Vein Ligation Research Articles

SS16. Long-Term Results of Deep Vein Valve Reconstructions for Nonhealing C6 Venous Ulcers: An 18-Year Experience

In an era that has seen significant changes in the way we manage nonhealing venous leg ulceration, this study reports the rationale, results, and changing trends of an 18-year experience of deep vein valve reconstruction with evaluation of end points at 2, 5 and 10 years in the management of nonhealing venous leg ulcers in 228 patients. A total of 228 patients (302 limbs) undergoing deep vein reconstructions were followed up for 2 to 18 years (mean, 8 ± 2.3 years). All patients had nonhealing C6 venous leg ulcers of >3 months' duration and were offered deep venous reconstruction as a “last resort” treatment. End-points of the study were freedom from leg ulceration, vein valve patency, and competence assessed serially by physical examination and duplex scanning. Primary refluxive disease was present in 156 patients (209 limbs). External valvuloplasty was performed in 12 limbs (19 valves), and internal valvuloplasty was performed in 181 limbs (324 valves). External supports were used in 16 limbs (16 valves). Multilevel (≥2) reconstructions were performed in 126 limbs. Seventy-two patients had secondary valvular defects involving 93 limbs. Axillary-femoral vein valve transplant was performed for 49 patients (64 limbs) and Maleti Neovalve in five patients (five Limbs) respectively. Saphenofemoral venous transposition was performed in 7 patients (nine limbs), and femoral/popliteal vein ligation was carried out in 11 patients (15 limbs). At 10 years, external valvuloplasty showed ulcer healing in 16% of limbs, with maintenance of competency at only 15.7% of valve stations. Internal valvuloplasty was the most durable valve repair procedure, with actuarial leg ulcer healing rates of 67% and valve station competency of 79%. It was also noted that single-level repairs had significantly lower ulcer healing rates than multilevel repairs (P = .0018). For secondary incompetence, valve transplants had a gradual but increasing deterioration in valve patency and competency at 10 years: 46.8% and 38.3%, respectively, with 36.6% actuarial leg ulcer healing. Although the Maleti Neovalve in our hands performed well initially, all repairs thrombosed by 9 months. Even venous transpositions had no valve competency >2 years. Valvular reconstruction for refluxive disease is effective in healing venous ulcers that defy conservative management and superficial/perforator venous surgery out at 10 years. Furthermore, these procedures are useful for primary but not for secondary incompetence. Multilevel or multivalve reconstructions yield superior results to single-level repairs in medium-term follow-up. Open reconstructions for secondary incompetence may be a waste of time, with increased morbidity.

Pulmonary embolism prevention in out-patients with malignancies during the first year of follow-up

Aim. To decrease the one-year mortality rate in out-patients with malignancies undergoing periodic health examination.Methods. The study included 270 patients, who were examined and followed up. The main group included 140 patients, who monthly underwent ultrasonography of inferior vena cava branches during the first year of follow-up. The control group included 130 patients, in whom ultrasonography of inferior vena cava branches was performed only if clinical manifestations of venous thrombosis were registered.Results. Venous thrombosis was diagnosed in 35 patients of the main group, including 21 cases of venous thrombosis at very high risk for embolism. In control group, ultrasonography of inferior vena cava branches was performed in 13 patients who developed clinical manifestations of venous thromboembolic events, in whom 6 patients were diagnosed with deep vein thrombosis of the lower limbs, in 3 patients venous thrombosis was assessed as at very high risk for embolism. In 24 patients (21 in the main group and 3 in the control group), targeted measures to prevent pulmonary embolism were administered, including cava filter implantation, vein ligation above the venous thrombosis at very high risk for embolism site, and crossectomy. The rest of the patients were administered conservative prevention of thromboembolism. In the main group, no deaths associated with pulmonary embolism were registered. In the control group, 19 patients died due to developing pulmonary embolism.Conclusion. Preventive measures for pulmonary embolism, selected according to the results of timely ultrasound diagnosis of venous thrombosis, may reduce the one-year mortality rate in patients with cancer.

Patterns and outcomes of traumatic neck injuries: A population-based observational study.

Objectives:We aimed to analyze the pattern and outcome of traumatic neck injury (TNI) in a small population.Materials and Methods:It is a retrospective analysis of all TNI patients who were admitted to the trauma center between 2008 and 2012. Patients’ demographics, details of TNI, associated injuries, hospital course, and mortality were analyzed.Results:A total of 51 TNI cases were included revealing an overall incidence of 0.61/100,000 population. The mean age was 31 ± 9 years. The most frequent mechanism of injury was motor vehicle crash (29.4%) followed by stab (17.6%), machinery injury (17.6%), fall (9.8%), and assault (7.8%). Larynx, thyroid gland, trachea, jugular veins, and carotid were the commonly injured structures. The majority of cases had Zone II TNI whereas isolated injury was observed in 11 cases. TNI were mainly presented with active bleeding (38%), hypovolemic shock (16%) and respiratory distress (16%). Surgical interventions mainly included simple repair and closure (53%), vein ligation (12%), repair of major arteries (4%), tracheal repair (6%), larynx and hypopharynx repair (4%), and repair of parotid gland (2%). Neck exploration was performed in 88%, and emergency tracheostomy was required in 18% of cases. Overall mortality rate was 11.8%, of which five patients had associated injuries, and one had isolated TNI.Conclusion:TNI are not frequent but represent an alarming serious entity in Qatar. Patients with persistent signs of major injuries should undergo early operative interventions. Moreover, the effective injury prevention program should be developed to minimize these preventable injuries in the majority of cases.

Primary Varicose Veins on the Whole Body, Including Genital Area: A Case Report

Primary varicose veins are a common affliction of the extremities, whereas the whole body including the genitals are very rarely affected, for reasons not clearly understood. The literature has little references in regards to the number of cases and management these type varicose veins. Treatment of the upper and lower extremities is the ligation and stripping of the varicose veins but what we can done for chest, abdomen, back, and genital varicose veins, is a query. Here we present a case of a 20-year-old male with this unusual condition of primary varicose veins of the whole body with genitals. Diagnosis in our case was made by means of physical examination and venography. The patient was treated surgically by ligation and stripping of the varicose vein from the upper and lower extremities with excellent functional and cosmetic outcome, but left the chest, abdomen, back, and genital veins for laser or other methods, and the patient was referred to higher center for that treatment.

Primary Aneurysm of the Medial Marginal Vein of the Foot

The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs.

MORPHOLOGICAL CHANGES OF VASCULAR WALL AT DIFFERENT STAGES OF EXPERIMENTAL THROMBOSIS

Objective. To study interactive structural changes of vascular wall at experimental modeling thrombosis of the inferior cava vein system deep veins. Thrombosis caused by ligation of external iliac vein and injection of thrombin (40 /kg) into femoral vein. At the outset thrombotic process causes local destruction of endotheliocytes plasmolemma and karyolemma. Clot compressive effect upon veinous wall blocks severe and rapid endothelium swelling. At 30-th min leucocytes appear in peripheral parts of clot and along the vein intima. Transendothelial leucocytes migration appears on the 60-th min, that more severe increase the endothelium damage and, as result, focal desquamation of these cells. By the 12-24 hours increase of collagen and elastic fibers was distinct registered in the intima.

Systemic and flap inflammatory response associates with thrombosis in flap venous crisis.

Venous crisis represents the most common complication in flap surgery and often results in flap failure. The gold standard for free flap monitoring is frequent clinical examination. The current study examined the systemic inflammatory response during the immediate post-operative period following flap venous crisis. Superficial epigastric artery perforator flap transplantation was performed in a total of 30 rabbits. Fifteen animals received venous obstruction by vein ligation (venous crisis group, n = 15) and others were sham treated (control group, n = 15). Venous thrombosis was examined by immunohistochemistry staining. Plasma levels of inflammatory response markers (IL-6, IL-8, TNF-α, and C-reactive protein) and thrombosis biomarkers (von Willebrand factor and tissue factor) were measured at 0, 2, and 4 h post-operation by enzyme-linked immunosorbent assay. The mRNA levels of relevant biomarkers in the flap were analyzed with quantitative real-time PCR. Flap histopathological examination showed erythrocyte and neutrophil aggregations in venous lumen and erythrocyte diapedesis. At 8 h post-operation, serious edema and fibrinoid necrosis were observed and the venous lumen was almost blocked by thrombus. The venous crisis group had higher plasma levels of IL-8, TNF-α, and thrombosis biomarkers. Vein ligation also increased the mRNA levels of IL-8, TNF-α, C-reactive protein, von Willebrand factor, and tissue factor in the flap. No significant change in IL-6 levels was observed between the control group and the venous crisis group. Flap venous crisis was accompanied by the increase in a number of inflammatory and thrombosis markers, both in the peripheral blood and the flaps.

Outcomes from mesenteric-portal axis resection during pancreatectomy.

BackgroundDue to their complexity and risks, mesenteric-portal axis resection and reconstruction during the pancreatectomy procedure were not recommended back in the early nineties. However, as per technical improvements and the reduction in morbidity and mortality rates, they have been routinely indicated in large medical centers.AimTo show results from cases of patients subjected to mesenteric-portal axis resection during pancreatectomy.MethodPatients subjected to mesenteric-portal axis resection during pancreatectomy were prospectively and consecutively assessed. The procedure was indicated according to anatomical criteria defined by imaging exams or intraoperative assessment.ResultsTen patients, half of them were male, with mean age of 55.7 years (40-76) were included. The most frequent underlying diseases were pancreatic adenocarcinoma and Frantz tumor. The circumferential resection of the portal vein associated with the superior mesenteric vein with splenic vein ligature (4 cases=40%) and the primary anastomosis of the vascular stumps (5 cases=50%) were, respectively, the most performed types of vascular resection and reconstruction. Surgery time ranged from 480 to 600 minutes (average=556 minutes) and postoperative hospitalization time ranged from 9 to 114 days (average=34.8 days). Morbidity rate was 60%, and clinical pancreatic fistula (grade B and C) was the most common complication (3 cases=30%). Mortality rate was 10% (1 case).ConclusionMesenteric-portal axis resection is a valid technical procedure. It should be taken into account after a clinical assessment that included not only the patients' clinical condition but also the technical and anatomical conditions of the mesenteric-portal axis tumor infiltration as well as life expectancy based on the patient's cancer prognosis.

Proposal for describing procedures to correct varicocele. A new terminology.

Although the use of eponyms to describe specific surgical operations is often discouraged (1), the custom is so deeply ingrained in medical writing that readers inevitably encounter them. Therefore, for the sake of clarity in communications, one should strive to be correct in their use. A classic case of perpetuation of misinformation is the use of eponyms to describe the operations performed to correct varicocele. Most seemingly authoritative reviews repeatedly state that the eponym “Ivanissevich procedure” refers to the transinguinal ligation of the spermatic vein. This is a mistake and is repeated through the published literature since access to the original papers may require an additional effort rarely made in this era of computerized searches (2–5).

Abstract 16: FDG-PET/CT Enables the Detection of Recurrent, Same-Site Deep Vein Thrombosis by Illuminating Recently Formed Neutrophil-Rich Thrombus

Background: Specific detection of recurrent deep vein thrombosis (DVT) is a challenging clinical problem. As DVT formation and resolution are inflammatory processes, we experimentally investigated whether noninvasive 18F-fluorodeoxyglucose (FDG)-PET imaging could identify inflamed, recently formed thrombi and thereby improve the diagnosis of recurrent DVT. Methods: We established a stasis-induced DVT model in murine jugular veins and also a novel model of recurrent stasis DVT in mice. C57BL/6 mice (n = 30) underwent ligation of the jugular vein to induce stasis DVT. FDG-PET/CT was performed at DVT timepoints of day 2, 4, 7, 14, or 2+16 (same-site recurrent day 2 DVT overlying a 16 days old DVT). Antibody-based neutrophil depletion was performed in a subset of mice prior to DVT formation and FDG-PET/CT. In a clinical study, 38 patients with lower extremity DVT or controls undergoing FDG-PET were retrospectively analyzed. Results: Stasis DVT demonstrated that the highest FDG signal occurred day 2, followed by a time-dependent decrease (p<0.05). Histological analyses demonstrated that thrombus neutrophils (p<0.01), but not macrophages, correlated with thrombus PET signal intensity. Neutrophil depletion decreased FDG signals in day 2 DVT compared to that of control mice (p<0.05). Recurrent DVT demonstrated significantly higher FDG uptake than organized day 14 DVT (p<0.05). The FDG DVT signal in patients also exhibited a time-dependent decrease (p<0.05). Recurrent day 2 DVT showed neutrophil-dominant infiltration pattern with few macrophages, similar to standalone day 2 DVT. Conclusions: Noninvasive FDG-PET/CT identifies neutrophil-dependent thrombus inflammation in murine DVT, and demonstrates a time-dependent signal in both murine and clinical DVT. FDG-PET/CT may offer a molecular imaging strategy to accurately diagnose recurrent DVT.

Embryo transfer cannot delineate between the maternal pregnancy environment and germ line effects in the transgenerational transmission of disease in rats

Adverse conditions in utero can have transgenerational effects, in the absence of a subsequent insult. We aimed to investigate the contribution of the maternal pregnancy environment vs. germ line effects in mediating alterations to cardiorenal and metabolic physiology in offspring from mothers born small. Uteroplacental insufficiency was induced by bilateral uterine artery and vein ligation (Restricted group) or sham surgery (Control group) in Wistar-Kyoto rats. Restricted and control female offspring (F1) were mated with either breeder males (embryo donor) or vasectomized males (embryo recipient). Embryo transfer was performed at embryonic day (E) 1, whereby second-generation (F2) embryos gestated (donor-in-recipient) in either a control (Cont-in-Cont, Rest-in-Cont) or restricted (Cont-in-Rest, Rest-in-Rest) mother. In male and female offspring, glomerular number and size were measured at postnatal day (PN) 35, and systolic blood pressure, glucose control, insulin sensitivity, and pancreatic β-cell mass were measured in separate sibling cohorts at 6 mo. Rest-in-Rest offspring were hypothesized to have similar characteristics (reduced growth, altered metabolic control, and hypertension) to non-embryo-transferred Rest, such that embryo transfer would not be a confounding experimental influence. However, embryo-transferred Rest-in-Rest offspring underwent accelerated growth during the peripubertal phase, followed by slowed growth between 2 and 3 mo of age compared with non-embryo-transferred Rest groups. Furthermore, renal function and insulin response to a glucose load were different to respective non-embryo-transferred groups. Our data demonstrate the long-term effects of in vitro embryo manipulation, which confounded the utility of this approach in delineating between the maternal pregnancy environment and germ line effects that drive transgenerational outcomes.

Massive Haemothorax and Tension Pneumothorax Due to Fractured Second Rib

Massive haemothorax and tension pneumothorax due to injury of internal thoracic vein and second rib fracture after blunt trauma is very rare. Possible mechanisms of injury to the thoracic vein include fracture of an bony structure, such as a rib, clavicle and sternum or shearing forces acting on the vessel during period of extreme acceleration or decelerations. We presented an urgent thoracotomy and ligation of the internal thoracic vein ruptured by blunt trauma immediately.

Laparoscopic ligature of spermatic veins as a method of surgical management of varicocele

Objective: To present the surgical technique of laparoscopic ligation spermatic vein in the treatment of varicocele as well as the results of this procedure. Material and methods: The study was conducted at the Clinic of Urology, Clinical Centre of Serbia, during the seventeen months, from November 2012 till March of 2014. During this time, the thirteen patients underwent laparoscopic ligation of spermatic vein. Including factors for this type of surgical treatment were clinically manifest varicocele and/or bad finding of semen. Results: During the seventeen months, thirteen patients underwent laparoscopic spermatic vein ligature. The youngest patient was 21 years old, while the oldest patient was 38 years old. The median was 28.46 years. 6 patients had varicocele Gr III, and with 7 patients we verified varicocele Gr II. The duration of surgery ranged from 15 to 70 minutes, with a median of 35.46 minutes. The amount of gas that was insufflated during surgery ranged from 14.1 l to 45 l, with a median of 23:32 litters. Three patients underwent laparoscopic ligature of spermatic vein with preservation of spermatic artery. Interventions in which underwent preservation of artery lasted longer (median 60 minutes) than it was the case in the group of patients without preservation (the median 28.1 minutes). Conclusion: Laparoscopic ligation of spermatic veins is a safe, minimally invasive, rapid and effective procedures. The level of postoperative complications is minimal learning curve fast and patient discomfort is minimized. The procedure is the financial cost effective, especially compared with the open surgical procedure.

Hepatectomy: a critical analysis on expansion of the indications

BackgroundHepatic resection has evolved to become safer, thereby making it possible to expand the indications.AimTo assess the results from a group of patients presenting these expanded indications.MethodWere prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs).ResultsWere operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery.ConclusionThe indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion.

Internal Jugular Vein Aneurysm Presenting after Emesis Episode

75% percent of all jugular vein aneurysms cases are diagnosed in children. The authors present an unusual case of a voluminous internal jugular vein aneurysm in a 40 year-old woman. The patient developed a progressive enlarging cervical bulging after an intense emesis episode five years before. The aneurysm was managed by cervicotomy and jugular vein ligature and the patient had an uneventful postoperative recovery. The authors provide a brief review of diagnosis aspects and treatment options for this disease.

To Shunt or Not to Shunt? An Experimental Study Comparing Temporary Vascular Shunts and Venous Ligation as Damage Control Techniques for Vascular Trauma

To evaluate vascular flow through temporary vascular shunts inserted into peripheral arteries and veins and the repercussion, on the arterial perfusion, of venous ligation and venous shunt insertion in an experimental model for damage control. Experimental study in pigs. Animals were distributed in 5 groups: group 1, right external iliac artery (EIA) shunting and right external iliac vein (EIV) ligation; group 2, right EIA shunting and right EIV shunting; group 3, right EIV ligation; group 4, right EIV shunting; group 5, no vascular shunting and no venous ligation. Flowmeters were used to measure vascular flow on right and left external iliac vessels, and blood samples were collected from the EIVs for biochemical analysis. A right anterior limb biopsy was performed before shock. Hemorrhagic shock was induced through the external right jugular vein, until the vascular flow through right iliac external artery shunt or right iliac external vein shunt (group 4) ceased or until the animal's death. After the end of the experiments, biopsies of bilateral hind limb were obtained for histologic analysis. For statistical analysis, Microsoft Office Excel 2007 and BioEstat 5.0 (2007) were used. In the absence of hemorrhagic shock, venous ligation (group 1) was associated with a 38.8% reduction (P < 0.05) and venous shunting with a 28.4% reduction on the vascular flow through the arterial shunt. When associated with hemorrhagic shock, the mean vascular flow on the right EIA was 13 mL/min and on the left EIA was 41.2 mL/min; on group 2, the right EIA flow was 8.5 mL/min and the left EIA flow was 8.1 mL/min. When associated with hemorrhagic shock, the pO2 was 25.8 mm Hg on right EIV and 33.8 mm Hg on the left EIV for group 1 (P < 0.05), whereas for group 2, the pO2 was 22.6 mm Hg on right EIV and 22.8 mm Hg on the left EIV. On group 1, serum potassium was 3.84 mEq/L on the right EIV and 3.96 mEq/L on the left EIV, whereas on group 2, it was 7.1 mEq/L on the right EIV and 5.88 mEq/L on the left EIV (P < 0.05). In the developed experimental model, venous shunting, when compared with venous ligation, offered less resistance to vascular flow through the arterial shunt and allowed a more efficient limb venous drainage than simple vein ligature.

Incidence of postembolization syndrome after complete renal angioinfarction: a single-institution experience over four years

Objective. Renal angioinfarction (RAI) has been used for various indications in the management of renal tumors. While historically used for palliation of local symptoms (pain or hematuria), this technique has theoretical use in facilitating radical nephrectomy by allowing early ligation of the renal vein, decreasing blood loss and creating edema in resection planes. A common impediment to embolization is the development of postembolization syndrome (PES), which has been reported to have an incidence as high as 89%. This study reports the authors' experience with RAI as a safe palliative and adjunctive procedure over 4 years. Material and methods. From 2008 to 2011, 113 patients underwent complete RAI at Washington Hospital Center for palliative or adjunctive therapy by an interventional radiologist. Procedures were performed in a radiology suite using mild sedation with vascular access obtained by femoral artery puncture. RAI was performed by subsegmental injection of polyvinyl alcohol particles. Results. All 113 patients underwent successful RAI with confirmation of total arterial flow ablation via postprocedure arteriogram: 38 underwent embolization for preoperative adjunctive therapy, 34 for palliation of renal mass, 36 for trauma/hemorrhage and five for symptomatic renal artery pseudoaneurysm after partial nephrectomy. PES occurred in 33 out of 75 patients (44.0%), with symptomatic PES in only two patients (2.6%). No major complications (>Clavien grade III) occurred. Thirty-eight patients were excluded from analysis as they underwent radical nephrectomy within 24 h, preventing accurate assessment of PES. Conclusions. RAI is a safe and reliable procedure for palliation of renal masses, as an adjunctive procedure for radical nephrectomy, and for conservative management of renal hemorrhage or aneurysm. PES occurs in relatively few patients, with no major complications, and should not impede clinical consideration of this procedure.

Comprehensive review of 18 cases with Abernethy malformation in China from 2001 to 2012

Objective To acquire more knowledge about Abernethy malformation. Methods Eighteen cases with Abernethy malformation published previously in China from 2001 to 2012 were reviewed.The clinical, radiological and pathological manifestations and treatment were summarized. Results Of 13 cases with type Ⅰ Abernethy malformation (including 6 type Ⅰ a and 7 type Ⅰ b, 5 male and 8 female ), 11 cases occurred by the age of 18 years.Their clinical manifestations included hematochezia in 4, hematemesis in 4, liver dysfunction in 5, liver cirrhosis in 2, hepatic encephalopathy in 2, hepatic nodule in 4, splenomegaly in 5, hypersplenism in 4, portal hypertension in 3 and other associated malformations in 3.Of 5 cases with typeⅡAbernethy malformation, 2 cases occurred by the age of 18 years.Their clinical manifestations included liver dysfunction in 4, hematochezia in 1, liver cirrhosis in 1, hepatic encephalopathy in 1, hepatic nodule with focal nodular hyperplasia in 1.All 18 patients underwent imaging evaluation, multi-slice computed tomography(CT) angiography (MSCTA) in 16, including vascular ultrasound in 15, digital subtraction angio-graphy (DSA) in 7, magnetic resonance angiography (MRA) in 1 and magnetic resonance imaging (MRI) in 1.The sites of drainage for portal vein system in 15 cases were documented, including the inferior vena cava (2/15 cases), internal iliac vein (5/15 cases), left renal vein (3/15 cases), azygos vein (2/15 cases), right atrium (2/15 cases) and pelvic venous plexus (1/15 case). And there was no record of specific draining site in other 3 cases.Ballooning dege-neration of liver cells, liver cells nodular hyperplasia and fatty degeneration were detected in 2 cases of type Ⅰ Abernethy malformation.And liver focal nodular hyperplasia was demonstrated in 1 case of typeⅡAbernethy malformation.Four cases with hematochezia were misdiagnosed as ulcerative colitis, hemorrhoids or purpura.Two cases with clitoral hypertrophy were misdiagnosed as genital malformations.Due to crying, one 5-month-old baby was misdiagnosed as sepsis.Of these 18 cases of Abernethy malformation, most of the cases received conservative treatment.Surgical techniques such as splenectomy, surgical ligation of the veins of sigmoid and interventional embolization to occlude the shunt were used to treat splenomegaly, hematochezia, hematemesis or hepatic encephalopathy. Conclusions Abernethy malformation mainly occurs in children.Clinical presentation is nonspecific.Liver dysfunction, hepatic nodule, hematochezia, hematemesis, plenomegaly and hypersplenism are common manifestations.Compared with overseas reports, hepatic nodule, hepatic encephalopathy and concomitant abnormalities are rare, while hematochezia and hematemesis are more common.The diagnosis is made primarily according to imaging changes, and MSCTA is a useful tool to make a diagnosis.Indivi-dualized treatment of Abernethy malformation is determined by the type of deformity and the conditions of the patient. Key words: Abernethy malformation; Absence of portal vein; Portocaval shunt

Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric, adolescent and young adult varicoceles

Anatomical variations on venous drainage in varicoceles are under-reported. We report our experience in scrotal antegrade sclerotherapy (SAS) for adolescent varicoceles. Since 2011, 15 consecutive boys with left varicoceles were recruited. Under general anaesthesia, a 5-mm transverse incision was made at scrotal neck, testicular vein was cannulated at pampiniform plexus with venogram performed. Foam sclerosant by mixing sodium tetradecyl sulphate (STS), Lipiodol(®) and air was slowly injected under fluoroscopy. Postoperatively the patients were followed-up for varicocele grading, testicular size, and complications. Median age at operation was 14 (10-19) years. 80 % had grade three varicoceles, 33.3 % had smaller left testis before operation. Intra-operative venogram showed three different anatomical variations. Group I: eleven patients (73.3 %) had single distinct internal spermatic vein; Group II: two patients demonstrated duplication of internal spermatic vein draining into left renal vein; Group III: two patients had pampiniform plexus draining to iliac and/or paraspinal veins. SAS was performed in Group I and II patients. Sclerosant volume injected ranged from 1.5 to 4.5 ml. In Group III patients, surgical ligation of testicular veins was performed rather than SAS to avoid uncontrolled systemic sclerosant spillage. Mean length of stay was 1.13 day. One patient with scrotal haematoma and one other with minor wound dehiscence were managed conservatively. Mean follow-up period was 10.9 (1-22) months. Thirteen patients (86.7 %) achieved varicocele grading ≤ 1. There was no postoperative testicular atrophy, hydrocele and epididymo-orchitis. Scrotal antegrade sclerotherapy using STS foam is a safe and effective treatment for adolescent varicoceles. Anatomical variations on venous drainage in varicoceles are common.

Acute Compartment Syndrome of the Thigh Secondary to Isolated Common Femoral Vessel Injury: An Unusual Etiology

We report a case of acute compartment syndrome of the thigh secondary to common femoral vessel injury. The lesion was associated with common femoral artery dissection and common femoral vein rupture. Emergency surgical treatment consisted of resection-anastomosis of the arterial dissection, vein ligature, and fasciotomies. The patient is symptom-free after 15 months of follow-up. Isolated vascular injury is an unusual cause of acute compartment syndrome of the thigh. This case serves to increase awareness that isolated vascular injury, without femoral fracture or multiple injury, can result in thigh compartment syndrome. Early recognition and treatment of vascular involvement contributes to better functional outcome of this rare condition, but treatment modalities remain subject to discussion.