Internal Vein Research Articles

Rapid vascular uptake of contrast during a retrograde urethro-cystogram in a cat with chronic lower urinary tract disease

Case summaryA 9-year male neutered domestic longhair cat was referred to our hospital for investigation of recurrent urinary tract obstruction. The clinical signs had started 12 months earlier and the cat had been catheterised on multiple occasions. Clinical examination and abdominal ultrasound of the abdomen was unremarkable but examination of the penis revealed it to be prolapsed and extremely erythematous and friable. A retrograde contrast urethrocystogram was performed, showing extravasation of the contrast medium and establishing the presence of partial leakage or a tear of the urethra. In subsequent radiographs, the contrast was seen being rapidly absorbed into the pelvic and systemic vasculature via the penile veins, internal and external pudendal veins, internal and external iliac veins, and, ultimately, the caudal vena cava. Later, the contrast medium was seen within the renal pelves. Retrograde urethrocystography revealed stenosis and irregularities of the caudal urethral mucosa consistent with strictures. A routine perineal urethrostomy was performed and the cat recovered well.Conclusions and relevanceRapid vascular absorption of extravasated contrast medium has not been reported before. In this case, the increased blood supply to the distal urethra and penis is likely secondary to (chronic) inflammation, as demonstrated by the urethral strictures and the friable, oedematous nature of the penis. Whether the inflammation was caused by chronic obstruction or repeated iatrogenic trauma, or a combination of these factors, will remain debatable. Nonetheless, this case demonstrates that when a retrograde contrast urethrocystogram is considered, it is imperative that a contrast medium (or other intraurethral medication such as local anaesthesia) is chosen that is safe for intravascular use. Equally, an absolute aseptic technique is essential considering the potential for contaminants to be absorbed quite rapidly into the systemic circulation. Multiple catheterisations should be avoided when there is chronic inflammation, and alternative options should be considered when chronic disease is suspected.

Palm Vein Authentication Based on the Coset Decomposition Method

The palm vein authentication technology is extremely safe, accurate and reliable as it uses the vascular patterns contained within the body to confirm personal identification. The pattern of veins in the palm is complex and unique to each individual. Its non-contact function gives it a healthful advantage over other biometric technologies. This paper presents an algebraic method for personal authentication and identification using internal contactless palm vein images. We use MATLAB image processing toolbox to enhance the palm vein images and employ coset decomposition concept to store and identify the encoded palm vein feature vectors. Experimental evidence shows the validation and influence of the proposed approach.

Correlation between the milk vein internal diameter surface andmilk yield in Simmental cows

It is known that milk production is directly correlated with the blood flow through the mammary gland, and milk veins drain approximately 90% of the total blood passing through this organ. The aim of the present study was to determine the relationship between milk vein internal diameter surface and milk production in Simmental cows. The milk vein internal diameter was measured by ultrasonography in heifers during the 2nd month of the first gravidity, and again on day 50 following the second calving. After the application of exclusion criteria, the internal vein diameter surface area was mathematically calculated (mm2) for a total of 80 cows. No significant correlation between milk vein internal diameter surface in heifers and milk production for the same animal during the second lactation was recorded. However, greater milk vein internal diameter surface 50 days following the second calving was correlated with higher milk production during the second lactation (P < 0.05). These findings suggest that ultrasonography is a useful tool in calculating the milk vein internal diameter surface as an indicator of possible milk production in Simmental cows.

Mechanisms of flexural flow folding of competent single-layers as evidenced by folded fibrous dolomite veins

Flexural flow is thought unlikely to occur in naturally deformed, competent isotropic single-layers. In this study we discuss a particular case of folded bedding-parallel fibrous dolomite veins in shale, in which the internal strain pattern and microstructural deformation features provide new insights in the mechanisms enabling flexural flow folding. Strain in the pre-folding veins is accommodated by two main mechanisms: intracrystalline deformation by bending and intergranular deformation with bookshelf rotation of dolomite fibres. The initially orthogonal dolomite fibres allowed a reconstruction of the strain distribution across the folded veins. This analysis shows that the planar mechanical anisotropy created by the fibres causes the veins to approximate flexural flow. During folding, synkinematic veins overgrow the pre-folding fibrous dolomite veins. Microstructures and dolomite growth morphologies reflect growth during progressive fold evolution, with evidence for flexural slip at fold lock-up. Homogeneous flattening, as evidenced by disjunctive axial-planar cleavage, subsequently modified these folds from class 1B to 1C folds. Our study shows that the internal vein fabric has a first-order influence on folding kinematics. Moreover, the fibrous dolomite veins show high viscosity contrasts with the shale matrix, essential in creating transient permeability for subsequent mineralising stages in the later synkinematic veins during progressive folding.

Uma sessão de exercícios de treino de força não promove alterações negativas na estrutura venosa dos membros inferiores em homens

The increase of the venous diameter is associated with the incompetence of the venous system of lower limb. In order to analyze the acute effects of one session of strength exercise (SE) on superficial venous diameter (VD) of the lower limbs (LL). Twenty-two men (22 ± 2 years old, 81.2 ± 13.4kg weight, 173.0 ± 4.0 cm height and 18.6 ± 3.3% estimated body fat) performed a circuit of three SE, with 3 sets of 6 repetitions, controlled by metronome, with a load of 85% (1-RM) and 3 minutes rest. The VDs of the internal saphenous vein (ISV), in right and left LL, were measured at baseline and immediately after each set with color eco-Doppler. Data were analyzed by means of a one-way ANOVA for repeated measures. There was a significant effect of time for the right and left VSI ( p = 0.001), the VDs at baseline were higher than in series for both. Furthermore, between sets, there was a significant decrease between the first and second ( p = 0.009) and an increase between the second and third series ( p = 0.027) for the right ISV. For the left ISV, only measured after the first and second are different ( p = 0.001). There was a trend toward reduction in VD after the acute bout of strength exercise, indicating that their practice is efficient for the performance of this structure.

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.

Risk factors for recurrent events in subjects with superficial vein thrombosis in the randomized clinical trial SteFlux (Superficial Thromboembolism Fluxum)

To evaluate risk factors for recurrent events in patients enrolled in the SteFlux (Superficial Thromboembolism Fluxum) clinical trial which compared different doses and duration of low molecular weight heparin (parnaparin) for superficial vein thrombosis (SVT). Outpatients with acute SVT of at least 4 cm in length of the internal or external saphenous veins or their collaterals were randomized in a double blind fashion to receive either parnaparin 8500 UI aXa od for ten days followed by placebo for 20 days or 8500 UI aXa od for ten days followed by 6400 UI aXa od for 20 days or 4250 UI aXa od for 30 days. Outcomes were the composite of symptomatic and asymptomatic deep vein thrombosis, pulmonary embolism and SVT recurrence or extension in the first 30+/-3 days with a 60+/-3 day follow-up. 98 outcomes (14.7%) were recorded during 93 days among 664 patients (M/F: 246/418, mean age 65). After correction for treatment, outcomes during 33 days were associated with previous venous thromboembolism (VTE) and/or SVT and/or family history of VTE (odds ratio-OR: 2.5; 95% confidence interval - CI: 1.4-4.8; p=0.003). After stopping LMWH treatment, only the absence of varicose veins (OR: 2.5; 95% CI 1.3-5.0; p=0.004) and previous VTE and/or SVT and/or family history of VTE (OR: 1.9; 95% CI:1.0-3.7; p=0.048) were significantly associated with outcomes. SVT patients with these factors may deserve a higher intensity and/or longer anticoagulant treatment.

Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy

IntroductionOne of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience. MethodsA prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range). ResultsTwenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6–15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100–126) minutes. ConclusionIntra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature.

The effects of hypothermia on dexmedetomidine induced contraction on human internal mammarian artery and saphenous vein

Methods The Ethics Committee approved the study protocol. The contractile response of human IMA (n=6) and SV strips (n = 6) with and without endothelium, suspended in organ baths, bubbled with 95% O2 + 5% CO2 which were subjected to cumulative concentrations of 10-9 – 10-6 M dexmedetomidine were recorded at 37oC and at 28oC. The results were expressed as percentage of maximum contraction to phenylephrine. Statistical Analysis: Contractions induced by dexmedetomidine were expressed as a percentage of phenylephrine induced response. Results are expressed as means ± SD. Student’t test was used for analysis between in groups and results between these groups were determined by unpaired test. A p value of < 0.05 was considered significant.

The interrupted V-Y advancement flap for the reconstruction of the vulvovaginal defect

High-quality reconstruction of vulvovaginal defects after tumor excision is critical. Various techniques for vulvovaginal reconstruction have been described. However, these flaps are often bulky, and tip necrosis occasionally occurs. To reduce bulkiness and prevent flap necrosis, we have therefore developed an ideal approach using a fasciocutaneous flap that is advanced in a modified V-Y fashion. The V-Y flap is interrupted in the defect area by a bipedicled flap and therefore termed "the interrupted V-Y advancement flap". We used the interrupted V-Y advancement flap to cover vulvovaginal defects in five patients who underwent surgical treatment for extramammary Paget's disease or carcinoma of the vulva. Each flap survived completely without complications. This flap is easily elevated, not bulky, and reliable because it is supplied by the internal pudendal artery and vein without excessive skeletonization of the vascular pedicle; it also matches the local skin quality.

Microsurgical Rat Varicocele Model

A rat varicocele model using partial occlusion of the left renal vein was described previously. Reproducibility in creating this model has met with varied success. Alternate routes of testicular venous drainage may negate the effect of partial renal vein occlusion on varicocele creation. We hypothesized that varicocele induction would be more effective if microsurgical ligation of the gonadal venous drainage to the common iliac vein was combined with partial occlusion of the left renal vein. We randomly assigned a total of 36 rats to 3 groups, including sham surgery, partial renal vein occlusion alone (the classic technique) and microsurgical ligation. Half of the rats in each group were evaluated at 5 and 12 weeks, respectively. We evaluated internal gonadal vein and spermatic cord diameter, testicular weight, cauda epididymal sperm concentration and motility and testicular histology using the Johnsen score as well as serum and intratesticular testosterone and dihydrotestosterone. Five weeks after varicocele creation the microsurgical ligation group had a larger spermatic cord diameter and lower Johnsen scores than rats in the classic technique and sham surgery groups. At 12 weeks the microsurgical ligation group had a larger spermatic cord diameter, lower cauda epididymal sperm concentration, lower sperm motility and worse histology than the classic technique and sham surgery groups. There was no difference in serum androgen outcomes but the microsurgical ligation group had lower intratesticular androgens. Adding microsurgical ligation of testicular vein collaterals in the pelvis to partial renal vein occlusion appears to improve the effectiveness of creating a rat varicocele model.

Is it safe to divide and ligate the left innominate vein in complex cardiothoracic surgeries?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to divide the left innominate vein (LIV) in aortic arch surgery to improve access. Altogether, 228 relevant papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Following LIV division, the venous drainage takes place via multiple collateral systems such as the azygous/hemiazygous, the internal mammary veins, the lateral thoracic and superficial thoracoabdominal veins, vertebral venous plexus as well as the transverse sinus. The possible complications are mainly left upper limb swelling and neurological symptoms. In one case series of 14 patients, the LIV was divided and ligated to facilitate the exposure for aortic arch surgery. More than 2-year follow-up did not reveal upper limb oedema or neurological symptoms. In two cohorts of 52 patients, the LIV was ligated prior to the superior vena cava (SVC) resection for malignancy. During the mid-term follow-up, no neurological or upper limb symptoms were reported. Although in two studies with 72 and 70 patients undergoing SVC resection it was not specified how many of them had LIV ligation, no relevant complications were reported. In a report, LIV occlusion was observed in 4 patients undergoing left internal jagular vein catheterization for haemodialysis. The reported symptom was left arm swelling with no neurological problems. In a cohort of 18 patients undergoing SVC resection for malignancy and major vein reconstruction, 7 patients underwent ligation of the LIV with no neurological symptoms. It was also concluded that reconstruction of the LIV is not consistent with favourable patency. In a case series of 10 patients with central venous obstruction, collateral pathways to conduct efficient venous drainage were mapped. We conclude that division of the LIV is safe in selected patients and operations. Patients will initially have symptoms of central vein obstruction, but these will decrease with conservative management as collaterals form.

Abstract WP31: Asymmetrical Internal Veins Sign In Acute Ischemic Stroke: A New Marker For Poor Collateral Circulation.

INTRODUCTION: Changes in venous drainage imaging have been directly related to parenchymal damage in acute ischemic stroke during endovascular treatment. Venous asymmetry assessed by CT prior to treatment may be directly related to delayed flow in the hypoperfused territory. We investigated the prevalence of asymmetry in internal cerebral vein (AIV) drainage and its correlation with collateral flow in patients with acute ischemic stroke by a multimodal CT protocol. Subjects and methods: We retrospectively evaluated clinical and radiological data of 29 consecutive patients with acute anterior circulation ischemic stroke within 6 hours from symptoms onset. Collateral status was graded as good or poor depending on the extent of contrast visualized distal to the occlusion on CT angiography (CTA). Presence and AIV (analyzed by density units, time to peak and volume) and arterial collateral score were blinded assessed on CT perfusion (PCT), CTA source images (CTASI) and MIP reconstructions. Results: We included 29 patients, with a median age of 77 ± 15 y, and 31% of them were men. Median baseline NIHSS was 11 ± 7. Mean infarct ASPECTS was 9.3 ± 1 and size 2 cm3 ± 4. Asymmetrical veins were present in 33% of patients. This sign was more prevalent in patients with proximal occlusions than in distal occlusions (67% versus 33%) and in patients with poor collaterals compared to those with good collaterals (62% versus 29%). AIV was significantly associated with increasing age (p= 0.03), increasing baseline NIHSS (p= 0.02) and poor collaterals (p=0.01). Presence of AIV reached high specificity (93%) and good sensitivity (66%) for poor arterial collaterals prediction (p=0.001). Conclusion: Impairment of venous circulation, assessed by means of AIV, is present in one third of the patients and was associated with stroke severity and low effectiveness of collateral flow. Presence of internal veins asymmetry is highly specific in detecting poor collateral circulation in acute stroke and may be a predictor of clinical and radiological severity, possibly useful for patients selection in planning reperfusion therapy strategies.

A misplaced and entrapped pulmonary artery catheter

A misplaced and entrapped pulmonary artery catheter

Cephalad malposition after central venous catheterization through right internal jugular vein

Central venous catheterization is performed in the operating room, intensive care unit and emergency room for various reasons. Internal jugular vein is preferred in the operating room due to little chance of pneumothorax and straight route for catheterization to the right atrium. We experienced a case of central venous catheter malposition to cephalad in the right internal jugular vein. A 60-year-old man, 176 cm in height and 82 kg in weight, was presented for Whipple's operation due to the bile duct cancer. After completion of anesthesia induction and intubation, patient's head was turned left in Trendelenburg position. After skin disinfection, 18 guage, 2 inch thin-walled needle was inserted at the point of sternocleidomastoid (SCM) muscle apex along with medial border of lateral head of SCM muscle about angle of 45 degree to skin without using the finder needle. At the same time, anesthesiologist's left 2nd, 3rd, and 4th fingers palpated the patient's right carotid artery for avoiding arterial puncture. However, blood was not aspirated, needle was reinserted more medial direction about angle of 70 degree to skin. After aspiration of venous blood from needle, the J shape guide wire was introduced via the guiding needle using Seldinger technique. Introduction of 20 cm of J-shaped wire was done without any problem, except some resistance at 5 cm depth of the internal jugural vein. Seven Fr double lumen catheter (Prime-S®, Sungwon medical, Cheongju, Korea) was advanced to the following J-shaped wire. Blood aspiration was done to remove the air in catheter without any resistance. Catheter was sutured at the proper site and surgery was done as planned. After the operation, the patient was transferred to an intensive care unit. Head and neck antero-posterior view X-ray was checked because the central venous catheter was not seen on chest X-ray. Antero-posterior view of the head and neck showed that central venous catheter was bent sharply to the cephalad in the right internal jugular vein (Fig. 1). We removed malpositioned catheter and reinserted central venous catheter via the same side subclavian vein. The proper position of subcalvian catheter was confirmed by a chest X-ray and the patient discharged at postoperative day 13. Fig. 1 Neck anteroposterior view shows that central venous catheter is bent sharply to the cephalad in right internal jugular vein. As one of the various complications, catheter malposition via Internal jugular vein (IJV) can be associated with central venous catheterization via IJV (5.3%) [1]. There are many case reports of malpositioning central venous catheter that were positioned in the jugular venous arch via the right subclavian vein [2], in the internal thoracic vein via the internal jugular vein [3] etc. However, this is the first case of malposition of the catheter, which was bent upward. Bending the catheter is very rare because the right internal jugular vein is the straight route for catheterization to the right atrium. Although there was some resistance during introduction of the J-shaped wire, blood aspiration via catheter was normal, dripping of the fluid seemed normal and central venous pressure curve showed no other abnormal findings. We postulate that the J-shaped wire was bent in the cephalad direction at the moment of resistance. The other postulated cause is an acute angle of the introducing needle when it punctured the internal jugular vein. We cannot rule out the anatomical variation of the external jugular vein and internal jugular vein. Deslaugiers et al. [4] reported that 60% of the external jugular vein is drained to junction of the internal jugular vein and subclavian vein, drained to the subclavian vein in 36%, and drained to the internal jugular vein in 4%. However, we did not confirm the anatomical variation with venous angiogram. It seems that we should be careful when we introduce the wire with some resistance. Malpositioning of the catheter results in monitoring inaccurate central venous pressure, damage to vascular wall, and forming the thrombus. However, the chance of thrombus formation is very low since the blood flow velocity is very fast in the internal jugular vein. In addition, it is impossible that the infused drug inflows to the brain. Although, the most precise method to confirm the complications is examination of the X-ray after the catheterization, ultrasono-guided central venous catheter placement is increasing the success rate, shortening the procedure time, decreasing the complication and the easiest method for acknowledging the direction of catheter, needle and guide wire during the entire catheterization process [5]. In summary, if there is any problem during the central venous catheterization, ultrasonography can be used for optimal catheter placement, and prevention of complications. Additionally, X-ray must be examined to confirm the position of the catheter and incidental complication.

Dynamic change in cerebral microcirculation and focal cerebral metabolism in experimental subarachnoid hemorrhage in rabbits

Regional cerebral blood flow (rCBF) in the cerebral metabolism and energy metabolism measurements can be used to assess blood flow of brain cells and to detect cell activity. Changes of rCBF in the cerebral microcirculation and energy metabolism were determined in an experimental model of subarachnoid hemorrhage (SAH) model in 56 large-eared Japanese rabbits about 12 to 16-month old. Laser Doppler flowmetry was used to detect the blood supply to brain cells. Internal carotid artery and vein blood samples were used for duplicate blood gas analysis to assess the energy metabolism of brain cells. Cerebral blood flow (CBF) was detected by single photon emission computed tomography (SPECT) perfusion imaging using Tc-99m ethyl cysteinate dimer (Tc-99m ECD) as an imaging reagent. The percentage of injected dose per gram of brain tissue was calculated and analyzed. There were positive correlations between the percentage of radionuclide injected per gram of brain tissue and rCBF supply and cerebral metabolic rate for oxygen (P < 0.05). However, there was a negative correlation between radioactivity counts per unit volume detected on the SPECT rheoencephalogram and lactic acid concentration in the homolateral internal carotid artery and vein. In summary, this study found abnormal CBF in metabolism and utilization of brain cells after SAH, and also found that deterioration of energy metabolism of brain cells played a significant role in the development of SAH. There are matched reductions in CBF and metabolism. Thus, SPECT imaging could be used as a noninvasive method to detect CBF.

Variations of the Iliolumbar and Ascending Lumbar Veins

A cadaveric retrospective study. To verify the variation of tributaries draining into the iliac system at the lumbosacral junction. Special attention to vascular anatomy at the great venous bifurcation during anterior lumbar surgery is needed as more tributaries may increase the rate of operative bleeding. Although important, there have been very few detailed anatomic studies about variations of the ascending and iliolumbar veins. The latter tributary forms a horizontal system draining blood into the iliac vein. A total of 116 formaldehyde-preserved specimens (61 male and 55 female) were studied. All specimens were dissected and simply classified into patterns and subpatterns according to the similar or different tributaries and their entry points. There were 2 patterns of tributaries: symmetric and asymmetric. More variants were found in the asymmetric group. Each pattern comprising 58 specimens was further classified into 3 subpatterns according to their main tributary trunks. One to 3 tributaries may enter into any trunk of the iliac vein. The most common trunk was the common iliac vein seen in 75.9% of specimens. Draining into the external and internal veins was found in 21.6% and 2.6% of specimens, respectively. One common drainage of the ascending and iliolumbar veins on 1 or both sides was found in 0.9% and > 50% of specimens, respectively (right, 51.7%; left, 56%), whereas 2 or more tributaries were seen in < 50% of specimens (right, 47.4%; left, 43.1%). There was no significant statistical difference among sexes and body sides. Draining into the iliac system has a high frequency of variations through a number of tributaries and their entry points. The iliolumbar vein will mainly drain into the common iliac vein with frequently 2 or 3 tributaries, whereas drainage into the external iliac or the internal vein is less often observed.

Kronik Böbrek Yetmezlikli Hastalarda Hemodiyaliz Amaçlı Kateter Uygulamalarında Hasta Memnuniyeti

Purpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85±14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter.There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction.

Venöses Aneurysma als therapeutisches Problem. Behandlungsmöglichkeiten. Die Vorgehensweise bei den gewählten Kranken – unsere Erfahrung

Venous system aneurysms appear relatively rarely, and are even more rarely diagnosed, especially if asymptomatic. In the material of our clinic we provide a variety of practices in three patients with venous aneurysms depending on the location, symptoms and main disease. In some patients the occurrence of pulmonary embolism is the first symptom of venous aneurysms, having influence on the selection of further diagnostics, conservative treatment, as well as on endovascular or operating procedure. The proper diagnosis of a venous aneurysm takes place in case of doubling or tripling of the diameter of the basic dimension of the lumen, often with the presence of thrombotic material. Asymptomatic venous aneurysms are usually detected during routine pre-operative diagnosis also including duplex-Doppler studies. In the presence of pulmonary embolism positive angio-CT and scintigraphy raise the suspicion of venous aneurysm unless any other reason is apparent. There is no standard treatment of venous aneurysms. This has to do with the relatively low epidemiology, diversity of location, difficulties in determining the proper primary and secondary aetiology, anatomy and coexisting diseases. Despite the many unknowns a few issues should be considered before appropriate treatment is undertaken. Undoubtedly, the shape itself, the location and size of the aneurysm with the presence or not of thrombotic material are of great value in evaluating the risk of complications, including possibly lethal pulmonary embolism, local symptoms of venous hypertension and possible complications of surgery. In this paper we present 3 patients treated for venous aneurysms located in different regions: popliteal vein, brachial vein and iliac internal vein.

A New Surgical Procedure in Kidney Transplantation with a Short Vein of Renal Graft

Introduction: To choose the site of incision in kidney transplantation (KTx), traditionally, we usually use right iliac fossa (RIF) for the left renal graft (LRG), and other site for the right renal graft (RRG). If the renal vein is long enough, this classic procedure hasn't problem. But in living donor and laparoscopic nephrectomy when the graft vein short, we have to prolong it. Some techniques using genital vein or internal saphene vein were reported. We choose a new procedure for RRG and for short renal graft vein, which were transplanted also on right graft on right site. Methods: This is a prospective study with control group of series of transplantation on living donor from 2004 to 2010 of Cho Ray Hospital (CRH). Patients (pts), with end stage chronic renal disease (ESRD), received the graf, devised to 2 groups. Group A: pts who received graft with short vein ≤20mm, transplanted on RIF no matter the graft is left or right kidney. A special technique to prolong the vein (by dissection the renal hilum), and dissection and moving of right iliac vein (RIV) to the right side of the right external iliac artery, we also call it the vein dispositions procedure, VDP. Group B: pts who received graft with vein > 20mm, enough for normal transplantation, but always on RIF. Preoperative criteria and surgical team were the same for both 2 groups. Postoperative following up (FU): the vascular perfusion, kidney function. Results: There were 184 pts undergone the KTx, related donor were 97.7%. Group A: 56 pts, 16 females and 40 males, mean age is 35,3 ± 8,4 yo. Group B: 128 pts, 46 females and 82 males, mean age is 32,9 ±9,5yo (no signicant difference of age and sex of A and B group). Group A: received 13 left graft and 43 right graft; 11 pts with hilar disection to prolong the vein (19.4%) and 45 pts with VAD (80.6%). Group B: received 128 left graft and 0 right graft, no need any hilar disection to prolong the vein either VDP. No early surgical complications (beeding, strangulation, stetching). Postoperatively doppler ultrasound control of renal vein (mean FO: 3 years, range:1 to 6 years), venous blood flow were normal, there were'nt statistic significant between 2 groups (12,88±4,23 versus 12,36±3,51 cm/s, P>0,05); one year serum creatinine seemed better for group A (1,27±0,29 versus 1,29±0,33 mg/dL, P< 0,05). Conclusion: In the living donor kidney transplantation could perform on the RIF both for the LRG and also for the RRG, and were better for the short renal graft vein, no need to a graft to prolong the vein. It seems we need change the classic rule LRG for right side and RRG for left side