Superficial Venous System Research Articles

Anatomical Venous Variants in Children With Cerebral Sinovenous Thrombosis.

Background and Purpose- Literature is sparse on the frequency and significance of anatomical venous variants (AVVs) in pediatric cerebral sinovenous thrombosis (CSVT). Methods- We retrospectively reviewed children with CSVT and controls undergoing computed tomography/magnetic resonance venography from January 2008 to 2014. Clinical features examined included raised intracranial pressure, risk factors, and treatment. Radiological features examined included CSVT location, presence and type of AVVs, hemorrhagic venous infarction, and venous collateralization. Clinical outcome was measured by the pediatric stroke outcome measure and radiological outcome by thrombus recanalization. Results- Fifty-one children with CSVT were identified. Twenty-two (43%) had AVVs at presentation. Nineteen (86%) had hypoplasia/absence of major dural sinus, 5 (23%) had persistent fetal structures, 3 (14%) had duplications/fenestrations, and 1 (5%) had disconnected superficial and deep venous systems. Controls had a slightly higher but nonsignificant prevalence 26 (51%) of AVVs. No significant clinical and radiological differences were observed between children with CSVT and AVVs compared with those with typical venous anatomy. Conclusions- AVVs are seen in many children with and without CSVT and do not seem to alter the presentation or clinical course. The influence of these variations on the brain's ability to tolerate venous congestion because of thrombosis merits further study.

Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population

BackgroundThe objective of this study was to evaluate the association between the clinical classification of chronic venous insufficiency and duplex ultrasound findings. MethodsA total of 1010 limbs with clinically suspected chronic venous insufficiency were stratified according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification and underwent duplex ultrasound evaluation consecutively between January 2012 and June 2015. Venous thrombosis, venous reflux, and anatomic distribution of the deep and superficial venous systems were investigated across the CEAP clinical classes. ResultsThere were 259 male limbs (25.6%) and 751 female limbs (74.4%) in clinical class C0 (24 limbs [2.4%]), C1 (130 limbs [13.1%]), C2 (452 limbs [44.8%]), C3 (183 limbs [18.1%]), C4 (163 limbs [16.1%]), C5 (31 limbs [3.1%]), and C6 (27 limbs [2.7%]). The mean age in clinical class C4-C6 (60.77 ± 14.67 years) was statistically significantly higher than in C0-C3 (55.73 ± 18.85 years; P < .001). Male limbs were shown to have a predilection for presenting with clinical class C4-C6 over female limbs (36.3% vs 16.9%; odds ratio, 2.8; 95% confidence interval, 2.0-3.8). Positive findings were predominantly displayed in clinical class C4-C6 compared with C0-C3 (deep venous thrombosis, 3.2% vs 1.3%; deep venous reflux, 30.8% vs 26.9%; superficial vein thrombosis, 2.7% vs 2.0%; superficial venous reflux, 56.6% vs 47.6%; perforator vein reflux, 12.7% vs 8.2% [P = .049]). A low prevalence of small saphenous vein and perforator vein reflux in C1 limbs (0.3% and 4.6%) and C3 limbs (3.8 and 6.6%) was discovered. ConclusionsThe prevalence of CEAP class C0-C3 was found to be higher than C4-C6. However, men were shown to have a predilection for presenting in clinical class C4-C6 over women. The mean age of patients with clinical class C4-C6 limbs was statistically significantly higher than of those with clinical class C0-C3 limbs. The prevalence of deep venous reflux, superficial venous reflux, and coincident deep and superficial venous reflux in clinical class C4-C6 limbs was higher than in clinical class C0-C3 limbs. Detection of incompetent perforator veins was shown to have a statistically significant correlation with clinical class C4-C6 limbs.

The use of High Venous Ligation as an Adjunct to Endovenous Therapy in the Management of Great Saphenous Vein Incompetence: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: In recent years endovenous intervention (EI) has emerged as a minimally invasive alternative to the open venous surgery. However, EI does not formally disconnect the deep and superficial venous systems and thus it has been hypothesized that recurrence may be greater in the absence of high venous ligation. This study aims to compare the efficacy of a hybrid endovenous approach with adjuvant high venous ligation and standard operative intervention in the management of Great Saphenous incompetence (GSI). Methods: In March 2018 Medline was systematically searched for relevant randomized controlled trials (RCT). All RCT’s comparing a hybrid approach with standard operative intervention (SI) were included. Studies were required to include at least one pre-defined outcome. Data were extracted and assessed by two reviewers. Pooled odds ratios were calculated using a random effects model. Additional subgroup analyses were performed. Results: Eight randomized controlled trials with 1,244 participants were analyzed. Pooled standardized data revealed no difference in overall recurrence (pooled OR=1.04 [95% CI, 0.49,2.23]), operative complications (pooled OR=1.14 [95% CI, 0.82,1.58]), or re-interventions (pooled OR=1.01 [95% CI, 0.46,2.21]) for the hybrid group compared with SI alone. Subgroup analysis indicated comparable recurrence outcomes for both groups in the short, medium and long term. Furthermore, no difference in recurrence was identified when the hybrid approach was compared to open surgery (pooled OR=0.59 [95% CI, 0.33,1.06]) or endovenous monotherapy (pooled OR=1.03[95% CI, 0.55,1.93]). Conclusion: The use of a hybrid approach in the management of GSI appears to offer no recurrence, re-intervention or complication benefit when compared to SI.

Correlation Between Various Definition of Superficial Venous Reflux and Clinical Presentation of Venous Disease

There have been various ways of reporting venous reflux in chronic venous insufficiency (CVI). Some vascular laboratories tend to describe venous reflux with categorical presence of reflux and some use grading method by measuring duration of venous reflux in seconds. The primary objective of study is to find out which method of describing venous incompetency in superficial venous system at great saphenous veins (GSV) and saphenofemoral junction (SFJ) would best correlate with clinical presentation of venous disease using CEAP (clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction) classification.

Abstract: Refinements in Microcirculation of the Deep and Superficial Venous Territories &amp; Contribution of the Dermal Plexus in DIEP Flap Reconstruction: An Anatomical Study

INTRODUCTION: Complications associated with venous microcirculation remains prevalent to autologous reconstruction with the free deep inferior epigastric artery perforator (DIEP) flap. It has been previously been demonstrated that retaining the dermal component in DIEP flap harvest has a significant role in overall flap perfusion. Studies of venous perforator anatomy and assessment of perforator vascular territories (venosomes) has not received the same attention compared to arterial studies. This study evaluates the venous microcirculation of the anterior abdominal wall integument of the DIEP and superficial inferior epigastric venous systems and the impact on the dermis on venous microvascular perfusion. METHODS: Fourteen hemi-abdominal flaps from the midline to mid-axillary line were harvested in fresh, non-frozen human cadavers. Following perforator mapping, the venae comitantes of the largest DIEP perforator and the superficial inferior epigastric vein cannulated using a 27-gauge butterfly catheter. Flaps were evaluated with high resolution computed tomography (CT) following an injection of iodinated contrast (Omnipaque ®) to the DIEP venae comitantes and SIEV. The contrast agent was flushed out from the flap between injections. The dermis was subsequently removed with cautery at the subdermal dissection plane and flaps were re-imaged with CTA following injection in the DIEV perforator. Three-dimensional CT angiography of the venous territories allowed detailed assessment at each stage including perfusion areas, volume and pattern of perfusion. RESULTS: Average territory of the largest DIEV perforator was 180cm2 and extended to 47% of the hemi-abdominal integument. Patterns of venous territory distribution from individual venous perforators were assessed in hemi-abdominal flaps of the anterior abdomen. The perfusion territory without the dermis was significantly reduced by a mean of 142cm2, P=0.01. Mean volume of perfusion was significantly reduced on average by 10cm3, P=0.01. A direct communication of the DIEV perforator with the superficial system was seen in 10/14 flaps (71%). CONCLUSION: Venous microcirculation plays a critical role in success of DIEP flap harvest. This study details patterns of venosomes of DIEV perforators, the comparison with the superficial system but appreciates the critical role of the preservation of the dermal integrity to preserve and optimize venous drainage of the flap by avoiding aggressive de-epithelialization.

Elevation Technique for Medial Branch based Superficial Circumflex Iliac Artery Perforator flap.

According to early studies on the superficial circumflex iliac artery perforator flap, there are two major types of perforators that are presumed to originate from the superficial circumflex iliac artery: the medial perforator with a direct cutaneous vessel (superficial branch) - located relatively medially on the flap, and the lateral perforator, traveling laterally beneath the deep fascia and often with an intramuscular pathway penetrating the deep fascia on the lateral aspect (deep branch) of the flap. Although there are well described studies on the anatomy of the arterial vasculature, design and elevation of the flap are different issues, as there are always some potential for anatomical variations, such as pedicle anatomy, location of lymph nodes, and thickness of superficial fascia. The presence of internal pudendal artery and superficial inferior epigastric artery in the groin may add to the confusion. One should also beware of the presence of major lymphatics which are drained into the superficial venous system. Therefore this paper will try to simplify the elevation technique based on the medial perforator. However, one must always be ready to identify a good perforator and to elevate it as a freestyle approach to overcome the variations wherever the perforator may originate from. The best way to feel comfortable using any flap is from practice and repetitive elevation. The same is for the medial branch based SCIP flap. The direct cutaneous nature of the pedicle will make the dissection even easier as the dissection course bypasses muscle and lymph nodes. This technical note describes practical surgical tips for elevating the medial perforator based SCIP flap.

Rápida cicatrización de la úlcera venosa con técnica TAPIRS-LF con láser, espuma y vendajes multicapa

IntroductionThe traditional surgical techniques are being replaced by minimally invasive procedures, such as Endovenous Laser (Thermal, Tumescent), and ultrasound foam sclerotherapy (Non-Thermal, Non-Tumescent). The aim of this study was to determine the healing time and rate of venous ulcers (VU) using a Terminal, Axial and Perforator Interruption of the Reflux Source (TAPIRS-LF) protocol. This included Endovascular Laser Treatment and endoluminal venous occlusion with ultrasound-guided foam and a multilayer bandage system until ulcer healing was achieved. Material and methodsA prospective non-controlled trial was conducted on patients with chronic venous leg ulcers (CEAP [clinical, etiological, anatomical and pathological elements] classification C6) during 2015 and 2016. A total of 27 patients aged 18 years and over, presenting with venous insufficiency, VU, and an ankle-brachial index greater than 0.8, were included, with a total of 27 extremities being analysed. All of the patients were subjected to thermal and non-thermal endoluminal occlusion, with endovenous laser treatment in axial venous system, with ultrasound-guided foam in the distal axial superficial venous system and perforator and terminal veins near to the ulcer, using the Tessari method with 3% polidocanol. Follow-up was carried out every week and a Doppler test was performed after 4, 12, and 24 weeks. ResultsThe mean age of the patients was 59.6 years. The active ulcer duration prior to treatment was 11.7 months. The mean VU diameter was 15.06 cm2, and 92.5% VU were seen to be healing at 8 weeks. ConclusionsThe minimally invasive ablation using Terminal, Axial and Perforator Reflux with compression in patients with active VU results in a faster healing during the treatment of chronic venous ulcers.

İzole inkompetan perforan venlerin sonografik değerlendirilmesi ve yaş, cinsiyet, vücut kitle indeksi, CEAP sınıflandırması ile korelasyonu

Purpose: Isolated incompetent perforating veins (IPVs) are poorly discussed in the literature and their importance and prevalence is unknown. This study aims to assess the prevalence and their relation with several factors; age, sex, location and body mass index (BMI). Materials and Methods: A total of 803 limbs of 485 patients were evaluated with duplex ultrasonography. The clinical severity of the affected limbs were assessed according to CEAP classification. Incompetent perforating veins were considered isolated if neither superficial nor deep venous system reflux were associated. Results: 617 legs were classified as CEAP 0-2, 186 legs were classified as CEAP 3 or higher. There was a significant correlation with age, sex, BMI, incompetent perforating veins and CEAP stage. 22 of 803 legs (2.7%) have been shown to have isolated incompetent perforating veins. Total of 25 isolated incompetent perforating veins were detected in these 22 legs (19 patients; 14 females, 5 males). All patients with isolated incompetent perforating veins had CEAP stage 0-2. The mean BMI of these patients was lower than the whole patients groups. Conclusion: The results of this study show that isolated IPVs may also be a cause of venous insufficiency. It may be inferred that the increase in the patients' weights or BMIs does not lead to development of isolated incompetent perforating veins because the BMI of the patients with isolated incompetent perforating veins are found to be lower.

An important superficial vein of the radial aspect of the forearm: An anatomical study.

Introduction:The superficial veins of upper limbs are seldom talked about. They are always avoided quoting them to be variable in anatomy. Other than the cephalic and basilic veins, no other superficial vein has caught the eyes of anatomists and other health professionals significantly. This article tries to explain the importance of a superficial vein that closely traces the radial vessels and explains its possible use in microvascular reconstruction.Materials and Methods:The forelimbs of 26 upper limbs of fresh frozen cadavers were dissected out. The anatomy of the superficial vein that follows the radial vessels was traced out from wrist to cubital fossa. Their relation to the deep venous system and cephalic veins was followed and documented.Results:All the 26 upper limbs showed the existence of the superficial vein that follows the radial vessels. The study also revealed the existence of venous perforators which are in turn the communication channels between the deep and superficial venous systems.Conclusion:The existence of the surface vein can logically hold an explanation for flap failure or success when one vein anastomosis is contemplated for radial forearm-free tissue transfers.

Posterior tibial perforators relationship with superficial nerves and veins: A cadaver study.

Most authors have evaluated the location of lower leg arterial perforators, but little is still known about the relationship between the arterial network and great saphenous vein (GSV) and saphenous nerve (SN). The aim of this study is to evaluate the relationship between the arterial network of the posterior tibial artery perforators, the cutaneous nerves, and the superficial venous system in the lower one third of the leg. Eighteen lower limbs from cadavers were used for this study. The arterial and venous compartment were selectively injected with a mixture of barium sulfate and epoxy. The specimen were CT scanned and the superficial veins, nerves, and the arterial perforators were dissected. A large perforator of the posterior tibial artery was found at a mean distance of 6.23 cm ± 0.88, with a 95% CI: 5.79-6.67, from the medial malleolus. The average diameter was 0.9 mm ± 0.17, with a 95% CI: 0.81-0.99. In 67% the connection of the venae comitantes to the superficial venous system was established with the GSV, in the other cases, with Leonardo's vein. Both dissection and imaging studies showed perineural interperforator connections along the branches of SN in all the specimens examined. The distribution pattern of posterior tibial artery perforators followed the superficial nerves in this region. There is an interperforator anastomotic network along the SN. The various patterns of the venous drainage system, in relationship to the distribution of the branches of posterior tibial artery perforators, have been clarified.

Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study.

Background & objectives:Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification.Methods:In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively.Results:Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively.Interpretation & conclusions:Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

A prospective randomized study to evaluate safety and efficacy of heparin topical solution (1000 IU/ml) compared to heparin topical gel (200 IU/g) in prevention of infusion-associated phlebitis.

OBJECTIVES:Thrombosis and thrombophlebitis of the superficial venous system are common in hospitalized patients. Efficacy and safety of topical quick penetrating solution (QPS) of heparin were compared to heparin sodium topical gel for the prevention of infusion-associated phlebitis.MATERIALS AND METHODS:Patients aged 18–65 years undergoing intravenous cannulation for at least 72 h were enrolled and randomized to receive 6–8 drops of topical solution of heparin (Group sodium topical solution [QPS]) or1 g of topical gel (Group GEL) over the cannulated vein every 8 hourly for a total of 10 doses. Enrolled patients were monitored every 8 ± 1 h for phlebitis using visual infusion phlebitis scale. The primary aim was to compare the proportion of patients with Grade 0, I, and II phlebitis at the end of 72 h of treatment period.RESULTS:Number of patients assessed for eligibility was 110; 26 excluded and 84 randomized. Analysis was done for 41 administered heparin QPS and 33 administered heparin gel as the rest were lost to follow-up. No phlebitis was reported in 32% of patients in QPS group and 9% in GEL group (P =0.0019). Proportion of patients with Grade I and Grade II phlebitis was 22.9% and 13.5% with QPS and 35.13% and 22.97% with gel, respectively, and the difference was statistically significant. Mean time to develop Grade I (Group QPS = 59.7 h; Group GEL = 58.46 h; P = 0.949) and Grade II (Group QPS = 62.4 h; Group GEL = 61.17 h; P = 0.732) phlebitis was comparable no adverse effects were reported in either group.CONCLUSION:Heparin QPS was more effective in he prevention of infusion-associated phlebitis with similar safety profile as heparin gel.

Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases.

Venous diseases are highly prevalent, mostly caused by valve incompetence and/or obstruction of the vein lumen. Signs and symptoms are diverse and unspecific. Careful clinical assessment and imaging interpretation are crucial to diagnosis. Duplex ultrasound is the first choice and often the gold standard imaging technique for this purpose, providing information on the anatomy and function of the veins. This article describes the sonographic anatomic and hemodynamic criteria used for the diagnosis of venous reflux, venous obstruction, and the most frequent complications after interventions in the superficial, perforating, and deep venous systems.

Alteration of Venous Drainage Route in Idiopathic Normal Pressure Hydrocephalus and Normal Aging.

Idiopathic normal pressure hydrocephalus (iNPH) is a highly prevalent condition in the elderly population; however, the underlying pathophysiology in relation to the aging process remains unclear. To investigate the effect of removal of cerebrospinal fluid by lumbar “tap test” on the cerebral circulation in patients with iNPH, 14 patients with “probable” iNPH were studied using a novel blood tracking technique based on blood oxygenation level-dependent (BOLD) magnetic resonance signal intensity. By tracking the propagation of the low-frequency component of the BOLD signal, extended venous drainage times were observed in the periventricular region of the patients, which was reversed by tap test. Interestingly, the venous drainage time in the periventricular region exhibited an age-related prolongation in the healthy control group. Additional regression analyses involving 81 control subjects revealed a dissociation of deep and superficial venous systems with increasing age, presumably reflecting focal inefficiency in the deep system. Our results not only provide insights into the etiology of iNPH, but also point to a potential non-invasive biomarker for screening iNPH.

Does additional superficial venous system involvement alter the outcome in patients with deep cerebral venous thrombosis?

Does additional superficial venous system involvement alter the outcome in patients with deep cerebral venous thrombosis?

Nocturnal leg symptoms are not associated with specific patterns of superficial venous insufficiency.

Certain nocturnal symptoms such as leg cramping (LC) and restless leg symptoms (RLS) are found in patients with venous disease. This study investigates the relationship between nocturnal symptoms and anatomic locations of superficial venous insufficiency. A retrospective review of 371 consecutive patients presenting to a venous disease practice over a 1-year period was conducted. Patients underwent comprehensive assessment including standardized duplex scans. Superficial venous disease was classified by anatomic location (great saphenous vein [GSV], small saphenous vein [SSV], tributaries). Information on patient symptoms was obtained from questionnaires and patient interviews. Most patients in the cohort were female (315/371, 85%) with an average age of approximately 56 years. The 56 men had an average age of 63.2. Nearly all patients (92%) had findings of superficial venous reflux with the anatomic site of involvement as follows: GSV (51%), SSV (16%), and tributaries (33%). Thirty-two percent of patients experienced LC and 16% experienced RLS. The patterns of reflux did not differ between patients with nocturnal symptoms compared to those without nocturnal symptoms. Nine percent of patients with nocturnal symptoms had no evidence of venous disease. Of those patients with LC, 76% had reflux in the GSV, 48% had reflux in the SSV, and 92% had reflux in at least one segment of the superficial venous system. Of those patients with RLS, 78% had reflux in the GSV, 35% had reflux in the SSV, and 87% had reflux in at least one segment of the superficial venous system. No significant difference was detected between patterns of superficial venous reflux in patients with nocturnal symptoms compared to those without nocturnal symptoms. In addition, the presence of nocturnal symptoms does not predict a specific pattern of disease. Future studies are needed to determine whether correction of the main truncal disease is sufficient or if ablation of both the truncal and tributary veins is necessary for alleviation of nocturnal symptoms.

Proper Choice of Donor Site Veins for Patients Undergoing Free Radial Forearm Flap Reconstruction for the Defects of Head and Neck

The purpose of this study was to analyze the reliability of the deep venous drainage system of the free radial forearm flap. The authors implemented a retrospective cohort study and enrolled patients admitted for the evaluation and management of head and neck tumors with radial forearm flap reconstruction. The primary predictor variables were the donor site veins, including the deep, dual, and superficial venous drainage systems. The primary outcome measurement was the incidence of venous compromise. Potential confounders included patient demographics, history of chemotherapy with or without radiotherapy, defect sites, and the recipient artery and vein. The χ2 test and logistic regression analysis were used for statistical analysis. The final study population consisted of 520 patients (mean age, 54years) who underwent head and neck soft tissue reconstruction using the free radial forearm flap. Patients with the deep system (odds ratio [OR]=0.251; 95% confidence interval [CI], 0.108-0.581) or dual system (OR=0.197; 95% CI, 0.064-0.605) had a markedly lower risk of venous compromise than those with the superficial system. The overall incidence of inadequate outflow was 2.5% (5 of 204) when the deep system was used alone and 8.9% (19 of 212) when the superficial system was used alone (P=.004). Patients with the deep venous drainage system had a statistically lower risk of venous compromise. This study recommends using the deep system as a drainage vein for the free radial forearm flap.

Isolated Perfusion of the Upper Extremity with TNF-α - Double Venous Cannulation

The authors present a technical variation of the standard cannulation for cardiopulmonary bypass perfusion during hyperthermic isolated limb perfusion (ILP) procedures in selected patients with unresectable soft tissue sarcoma or malignant melanoma. Of 55 ILP procedures performed at our institution since the procedure was established in 2009, nine were performed at the upper extremity. Standard single venous cannulation was used in five cases, and extended, double venous cannulation in the last four. The standard technique for brachial vein cannulation in a small compartment of the upper extremity entails a problematic and longer perfusion of the upper extremity. This is due to the lower flow rate in the venous system and relatively large surface area with respect to weight. We present a simple technique based on a "Y" cannulation of the venous system via the deep brachial vein and superficial venous system via the basilic vein, delivering a 20% increase in flow rate in the extracorporeal circulation. Faster heating of the upper extremity and a stable thermal environment throughout upper-extremity ILP are essential for successful treatment. Extended technique of venous cannulation for extracorporeal circulation setting, due to their advantages, became standard in the upper limb ILP procedure at our institution.Key words: isolated limb perfusion - malignant melanoma - soft tissue sarcoma - upper limb - extracorporeal circulation The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 8. 1. 2017Accepted: 15. 1. 2017.

Interpositional Lateral Thoracic Vein Graft for DIEP Flap Salvage in Setting of Superficial Venous System Dominance.

Interpositional Lateral Thoracic Vein Graft for DIEP Flap Salvage in Setting of Superficial Venous System Dominance.

Evaluation of asymptomatic venous disease by Doppler ultrasonography in Behçet’s disease patients

Aim of the workEvaluation of asymptomatic venous disease in patients with Behçet’s disease (BD) using venous Doppler ultrasonography (US) and its relation to different disease manifestations and activity. Patients and methodsTwenty-two BD patients (20 males and 2 females) with a mean age of 36.9±10.6years and disease duration of 10.8±11.3years without any known vascular disease and 22 age and sex matched controls were enrolled in this study. The Behçet’s disease current activity form (BDCAF) was used to assess disease activity. Patients and controls were subjected to venous Doppler US for both upper and lower limbs as well as the inferior vena cavae (IVC). The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) severity score was used to evaluate the severity of venous insufficiency. ResultsThe 22 patients had a mean BDCAF score of 2.2±0.2. No venous thrombosis or thrombophlebitis was detected in patients or controls. Three patient (13.6%) and one control (4.5%) revealed venous-insufficiency (venous reflux >1s) in the lower extremities. The venous-insufficiency involved the superficial venous system and involved the deep venous system in 1 patients and the control. The lower limb veins were normal on both sides as regards compressibility, wall thickness and competency of perforator veins. Upper extremity veins were totally normal in all subjects. ConclusionNo superficial, deep venous dysfunction on both lower or upper limbs and/or IVC thrombosis was found in BD patients. Further follow-up venous Doppler for BD patients even without vascular complications is recommended to detect subclinical cases that may predict future thrombotic events.