal cell carcinoma underwent resection of a solitary right upper lobe metastatic pulmonary nodule and was referred to the Vascular Medicine clinic after surveillance chest computed tomography performed 1-month postoperatively demonstrated a right lobar PE. She noted fatigue since her surgery but denied any dyspnea or chest discomfort. On physical examination, her heart rate was 82 beats per minute, blood pressure was 102/66 mm Hg, and oxygenation was 96% on room air. Cardiac and pulmonary examinations were unremarkable. Although the association between cancer and venous thromboembolism (VTE) was first noted in 1823 by Bouillard, Trousseau provided the most detailed early description in 1865. VTE is now recognized as a common cause of morbidity and mortality in patients with cancer. Increasing life expectancy attributable to advances in cancer therapy and greater use of imaging for cancer surveillance have contributed to the growing incidence of VTE in patients with malignancy. The rate of symptomatic VTE in patients with cancer who have been hospitalized approaches 5%.1 VTE, especially when unprovoked, may herald an impending diagnosis of cancer in a subset of patients without known malignancy. Although the frequency of VTE is considered highest among patients with solid …

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Introduction: A 36 year old male underwent AVR with aortic root and sinus of valsalva enlargement. Patient recovered and was transferred out of ICU on POD (postoperative day) 3. On POD 4 he was reintubated for respiratory insufficiency and heparin was started for femoral deep vein thrombosis. On POD 10 argatroban was started for suspected HIT (high 4Ts score); diagnosis later confirmed with a positive heparin platelet factor 4 antibody and serotonin release assay. Emergent embolectomy was performed for large right and left main pulmonary artery thromboemboli which were causing recurrent pulseless electrical activity requiring near continuous cardiopulmonary resuscitation. Intraoperatively a clot was found adherent to the right atrial wall and right atrial appendage; the appendage was extracted and remaining clot debulked. ECMO was required for oxygenation and right ventricular failure. Consumptive coagulopathy and DIC developed. The patient was placed in a hypothermic protocol for CNS resuscitation. Argatroban anticoagulation goals while on ECMO were an aPTT of 45-90 seconds and an ACT of 250-300 seconds. Oxygenation and right ventricular function improved over the next 4 days. Argatroban infusion rates while on ECMO ranged from 0.1 to 1mcg/kg/minute. Throughout ECMO numerous elevated clotting times (ACT > 1000 seconds, aPTT > 124 seconds) resulted in the need to hold the argatroban infusion four times; totaling 77 hours or 64% of the time on therapy. Although holds were warranted for supratherapeutic clotting times; numerous factors other than argatroban were elevating the aPTT and ACT including hepatic impairment, DIC, hemodilution and hypothermia. The patient was successfully de-cannulated and subsequently returned to OR for sternal closure and placement of a Greenfield filter. Intraoperatively an enlarging right atrial thrombus; 3 cm wide by 6cm long was removed via right open atriotomy. After return to the ICU the patient developed bi-ventricular failure and expired. This case illustrates the challenges of argatroban dosing in ECMO, the limitations of argatroban monitoring tests, and the potential life threatening thrombotic consequences of HIT during argatroban infusion interruption despite therapeutic clotting time tests.

Femoral vein thrombosis after right-sided electrophysiological procedures

Electrophysiological studies and radiofrequency catheter ablations require single or multiple sheath placements through femoral vein cannulation. The objective of this study was to determine the incidence, predictors, and outcomes of deep vein thrombosis (DVT) following such procedures. We prospectively enrolled 220 consecutive patients with a median age of 70 [60-79] years. The median duration of the procedures from insertion to removal of sheaths was 45 [30-75] min. At least two sheaths were inserted in 158 (72%) of the cases. Duplex ultrasonography evaluation of the lower leg veins was performed 6 h after the procedure and revealed common femoral vein thrombosis in 11 (5%) patients. All thrombi were partial and none was complete. Thrombi were mobile in four patients and extended to the external iliac vein in three patients. None of the patients presented with clinical signs of DVT or pulmonary embolism. Anticoagulation was prescribed for 2-4 weeks and a follow-up duplex ultrasonography obtained in the first seven patients revealed complete resolution of thrombi in all cases. On multivariate analysis, two predictors of thrombosis occurrence were identified: a greater sum of sheath diameters (odds ratio, 1.41 [95% confidence interval, 1.25-1.60] per 1-French increase; p < 0.001) and a longer procedural duration (odds ratio, 1.02 [95% confidence interval, 1.00-1.04] per 1-min increase; p = 0.04). Asymptomatic femoral DVT occur in 5% of electrophysiological studies and right-heart radiofrequency catheter ablations, particularly when large sheaths are inserted for a longer period. The role of anticoagulation in this clinical setting warrants further evaluation.

PP195-SUN THE EFFECT OF OSMOLARITY ON THE GROWTH OF E. COLI AND E. DURANS IN PARENTERAL NUTRITION CONTAINING LIPID

Rationale: The use of the femoral vein for parenteral nutrition (PN) is relatively contraindicated, because of common believe it’s associated with a high risk of contamination at the exit site at the groin, leading to sepsis and a high risk of venous thrombosis. When veins of upper part of the body became occluded, the femoral access is the first choice for long term PN, but such situation is now recognised as indication for intestinal transplantation. The aim was to evaluate safety of modified femoral venous access for HPN. Methods: 20 from 962 HPN patients suffered from intestinal failure presented complete occlusion of upper vena cava on admission (n = 8) or during HPN (n = 12 ), confirmed by phlebography and/or CT scan. 6.6 F Broviac catheter tunnelised to abdominal wall up for over 15 20 cm and then reversed, putting the cuff 5 cm down and exit site 2 cm lower, was inserted under fluoroscopy through femoral vein into right atrium. Exit site infection and central catheter related blood stream infection (CRBSI) rate was retrospectively analysed and compared with observed in the same patients when tunnelised upper vein access was used before occlusion of upper veins or after theirs recanalization. Results: HPN was provided for total of 31 206 days through femoral and 20422 days through subclavian or jugular vein. The CRBSI rate was 1.66/1000 HPN days for upper access and 0.27/1000 HPN days for femoral vein and exit site infection 0.09/1000 HPN days for both. Thrombosis of both femoral veins has occurred in 2 patients, upper veins recanalised after 3 12 years in 4 patients. Conclusion: Modified femoral access is safe. The risk of thrombosis is low with systemic anticoagulation. The reason for lower complications rate may be due to better catheter care performance with growing experience but also due to easier handling by the patients.

Percutaneous Femoral Vein Access for Inferior Vena Cava Filter Placement Does Not Cause Insertion-Site Thrombosis

The efficacy of inferior vena cava (IVC) filters in the prevention of pulmonary embolism in patients with lower extremity deep venous thrombosis (DVT) has been well described. What remains uncertain is the risk of insertion-site thrombosis of the femoral vein after filter placement. Historically, the risk was relatively high, most likely due to large delivery systems and therefore a need for longer compression at the insertion site to provide hemostasis. The purpose of this prospective study was to determine the incidence of thrombus formation at the femoral vein puncture site after percutaneous insertion of contemporary IVC filters. From October 2010 to November 2011, 61 consecutive patients underwent placement of an IVC filter by 3 vascular surgeons and 3 interventional radiologists at our tertiary-care Level I trauma center. All filters were inserted through the right or left common femoral vein. Duplex ultrasound studies (DUS) were performed within 24 hours before filter placement and 24‒72 hours after filter placement. Fifty-six patients completed the study, including 46 men and 10 women. They ranged in age from 19 to 90 (mean 50) years. Forty-one filters (73%) were placed for prophylaxis: 39 of the patients were trauma victims with immobility and/or contraindications to anticoagulation, 1 had an intracranial hemorrhage with an underlying malignancy, and 1 had very limited mobility. The remaining 15 filters (27%) were placed because of an acute DVT with a contraindication to or a complication from anticoagulation. The filters utilized were: Boston Scientific-Greenfield (n=25); Cook-Celect (n=18); Bard-G2X (n=2); Bard-Eclipse (n=6); and Cordis-TrapEase (n=5). Sheath diameters ranged from 6- to 12-French. None of the 56 patients had thrombus formation at the insertion site on follow-up DUS. Based on our study findings, the risk of femoral insertion-site thrombosis after percutaneous placement of contemporary IVC filters is negligible. Concern for femoral vein thrombosis should not be a reason for using the internal jugular vein to deploy IVC filters.

Cystic Adventitial Disease of the Common Femoral Vein

We report on a 52-year-old female patient who presented with a 6-month history of right lower extremity swelling and tenderness. The patient was treated as an outpatient with full anticoagulation, without any improvement. Her medical history was significant for hypertension and high cholesterol, and she had a full coagulopathy profile that was negative for any hypercoagulable syndrome. On examination, the patient was moderately obese, with significant tenderness over the medial aspect of the right groin. A venous duplex examination revealed hypoechoic structure ± acute deep vein thrombosis of right common femoral vein (CFV). A computed tomography of the venous phase revealed an eccentric compression over the medial wall of the right CFV. During surgical exploration, adventitial cystic mucinous disease was enucleated from the medial wall of the right CFV, and the pathological examination confirmed the diagnosis. The postoperative course was uneventful, and all swelling and tenderness were completely resolved. The patient continued to do well, and she had an unremarkable venous duplex evaluation at her 6-month follow-up.

Surgical treatment for pelvic ring fractures in pediatric and adolescence age

Fractures of the pelvis in pediatric population are extremely rare. Children with complex pelvic fractures are most often pedestrians who have been struck by a motor vehicle. Head injuries are the main cause of death, unlike the adult, where severe hemorrhages are common and contribute to mortality. Long-term follow-up studies have reported significant residual morbidity in children's pelvic fractures treated non-operatively. The aim of this study is to analyze our cases in order to evaluate the final outcome and to suggest the surgical indications for the management of this kind of injuries. From January 2000 to July 2011, eight pediatric patients were surgically treated for pelvic ring fractures in our department. The functional result at follow-up was evaluated using the functional independence measure (FIM). In most cases the clinical outcome was good with functional recovery of the hip and complete resumption of physical activity. The mean FIM score was 125.3. One patient underwent permanent colostomy for perineal lacerations, one case showed a slight scoliosis at follow-up, and one patient showed the early fusion of the triradiate cartilage. One patient presented a deep thrombosis of the common femoral vein. Fractures of the pelvic ring should be carefully assessed by radiographs and CT scan. The centralization of these young patients is important to get the experience and ensure the proper treatment. A correct indication for surgery may prevent or limit the consequences of these complex fractures.

Endovascular management of inferior vena cava filter perforation.

A 24-year-old female, 7 days status post orthotopic liver transplant, developed a femoral deep vein thrombosis (DVT). A perihepatic hematoma was seen on surveillance right upper-quadrant ultrasound, making treatment of the DVT with anticoagulation relatively contraindicated. As such, the patient had an inferior vena cava (IVC) filter placed (Celect; Cook, Inc, Bloomington, Ind) for pulmonary emboli prophylaxis.