Superficial Vein Research Articles

Changes in Macular Thickness and Microvasculature in Koreans with Early Parkinson’s Disease

Purpose: To investigate the thickness of the nerve fiber layer-ganglion cell inner plexiform layer (NFL-GCIPL) complex and microvascular macular changes in Korean patients with early Parkinson’s disease using optical coherence tomography (OCT) and OCT angiography (OCTA).Methods: Forty-three eyes of 22 patients with early Parkinson’s disease were included. A control group of 20 patients (40 eyes) was also recruited. The thickness of the NFL-GCIPL macular complex was measured using OCT, and the densities of the superficial and deep macular retinal vessels were evaluated via OCTA in all subjects.Results: The NFL-GCIPL thicknesses of the superior, inferior, temporal, and nasal sectors were 94.70 ± 9.35, 93.32 ± 9.16, 90.18 ± 6.32, and 93.11 ± 8.75 μm in the control group and 92.05 ± 4.96, 91.32 ± 7.48, 84.74 ± 6.82, and 91.32 ± 7.47 μm in the Parkinson’s disease group, respectively; all thicknesses were significantly greater in the control group. The superficial and deep retinal vessel densities did not differ between the two groups.Conclusions: Neurodegenerative macular changes are more obvious than microvascular changes in patients with early Parkinson’s disease. Such neurodegenerative changes should be further evaluated in future cohort studies.

Rare Association of Takayasu Arteritis and Antiphospholipid Syndrome with Severe Thrombocytopenia

The association of Takayasu arteritis (TA) with antiphospholipid syndrome (APS) has rarely been described in the literature. This paper reports the first documented case of TA and APS in a 24-year-old woman in Bangladesh. This patient had claudication pain in upper and lower limbs for four years and Raynaud’s phenomenon in right hand for eight months. During the course of her illness, she suddenly developed deep vein thrombosis in left superficial femoral, popliteal and posterior tibial veins. Conventional angiography revealed total occlusion of right subclavian artery and 60-70% stenosis of right common iliac artery. CT angiography of right upper limb also supported these findings along with increased wall thickening in the 2nd part of right subclavian artery and moderate narrowing of the 1st part of right axillary artery. She had persistently positive anticardiolipin antibodies in high titers, positive lupus anticoagulant (LA), prolonged activated partial thromboplastin time (APTT) and severe thrombocytopenia. We started high dose prednisolone (1mg/kg daily). Her platelet count increased rapidly. Based on review of 10 case reports, we considered the rare association of TA and APS. Both conditions should be determined promptly for the sake of early institution of the appropriate therapy. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 59-63

Superficial dorsal penile vein rupture mimicking penile fracture

Introduction: Superficial dorsal penile vein rupture is a rare penile emergency that mimics penile fracture. Many times, diagnosis will be uncertain as they both have similar symptoms and signs. Delay in treatment of penile fracture can lead to long-term sequelae like erectile dysfunction and thus prompt diagnosis and treatment are required. Case Report: We report a case of a 35-year-old male patient with acute penile swelling and ecchymosis which developed during sexual intercourse suggesting penile fracture. Surgical exploration revealed rupture of superficial dorsal penile vein and no corporal injury. Hematoma was evacuated and vein was ligated. The patient had a good prognosis and reported maintained erectile function. Conclusion: Superficial dorsal penile vein rupture is a rare penile emergency which usually has similar clinical features of penile fracture and hence called false penile fracture. If diagnosis is uncertain, surgical exploration is recommended for definitive diagnosis and to prevent potential long-term sequelae of untreated penile fracture.

Enhanced interleukin-6 in human adipose tissue vein after sprint exercise: Results from a pilot study.

Low-volume sprint exercise is likely to reduce body fat. Interleukin (IL-6) may mediate this by increasing adipose tissue (AT) lipolysis. Therefore, the exchange of ATIL-6 and glycerol, a marker of lipolysis, was examined in 10 healthy subjects performing three 30-s all-out sprints. Blood samples were obtained from brachial artery (a) and a superficial subcutaneous vein (v) on the anterior abdominal wall up to 9 min after the last sprint and analysed for IL-6 and glycerol. Arterial IL-6 increased 2-fold from rest to last sprint. AT venous IL-6 increased 15-fold from 0.4 ± 0.4 at rest to 7.0 ± 4 pg × mL-1 (p < 0.0001) and AT v-a difference increased 45-fold from 0.12 ± 0.3 to 6.0 ± 5 pg x mL-1 (p < 0.0001) 9 min after last sprint. Arterial glycerol increased 2.5-fold from rest to 9 min postsprint 1 (p < 0.0001) and was maintained during the exercise period. AT venous and v-a difference of glycerol increased 2-fold from rest to 9 min postsprint 1 (p < 0.0001 and p = 0.01, respectively), decreased until 18 min postsprint 2 (p < 0.001 and p < 0.0001), and then increased again until 9 min after last sprint (both p < 0.01). The concurrent increase in venous IL-6 and glycerol in AT after last sprint is consistent with an IL-6 induced lipolysis in AT. Glycerol data also indicated an initial increase in lipolysis after sprint 1 that was unrelated to IL-6. Increased IL-6 in adipose tissue may, therefore, complement other sprint exercise-induced lipolytic agents.

Does SarsCoV-2 infection really cause damage to retinal microcirculation in mild cases of COVID-19?

Aim To evaluate changes of retinal microcirculation in mild cases of recovered COVID-19 patients at least three months after the infection by optical coherence tomography angiography (OCTA) non-invasive method. Methods In this prospective cross-sectional study, 50 right eyes of 50 recovered COVID-19 patients were compared with 50 right eyes of age and gender-matched healthy controls. After the complete ophthalmological examination, all participants underwent OCTA measurements (RTVue XR Avanti, Optovue, Fremont, CA, USA). Results The time between the initial onset of symptoms, and ophthalmologic examination was 479.20 ±197.10 (126-754) days. Findings of ophthalmic examination of all eyes of the recovered COVID-19 patients were within normal range. Significantly reduced superficial (p=0.046) and deep (p=0.044) macular vessel density (VD) in foveal region in the eyes of the recovered COVID-19 patients was found compared with healthy controls. Significantly enlarged foveal avascular zone (FAZ) area and perimeter in the eyes of the recovered COVID-19 patients (p<0.001) were found too. Conclusion Recovered COVID-19 patients have impaired retinal microcirculation, which can be a cause of the development of retinal vascular diseases.

Mesoglycan for the secondary prevention of superficial vein thrombosis: a randomized, controlled, double-blind study (METRO Study)—rationale and protocol

No data is available about pharmacological secondary prevention of superficial vein thrombosis (SVT) despite 10–15% of patients develop venous thromboembolic complications at 3–6 months after an adequate treatment of the acute phase. To verify efficacy and safety of mesoglycan in secondary prevention of SVT recurrence and venous thromboembolic complications. Phase III multicenter, double-blind, randomized, superiority trial comparing mesoglycan 50 mg bid vs placebo in consecutive patients with a SVT extended at least 5 cm, after the initial 45-day treatment course with fondaparinux 2.5 mg once-daily. Primary efficacy outcome: SVT recurrence/extension, symptomatic venous thromboembolism (VTE), asymptomatic proximal deep-vein thrombosis, death. Primary safety outcome: major bleeding. We hypothesized a 12-month 15% incidence of the primary efficacy outcome in placebo group and a 50% risk reduction in mesoglycan group. A bilateral log-rank test with a sample of 650 patients (randomization 1:1) reach a 90% power, with an α-error of 0.025, of detecting a 7.0% difference (HR = 0.51) after 12 months of treatment, considering a 10% patients drop-out. At deadline (December 31, 2022) 570 patients have been randomized (10% drop rate). Mean age was 63.9 years, 58.8% were women. SVT involved great saphenous vein in 69.3%, small saphenous vein in 13.1%, and collaterals in 17.6% of patients. SVT was the first event in 61.7%, a recurrence in 38.3%, provoked in 50.2% and unprovoked in 49.8%. Patients not experiencing a primary outcome, or not retiring their consent will be followed up to December 31, 2024 when the final data analysis will be performedClinicalTrials.gov: NCT03428711.

The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction.

Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.

Evaluation of the Superficial Collecting Lymph Vessels’ Vasa Vasorum in Lymphoedematous Limbs Using Video Capillaroscopy

The pre-collecting and collecting lymph vessels have smooth muscle cells, and sufficient perfusion is vital to maintain their function. Although the vasa vasorum of the collecting lymph vessels (VVCL) have been histologically investigated, little is known about their physiology. This study aimed to investigate the relationship between morphology and blood flow of the VVCL in lymphoedematous limbs. Medical records of lower extremity lymphoedema patients who underwent video capillaroscopy observation during supermicrosurgical lymphaticovenous anastomosis (LVA) surgery were reviewed. The collecting lymph vessels, dissected for LVA, were examined under video capillaroscopy (GOKO Bscan-ZD, GOKO Imaging Devices Co., Japan) with a magnification of 175x and 620x. Blood flow velocity of the VVCL was calculated by measuring the red blood cell movement using software (GOKO-VIP ver. 1.0.0.4, GOKO Imaging Devices Co., Japan). Based on the video capillaroscopy findings, the VVCL were grouped according to their morphology; the VVCL morphology types and blood flow velocity were then compared according to lymphosclerosis severity grade. Sixty-seven lymph vessels in 20 lower extremity lymphoedema patients were evaluated, including s0 in 19 (28.4%), s1 in 34 (50.7%), s2 in 10 (14.9%), and s3 in four (6.0%) lymph vessels. The VVCLs were grouped into four types: type 1 (n = 4), type 2 (n = 37), type 3 (n = 19), and type 4 (n = 7). Blood flow velocity of the VVCL ranged 0 - 189.3 μm/sec (average 26.40 μm/sec). There were statistically significant differences in VVCL morphology (p < .001) and blood flow velocity (p < .001) according to lymphosclerotic severity. Vasa vasorum of the collecting lymph vessels could be grouped into four types with different characteristics. Morphological and physiological changes of the VVCL were related to sclerotic changes of the collecting lymph vessels.

Incidence of venous thromboembolism, recurrence, and bleeding after isolated superficial vein thrombosis: findings from the Venous Thrombosis Registry in Østfold Hospital

BackgroundThere are limited data on the long-term risk of venous thromboembolism (VTE) after high-risk isolated superficial vein thrombosis (iSVT) treated with anticoagulants. ObjectivesTo determine the short- and long-term risk of VTE and iSVT recurrence after cessation of anticoagulant treatment and to calculate 45-day cumulative bleeding incidence in patients with iSVT. MethodsBetween January 2014 and December 2021, 229 patients with high-risk iSVT (ie, thrombus length ≥5cm), without active cancer, with no history of VTE or iSVT, and who had received anticoagulant treatment for the iSVT were identified through the Venous Thrombosis Registry in Østfold Hospital (TROLL registry), Norway. Cumulative incidences of VTE and iSVT recurrence, as well as cumulative incidences of major and clinically relevant nonmajor bleeding events, were assessed. ResultsMedian age was 60 years (IQR, 48-71), and 125 (55%) were women. Most patients were treated with direct oral anticoagulants (74%), and of these, 79% received a dose of rivaroxaban 10 mg daily. Low-molecular-weight heparin was given to 26% of the patients. The 1- and 5-year cumulative incidences of VTE after iSVT were 4.6% (95% CI, 2.5-8.3) and 15.9% (95% CI, 10.8-22.9), respectively. Further, the 1- and 5-year cumulative incidences of iSVT recurrence were 6.5% (95% CI, 3.9-10.7) and 15.9% (95% CI, 10.8-23.1), respectively. The overall 45-day cumulative incidence of major and clinically relevant nonmajor bleeding events was 0.4% (95% CI, 0.06-3.06) and 1.8% (95% CI, 0.7-4.6), respectively. No major bleeding events were observed in patients treated with direct oral anticoagulants. ConclusionDespite anticoagulant treatment, the risk of VTE after high-risk iSVT was substantial, while bleeding complications were low.

Superficial Vein Thrombosis After Intra-articular Particulate Steroid Injection for Knee Osteoarthritis.

Intra-articular steroid injections for knee osteoarthritis are a routine procedure in musculoskeletal clinics. While their role in osteoarthritis care is debatable, they serve as an important therapeutic option to relieve osteoarthritis-associated pain. Potential risks are self-limited (increased pain flare, local skin irritation, flushing, insomnia) or severe (septic arthritis, intravascular medication placement, and the deleterious effect on cartilage and bone). In our experience, more serious adverse events are rare. In this case, we present a complication secondary to intra-articular steroid administration that has not previously been reported in the literature: superficial vein thrombosis. This will raise awareness among clinicians, improve the informed consent process, and provide an approach for the management of subsequent injections.

Arm-only combined transarterial and transvenous access for neurointerventional procedures: a double-center retrospective study.

This study aims to share our experience with the arm-only combined transarterial and transvenous access approach for neurointerventional procedures and evaluate its efficacy and safety. The arm-only combined transarterial and transvenous access approach was performed using the right/bilateral proximal radial arteries and the right forearm superficial vein system, guided by ultrasonic guidance. Arterial access closure was achieved using a transradial band radial compression device, while manual compression was utilized for venous approach closure. Thirteen procedures were successfully performed using the arm-only combined transarterial and transvenous access approach, yielding favorable outcomes. The procedures included dural arteriovenous fistula embolization (seven cases), cerebral arteriovenous malformation embolization (four cases), venous sinus thrombosis catheter-directed thrombolysis and intravenous thrombectomy (one case), and cerebral venous sinus stenosis manometry (one case). All procedures were uneventful, allowing patients to ambulate on the same day. At discharge, all patients exhibited modified Rankin scores of 0-2, without any access site or perioperative complications. This double-center study preliminarily demonstrates the feasibility and safety of arm-only combined transarterial and transvenous access applied in neurointerventional procedures for complicated cerebrovascular diseases. The proximal radial artery and forearm superficial vein are recommended as the primary access sites. Unobstructed compression is strongly recommended for radial approach closure. This study aimed to add evidence and experience on the arm-only combined transarterial and transvenous access, as a new approach, for neurointerventional treatment that required arteriovenous approaches.

Evaluation of retinal angioarchitectonics by optical coherence angiography and its diagnostic value in functional amblyopia

AIM: This study aimed to evaluate the density parameters of the superficial and deep plexuses of the retina, choriocapillary layer, and avascular zone in eyes with amblyopia of various origins and paired fellow eyes.&#x0D; MATERIAL AND METHODS: The study included 40 patients aged 616 (mean, 8.723.04) years. All patients were divided into 2 groups: group 1 included amblyopic, dysbinocular, and anisometropic eyes (n=48), and group 2 (control group) included paired fellow eyes without amblyopia (n=32). The density of the superficial and deep vascular plexuses of the retina, choriocapillary layer, and avascular zone parameters (area, perimeter, and circumference) were evaluated using spectral optical coherence tomography (RS-3000 Advance 2, Nidek, Japan). Correlation analysis was performed using Pearsons linear correlation coefficient (r).&#x0D; RESULTS: No significant differences were found in the density of the superficial and deep retinal vessels, choriocapillary layer, and avascular zone parameters of the retina in eyes amblyopia of various origins compared with paired fellow eyes (p 0.05). No correlation was found between retinal perfusion data and functional and anatomical parameters of amblyopic eyes.&#x0D; CONCLUSION: No relationship was noted between the vascular parameters of the posterior pole of the eye and the maximally corrected visual acuity, which confirms the absence of changes in retinal perfusion in amblyopia and excludes its role in the pathogenesis.

Clinical and ultrasound features of Mondor's disease of the breast: a case series

Objective: Mondor's disease (MD) is a rare disease, more commonly known as thrombophlebitis of the superficial veins of the anterior chest wall. Patients with Mondor's disease, usually middle-aged women, have a cord-like, subcutaneous tender induration with or without infiltration of the skin and subcutaneous tissue that tends to resolve on its own within three to four weeks. However, these cases are fairly rare and the lack of clear diagnostic criteria makes them often misdiagnosed. In 50–60% of cases, no cause is identified (primary idiopathic disease), and in 40–50% of cases, some factors may be present, such as pregnancy or breast cancer. We aimed to demonstrate case series of MD of the breast, as a replenishment of the clinical base of this pathology. Methods: All patients underwent clinical examinations and breast sonography with triplex Doppler. Results: We described the clinical and sonographic picture of thrombophlebitis of the superficial veins of the mammary glands in 5 patients with an idiopathic course, during pregnancy, and in combination with breast cancer to indicate clear diagnostic criteria. Conclusion: Thus, the clinical cases presented in the article demonstrate different clinical features of Mondor's disease with a single outcome. The disease is a spontaneously regressive disease within one, rarely more than one month.

Venous anatomy of the superficial circumflex iliac artery perforator flap: A cadaveric and clinical study

Reconstructive surgeons frequently face challenges with free tissue transfer when transplanted flaps are thicker than intended. This is especially pronounced in lower limb cases, where the soft tissue below the knee is thin. The supra-fascial superficial circumflex iliac perforator (SCIP) flap overcomes this problem, but venous congestion remains a concern. We aim to examine the venous anatomy of the SCIP flap through cadaveric dissections and clinical data analyses to enhance the understanding of the venous anatomy and reduce venous congestion in future procedures. Eight cadaveric groins underwent venous dye injection and dissection to identify the superficial circumflex iliac vein (SCIV) and venae comitantes (VC) vascular networks. The venous anatomy was studied for dominant drainage. From April 2015 to December 2019, we conducted 102 SCIP flap reconstructions, mainly using the superficial circumflex iliac artery's superficial branch. Clinical data were analyzed and correlated with cadaveric dissections. SCIP flaps were categorized into three groups: dual drainage (VC and SCIV) in group I, SCIV-only in group II, and VC-only in group III. Correlations between clinical cases and cadaveric dissections revealed the SCIV as an independent drainage system with oscillating links to the VC. The SCIV is approximately twice the diameter of the VC, and the area of each vascular network suggests codominance. No significant difference in flap loss or venous congestion rates was noted when SCIV was the sole drainage, compared with VC or dual drainage. The SCIP flap with one artery and SCIV anastomosis, exhibits low venous congestion rates. Surgeons should consider SCIV for safe SCIP flap reconstruction.

Oxidative stress and optical coherence tomography angiography evaluation of choriocapillaris and retinal vessel density in children with obstructive sleep apnea.

To investigate the vascular networks of the retina and choroid using optical coherence tomography angiography (OCTA) to identify early biomarkers of obstructive sleep apnea (OSA) severity and to evaluate correlations with blood levels of oxidative stress. Patients with OSA were diagnosed based on video-polysomnography (PSG) and blood samples were collected to evaluate oxidative stress markers: total antioxidant status (TAS), biological antioxidant potential (BAP) test, Diacron reactive oxygen metabolites (d-ROMs) test. The eyes of children with OSA were evaluated and compared with eyes of healthy age-matched children. OCTA imaging was carried out to evaluate the choroidal and retinal vascular network density indices. A total of 31 children with OSA were recruited and compared with 10 healthy children. Choriocapillaris flow area decreased (p = 0.006) and superficial capillary plexus vessel density increased (p=0.01) with increasing severity of OSA. Children with OSA showed significant differences in TAS and d-ROMs test when compared to normal pediatric values (p<0.05). In calculating the correlations between PSG, oxidative stress, and OCTA variables, there was a negative correlation between choriocapillaris flow area and apnea hypopnea index (AHI) (p = 0.02, r2 -0.5) and between choriocapillaris flow area and the d-ROMs test (p 0.03; r2 0.5). The severity of OSA was associated with the choroidal and retinal capillary vascular networks. The correlation of the choriocapillaris flow area with AHI and the d-ROMs test indicates the connection of the choroidal microvasculature with the number of obstructive apnea and hypopnea events and oxidative stress.

Current modalities for the diagnostic and management approach of buerger’s disease: a case report and comprehensive review

Background: Thromboangiitis obliterans (TAO or Buerger’s disease) is a non-atherosclerotic inflammatory vascular disease usually related to smoking. Until now, there is no consensus establishing the diagnosis and standard treatment. Case Illustration: A 74-year-old smoker woman complained of blackening and painful fingertips in both upper limbs. On upper-extremities examination, we found necrotic gangrene at the 3rd fingertips of the right hand, and the 2nd and 4th fingertips of the left hand, with limitation of the movement at the affected finger due to the pain. On laboratory findings, there was a leukocytosis, mild Anemia, no coagulopathy, and normal autoimmune screening. Doppler Ultrasonography showed vascular incompetence of the left palmar arch artery, with no deep or superficial vein thrombosis. Arteriography revealed multiple stenosis of the Left Radial artery and Right Ulnar artery with collateral corkscrew-shaped. The patient was diagnosed with peripheral Critical Limb Threatening Ischemia caused by TAO, which underwent conservative management for 10 days and Percutaneous Trans Angioplasty (PTA) ballooning. Discussion: Buerger disease commonly affects smoker men between 40-45 years old. Several clinical criteria were used to establish TAO, including Shinoya and Olin's criteria. There are still no specific management guidelines for TAO, and smoking cessation is the only accepted effective treatment to prevent the progression of the disease and avoid amputation, followed by conservative and interventional management for patients with Critical Limb Ischemia. Conclusions: Awareness of the entity and familiarity with the clinical, angiographic, and pathologic features are the keys to a prompt and correct diagnosis of TAO. Although still controversial, endovascular intervention is regarded as a potentially efficacious approach in TAO with critical limb ischemia management.

Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap

To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Clinical Efficacy of a Modified Surgical Procedure in the Treatment of Incompetent Great Saphenous Veins.

The aim of this study was to evaluate the clinical efficacy of a modified surgical procedure for the treatment of varicose veins. This retrospective analysis was conducted on lower extremities with symptomatic great saphenous vein (GSV) incompetence that underwent stripping from the groin to the knee, with preservation of the superficial epigastric vein (SEV), between January 2015 and April 2022. Follow-up assessments were performed using Doppler ultrasound, Venous Clinical Severity Score (VCSS), and the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6 and 12 months after surgery. The study included 179 limbs from 120 patients (47 men and 73 women). The mean patient age was 56.5 years (range, 20-78 years), and the distribution of preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical classes was 8% C0-C1, 88% C2, and 4% C3-C6. The preoperative diameter of the saphenofemoral confluence averaged 6.9 mm (range, 2.7-15.8 mm). After a mean postoperative follow-up period of 24 months, evidence of neovascularization around the stump of the saphenofemoral junction (SFJ) was observed in 2 limbs (1.1%). Additionally, varicose vein recurrence was found in 1 limb (0.6%) and was associated with an incompetent thigh perforator. At postoperative follow- up, both VCSS and AVVQ scores were significantly lower than the preoperative scores. Modified surgical treatment of GSV incompetence, involving preservation of the SEV and stripping of a short segment up to the knee, demonstrated favorable clinical results in terms of postoperative complication rate, neovascularization rate around the SFJ stump, varicose vein recurrence rate, and improvement in lower extremity symptoms.

Deep orientated distance-transform network for geometric-aware centerline detection

The detection of structure centerlines from imaging data plays a crucial role in the understanding, application and further analysis of many diverse problems, such as road mapping, crack detection, medical imaging and biometric identification. In each of these cases, pixel-wise segmentation is not sufficient to understand and quantify overall graph structure and connectivity without further processing that can lead to compound error. We thus require a method for automatic extraction of graph representations of patterning. In this paper, we propose a novel Deep Orientated Distance-transform Network (DODN), which predicts the centerline map and an orientated distance map, comprising orientation and distance in relation to the centerline and allowing exploitation of its geometric properties. This is refined by jointly modeling the relationship between neighboring pixels and connectivity to further enhance the estimated centerline and produce a graph of the structure. The proposed approach is evaluated on a diverse range of problems, including crack detection, road mapping and superficial vein centerline detection from infrared/ color images, improving over the state-of-the-art by 2.1%, 10.9% and 17.3%/ 4.6% respectively in terms of quality, demonstrating its generalizability and performance in a wide range of mapping problems.

Size correction and deep image optimization in optical coherence tomography angiography with structural image-assisted common parts extraction method.

Tail artifact elimination is essential in optical coherence tomography angiography (OCTA) for the artifacts will prevent the reconstruction of the 3D vessel image. The tail artifacts of superficial vessels obscure the deep vascular signals and cause the signals at different depths to mix with each other. Most tail artifact elimination methods can shorten the tails but have difficulty in determining the lower boundary of the vessels. In this letter, we introduce a technique to extract vascular signals with more accurate vascular boundaries. With the help of structural image, our method can reconstruct the 3D image of the vascular network more precisely and perform better in deep areas. The images of vessels of palm are used to compare our new technique with previous common parts extraction method experimentally. The results show that our method removes the tail artifacts more thoroughly and has a significant advantage in imaging deep vessels.