Flush Ligation Research Articles

Arterial intimal hyperplasia after occlusion of the adventitial vasa vasorum in the pig.

Oxygenation of the arterial wall is provided by diffusion of oxygen outward from the main vessel lumen and inward from the adventitial vasa vasorum. In a group of four Yucatan miniature pigs the oxygenation profiles across the superficial femoral arteries were recorded by polarographic oxygen microelectrodes. The profiles obtained suggested a relatively poorly oxygenated media (a trough value of approximately 25% that of the intimal oxygenation) with a progressive rise in oxygenation toward the intimal and adventitial surfaces. In four other survival experiments, occlusion of the adventitial vasa vasorum by flush ligation of the arterial branches that supply them resulted in the production of a focal, intimal hyperplastic lesion that was absent in control vessels (intimal to medial ratios [mean +/- SEM] of 0.053 +/- 0.008, n = 8, p < 0.001 and 0.013 +/- 0.001, n = 8, respectively). By electron microscopy this lesion was seen to be composed mainly of smooth muscle cells. This evidence would support the hypothesis that arterial wall hypoxia may be involved in the initiation of intimal hyperplasia. It is proposed that human atherosclerosis may be initiated by occlusion of the vasa vasorum and concomitant hypoxia.

Preoperative localisation of the saphenopopliteal junction with duplex scanning

The anatomy of the saphenopopliteal junction shows considerable variation, and clinical localisation of this junction is inaccurate. Duplex scanning in preoperative mapping of the saphenous vein system in bypass surgery has been shown to be highly effective. In 62 patients with clinical evidence of insufficiency of the saphenopopliteal junction, preoperative localisation with duplex scanning was performed in 66 extremities. In 62 extremities duplex localisation matched the operative findings and in four extremities a difference of 2 cm or more was found. There was 1 false negative surgical exploration. In 93% of the cases exact localisation of the junction enabled us to perform flush ligation of a small saphenous vein through minimal exposure. Preoperative duplex scanning of the saphenopopliteal junction is highly accurate.

Lateral thigh varicose veins: a phlebographic study.

The phlebographic findings in nine patients with primary varicose veins on the lateral aspect of the thigh are described. These were shown by varicography to connect primarily with the deep femoral vein via communicating veins: the symptoms were either cosmetic or mild aching in the thigh. Surgical treatment, if indicated, consists of subfascial ligation or sclerosis of the varices, or flush ligation of the incompetent communicating veins at their connections with the deep femoral vein.

Flush ligation and compression sclerotherapy for the control of venous disease

Tailoring treatment to the individual limb, by using flush ligation for the incompetent long saphenous vein and compression sclerotherapy for perforating veins and major control points, gives good control of venous disease. The long saphenous vein can be preserved in these circumstances. Compression sclerotherapy is easily repeated if necessary. Varicography and local ligation should be considered for large recurrences in the thigh where compression sclerotherapy is difficult. Compression sclerotherapy has replaced fasciotomy in my practice, and I strongly recommend this combined approach to surgeons interested in the treatment of venous disease.

Exclusion of Nonisolated Splenic Vein in Distal Splenorenal Shunt for Prevention of Portal Malcirculation

In an attempt to prevent portoprival malcirculation after distal splenorenal shunt (DSRS), a splenic hilar renal shunt (HRS) with proximal flush ligation of splenic vein was designed. To accomplish this procedure, two methods were compared: HRS alone (Group A) and HRS plus proximal flush ligation of the splenic vein (Group B). In Group A, which included 20 cirrhotic patients with esophageal varices, angiographic as well as pulsed Doppler flowmetric follow-up study revealed a portal thrombosis in two patients and severe narrowing of a portal vein in another two. Considerable stealing flow was observed in these four patients. In the Group B series, which included 33 cirrhotic patients, there were no gross changes in the portal hemodynamics. Normal prograde portal flow was confirmed by Doppler flowmeter in this series including 14 patients of more than 8 months after surgery. When the amount of nonisolated splenic vein embedded in the pancreas is minimized, portal malcirculation after distal splenorenal shunt can, to a great extent, be prevented.