External support stent is a potential means for restricting the deformation and reducing wall stress of the vein graft, thereby improving the long-term patency of the graft in coronary artery bypass surgery. However, there still lacks a theoretical reference for choosing the size of stent based on the diameter of graft. Taking the VEST (venous external support) stent currently used in the clinical practice as the object of study, we constructed three models of VEST stents with different diameters and coupled them respectively to a model of the great saphenous vein graft, and numerically simulated the expansion-contraction process of the vein graft under the constraint of the stents to quantitatively evaluate the influence of stent size on the radial deformation and wall stress of the vein graft. The results showed that while the stent with a small diameter had a high restrictive effect in comparison with larger stents, it led to more severe concentration of wall stress and sharper changes in radial deformation along the axis of the graft, which may have adverse influence on the graft. In order to solve the aforementioned problems, we ameliorated the design of the stent by means of changing the cross-sectional shape of the thick and thin alloy wires from circle into rectangle and square, respectively, while keeping the cross-sectional areas of alloy wires and stent topology unchanged. Further numerical simulations demonstrated that the ameliorated stent evidently reduced the degrees of wall stress concentration and abrupt changes in radial deformation, which may help improve the biomechanical environment of the graft while maintaining the restrictive role of the stent.
Alloys ; Coronary Artery Bypass ; Saphenous Vein/surgery* ; Stents

OBJECTIVETo summarize clinical application experience of treatment of occluded iliofemoral veins with great saphenous vein cross-over bypasses.

METHODSFrom September 1998 to December 2005,6 patients(5 men, 1 woman) with occluded iliofemoral veins underwent great saphenous vein cross-over bypasses. They ranged in age from 36 to 52 years (mean, 41 years old). All patients had unilateral thigh and leg edema and swelling with accompanying pain. The normal contralateral great saphenous vein was dissected and it was tunneled across the super-pubic fat pad and anastomosed to the femoral vein or the proximal portion of great saphenous vein in distal to occluded iliofemoral veins.

RESULTSThe postoperative course was uneventful. One case sustained superficial infection postoperatively at donor site and the gradual wound healed by daily wound dressings. At 1 to 3.5 years (mean 1.8 years) followed up, all patients had pain disappearance and obvious relief of the edema but some swelling.

CONCLUSIONGreat saphenous vein cross-over bypasses is effective operative method of treatment of occluded iliofemoral veins. The operation is relatively simple and safe.

Adult ; Embolism ; surgery ; Female ; Femoral Vein ; surgery ; Humans ; Iliac Vein ; surgery ; Male ; Middle Aged ; Saphenous Vein ; transplantation

OBJECTIVETo evaluate the curative effect of the combination of endovenous laser treatment of varicose saphenous vein (ELVS) and classic ligation and stripping treatment.

METHODSWe retrospectively analyzed the clinical data of 21 patients with varicose saphenous vein (VS) who were treated with ELVS alone or combined with ligation and stripping in our hospital.

RESULTSAll the patients got good therapy result. The early symptom relief rate was 82.4%, while the late symptom relief rate was 100%. No infections, haematoma of wound, and any other major complications were reported. The common complications included pain induced by remains of the thrombosis phlebitis (n = 2, 11.7%), minor skin burn (n = 1, 5.9%), residue vein varicose (n = 1, 5.9%), numbness of the calf (n = 1, 5.9%), and mild peri-phlebitis (n = 1, 5.9%). All the complications were resolved after proper management. The 1-year follow-up showed no recurrence.

CONCLUSIONThe combination of ELVS and classic ligation and stripping is safe and effective in the treatment of varicose saphenous.

Adult ; Aged ; Female ; Humans ; Laser Therapy ; Ligation ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Varicose Veins ; surgery

Edema ; pathology ; Humans ; Ischemia ; pathology ; Leg ; blood supply ; Ligation ; Male ; Popliteal Vein ; abnormalities ; pathology ; surgery ; Saphenous Vein ; pathology

Varicose vein can cause embarrassment in life not only for pathophysiological reasons but also for aesthetic reasons, especially when wearing shorts or swimming suits. The main traditional therapy has been the surgical obliteration or stripping of greater or lesser saphenous veins. However, as the varicose veins are not bothersome in life, many patients can not easily decide to receive such painful operations. In Europe, the sclerotherapy has been applied since several decades ago with good results, which can obliterate these veins by the simple injection of a sclerosing solution into the vessel. From 1995 to 1999, We conducted the sclerotherapy of varicose veins in 549 patients (765 cases). Selected sclerosing agent was Fibrovein (sodium tetradecyl sulfate) which has the safest, painless and excellent effect. Due to the above mentioned benefits, this agent has been used popularly by phlebologist in the world. The results were excellent, average treatment sessions were 3 times and average follow up period was 1 year (3 months - 5 years). Most of the patients were satisfied with the results and no severe complications were observed. Recurrence were recognized in 69 cases (9%) within the first year. We did not experience any life threatening allergic reaction nor severe complications. The pain elicited by needle injection could be minimized using small caliber. In conclusion, compression sclerotherapy is simple, safe, excellent treatment for varicose veins and it would be applicable in the field of plastic surgery.
Europe ; Follow-Up Studies ; Humans ; Hypersensitivity ; Lower Extremity* ; Needles ; Recurrence ; Saphenous Vein ; Sclerotherapy* ; Surgery, Plastic ; Swimming ; Varicose Veins* ; Veins

OBJECTIVETo investigate the possibility of using the lesser saphenous vein as the alternative bypass graft in coronary artery bypasss graft (CABG).

METHODSeven pieces of lesser saphenous veins of 6 patients were harvested as the single or sequential grafts of CABG procedure with No-touch technique.

RESULTSThe diameter and length of lesser saphaneous vein met the requirement of graft for entire revascularization. All grafts achieved good flow without significant complications.

CONCLUSIONThe lesser saphenous vein graft is an excellent choice for CABG patient who lacks routine grafts as an alternative material.

Aged ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Middle Aged ; Saphenous Vein ; transplantation

Coronary Artery Bypass, Off-Pump ; methods ; Coronary Artery Disease ; surgery ; Humans ; Male ; Middle Aged ; Saphenous Vein ; transplantation

OBJECTIVETo verify the role and effect of external vavuloplasty in the treatment of chronic venous insufficiency (CVI) of lower extremity.

METHODSThirty patients with CVI of bilateral lower extremities were enrolled to accept surgical management of vein systems. Both limbs of each patient were randomized into two groups respectively according to the operating style. One limb was given external vavuloplasty of the superficial femoral vein and surgery of superficial venous system (group A), the another limb was only given the surgery of superficial venous system (group B). The effect comparison between both limbs of each patient and two groups by color duplex scanning, color doppler velocity profile (CDVP), air plethysmography and CEAP score system one month and 3 years after operation.

RESULTSAll 60 limbs of 30 cases were CEAP C(2)-C(4) with degree III reflux (Kistner's method) in the deep veins confirmed by color duplex scanning and venography. In 1 month and 3 years after surgery, all the indexes of the limb in the group A were dramatically improved compared with those of the limbs in the group B. The average value of venous reflux degree, reflux volume, and venous filling index (VFI) had significant difference between the two groups (P < 0.001). In 3 years after surgery, there was significant difference between the two groups on ejective fraction (EF)and residual volume fraction (RVF) (P < 0.05) and CEAP clinical score (P < 0.001).

CONCLUSIONExternal vavuloplasty of deep vein may reduce the reflux volume of the affected deep vein and improve the valve function, and can result in better outcomes when combined with surgery of the superficial venous system.

Adult ; Aged ; Chronic Disease ; Female ; Femoral Vein ; surgery ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Popliteal Vein ; surgery ; Prospective Studies ; Saphenous Vein ; surgery ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery

OBJECTIVE: To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities. METHODS: From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery. RESULTS: The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found. CONCLUSIONS Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.
Humans ; Lower Extremity ; surgery ; May-Thurner Syndrome ; complications ; surgery ; Minimally Invasive Surgical Procedures ; standards ; Radiofrequency Ablation ; Saphenous Vein ; surgery ; Treatment Outcome ; Varicose Veins ; complications ; surgery

BACKGROUNDConventional high ligation and stripping of the great saphenous vein (GSV) has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery (SEPS) plus endovenous laser treatment (EVLT) could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators.

METHODSPlacement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls.

RESULTSPostoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5 - 11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively (P < 0.01 in all cases).

CONCLUSIONCombined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.

Adult ; Aged ; Endovascular Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Varicose Ulcer ; surgery ; Varicose Veins ; surgery ; Vascular Surgical Procedures ; methods