Venous Trunk Research Articles

Mechano-electric finite element model of the left atrium

Mechanical stretch plays a major role in modulating atrial function, being responsible for beat-by-beat responses to changes in chamber preload, enabling a prompt regulation of cardiac function. Mechano-electric coupling (MEC) operates through many mechanisms and has many targets, making it experimentally difficult to isolate causes and effects especially under sinus conditions where effects are more transient and subtle. Therefore, modelling is a powerful tool to help understand the role of MEC with respect to the atrial electromechanical interaction. We propose a cellular-based computational model of the left atrium that includes a strongly coupled MEC component and mitral flow component to account for correct pressure generation in the atrial chamber as a consequence of blood volume and contraction. The method was applied to a healthy porcine left atrium. Results of the strongly coupled simulation show that strains are higher in the areas adjacent to the mitral annulus, the rim of the appendage, around the pulmonary venous trunks and at the location of the Bachmann's bundle, approximately between the mitral annulus and the region where the venous tissue transitions into atrial. These are regions where arrhythmias are likely to originate. The role of stretch-activated channels was very small for sinus rhythm for the single cardiac beat simulation, although tension development was very sensitive to stretch. The method could be applied to investigate potential therapeutic interventions acting on the mechano-electrical properties of the left atrium.

Complications after toe-to-hand transfers in children with pathologies of the hand

Background. Complications after microsurgical toe-to-hand transfer is a problem for which there is no common approach to treatment.
 The aim of this study was to analyze the ischemic complications after microsurgical operations in children with pathologies of the hand to improve the quality of surgical treatment.
 Materials and methods. From 2007 to 2016, we performed 210 microsurgical toe-to-hand transfers involving 306 transplants, 267 (87.3%) of which were performed in patients with congenital pathologies and 39 (12.7%) in patients with post-traumatic deformities of the hand. In total, 352 fingers were reconstructed.
 Results. Blood supply disturbance following toe transplants occurred in 19 (6.2%) of the 306 transplants, most often in the early postoperative period (73.7%). The main cause of microcirculatory disorders was thrombosis of the venous or arterial trunks (8 cases). In 6 patients, the blood supply disturbance occurred because of thrombosis of autovenous grafts. Two patients underwent necrectomy at days 7 and 18 because conservative and operative treatments were not successful.
 Conclusion. The treatment method of choice after the first appearance of signs of blood supply disturbance in a transferred toe is conservative therapy, which includes disaggregants, anticoagulants, and hirudotherapy. Conservative therapy should be performed within 3 hours from the beginning of ischemia; if ischemia is absent, the patient must undergo surgery. The operation includes soft tissue decompression, mechanical pumping across vascular anastomoses, and if necessary, excision of the abnormal vessel part with subsequent autoplasty.

Internal venous anomalies in patients with a genital venous malformation.

Cutaneous venous malformation (VM) can be associated with internal vascular anomalies. Our objective was to investigate the frequency of internal vascular anomalies in patients with an isolated genital venous malformation to assess the utility of screening for internal findings. We retrospectively reviewed our Vascular Anomalies Center database for patients with a focal genital venous malformation presenting between 1999 and 2016. Abdominal and pelvic imaging reports were reviewed for internal vascular anomalies. Endoscopy reports were also reviewed when available. A focal genital venous malformation was found in 22 patients (14 female, 8 male). Ten (45%) had a venous malformation of at least one internal structure, most commonly the pelvic floor (n=6), colon (n=5), urethra (n=4), and/or bladder (n=3). Eight experienced hematuria, hematochezia, and/or rectorrhagia secondary to their internal venous malformation. In patients with internal venous malformations, the mean age of symptom presentation was 7.3years (range 1-22years). Two patients had malformed inferior mesenteric and portal veins visible using ultrasonography and magnetic resonance imaging. They required surgical intervention to prevent thrombosis and decrease urogenital and gastrointestinal bleeding. Nearly half of our patients with a focal genital venous malformation had internal venous anomalies. Physicians should suspect urogenital or gastrointestinal venous malformations in patients with a focal genital venous malformation, especially if they develop hematuria, hematochezia, or rectorrhagia. Significant mesenteric venous trunk anomalies can also occur. Because these require surgical intervention, early recognition is important. We recommend that all patients with a focal genital venous malformation undergo abdominal and pelvic ultrasound to evaluate for internal venous anomalies.

Vascular anatomy of the jejunal mesentery and complications associated with division of the first jejunal venous trunk during pancreaticoduodenectomy.

Little is known about the anatomy of the jejunal veins (JVs) flowing into the superior mesenteric vein (SMV), and whether they can be safely divided during pancreaticoduodenectomy. Computed tomography was used to review the jejunal branches off the superior mesenteric artery (SMA) and into the SMV in 123 consecutive patients. The common trunk of the JVs (jejunal venous trunk, JVT) was classified as ventral or dorsal to the SMA. The first JVT involved multiple JVs in 108 (87.8%) cases. The first JVT diameter (≥7 or <7 mm) was significantly associated with the number of JVs (≥4 or <4; P < 0.05). Surgical outcomes were not significantly different between cases in which the first JVT was sacrificed (n = 32) or preserved (n = 91), except for operation time and portal venous resection frequency. One of the 32 cases (3.1%) with first JVT sacrifice showed severe congestion of the jejunal limb requiring emergency jejunal resection. The size and topology of the first JVT are associated with the number of JVs involved. This is important for understanding the resectional area of the mesojejunum and the pathogenesis of jejunal congestion.

Ultrasound changes of the varicose veins of the lower extremities against connective tissue dysplasia

Background. The article presents the data of sonographic study of patients with varicose veins of the lower extremities in order to determine the typical ultrasound manifestations of connective tissue dysplasia. Revealed changes in these patients indicate a widespread and combined lesion of the lower extremity venous system almost on all the levels, which explains the pathogenic role of connective tissue weakness of veins framework and has a great diagnostic value in the planning stages of surgical treatment and selecting the volume of full and adequate surgical intervention. The purpose was to identify typical preoperative sonographic changes of the venous system in patients with varicose veins of the lower extremities with connective tissue dysplasia. Materials and methods. One-hundred and four patients with varicose veins of the lower extremities were preoperatively examined for typical clinical, phenotypic and biochemical markers of undifferentiated connective tissue dysplasia and divided into two groups according to the presence or absence of connective tissue dysplasia manifestations. Then, during preoperative preparation sonographic features were identified by ultrasound scanning using standard protocol for examination. Results. The form of varicose veins was determined in all patients. In patients with dysplasia symptoms mixed form dominated (23 (67.65 %) patients). During measuring main venous trunks the patients of this group had mainly thinning of vein walls, with significantly expanded diameters, reduced contractility, increased rigidity. In some places the walls of veins were significantly thinned. Valve unit worked poorly with signs of failure, which manifested by hemodynamic significant vertical and horizontal reflux. Reflux was mainly decompensated with retrograde blood flow over 1.5–3 seconds. Valve failure was observed in the superficial and deep veins. The patients often had abnormalities of sapheno-femoral junction: aneurysm extensions (7 (20.59 %)); tortuous great saphenous vein looking like a cluster of grape (4 (11.76 %)); real doubling the main trunk of the thigh (7 (20.59 %)) and shin (3 (8.82 %)). Also in this group of patients (23 (67.65 %)) widespread and combined varicose process of the main trunk in thighs and shins predominated. In addition, multiple perforating veins failure was observed, mainly in shins with hemodynamic significant reflux at these levels. Conclusions. Restructuring of the connective tissue in patients with symptoms of connective tissue dysplasia significantly affect the state of the venous system of the lower extremities, namely its functionality, which can be efficiently evaluate today with ultrasound scanning. In these patients sapheno-femoral junction valve failure with pronounced vertical reflux along a significant segment of the limb prevails. Perforating veins of shin and foot manifested with horizontal refluxes at their levels. In 2/3 patients mixed form of varicose vein of the low extremities was diagnosed that confirms the prevalence of venous system lesions with more severe varicose of the main venous structures. More often different configurations of vein aneurysm are determined, both in the area of junctions and along the venous trunk.

Left Superior Vena Cava: Radiologic Finding

The left superior vena cava represents an infrequent variant found in about 0.5% of the general population. We present an incidental finding of a left superior vena cava during a radiologic scan. It consisted of a single venous trunk that originated from the junction of both right and left innominate veins and ran through the left side of the upper mediastinum in direction to the heart. The superior vena cava on the right side was absent. Although a rare variation, the presence and the anatomical features of the left superior vena cava should not be omitted due to its implications in both percutaneous and surgical approaches to the veins of the neck and thorax.

Utility of Adjunctive Digital Subtraction Venography for the Treatment of Saphenous Vein Insufficiency

Purpose: To report the use of adjunctive venography for the treatment of superficial venous reflux. Methods: Two hundred consecutive patients (mean age 60.9 years, range 33–86; 128 women) with chronic venous disease underwent saphenous or perforator vein ablation in 268 limbs (305 venous trunks) guided by adjunctive venography and fluoroscopy in addition to ultrasound between October 2010 and May 2016. Intraprocedural venograms were independently evaluated by 2 vascular specialists to identify the presence of venous anomalies and the need for fluoroscopy-guided maneuvers to successfully complete venous ablation. Intraprocedural venography results were compared with preoperative venous duplex scan reports to ascertain if the duplex study could be of value in identifying preoperatively any anatomical variants that may pose a technical challenge to the operator. Results: In this cohort, 542 venograms (2.0/limb) were performed with a mean duration of 4.9±9.1 minutes (range 1–48). Two thirds of patients (132, 66%) had anomalies or abnormalities within the target vein; more than a third (88, 44%) required an endovascular maneuver to successfully complete the ablation and 17% (34) of cases were impossible to complete without adjunctive fluoroscopic guidance. Per-patient comparison of intraprocedural venography with preoperative venous duplex reports identified 21 (11%) patients with abnormalities detected on ultrasound (23 anomalies) compared with 123 (64%) on venography (193 anomalies). This gave ultrasound a 17.1% sensitivity, 100% specificity and positive predictive value, and 40.7% negative predictive value. Conclusion: Venography is a valuable addition to ultrasound to facilitate complete ablation of insufficient saphenous veins in selected patients with complex anatomy.

Endovascular Radiofrequency Ablation. Effect on the Vein Diameter Using the ClosureFast® Catheter

IntroductionEndovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. MethodsRetrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. ResultsBetween 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9±3.1mm showing a reduction of it after 6 months with a mean value of 5.2±0.8mm (P<.0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. ConclusionsA significant reduction in venous diameter after endovascular treatment with the new ClosureFast® catheters was checked, even in veins with diameters greater than 12mm.

Anterior Mediastinal Pseudo-Tumor Tuberculosis: Should We Settle for This Diagnosis?

Face Chest x-ray had highlighted right anterior Mediastinal opacity with right low abundance pleural effusion (Figure 1). On a chest CT scan with contrast injection, the mass was tissue, heterogeneous, and measured 73x93x108mm. This mass included the superior vena cava and right innominated venous trunk that was the seat of intraluminal thrombosis associated with mediastinal lymph nodes (Figure 2). Physical examination found: polypnea to 25 cycles/min, with a blood pressure at 120/80 mmHg. The cervico-thoracic examination noted a higher cellar syndrome with swelling in Pilgrim and a turgor of the jugular veins. He has combined to a collateral vein circulation at the cervical level of and high thoracic region.

Ablación endovascular por radiofrecuencia. Efecto sobre el diámetro venoso con el uso del catéter ClosureFast®

IntroductionEndovascular radiofrequency with first generation catheters was not successful due to its technical difficulty and restrictions in veins with diameters larger than 12mm. However, using the new catheter there is not enough scientific evidence to affirm that the diameter represents a technical limitation. The aim of this study was to evaluate and compare pre and post-operative venous trunks diameter, aiming at the reduction of size after 6 months with last generation catheters. MethodsRetrospective observational and descriptive study on a cohort of patients with insufficiency of the great saphenous vein, small saphenous vein and anterior accessory vein operated on with last generation radiofrequency catheters. The diameters were evaluated in the pre and post-operative period with ultrasound. ResultsBetween 2007 and 2014 a total of 365 ablations were performed in veins with an average diameter of 9±3.1mm showing a reduction of it after 6 months with a mean value of 5.2±0.8mm (P<.0001). Total occlusion was also observed in 100% of cases and complications such as deep vein thrombosis in 0.5% and heat-induced thrombosis in 1.1%. ConclusionsA significant reduction in venous diameter after endovascular treatment with the new ClosureFast® catheters was checked, even in veins with diameters greater than 12mm.

Endovenous laser therapy of varicose veins – 13-year Czech experience

Aims In last more than 15 years, mini-invasive endovascular therapy of varicose veins have been introduced into clinical practice – one of the first was endovenous laser ablation (EVLA) of venous trunks. Thermal damage of the patological venous wall leads to contraction and obliteration of the vein and, gradually, to its full resorption. This review describes our own laboratory and clinical experience with these procedures. Material and methods After meticulous laboratory experiments starting in 2002 we performed in total more than 1700 endovenous laser procedures of trunk varicose veins of lower extremities using different lasers in more than 1300 patients (great, small and accessory saphenous and Giacomini veins). Every patient was preoperatively examined clinically and with color duplex machine. Postoperative follow-up (clinical and duplex ultrasound) was performed after 3–5 days and 1 month, 6 months and yearly thereafter. The results were evaluated by comparison of CEAP clinical class and quality of life (QoL) pre- and postoperatively and by the percentage of recanalizations and also using Kaplan-Meier life-table method. Results Two cases of peripheral thrombosis but no pulmonary embolism were diagnosed in the postoperative period; from the whole cohort, the postoperative data were available during different time periods in 99% of cases. Saphenous occlusion was verified in 97.3% after 1 month, non-occlusion or early reopening was seen in 2.7%. Final occlusion rate was 94%. Kaplan-Meier analysis showed nearly 89% occlusion rate. Mean clinical CEAP classification improved from 2.22 (before operation) to 0.24 (1 month after) and 0.48 (last visit) and also QoL was significantly better in laser group compared to traditional surgery group (P Conclusions Apart from minimizing recurrence, EVLA is also valuable with respect to its cosmetic effect and gentleness of the procedure, allowing fast return to full activity. The results of the procedure depend mainly on meticulous preoperative ultrasound examination and technically excellent procedure to administer sufficient amount of energy to the venous wall. The long-term results of these procedures are equal or even better than traditional open surgery.

Venous Vascular System of the Mammary Gland in the Buffalo Cow - Morphological Aspects -

Considering the clinical benefits derived from the extensive morphological data existing in relation to the vascularisation of the udder in various milk cow breeds, our study focused on assessing the venous vascularisation of the udder in buffalo cows. Ten adult female buffalo cow udders were sampled, their vascularisation highlighted by arterial injection of a coloring agent, then fixed in a 2% formalin solution for 24 hours. The venous vascular system was identified by stratigraphic dissection under a magnifying glass and examined. We have identified common venous trunks for the homolateral anterior and caudal quarters and perforating veins going through the median septum. In 7 out of 10 examined udders, teat and parenchyma veins merged into a venous circle for each caudal quarter, both of them merging caudally with the greater venous circle at the base of the udder. 5 out of 10 samples also presented secondary venous circles around each anterior quarter. The results of the present study indicate a proportionally better developed venous vascularisation of the caudal quarters in the buffalo cow, correlated with a higher milk production at this level; a superior number of veins and a higher occurrence of venous circles at this level illustrate this aspect. However, the udder presents a unified venous drainage, as superficial veins of homolateral quarters merge, and the median suspensory ligament is traversed by perforating veins.

An interesting and rare anomaly of external jugular vein: Case report

External jugular vein is being increasingly utilized for central venous access for parenteral nutrition, intravenous chemotherapy, diagnostic procedures, and anastomosis for free tissue transfer. Therefore, knowledge of its variation is important to clinician's associated with critical care, intervention radiology, and micro-vascular reconstruction. We report a very rare and interesting situation in which linguofacial venous trunk joined with external jugular vein forming a common trunk and drained into the anterior aspect of the internal jugular vein above the omohyoid muscle. The knowledge of such variation is also of importance to head and neck oncologists to avoid unnecessary bleeding during neck dissection.

CT Characterization of Duodenal Gastrointestinal Stromal Tumors.

Diagnosis and staging of duodenal gastrointestinal stromal tumors (GISTs) by noninvasive imaging is critical for effective treatment, but the imaging features of duodenal GISTs remain largely undefined because of their rarity. The purpose of this article was to characterize duodenal GISTs using CT. Thirty-four patients with duodenal GISTs were analyzed by clinical symptom evaluation, pathologic examination, and CT in this retrospective study. Unenhanced and contrast-enhanced examinations were performed in all patients. Imaging characteristics, including the lesion location, size, growth pattern, ulceration, internal components, arterial blood supply, intratumoral arterioportal shunting, intratumoral vessels, rim enhancement, and enhancement patterns were reviewed. The duodenal GISTs were solitary masses with well-defined margins. The average diameter was 7.1 cm. The second portion was the most common site (20/34). Ulceration was a common feature (15/34). Calcification was uncommon (3/34), and mixed growth pattern was more common (26/34). Rim enhancement (24/34) and mixed enhancement pattern (15/34) were common. Arterial blood supply, intratumoral vasculature, and draining veins were all detected and were obvious on the arterial phase. The portal venous trunk and superior mesenteric vein were the main veins into which early arterioportal shunting drained. Primary duodenal GISTs are generally large, well-defined, heterogeneously enhancing, and hypervascular masses with a prominent mixed growth pattern on CT images. Our findings suggest that CT can help depict the origin of the tumoral arteries and draining veins on the arterial phase and may be a key defining diagnostic feature for duodenal GISTs.

Successful removal of a giant pulmonary hamartoma coexisting with an anomalous common pulmonary venous trunk.

We present an extremely rare case of a giant pulmonary hamartoma (PH) coexisting with an anomalous common pulmonary venous trunk (ACPVT). An asymptomatic 39-year-old man was referred for evaluation of a giant pulmonary lesion in his left thorax detected on chest X-ray during a routine medical examination. After clinical work-up, the patient underwent left exploratory thoracotomy. Since the extent of the tumor and coexistence of an ACPVT, a left pneumonectomy was performed. The specimen measured 28 cm × 18 cm × 17 cm and weighted for 2.1 kg. Histology revealed a blend of pieces of rounded cartilage separated by fibrous bands in which mature adipose tissue and cleft-like structures lined. The features were consistent with those of a chondromatous hamartoma. The patient made a satisfactory recovery and 10 months after the operation was asymptomatic.

The new test for the detection of superficial venous reflux

Ultrasound duplex angioscanning (USAS) is designed to detect, among other things, venous reflux, its source and extent. Up to now, there have been no reliable tests making it possible to unambiguously detect the valvular incompetence of the superficial veins. Hence, the necessity of developing methods for the solution of tis problem. We proposed the method for the detection of superficial venous reflux with the use of ultrasound duplex angioscanning that allows to generate the retrograde blood flow in the subcutaneous veins by means of manual compression, i.e. sliding movements of the hand along the incompetent venous trunk, to enhance the effectiveness of this 7 procedure.

PATHOLOGY OF CEREBROVASCULAR ANGIOARCHITECTONICS AND MICROCIRCULATION IN ETIOLOGY AND PATHOGENESIS OF ALZHEIMER'S DISEASE

There have recently appeared many reports dedicated to cerebral hemodynamics disorders during AD progression. However, certain aspects of cerebral blood flow and microcirculation during AD are not fully understood. This research focuses on the identification of cerebral angioarchitectonics features and the study of microcirculatory disorders arising during AD progression, and on the determination of their importance in AD etiology and pathogenesis. 164 patients participated in the research: Test Group - 81 patients with different AD stages; Control Group - 83 patients with etiologically different neurodegenerative brain lesions accompanied by manifestations of dementia and cognitive impairment of varying severity but without AD. All patients underwent: assessment of cognitive function (MMSE), severity of dementia (CDR) and AD stages (TDR), laboratory examination, computed tomography (CT), magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG) and cerebral multi-gated angiography (MUGA). All Test Group patients, with both pre-clinical and clinical AD stages, had disorders of cerebral microcirculation manifested in dyscirculatory angiopathy of Alzheimer's type (DAAT), namely: capillary bed reduction in the hippocampus and frontal-parietal regions; multiple arteriovenous shunts in the basin of arterial branches supplying the hippocampus and fronto-parietal brain regions; early venous dumping of arterial blood through these shunts with simultaneous filling of arteries and veins; abnormally enhanced lateral venous trunks receiving blood from the arterio-venous shunts; anomalous venous congestion at the border of frontal and parietal lobe caused by the increased blood inflow from the arterial-venous shunts; increased looping of distal intracranial arterial branches. Control group patients had no combinations of such changes in angioarchitectonics and microcirculation. The primary basis for these changes is cerebral microcirculation disorders manifested in capillary bed reduction and decreased blood flow to cerebral tissues. The process is accompanied by natural arteriovenous shunts leading to arterial blood dumping to the venous bed followed by temporal and fronto-parietal lateral veins enlargement and subsequent blood congestion. Finally, long-term chronic hypoperfusion of these areas follows causing specific cerebral tissue hypoxia and ischemia. These changes may then affect amyloid beta metabolism and facilitate its accumulation in brain tissue stimulating AD progression. Patient Sh., 68 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, arterial phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular region; 2: Multiple arteriovenous shunts in fronto-parietal and temporal regions Patient O., 72 years old. Angiogram of the left internal carotid artery; TDR-2; lateral projection, capillary phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular area; 2: Multiple arteriovenous shunts in fronto-parietal and temporal regions; 3: The development of early venous discharge in the temporal and fronto- parietal region. Simul-taneous filling of arteries and veins. Patient P., 75 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, venous phase; 4: The development of pathologically enlarged veins that receive blood from arteriovenous shunts in the temporal and fronto-parietal region; 5: Blood congestion on the border of the fronto-parietal region. Patient P., 75 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, early arterial phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular area; 6: Multiple loop formation.

Commentary on ‘Ultrasound-guided Intralesional Diode Laser Treatment of Congenital Extratruncular Venous Malformations: Mid-term Results’

Jiang et al. reported successful results of endoluminal laser therapy (ELT) on extratruncular venous malformation (VM) lesions using ultrasound-guided intralesional diode laser method. A new role for ELT in extratruncular VM management has yet to be established, although ELT has been well accepted for varicose vein management. The VM lesion is not a fully matured normal vein, it is a residual embryonic tissue remnant following the defective development, so its clinical behavior/response to ELT and long-term outcome will be quite different from those of varicose veins. Extratruncular type VM lesion is the outcome of developmental arrest occurring at a reticular stage of embryonic life before the venous trunk is formed (cf. truncular lesion). Therefore, like all other extratruncular congenital vascular malformations (CVMs), this primitive venous tissue retains the characteristics of mesenchymal cells (angioblasts) to grow when stimulated (e.g. trauma, surgery, female hormone, menarche, pregnancy). Therefore, extratruncular VM lesions have a perpetual risk of recurrence after suboptimum management; improper treatment strategy often stimulates dormant lesions to respond in an erratic way. Such infiltrating lesions have a notorious reputation for high tendency to progress and high recurrence even with a well-established treatment plan (surgery; embolo-sclerotherapy). Laser therapy on extratruncular VM is no exception; it is not better than any other forms of treatment modality (e.g. foam sclerotherapy), but rather more vulnerable as its experience is mostly with Nd:YAG as an interstitial form to superficially located localized VM lesions. Besides, all the principles of laser application to the VM were adopted from

Morphological aspects of the pulmonary veins

ABSTRACT Our study was performed on 21 cases, of which 12 were plastic casts and 9 were CT reconstruction. We found that, most frequently (68.75% of the cases), the pulmonary veins were formed by two roots, one superior and one inferior. In 28.13% of cases, the pulmonary veins were formed from three roots (superior, middle and inferior) and in only one case the superior right pulmonary vein had five roots. The venous roots confluence to form the corresponding trunk was at a distance of between 0.5-2 cm. The termination of the superior pulmonary veins was on the upper part of the anterior atrial wall, most commonly in its lateral side. The distance between the right pulmonary veins was between 0.4-3 cm. The inferior pulmonary veins ended on the infero-lateral part of the posterior atrial wall. The distance between the left pulmonary veins was 1.2-3.4 cm. Among the variation in number of the pulmonary veins we met: three cases with three right pulmonary veins and one case when the inferior right pulmonary vein joined terminally the inferior left pulmonary vein, forming a single venous trunk. Supplementary pulmonary veins were encountered only on the right; in one case there were two posterior right pulmonary veins (superior and inferior), in the second case were anterior right pulmonary veins (superior and inferior) and in a third case were three veins, superior, middle and inferior

Anatomical considerations on the place and formation of the renal veins

Abstract Our study on the venous vasculature of the kidney (the location and the formation of the renal veins) was performed on a total of 148 cases, using as working methods the dissection, the injection of contrast medium followed by radiography and the plastic injection followed by corrosion. Not all anatomical landmarks could be studied in all cases, each anatomical landmark being assessed on a number of different cases. The left renal vein formation was studied on 124 cases and we have found that the left renal vein may appear inside the renal sinus (intrarenal or intrasinusal) in 13.71 % of cases; in 17.74 % of the cases the confluence of the tributaries of the renal was at the medial border of the kidney, so juxtarenal and the most common form was the extrarenal vein (68.55 % of cases). The level of appearance of the right renal vein was studied on 122 cases, describing the following patterns: intrasinusal in 19.67 % of cases, juxtarenal in 27.87 % of cases and extrarenal in 52.46 % of cases. The formation of renal veins was studied on a number of 114 cases, finding the following variations: in 56.14 % of the cases the renal vein formed from two venous trunks, in 38.60 % of cases from three venous trunks and in 5.26 % of cases from four venous trunks; we did not found cases of renal vein formed from more than 4 tributaries.