Iliofemoral Region Research Articles

Biochemical Endothelial Injury and Platelets Activation Detectionin Endovenous Laser Ablation of Varicose Veins

Background: Thrombus formation and extension to femoral or popliteal veins and pulmonary embolism may be though as a complication of EVLT in varicose veins treatment we aimed to study the thermal energy effect of the procedure under standardized conditions on biochemical markers of platelets and endothelium activities. Patients and methods: 25 patients admitted to vascular surgery dept. of Alexandria armed forces hospital with varicose veins and GSV. reflux and all treated by endovenous laser ablation during: 1/1/2018_12/31/2018. Venous blood samples were taken from iliofemoral and antecubital veins, before during and one day after surgery of P-selectin, soluble thrombomodulin, fibrin degradation products and D-dime Results: There was no immediate rise of P-selectin and s TM in neither iliofemoral nor antecubital veins, where FDPs D-dimer was significantly elevated post operatively in the two regions. Conclusion: 1480 pulsed mode diode laser doesn’t induce measurable endothelial and platelets activation in iliofemoral region during endovenous ablation of varicose veins.

The biomechanical impact of hip movement on iliofemoral venous anatomy and stenting for deep venous thrombosis

BackgroundStenting of the iliofemoral vein may be an effective treatment to improve post-thrombotic symptoms. Iliofemoral vein stents have requirements different from those of lower extremity artery stents, and there is a paucity of literature regarding the biomechanical motion of the iliofemoral vein. MethodsIn a novel cadaveric model, stents were bilaterally inserted into the veins in the iliofemoral region. The veins were pressurized and underwent computed tomography angiography at various hip angle positions. In addition, 21 patients with iliofemoral vein disease had supine computed tomography angiography before and after stenting. The stents and vasculature were reconstructed into three-dimensional geometric models to quantify stent deformations and the interaction between the iliofemoral vein, inguinal ligament, and pubis bone due to hip flexion-extension. ResultsIn the cadavers, from supine to 30 to 45 degrees and 50 to 75 degrees of hip flexion, iliofemoral vein stents became less compressed (4.5% minor diameter expansion), and the inguinal ligament was separated from the iliofemoral veins by 1 to 3 cm in all hip positions. In the patients, the pubis compressed 47% of femoral veins; 78% were within 3 mm of the pubis. There was also evidence of contrast-enhanced flow disruption at the superior ramus. ConclusionsThe cadaver and clinical evidence shows that contrary to widely accepted dogma, the common femoral vein is not compressed by the inguinal ligament during hip flexion but rather by the superior ramus of the pubis during hip extension, which may have an impact on future stent design and influence deep venous thrombosis treatment strategies.

Valentín Fuster: From Platelets to Preschoolers, Always With Scientific Rigor.

Why did Sesame Street’s Cookie Monster cut his consumption of the sweet treat from daily to once a week? The credit (or blame, depending on your perspective) goes to Valentin Fuster, who was asked to consult on the Spanish version of the show and eventually became Dr Ruster, a muppet sharing health advice with its young and avid audience. “Our behavior as adults depends greatly on the environment we are in between ages 3 and 6, and Sesame Street wasn’t taking advantage of this to focus on prevention and heart health,” says Fuster. Fuster, a renowned physician scientist with a daunting schedule and a decades-long record of bench and translational science and clinical trials, sees no discontinuity between the work that made him famous and his recent focus on preschoolers. “I became convinced that the same scientific tools I used to understand disease could be used to understand and promote health and prevent disease,” Fuster says. Fuster received his undergraduate and medical degrees in his hometown, Barcelona, and did clinical training and completed his doctorate in pathology at the University of Edinburgh. While at the Mayo Clinic between 1971 and 1982, starting as a medical resident and ending as professor of medicine and cardiovascular diseases, he showed in a dog model that platelets were important in the occlusion of bypass grafts and that aspirin could prevent it. Then, in the first clinical trial of aspirin in cardiac disease,1 the team demonstrated that aspirin prevented the occlusion of bypass grafts, leading to clinical guidelines calling for its use. In 1982, Fuster was recruited to become head of cardiology at Mt. Sinai Hospital in New York. After 10 years there, he spent 3 years in Boston at Harvard Medical School and Massachusetts General Hospital, where he began work on using magnetic …

Cardiovascular magnetic resonance imaging of aorto-iliac and ilio-femoral vascular calcifications using proton density-weighted in-phase stack of stars

BackgroundComparing cardiovascular magnetic resonance (CMR) angiography with computed tomography angiography (CTA), a major deficiency has been its inability to reliably image peripheral vascular calcifications that may impact the choice of interventional strategy and influence patient prognosis. Recently, MRI using a proton density-weighted, in-phase stack of stars (PDIP-SOS) technique has proved capable of detecting these calcifications. The goal of the present study was two-fold: (1) to determine whether magnetic field strength impacts the apparent size and conspicuity of ilio-femoral arterial calcifications; and (2) to determine whether the technique can be accurately applied to image aorto-iliac arterial calcifications.Main bodyTwo patient cohorts were studied. For the first cohort, ilio-femoral arterial calcifications were imaged at 1.5 Tesla in 20 patients and at 3 Tesla in 12 patients. For the second cohort, aorto-iliac arterial calcifications were imaged in 10 patients at 3 Tesla and one patient at 1.5 Tesla. Qualitative image analysis as well as quantitative analysis using a semi-automated technique were performed using CTA as the reference standard.Qualitatively, most PDIP-SOS CMR images showed good-to-excellent confidence to detect vascular calcifications, with good-to-excellent inter-reader agreement (κ = 0.67 for ilio-femoral region, P < 0.001; κ = 0.80 for aorto-iliac region, P < 0.01). There was an overall excellent correlation (r = 0.98, P < 0.001) and agreement (intraclass correlation coefficient = 0.97, P < 0.001) between PDIP-SOS CMR and CTA measures of calcification volume in both regions, with no overt difference in performance at 1.5 Tesla vs. 3 Tesla for ilio-femoral calcifications. CMR lesion volumes were slightly lower than those measured for CTA.ConclusionUsing PDIP-SOS CMR, aorto-iliac and ilio-femoral calcifications could be simultaneously evaluated at 3 Tesla in less than six minutes with excellent correlation and agreement to CTA. Our results suggest that PDIP-SOS CMR provides a reliable alternative to CT for pre-interventional evaluation of peripheral vascular calcium burden.

Regional Neurovascular Inflammation and Apoptosis Are Detected After Electrical Contact Injury

High-voltage electrical injuries are a devastating form of trauma often treated in burn centers. Examining superficial wounds alone may lead to an inaccurate assessment of local, regional, and systemic severity of injury. In this work, the neurovasculature at sites regionally distinct from the contact wound were assessed for cellular pathology. Nine male Sprague-Dawley rats subjected to 1000 V direct-current shocks were separated into three groups: high-shock (>10-second contact), low-shock (<4-second contact), and control. Injury video was captured with a forward-looking infrared camera, and a thermal excitation analysis was performed. The neurovascular bundles from the iliofemoral region to the distal posterior tibial region were dissected from the hind limbs of the shocked animals and stained by immunohistochemistry for antibodies specific to apoptosis (APO) 1, caspase-3, activating transcription factor 3, high-mobility group box-1, granulocyte-macrophage colony-stimulating factor and interleukin-6. Real-time reverse-transcription polymerase chain reaction was used to quantify differential transcript levels of superoxide dismutases 1, 2, and 3 and heat-shock protein 70 from peripheral blood mononuclear cells and liver tissue. Finally, a protein array was used to identify key inflammatory cytokines in blood plasma. Significant dose-dependent trends were identified in apoptotic markers as well as inflammatory markers in both arterial and nerve tissues. Although arterial tissue exhibited a gradual decline in these markers proximally from the wound site, nerve tissue maintained a constant level at every location. Transcript analysis revealed an up-regulation of extracellular superoxide dismutase, and down-regulation of heat-shock protein 70, whereas plasma inflammatory cytokine levels indicated no significant changes. Thermal excitation analysis revealed a linear temperature increase, with a dose-dependent thermal maximum. In this study the authors have shown that neurovascular APO and inflammation are present at locations extremely proximal to electrical injury contact sites and this appears to be dose-dependent. Nerve tissue APO and inflammation may extend farther proximally than the iliofemoral region, and multiple proapoptotic mechanisms may be activated. No systemic inflammatory response was indicated in this study.

An atypical impaling injury of the iliofemoral region

A 46-year-old man with a history of chronic alcoholismwas found at his home address dead lying next to barrelsfilled with flammable liquids and an iron picket fence witha gate into a nearby a forest area (Fig. 1). Examination ofthe scene revealed blood traces with pubic hair coveringthe surface of some of the iron spikes of the gate (Fig. 2).An emergency doctor evaluated the decedent and describeda bizarre tear-like wound of the right femoral region.Because of the unclear cause-of-death determination, thebody was referred for a medico-legal autopsy evaluation.External examination of the adequately nourished,174 cm, 80 kg adult male showed an apparent, channel-like tissue defect of the right femoral region with evidenceof multiple blunt impacts, as well as superficial sharp forcewounds, over the entire anterior surface of the body(Fig. 3). On the right anteromedial aspect of the proximalportion of the femoral region there was an extensive(20 9 20 9 13 cm), obliquely oriented, and irregularlyshaped laceration (Fig. 4a). The wound path penetrated andtransected the quadriceps femoris muscle, the right femoralartery, and vein and entered the right inguinal region(Fig. 4b). The wound track then ascended through theretroperitoneal space and pierced the right psoas majormuscle. There was pronounced hemorrhage into the softtissues along the wound channel and around the pubicregion (Fig. 4c). In addition, four cm to the left of theabove laceration, another obliquely oriented skin perfora-tion was discovered measuring three cm in its largestdimension, that communicated with the impaling wound.The anorectal area was free of injuries. As indicated,multiple abrasions, contusions, and sharp force woundswere also found: on the ventral aspect of the upperextremities there were multiple, small, irregularly shapedcutaneous abrasions, and one deep cutaneous laceration inthe left cubital fossa; on the anterior aspect of the thoraxthere were two oval contusions and multiple longitudinalabrasions. External examination of the lower extremitiesalso disclosed multiple abrasions, contusions, and superfi-cial incised wounds. Internal examination did not show anyother injuries except those described. Toxicological eval-uation of blood revealed a blood alcohol level of 220 mg/dL. Further toxicological investigations of the blood andurine were negative.The cause of death was extensive external blood losscaused by transection of the right femoral artery and veinas a result of an atypical impaling injury.It appeared that the decedent, under the influence ofalcohol, tried to climb over the picket fence and wasaccidentally impaled through the right femoral region.Thus, the manner of death was classified as accidental. Weassume that repeated falls prior to the fatal event and theuncoordinated movements and striking of the body againstthe fence while impaled was a plausible explanation for themultiple blunt force injuries on the anterior aspect of thebody.DiscussionRare injuries, such as impalements are sometimesencountered at autopsy. Impaling injuries usually result

Surgical treatment of non-traumatic aneurysm in ilio-femoral arterial region

To summarize the surgical experiences of treating 61 cases of non-traumatic aneurysms in ilio-femoral arterial region. The clinical data of 61 consecutive patients with non-traumatic aneurysms in ilio-femoral arterial region between January 1985 and November 2010 were retrospectively reviewed. There were a total of 76 non-traumatic aneurysms in ilio-femoral arterial region, including solitary iliac aneurysms (n = 29) and femoral aneurysms (n = 32). Seventeen (27.9%) patients had multiple aneurysms, 8 (13.1%) patients ruptured aneurysms and 4 (6.6%) patients coexistent peripheral vascular occlusive disease. Fifty patients underwent electively aneurysm excision and graft (or autogenous vein) replacement. Seven patients with ruptured aneurysms received emergency treatment. And one with multiple aneurysms died intra-operatively from ruptured iliac aneurysm. One patient with common iliac aneurysm underwent endovascular repair without endoleak and 1 with internal iliac aneurysm received embolization. There was no perioperative mortality. But one with femoral aneurysm underwent amputation due to acute thrombosis. Seven patients died during the follow-up period and the survivors remained stable and had a good graft patency without new aneurysm formation. Early management of aneurysms in ilio-femoral arterial region is rather important and multiple aneurysms should be considered. Aneurysm excision and arterial reconstruction yield an excellent outcome. Close and long-term follow-up is mandatory for the detection of new aneurysm formation.

Thrombolysis versus thrombectomy in acute deep vein thrombosis

Deep vein thrombosis (DVT) is a significant health problem, leading to the hospital admission of over 250,000 Americans each year. Its most serious acute complication, namely pulmonary embolus, kills approximately 100,000 each year, and is the third most common cardiovascular related mortality after myocardial infarction and stroke. Chronic leg problems following DVT include leg heaviness, tiredness, cramping and ulceration. These are termed the post-thrombotic syndrome. The current standard therapy of anticoagulation has changed little over 50 years. It does not remove or destroy thrombus, relying instead on the bodies own fibrinolytic mechanisms to do so. DVT needs to be more accurately categorized on an anatomical basis, and for a variety of reasons, the area of most importance is the iliofemoral region. The rationale for active, rather than passive, thrombus removal relies on multiple observations that, by doing so improves luminal patency, restores valvular function and has the potential to reduce th...

Update COPD 2011 – Was ist neu?

Im letzten Jahr waren im Bereich der COPD (chronisch obstruktive Lungenerkrankung) eine ganze Reihe interessanter Entwicklungen zu verzeichnen. Durch Weiterentwicklung von Klassifikationssystemen (BODE-Index) ist es gelungen, die Mortalität von COPD-Patienten wesentlich besser vorherzusagen als bisher. In der medikamentösen Therapie hat sich bei häufigen Exazerbationen, die oft zu Krankenhausaufenthalten führen, der erste 2010 zugelassene Vertreter der Substanzgruppe der Phosphodiesterase-4-Inhibitoren Roflumilast als interessant gezeigt. Das erste über 24 Stunden wirksame inhalierbare Beta-2-Mimetikum Indacaterol erweitert die medikamentösen Therapiemöglichkeiten zusätzlich. Zu den nicht-medikamentösen Therapieoptionen zählen die Lungenvolumenreduktion sowie moderne endoskopische Techniken zur Therapie des Lungenemphysems, ebenso wie die wichtige chronische nicht-invasive Beatmungstherapie. Eine weitere nicht-medikamentöse COPD-Therapie, die einen etwas ungewöhnlichen Ansatz verfolgt, ist die Implantation einer peripheren AV-Fistel, die letztlich wie ein Dialyse-Shunt funktioniert. Die Therapie ist in Deutschland bereits zugelassen, wird momentan jedoch ausschließlich im Rahmen von Studien angewendet.

An Arteriovenous Fistula Increases Exercise Capacity in Patients With COPD

Supplemental oxygen usually increases exercise capacity in hypoxemic COPD, but some patients are refractory because of venous admixture. An arteriovenous fistula (AVF) with left-to-right shunt increases mixed venous oxygen content and cardiac output; therefore, this might improve arterial oxygen delivery. We hypothesized that creation of an AVF would therefore increase exercise capacity in severe COPD. We created an AVF in 12 patients with severe hypoxemic COPD: mean (SD) age, 66 (6) years; Pao(2), 57.5 (3.0) mm Hg, and FEV(1), 19% (8%) predicted. We measured 6-min walk distance (6MWD) while the subjects were breathing room air and again while they were breathing portable supplemental oxygen at baseline, 6 weeks, and 12 weeks after creation of an AVF in the iliofemoral region. After surgery, the mean (SEM) 6MWD increased from 217 (63) m at baseline to 272 (18) m and 276 (25) m, 6 weeks and 12 weeks after surgery, respectively. Patients who walked > 54 m further while breathing supplemental oxygen at baseline (n = 5) increased 6MWD while breathing room air by 129 (34) m after 6 weeks (P = .02) and by 124 (29) m after 12 weeks (P = .004). Walking distance did not change in patients who did not have a clinically meaningful response to oxygen at baseline. An iliofemoral AVF increased 6MWD patients with severe COPD, matching the improvement seen with supplemental oxygen. An initial response to supplemental oxygen predicted a therapeutic response to the AVF.

Cystic Adventitial Arterial Disease in the Iliofemoral Region — Case Report

Cystic adventitial arterial disease (CAAD) is a rare vascular disease mainly affecting the popliteal artery in men. The authors present an unusual case of CAAD in the iliofemoral region in a twenty-six-year-old woman. Symptoms com prised rapid onset of claudication, and angiography of the lesion revealed a typical "scimitar" stenosis. Since treatment with transluminal angioplasty is known to be useless and since there is a high percentage of relapses after simple evacua tion of the cysts, the authors resected the affected arterial segment and recon structed the artery using a prosthetic polytetrafluoroethylene (PTFE) graft.

Color Doppler imaging of the iliofemoral region.

Color Doppler imaging has been used to evaluate a variety of abnormalities in the iliofemoral region. This pictorial essay demonstrates how use of color Doppler techniques aids in the diagnoses of iliofemoral pseudoaneurysms, fluid collections, aneurysms, arteriovenous fistulas and malformations, venous thrombosis, vascular grafts, and soft-tissue masses including tumors and benign lymphadenopathy.

Erythroblastic transformation of Philadelphia chromosome (Ph 1)-positive chronic myelogenous leukemia associated with marked chromosomal rearrangements

In a 22-year-old female with Philadelphia chromosome (Ph 1)-positive chronic myelogenous leukemia (CML) a tumor consisting of megaloblastic proerythroblasts appeared in the right ilio-femoral region 2 years and 8 months after the diagnosis of the disease and was treated effectively with irradiation. She developed erythroblastic transformation 3 months after the tumor appeared. Cytogenetic study of the bone marrow cells in the acute phase revealed marked chromosomal rearrangements such as ring, dicentric, or tricentric chromosomes.

Angiography of the Iliofemoral Arteriovenous System Supplying Free Groin Flaps and Free Hypogastric Flaps

The circulatory anatomy of the iliofemoral region was elucidated by doing detailed angiography in 50 cases, and we classified the vessels into 4 types. In most cases, the s.c.i.a. predominated over the s.i.e.a. Therefore, it is probably better to plan free flaps supplied by this artery. This vessel usually arises approximately two or three fingerbreadths inferior to the intersection of the femoral artery and the inguinal ligament, and the skin flap should be designed in the area inferior and parallel to the inguinal ligament.

Dynamic radionuclide phlebography. A clinical study in patients after total hip replacement.

Dynamic radionuclide phlebography was performed in 50 consecutive patients after total hip replacement to evaluate the diagnostic value of the method compared to contrast phlebography. The investigation was limited to the diagnosis of iliofemoral thrombi. A special injection technique was developed and flow curves, mean transit time and distribution of flow were recorded with a scintillation camera interfaced to a digital computer. Three principally different types of flow curves were observed. Mean transit time was of value in differentiating particle flow in the superficial veins from passage through the deep veins. Out of 15 legs with thrombi in the iliofemoral region, the distribution of flow was significantly changed in 12. Deep vein thrombosis in the lower leg did not influence mean transit time or distribution of flow in the iliofemora region. Extensive collateral flow was rare. Ninety per cent of the thrombi were asymptomatic. The method compares favorably with the 125 I fibrinogen method and cuff impedance phlebography, in diagnosing iliofemoral thrombi after total hip replacement.

The anatomy of several free flap donor sites.

The vascular anatomy of the supplying vessels to the iliofemoral, the deltopectoral, the axillary, and the thoracoabdominal regions has been investigated in detail in fresh cadavers. Other donor sites were also examined. The anatomical relationship of the supplying vessels is discussed-and the design, conversion, and utilization of these skin areas as donor sites for free flap transfer are detailed. The iliofemoral region is suggested as the best donor site for most free flap procedures.