Vein Anatomy Research Articles

First experience with percutaneous arteriovenous fistula creation using the Ellipsys® vascular access system

Abstract Objective Percutaneous creation of arteriovenous fistulae (pAVF) has been developed as an alternative to the creation of an upper arm cephalic or basilic vein fistula. Several studies have shown high technical success rates and comparable time of maturation. To our knowledge, the technique has not been used in Switzerland before. Methods Prospective data collection of the first consecutive patients undergoing the creation of pAVF between April and July 2020 at two vascular surgery centres. Results Seven patients underwent pAVF creation with the Ellipsys® vascular access system under regional anaesthesia for maximum vasodilation. The procedures were performed entirely under sonographic control without the use of fluoroscopy. The cephalic or basilic vein was punctured and the puncture needle advanced under sonographic control through the cubital perforator vein into the proximal radial artery. The Ellipsys® catheter was advanced over a guidewire and activated to create the fistula between the proximal radial artery and the perforator vein. The fistula was further dilated with a 5mm PTA balloon. We achieved technical success in 6 patients. In one patient with small and spastic vessels, the needle could not be advanced into the radial artery. A conventional upper arm cephalic fistula was created during the same procedure. In three patients primary maturation was achieved and the cephalic vein or distal basilic vein could be punctured for dialysis without any adjunct procedures. One patient required three additional procedures before the fistula could be used successfully (additional angioplasty of the fistula, superficialisation of the basilic vein and correction of a cubital vein stenosis by excision and end-to-end anastomosis). One patient required superficialisation of the basilic vein and one patient transposition of the arterialised brachial vein. Maturation was achieved in six pAVF after a mean of 158 days with a mean fistula flow of 920 ml/ min. Conclusion We achieved high technical success and maturation rates in our first patients undergoing pAVF creation with the Ellipsys® system. Prerequisites are suitable anatomy of the cubital perforator vein and good skills in sonography and endovascular techniques. We believe that pAVF is a promising alternative to the creation of a conventional upper arm fistula in patients unsuitable for a distal radio-cephalic fistula.

Abutting left atrial appendage and left superior pulmonary vein predicts recurrence of atrial fibrillation after point-by-point pulmonary vein isolation

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation is the cornerstone for rhythm control in patients with drug-refractory atrial fibrillation (AF). Baseline predictors of AF recurrence after catheter ablation are well established, such as female gender and left atrial enlargement. The role of the spatial relationship between the left superior pulmonary vein (LSPV) and left atrial appendage (LAA) is unknown. Purpose We sought to evaluate whether juxtaposed LSPV and LAA plays a role in AF recurrence after catheter ablation for paroxysmal AF. Methods Consecutive patients, who underwent point-by-point radiofrequency catheter ablation for paroxysmal AF at our hospital between January of 2014 and December of 2017, were enrolled in the study. All patients underwent pre-procedural cardiac CT-angiography (CTA) for the assessment of left atrial (LA) and pulmonary vein (PV) anatomy. Abutting LAA-LSPV was defined as cases when LSPV touched the posterior aspect of LAA (distance less than 2 mm). Results We included 428 patients (60.7 ± 10.8 years, 35.5% female). AF recurrence rate was 33.4% with a median recurrence-free time of 21.2 (IQR = 8.8-43.0) months. In the univariate analysis, female sex (HR = 1.45; 95%CI = 1.04-2.01; p = 0.028), LA volume (HR = 1.01; 95%CI = 1.00-1.01; p = 0.042), and cases when LSPV touched the posterior wall of LAA (HR = 1.53; 95%CI = 1.09-2.14; p = 0.013) were associated with AF recurrence. In the multivariate analysis, female sex (adjusted HR = 1.55; 95%CI = 1.06-2.28; p = 0.024), LA volume (adjusted HR = 1.01; 95%CI = 1.00-1.02; p = 0.028), and abutting LAA-LSPV (adjusted HR = 1.60; 95%CI = 1.13-2.50; p = 0.008) remained significant predictors of AF recurrence. Conclusion Female gender, higher LA volume, and abutting LSPV and LAA predispose patients to have a higher chance for arrhythmia recurrence after catheter ablation for paroxysmal AF.

Impact of pulmonary veins anatomy on outcome of cryoablation or radiofrequency catheter ablation for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Pulmonary vein isolation is the cornerstone of interventional treatment of atrial fibrillation (AF). Pulmonary veins frequently display anatomic variants. If this influences the recurrence of AF after catheter ablation is still a matter of debate. PURPOSE Our aim was to determine if pulmonary vein anatomy variants influences the recurrence of AF after catheter ablation with radiofrequency or cryoablation. METHODS Retrospective analysis of patients with paroxysmal or persistent atrial fibrillation who underwent pulmonary vein isolation by radiofrequency (RF) or cryoablation (CA) in a single center between January 2017 and September 2019. All patients underwent computed tomography before AF ablation. Within each treatment group (RF or CA), patients were stratified according to their PV anatomy in: regular (2 left PVs and 2 right PVs) or variant (left common trunk, right common trunk, bilateral common trunk, right intermediate branch or other). The primary end-point was 1-year recurrence of AF. Recurrence was defined as electrical documented AF. RESULTS A total of 425 patients (RF = 300 and CA = 125), aged 56.6 ± 11.7 years, 277 men (65.0%) were enrolled. The majority of patients had paroxysmal AF (n = 343, 81.5%). Mean CHA2DS2-VASc score was 1.12 ± 1.28. Regular PV anatomy was identified in 357 patients (84.0%), a left common trunk in 53 patients (12.5%), a bilateral common trunk in 5 patients (1.2%), a right intermediate branch in 3 patients (0.7%) and other mixed variants in 7 patients (1.6%). There were no significant differences in the baseline clinical and echocardiographic characteristics between groups. At 1-year follow-up, patients with atypical PV anatomy had more AF recurrence (regular 8.1% vs variant 16.2%; p = 0.037). Analyzing according to the ablation technique there was no difference in AF recurrence between PV anatomy groups in patients submitted to radiofrequency (regular 8.3% vs variant 13.0%; p = 0.224). On the other hand, in cryoablation group, patients with PV anatomic variant had significantly higher rates of 1-year AF recurrence (regular 7.8% vs variant 22.8%; p= 0.033). CONCLUSION The presence of atypical PVs anatomy seems to be associated with higher rates of AF recurrence at 1-year in patients undergoing cryoablation. Further prospective studies are needed to confirm the PV anatomy impact in the success of the procedure and if this needs to be accounted in the choice of ablation technique. Abstract Figure. Recurrence in AF after cryoablation

ANATOMO-MORPHOMETRIC PARTICULARITIES OF THE INTERNAL JUGULAR VEIN. A REVIEW

Objectives. The aim of the study was to analyze data and evidence from existing literature sources, regarding the topographic and morphometric features of the internal jugular vein, according to gender, age, laterality and its role in contemporary medicine. Materials and methods. Scientific publications which present information on the functional anatomy, morphological characteristics, functional features, application and paraclinical exploration of the internal jugular vein were analyzed. There were used local sources, elaborated by the collaborators of the department of anatomy and clinical anatomy, of the State University of Medicine and Pharmacy „Nicolae Testemițanu”, as well as international sources through the online platforms Google Scholar and PubMed. Keywords used in the search were: “internal jugular vein”, “internal jugular vein catheterization”, “internal jugular vein features”. Results. During search, 49 scientific publications were identified that report current information on the anatomical-morphometric features of the internal jugular vein and the applicative role of the vein in clinical practice. Conclusions. The obtained information reveals the importance of the addressed problem. This study was conducted to highlight the morphological, morphometric and functional features of the internal jugular vein, as well as its topographic appearance in patients of different ages and genders and to emphasize the most effective way to approach the nominated vein in case of its catheterization. Knowing that anatomically and functionally, the internal jugular vein is extremely varied, and its topography and diameter can vary greatly, its trajectory data, the relationship with neighboring vascular and nervous structures and its size will become valuable for anesthetists, radiologists and vascular surgeons. Some of the priority research directions are: the study of the topography, vein functions, study of the anatomical variants and anomalies, the studying of the catheterization and manipulations due to internal jugular vein positioning, possible complications following catheterization, exploration methods.

Anatomical changes of the internal jugular vein with Trendelenburg position: A systematic review and meta‐analysis

Introduction The anatomy of the internal jugular vein (IJV) may be influenced by the position of the patient. A head-down-tilt or Trendelenburg position could potentially increase the size and diameter of the IJV, however, its use in clinical scenarios, such as cathetherization (a frequent procedure), is debatable. Small venous cross-section could make cannulation difficult, even while guided by ultrasound, increasing the risk of complications. The objective of this study was to systematically review all studies that analyze parameters of IJV size variations due to Trendelenburg position evaluated by ultrasound. Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all cross-sectional studies comparing the effect of Trendelenburg position were included. Any degree of head-down tilt with a supine position on the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) in healthy adults were eligible. Measurements and outcomes had to be with ultrasonography. An experienced librarian designed and conducted the search strategy in Ovid MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane. Four independent reviewers, working in duplicate, assessed for eligibility of studies. Cross-sectional area (CSA) and anteroposterior (AP) diameter of the RIJV were collected and pooled using fixed-effects meta-analyses. Effect sizes are presented as mean difference (MD) and 95% confidence interval (CI). Heterogeneity between studies was assessed using the X2 test and I2 statistic. Data syntheses were conducted using Review Manager Version 5.3. Results A total of 22 articles (613 study subjects) were included. The overall risk of bias was moderate. In healthy adults, exposure to any degree of the Trendelenburg position significantly increased the CSA (MD:0.38cm²; [95% CI:0.35-0.41]; P<0.00001; I²=0%) and AP diameter (MD:1.87 mm; [95% CI:1.51-2.23]; P<0.00001; I²=0%) of the RIJV. No significant changes were exhibited when comparing the results of studies performed with the head rotated (MD:0.35cm²; [95% CI:0.29-0.42]; P<0.00001; I²=0%) with those using a neutral position of the head (MD:0.38 cm²; [95% CI:0.35-0.41]; P<0.00001; I²=0%) No significant increase of the AP diameter of the RIJV was identified from the 10° Trendelenburg position to both 15° and 20° inclinations. Conclusions The available published evidence favors Trendelenburg position, with a >5° statistically increasing RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended by international guidelines for CVC placement, when patient conditions allow it, as most guidelines fail to mention patient positioning.

Detailed anatomy of lumbar veins: Findings from preoperative computed tomography and retroperitoneoscopic retroperitoneal lymph node dissection.

Detailed anatomy of lumbar veins: Findings from preoperative computed tomography and retroperitoneoscopic retroperitoneal lymph node dissection.

Left atrial, pulmonary vein, and left atrial appendage anatomy in Indigenous individuals: Implications for atrial fibrillation.

BackgroundIndigenous Australians experience a greater burden of AF. Whether this is in-part due to differences in arrhythmogenic structures that appear to contribute to AF differences amongst other ethnicities is not known.MethodsWe studied forty individuals matched for ethnicity and other AF risk factors. Computed tomography imaging was used to characterise left atrial (LA), pulmonary vein (PV), and left atrial appendage (LAA) anatomy.ResultsThere were no significant differences in LA diameters or volumes between Indigenous and non-Indigenous Australians. Similarly, we could not detect any consistent differences in PV number, morphology, diameters, or ostial characteristics according to ethnicity. LAA analyses suggested that Indigenous Australians may have a greater proportion of non chickenwing LAA type, and a tendency for eccentric, oval-shaped LAA ostia; however, there were no other differences seen with regards to LAA volume or depth. Indexed values for LA, PV and LAA anatomy corrected for body size were broadly similar.ConclusionsIn a cohort of individuals matched for AF risk factors, we could find no strong evidence of ethnic differences in LA, PV, and LAA characteristics that may explain a predisposition of Indigenous Australians for atrial arrhythmogenesis. These findings, in conjunction with our previous data showing highly prevalent cardiometabolic risk factors in Indigenous Australians with AF, suggest that it is these conditions that are more likely responsible for the AF substrate in these individuals. Continued efforts should therefore be directed towards risk factor management in an attempt to prevent and minimise the effects of AF in Indigenous Australians.

The Pulmonary Venous Return from Normal to Pathological—Clinical Correlations and Review of Literature

Pulmonary veins carry oxygenated blood from lungs to the left atrium of the heart. The anatomy of the pulmonary veins is variable with some anatomic variants. In clinical practice the difference between the normal anatomy of pulmonary veins with its variants and abnormal anatomy is very important for clinicians. Variants of pulmonary veins may occur in number, diameter and normal venous return. We present a case report and a review of the literature with the pulmonary venous return that deviates from the usual anatomical configuration and ranges from normal variant drainage to anomalous pulmonary—systemic communication. Initially, it was considered as an anatomical variant of the pulmonary venous return associated with the persistence of the left superior vena cava. Upon detailed exploration it was established that it was an anomaly of the pulmonary venous return which led in time to the installation of its complications. Diagnosis can be difficult, sometimes missed, or only made late in adulthood when complications were installed. Knowledge of variant anatomy and anomalous pulmonary venous return play a crucial role in the diagnostically challenging patient.

The absence of the great saphenous vein: aplasia or involution? A clinical case

There are different types of great saphenous vein (GSV) anatomy that have been reported in the literature. GSV hypoplasia is frequently observed anatomical type with twice higher incidence than GSV aplasia. Proximal GSV aplasia including sapheno-femoral junction (SFJ) is the rarest anatomical type that is always accompanied by anterior accessory saphenous vein (AASV) acting as the alternative drainage route in such cases. In the case of SFJ absence the AASV connects common femoral vein at the level of typical SFJ location. In this case report we present the situation of complete GSF and AASV absence with the subsartorious perforating vein as the proximal junction between superficial and deep veins. At the same time this perforating vein is the source of pathological venous reflux towards the varicose veins of the thigh and leg. There is no information about phlebectomy of GSV in this case but it is known that the accident of the knee trauma with a subsequent operation and also the operation on the GSV tributaries on the leg (puncture without avulsion according to the patient memories) took place in the past. As such events are associated with the risk of thrombotic complications the postthrombotic involution of GSV could be contemplated in this case as the reason of GSV disappearance. Foam sclerotherapy of the incompetent thigh perforator vein with miniphlebectomy on the thigh was performed. Leg varicose veins were left untreated as their reduction after reflux elimination was expected. 14 days after treatment perforating vein obliteration and leg varicose veins reduction were diagnosed.

065 Perspectives of Non-contrast MRI for Penile Veins Visualization

Pharmaco-Penile Duplex Ultrasonography (PPDU) and Dynamic infusion cavernosometry and cavernosography (DICC) currently are the conventional methods for penile veins examination and veno-occlusive erectile dysfunction (VOD) diagnosis. CT cavernosography is a useful technique that is gaining popularity. The possibilities of MRI for penile veins anatomy study and assessment of the vein leakage were studied less.

ANATOMICAL VARIANTS OF INFERIOR MESENTERIC VEIN ACCORDING ON THE DATA OF MULTISPIRAL COMPUTED TOMOGRAPHY

Knowledge of the variants of the anatomical variability of the liver vascular bed can be of critical importance in liver resection, liver transplantation, laparoscopic operations, resection of the pancreas, surgical treatment of portal hypertension The main vessels of the hepatic portal vein system are characterized by pronounced anatomical variability in the formation of the portal vein trunk, the greatest variability is characterized by inferior mesenteric vein. The aim of the investigation was to study the variant anatomy of the inferior mesenteric vein according to multispiral computed tomography. The material was 100 multispiral computed tomograms of the abdominal organs from the archive of the clinics of the Samara State Medical University for 2018-2019. For mathematical modeling and the creation of three-dimensional models based on tomograms of the vascular bed, plugins were used in the programs «Luch» and «Autoplan». Variants of the portal vein formation, the angle of inflow of the inferior mesenteric vein into the superior mesenteric and splenic veins, the distance from the point of confluence of the inferior mesenteric vein to the point of confluence with the portal vein were studied. The study revealed that the inferior mesenteric vein in 40% of cases flows into the splenic vein, in 39% - into the angle of confluence of the superior mesenteric and splenic veins, in 16% - into the superior mesenteric vein. In 5% of cases, the absence of the inferior mesenteric vein was revealed. The angle of fusion of the inferior mesenteric vein with the superior mesenteric vein was statistically significantly greater than the angle of fusion of the inferior mesenteric vein with the splenic vein. The angles were 76.36 ± 1.53 ° and 64.89 ± 3.52 °, respectively (p = 0.004). The length of the common trunk of the inferior mesenteric and splenic veins was significantly greater than the common trunk of the mesenteric veins and amounted to 16.98 ± 1.09 mm and 9.37 ± 0.65 mm (p = 0.001), respectively. Thus, the study showed a high degree of anatomical variability of the inferior mesenteric vein.

Practical approach to the cryoballoon-ablation mapping technique in atypical pulmonary vein anatomy.

Practical approach to the cryoballoon-ablation mapping technique in atypical pulmonary vein anatomy.

Comparison of pulmonary vein sizing by transesophageal echocardiogram and by direct angiogram

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein (PV) anatomy and sizing is important to know before performing PV isolation. This information is conventionally obtained by angiography or by CT scan. Aim We undertook this study to identify and measure the PVs during TEE studies and validate these against angiography. Method 17 consecutive patients due to undergo PV isolation for paroxysmal atrial fibrillation were analysed. Using TEE, the PVs were visualised (Upper panel) as follows: i) From the mid-esophageal four chamber view, the chamber probe was turned to the right at 110-130º for the bicaval view, where the RSPV was seen entering the left atrium adjacent to the SVC. ii) At 0º the SVC was imaged in its short axis, and the probe advanced till the interatrial septum was seen. The angle was changed to 30º to visualise the right inferior PV (RIPV). iii) From the two chamber view (70-90º), the probe was turned to the left and withdrawn to display the left superior PV (LSPV) entering the left atrium parallel to the appendage.iv) Keeping the LSPV in focus, the angle was changed to 135º and the probe advanced till the AV groove, where the left inferior PV (LIPV) was visualised. After transseptal puncture, each PV was cannulated. The PV angiograms were performed in several projections to obtain the best PV profile (lower panel). Using electronic callipers, each PV was measured within 1 cm of its entry into the left atrium, after having received all tributaries. Those PVs were considered for analysis which were measured by both TEE and angiography. The paired ‘T’ test was used to compare the PV diameters by TEE and angiography and the Bland Altman analysis was done to see the level of agreement. Results Of a total of 68 PVs, 62 could be adequately visualised by TEE and 50 by angiography. These 50 PVs were measured using both methods. The diameters of the PVs measured by TEE and angiography were not statistically different by the paired t test; LSPV14 ± 1.8 mm v/s 14.4 ± 2.1 mm; RSPV 13 ± 1.8 mm v/s 14.6 ± 3.5 mm; LIPV 11.9 ± 2.1 vs 13.2 ± 2.8 mm and RIPV 10.5 ± 2.7 vs 12.1 ± 2.9 mm. Bland Altman analysis showed most PV sizes estimated by TEE and angiography lay within limits of agreement. Conclusions A majority of PVs can be visualised by TEE using a defined protocol. TEE is a good technique to visualise and assess the size of PVs, avoiding the need for contrast medium and radiation. Abstract Figure. TEE and angiographic images of PVs

Morphometric Characteristics of the Portal Vein According to Multispiral Computed Tomography

The article discusses the variability of the linear dimensions of the portal vein depending on gender and age. In modern foreign and Russian literature, there is no uniform information about the variant portal vein anatomy. Data on the extreme forms and on the range of anatomical differences in the portal vein vary considerably. All this requires the need for a more detailed study of the morphometric characteristics of the portal vein branch. Computed tomography, in contrast to dissection on a corpse, allows an in vivo study of various morphometric characteristics of the portal vein.The aim of the study is to identify patterns of variability in the linear dimensions of the portal vein in persons of different sex and age.Material and methods. The study material consisted of multispiral computed tomography images of the abdominal cavity with contrast enhancement taken in 100 patients. The study included results of 56 men and 44 women, divided into 4 age groups: 1) first mature age, 2) second mature age, 3) the elderly, 4) the senile. The length of the portal vein was measured between the angle formed at the junction of the superior mesenteric and splenic veins and the angle formed by the branches of the portal vein at the hepatic hilum. The diameter of the vessel was measured at the midpoint of the distance between the proximal and distal points.Results. The length of the portal vein in the general sample was 66.45±8.49 mm, and its diameter was 11.84±1.93 mm. In women, the length of the portal vein was 64.37±6.6 mm, and its diameter was 11.33±1.83 mm, respectively. In men, both the length and diameter of the black vein were significantly greater than in women and constituted 68.09±9.4 mm and 12.24±1.91 mm, respectively. No statistically significant correlation of the studied parameters with age was detected.

Anatomy of foot perforator veins in surgery of varicose veins

To clarify the role of clinical anatomy of foot and ankle perforator veins (PV) in surgical treatment of varicose vein disease. Anatomy of foot and ankle PV was assessed in 50 amputated lower extremities by anatomical dissection. There were 4-6 PVs at the medial surface of the foot. These veins connected medial marginal vein and vv. plantaris medialis (VPM). There were 2-3 PVs at the lateral surface of the foot. These veins connected lateral marginal vein and vv. plantaris lateralis (VPL). All PVs on the lateral surface of the foot constitute the neurovascular bundles. PVs flowing into vv. dorsalis pedis are localized on the medial surface of the medial marginal vein at the level of the ankle base. In most cases, we found an arterial branch nearby at the subfascial level. In anterior part of the plantar surface of the foot, we distinguished 4-5 small PVs (~1 mm) flowing into vv. digitales plantares through the commissural orifices of the aponeurosis. There were 6-9 vessels (~1 mm) along the fascial aponeurotic septa. These vessels connected superficial plantar venous network and plantar veins. Small arterial branch was found almost in all cases near these veins. Noteworthy is the area where the plantar veins lie on the quadratus plantae and are covered by a leaf of deep plantar fascia. This anatomy is similar to topography of posterior tibial veins. Foot perforator veins constitute the neurovascular bundles as a rule. Plantar vein topography and their relationship with PV confirm an existence of muscular-venous pump of the foot.

Ultrasound color duplex parameters of patients presenting with lower limb varicose veins at outpatient department of university hospital of Nepal

Background: Varicose vein is prominent dilated veins of lower limbs. Incomplete treatment and local recurrence are still the clinical challenge among the vascular surgeons. We aim to evaluate the range of imaging on color duplex describing the anatomy of veins, their variants, valve competencies, territories of defective venous system, demographic data, and the factors contributing among the patients referred to Vascular Outpatient Department of Kathmandu University Hospital. Objective: The aim was to know the ultrasound (US) color duplex parameters of superficial venous system in varicose vein. Materials and Methods: We included 299 patients during the study of 6 months with varicose veins for detailed US Doppler analysis. Gray-scale US was done to study the anatomy of veins followed by color duplex and color duplex spectrometry to determine the reflux of the superficial venous system. Quantification of reflux was determined by the use of Valsalva maneuver. Association of great saphenous vein (GSV) cross-sectional diameter and saphenofemoral junction incompetence was also studied. Results: Of 299 varicose vein cases, 52.50% were female. Among involved cases, the mean of GSV diameter was 5.43 mm in the right and 5.68 mm in the left. Saphenofemoral junction diameter was 7.89 mm in the right and 8.17 mm in the left. Receiver operative characteristics curve showed GSV diameter at femoral condyl of 4.5 mm as best cutoff value for the diagnosis saphenofemoral junction reflux. Conclusions: US color duplex is investigation of choice for varicose vein as a preoperative analysis tool, quantifying the superficial valve incompetency, studying and mapping the venous anatomy, and planning the surgery.

Anatomy of Fascial Canal of Great Saphenous Vein: An Observational Study

Introduction: The fascial canal for great saphenous vein has a variable presence throughout the course of the vein. The anatomy of great saphenous vein and its tributary becomes complicated owing to interruptions and variability of the saphenous fascia around the knee compared with the upper portion of thigh and lower portion of leg. It has been observed that vein not enclosed in saphenous fascial canal is prone to have dilatations which can lead to varicosity of the vein. Aim: To study the length and extent of fascia of great saphenous vein in 10 male and five female cadavers by macroscopic and microscopic observation. And also to note the length of great saphenous vein in thigh and leg. Materials and Methods: An observational cadaveric study was done in which 10 male and five female cadavers were obtained and superficial dissection was performed in order to expose the Great Saphenous Vein (GSV) and its fascia. The lower limb was divided into eight equal quadrants and sample was taken from each quadrant for microscopic examination to confirm presence of saphenous fascia. Results: In present study, there was absence of fascia in 30 lower limb (13.33%) in whole length of great saphenous vein. There was no case in which the fascia extended throughout the length of great saphenous vein. No fascial canal was found in the lowermost quarter of leg. Conclusion: Knowledge of the presence of saphenous fascia is essential while performing endovenous ablation. The utility of compression therapy and extent of compression needed may vary depending upon the presence or absence of saphenous fascia around great saphenous vein.

Impact of pulmonary vein ovality index on cooling kinetics and acute success of atrial fibrillation ablation with the third-generation cryoballoon catheter.

IntroductionAtrial fibrillation (AF) is the most common arrhythmia, increasing the risk of stroke and all-cause mortality. Pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) is a widely accepted approach for invasive treatment of patients with AF. CBA effectiveness is considered to be strongly dependent upon the anatomy of pulmonary veins, mainly the ovality of pulmonary veins’ ostia. However, most published results refer to the second-generation cryoballoon.AimTo investigate the impact of the ovality index (OI) of pulmonary veins (PVs) on cryokinetic parameters and acute effectiveness of PVI with the third-generation cryoballoon catheter.Material and methodsWe enrolled 54 patients with documented drug-refractory, symptomatic paroxysmal and persistent AF, who underwent CBA with the third-generation cryoballoon between March 2019 and July 2020. Prior to the procedure all patients underwent computed tomography (CT) scans to evaluate anatomy of PVs and calculate the ovality indices for each vein. Analyzed patients were divided into two equal groups depending on the mean OI for all veins.ResultsNo differences were observed in acute effectiveness, total procedure time, freeze time, need for additional applications and complications in the group with lower (OI < 1.27) and higher (OI > 1.27) OI values. Remarkably, fluoroscopy time was even slightly shorter (p = 0.046) in patients with high OI.ConclusionsIn the analyzed population, increased pulmonary vein OI had no negative effect on the CBA procedure performed with the third-generation cryoballoon catheter; therefore it can be considered as a more comprehensive single-shot PVI tool.

Connection of perforating and intramuscular veins of the crus in varicosity

This study was undertaken to investigate the clinical anatomy of indirect perforating veins and their connection to the intramuscular venous collector of the crus by means of MSCT phlebography. From 2015 till now, MSCT phlebography was used to examine a total of 400 patients with chronic diseases of lower limb veins. According to the CEAP classification, clinical class C0-C1 was present in 108 (27%) subjects, C2-C3 - in 173 (43.3%) patients, and C4-C6 - in 119 (29.7%) patients. All examinations were performed using a 128-slice multispiral CT scanner Philips Ingenuity, followed by 3D reconstruction with the help of the IntelliSpace Portal Image Editing Software package. In the 400 extremities examined, we identified a total of 11 655 indirect perforating veins of the calf. Studying the anatomical localization of perforating veins demonstrated that 3248 veins belonged to the posterior tibial group, 1830 veins - to the lateral group, 873 veins - to the paraachillary group, 276 veins - to the intergemellary group, 4451 veins - to the medial group, and 997 perforating veins - to the lateral group. 3D imaging made it possible to trace the entire course of the perforating veins originating from the posterior arched, intersaphenous, oblique veins or other communicating branches to the subfascial and intramuscular portions to the connection with the gastrocnemius and soleus veins which as the disease progresses undergo ectasia with the formation therein of pathological segmental hypervolemia. Studying the ratio of the revealed indirect perforating veins of the determined groups and the presence of gradually developing ectasia of the intramuscular venous collectors in patients of various clinical classes from C0-C1 to C4-C6 made it possible to draw a conclusion on the involvement of perforating veins and intramuscular veins of the crus into the common pathohaemodynamic circle of the development and progression of chronic venous insufficiency in patients with varicose veins.

Jugular vein venepuncture and anatomy in Australian

We describe our experiences collecting blood from Australian Rattus. We found uniform anatomy of the external jugular vein between Australian and exotic Rattus species. Understanding where the maxillary and linguofacial veins join to form the external jugular vein is critical to venepuncture. After locating this union, we consistently achieved successful venepuncture of the external jugular vein; yielding large blood volumes. All other routes of venepuncture yielded minute blood volumes or were unsuccessful. We provide recommendations for venepuncture in Australian rodents and encourage others to share their experiences; such reports facilitate sampling rarely sampled species and promote animal welfare.