1.Effects of primary deep venous valvular incompetence of lower limb in deep vein thrombus after total knee replacement.
Li YANG ; Hou-shan LÜ ; Wan-lei ZHANG ; Jian-guo LI ; Jun JIANG
Chinese Journal of Surgery 2009;47(5):356-358
OBJECTIVETo evaluate the effects of primary deep venous valvular incompetence of lower limb (PDVI) to the occurrence of deep vein thrombosis (DVT) after human total knee replacement (TKR).
METHODSOne hundred and twenty-six patients who planed to receive TKR were examined by color doppler flow imaging (CDFI). The patients were divided into 2 groups depending on whether they were found backstreaming in femoral vein or not. When the refluxing time > 1 s, the patients were included in PDVI group; When the refluxing time < or = 1 s, the patients were included in without PDVI group. In 7 d after operation all the patients were re-examined by CDFI to find if there was DVT. The results were tested by chi2 statistical analysis.
RESULTSAmong the 126 patients, 54 had PDVI, and 72 without PDVI. Fifty patients had DVT, total incidence rate 39.7% (50/126). In PDVI group 33 patients had DVT (61.1%, 33/54); In without PDVI group 17 patients had DVT (23.6%, 17/72), which was lower than PDVI group (chi2 = 21.227, P < 0.05).
CONCLUSIONSPDVI may be a risk for occurrence of DVT after TKR.
Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Venous Insufficiency ; complications ; Venous Thrombosis ; etiology
2.Palma-Dale Operation for Chronic Ilio-femoral Vein Thrombosis.
Sang Dong KIM ; Sun Cheol PARK ; Ji Il KIM ; Yong Sung WON ; Sang Seob YUN ; In sung MOON ; Jang Sang PARK ; Yong Bok KOH
Journal of the Korean Society for Vascular Surgery 2009;25(1):23-29
PURPOSE: Deep vein thrombosis is usually managed conservatively or with radiologic intervention. Yet deep vein reconstruction is of value as one of the treatments for a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent or occluded deep venous outflow such as occurs because of chronic ilio-femoral vein thrombosis. Therefore, we evaluate the improvement of symptoms and graft patency after a Palma-Dale operation as a treatment modality for chronic ilio-femoral vein thrombosis. METHODS: From January 2001 to August 2008, a retrospective study was performed on 15 patients with chronic ilio-femoral vein thrombosis that was treated with a Palma-Dale operation. RESULTS: The mean age of the patients was 51.1+/-15.9 years. The ratio of males to females was 8 to 7. All the patients had lower limb swelling. A Palma-Dale operation was performed on all the patients. Simultaneous thrombectomy was done for 1 patient and arteriovenous fistulas were used to improve graft patency in four patients. The mean follow-up period was 36.3+/-24.0 months. Postoperatively, there was improvement of symptoms in all the patients. However, there was recurrence of symptoms in three patients after two or three months. The rate of graft patency was 84.1% at one year after surgery. CONCLUSION: The Palma-Dale operation has the possibility of recurrence of deep vein thrombosis and postoperative complications. Yet in patients with significant chronic venous insufficiency due to chronic ilio-femoral vein thrombosis, this type of surgery is obviously of value with respect to improvement of symptoms and an acceptable graft patency rate.
Arteriovenous Fistula
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Female
;
Follow-Up Studies
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Humans
;
Lower Extremity
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Male
;
Postoperative Complications
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Recurrence
;
Retrospective Studies
;
Thrombectomy
;
Thrombosis
;
Transplants
;
Veins
;
Venous Insufficiency
;
Venous Thrombosis
3.Safety of a Single Venous Anastomosis in Anterolateral Thigh Free Flap for Extremity Reconstruction.
Sang Soo YU ; Hyun Woo SHIN ; Pil Dong CHO ; Soo Hyang LEE
Archives of Reconstructive Microsurgery 2015;24(1):1-6
PURPOSE: The main cause of flap loss in microsurgical tissue transfer is venous insufficiency. Whether or not multiple venous anastomoses prevents vascular thrombosis and reduces the risk of flap failure remains controversial. Some researchers are in favor of performing dual venous anastomoses, but the counterargument holds that performing a single venous anastomosis does provide advantages. MATERIALS AND METHODS: We carried out a retrospective analysis of 15 cases of anterolateral thigh free flap for extremity reconstruction performed between January 2011 and December 2013. The patients were categorized into two groups: group A that received a single venous anastomosis and group B that received dual venous anastomoses. The time of the anastomosis, size of the flap, complications of the flap, and survival rate of each group were analyzed. RESULTS: The total microsurgical time in the single venous anastomosis group ranged from 28 to 43 minutes (mean 35.9 minutes). The total time in the dual anastomoses group ranged from 50 to 64 minutes (mean 55.7 minutes). No statistically significant difference was found between the two groups with regards to postoperative complications and flap failure. CONCLUSION: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is a safe and feasible option for extremity reconstruction and provides shorter operative time and easy flap dissection.
Anastomosis, Surgical
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Drainage
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Extremities*
;
Free Tissue Flaps*
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Humans
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Operative Time
;
Postoperative Complications
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Reconstructive Surgical Procedures
;
Retrospective Studies
;
Survival Rate
;
Thigh*
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Thrombosis
;
Venous Insufficiency
4.Microwave ablation versus laser ablation in occluding lateral veins in goats.
Xu-hong WANG ; Xiao-ping WANG ; Wen-juan SU ; Yuan YUAN
Journal of Huazhong University of Science and Technology (Medical Sciences) 2016;36(1):106-110
Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation (EVLA) is a frequently used method. A newly developed alternative, based on thermal therapy, is endovenous microwave ablation (EMA). This study evaluated the effect of the two procedures, in terms of coagulation and histological changes, in occluding lateral veins in goats. Twelve animals were randomized into two group, with 6 treated with EMA (EMA group), and the rest 6 with EVLA (EVLA group). Results of coagulation, including coagulation, fibrinolysis and platelet activation, were assessed at three or four different time points: before, immediately after, 24 h (and 48 h) after ablation. The diameter change, a measure of efficacy, was ultrasonographically measured before and 1 month after the ablation. Histological changes were grossly and microscopically evaluated immediately, 1 and 3 month(s) after the ablation. The length of the ablated vein and preoperative average diameter were comparable between the two groups. In both EMA and EVLA groups, several coagulation parameters, fibrinolysis and platelet activation parameters only underwent slight changes. Ultrasound imaging displayed that the diameter reduction of the veins treated by EMA was significantly larger than by EVLA, in consistent with the results of macroscopic examination. Microscopic examination revealed necrosis and thickening of the vein wall, and occlusion of the lumen within 3 months after ablation in both EMA and EVLA groups. It is concluded that EMA is a minimally invasive therapy, which appears to be safe and effective for treatment of lateral veins in goats.
Animals
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Female
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Fibrinolysis
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Fibrosis
;
etiology
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Goats
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Laser Coagulation
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adverse effects
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instrumentation
;
methods
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Male
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Microwaves
;
therapeutic use
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Necrosis
;
etiology
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Platelet Activation
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Postoperative Complications
;
Venous Insufficiency
;
etiology
;
surgery
5.A Case of Venous Stasis Ulcer Treated by Subfascial Endoscopic Perforator Ligation and Split Thickness Skin Graft.
Seong Ho MOON ; Jong Wook LEE ; Jang Hyu KOH ; Dong Kook SEO ; Jai Koo CHOI ; Young Chul JANG
Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(3):336-340
PURPOSE: The wound of a patient who has chronic venous insufficiency is easy to recur. Also they develop a complication even after the conservative therapy or skin graft. We have to diagnose the venous stasis ulcer correctly and remove the cause to improve the effectiveness of treatment. We operated endoscopic perforating vein ligation and splitt thickness skin graft on a patient with venous stasis ulceration on right leg. METHODS: A 26 year old male patient who had a scalding burn on his right leg in July 2005 checked into our hospital in March 2008. Even though he got three operations-the split thickness skin graft-at different clinics, the wound did not heal. The size of the wound was 12 by 8 cm2 and granulation with edema and fibrosis had been formed. We kept observation on many collateral vessels and perforating vein through venogram and doppler sonography and firmly get to know that the wound came with chronic venous insufficiency. After a debridement and an application of VAC(r) for two weeks, the condition of granulation got better. So we proceeded with the operation using subfascial endoscopic perforating surgery and split thickness skin graft. RESULTS: Through the venogram after the operation, we found out that the collateral vessels had been reduced compared to the previous condition and the widened perforating vein disappeared. During a follow up of 6 months, the patient did not develop recurrent stasis ulcer and postoperative complications. CONCLUSION: Subfascial endoscopic perforator ligation is a relatively simple technique with a low complication rate and recurrence rate. Split thickness skin graft with subfascial endoscopic perforator surgery can be a valuable method for treating severe venous stasis ulcers.
Burns
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Debridement
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Edema
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Fibrosis
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Follow-Up Studies
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Humans
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Leg
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Ligation
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Male
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Porphyrins
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Postoperative Complications
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Recurrence
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Skin
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Transplants
;
Varicose Ulcer
;
Veins
;
Venous Insufficiency
6.Treatment for chronic venous ulceration of the leg by subfascial endoscopic perforator vein surgery.
Kai YAO ; Wanpin NIE ; Lingli LU ; Feizhou HUANG ; Xunyang LIU
Journal of Central South University(Medical Sciences) 2009;34(8):830-833
OBJECTIVE:
To observe the effect of subfascial endoscopic perforator vein surgery (SEPS) in the treatment of chronic venous ulceration of the legs.
METHODS:
Chronic venous ulceration for 91 patients with 102 limbs was treated by SEPS from January 2005 to July 2008. The effect of SEPS on chronic venous ulceration of the leg, the symptoms during and after the operation, and the durations of hospital treatment were analyzed.
RESULTS:
The symptoms of the 102 legs conducted by SEPS operation, except the pigmentation, were obviously improved (P<0.01). Its cicatrisation rate, the recrudesce rate, and the cut infection rate were 93.1%, 1.96%, and 1.0%, respectively. The time of the operation was short and the hemorrhage was small during the surgery. The durations of hospitalization and the cicatrisation time of ulceration were (6.5+/-3.4) d and (12.2+/-13.7) d, respectively.
CONCLUSION
SEPS is simple and effective in treating chronic venous ulceration of the leg, and particularly effective for patients classified into C5 and C6 in clinical-etiological-anatomical-pathophysiology (CEAP).
Aged
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Angioscopy
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methods
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Fasciotomy
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Female
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Humans
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Male
;
Middle Aged
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Varicose Ulcer
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surgery
;
Varicose Veins
;
surgery
;
Vascular Surgical Procedures
;
Venous Insufficiency
;
complications
;
surgery
7.RANTES expression in venous ulceration of lower limbs.
Liu-hua CHEN ; Cai-sheng YE ; Heng-hui YIN ; Jie-lian YE ; Shen-ming WANG
Journal of Southern Medical University 2008;28(5):861-862
OBJECTIVETo investigate the expression of RANTES in venous ulceration.
METHODSFrom patients with lower limb venous ulceration, patients with non-ulcerous venous insufficiency, and healthy individuals, peripheral blood was collected from the lower limb veins for measurement of RANTES mRNA using RT-PCR.
RESULTSIn the ulceration group, the expression of RANTES mRNA was significantly increased as compared with the other two groups (P<0.01). RANTES mRNA expression was also significant higher in the non-ulcerous group than the control group (P<0.01).
CONCLUSIONHigh expression of RANTES mRNA may be one of the important mechanisms of venous ulceration.
Adult ; Aged ; Chemokine CCL5 ; biosynthesis ; blood ; genetics ; Female ; Humans ; Male ; Middle Aged ; RNA, Messenger ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Varicose Ulcer ; blood ; etiology ; Venous Insufficiency ; blood ; complications ; Young Adult
8.Role of Dermal Melanocytes in Cutaneous Pigmentation of Stasis Dermatitis:A Histopathological Study of 20 Cases.
Journal of Korean Medical Science 2002;17(5):648-654
Stasis dermatitis is an itchy, scaly, and hyperpigmented condition of the lower leg due to venous insufficiency. Hemosiderin and/or melanin have been considered responsible for the brown pigmentation. However, there are not sufficient histopathologic studies. In this retrospective study the hospital records and biopsy slides of 20 patients were reviewed to determine the pathogenetic mechanisms of brown pigmentation in stasis dermatitis. Fifteen were men (75%) and 5 were women (25%) with a mean age of 46.2+/-8.2 yr (18-76), mean age at onset of 43.4+/-18.0 yr (17-73), and a mean duration of the disease 2.8+/-2.5 yr (0.25-10). All patients had varicose vein and complained of pruritus. On histopathologic evaluation, two cases out of 20 (3 skin biopsy specimens from 25 samples) showed dermal melanocytes containing melanin, and incontinence of melanin pigment was observed in 5 cases, which indicates that melanin pigments from epidermis could contribute to cutaneous pigmentation in stasis dermatitis. However, the existence of dermal melanocytes in two cases cannot be explained because normally the dermis contains no melanocytes. Further studies concerning the role of iron or inflammatory cytokines on the development of dermal melanocytes should be conducted.
Adolescent
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Adult
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Aged
;
Dermatitis/etiology/metabolism/*pathology
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Dermis/metabolism/pathology
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Female
;
Humans
;
Hyperpigmentation/etiology/metabolism/*pathology
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Leg Dermatoses/etiology/metabolism/pathology
;
Male
;
Melanins/metabolism
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Melanocytes/metabolism/*pathology
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Middle Aged
;
Venous Insufficiency/complications
9.Prevention of Venous Thromboembolism in Medical Intensive Care Unit: A Multicenter Observational Study in Korea.
Jinwoo LEE ; Seok Chan KIM ; Sun Jong KIM ; Jin Young OH ; Hyun Kyung LEE ; Ho Kee YUM ; Yang Ki KIM ; Sang Bum HONG ; Moo Suk PARK ; Sung Chul HWANG ; Hyoung Kyu YOON ; Hak Ryul KIM ; Jae Hwa CHO ; Sunghoon PARK ; Chul Gyu YOO
Journal of Korean Medical Science 2014;29(11):1572-1576
Patients admitted to medical intensive care unit (MICU) are at increased risk for venous thromboembolism (VTE); and prophylaxis is recommended. However, the actual range and frequency of VTE prophylaxis administered to MICU patients are not well defined. Patients over 40 yr of age and expected MICU stay of more than 48 hr were eligible for this observational cohort study of 23 MICUs in Korea. Patients already on anticoagulation therapy or those requiring anticoagulation for reasons other than VTE were excluded. Among 830 patients, VTE prophylaxis was given to 560 (67.5%) patients. Among 560 patients, 323 (38.9%) received pharmacoprophylaxis, 318 (38.4%) received mechanical prophylaxis and 81 (9.8%) received both forms of prophylaxis. About 74% of patients in the pharmacoprophylaxis group received low molecular weight heparin and 53% of the patients in the mechanical prophylaxis group used intermittent pneumatic compression. Most of the patients (90%) had more than one risk factor for VTE and the most common risk factor was old age, followed by heart and respiratory failure. In this observational cohort study of 23 MICUs in Korea, 67.5% of patients received thromboprophylaxis. Further studies are needed to clarify the role and efficacy of VTE prophylaxis in Korean critically ill patients.
Adult
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Age Factors
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Aged
;
Cohort Studies
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Female
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Heart Failure/complications
;
Heparin, Low-Molecular-Weight/therapeutic use
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Humans
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*Intensive Care Units
;
Length of Stay
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Male
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Mechanical Thrombolysis
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Middle Aged
;
Republic of Korea
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Respiratory Insufficiency/complications
;
Retrospective Studies
;
Risk Factors
;
Tomography, X-Ray Computed
;
Venous Thromboembolism/complications/*prevention & control/therapy
10.Screening and cloning of genes related to varicose great saphenous vein accompanying with primary deep vein valve insufficiency.
Shenming WANG ; Henghui YIN ; Jinsong WANG ; Zuojun HU ; Xueling HUANG
Chinese Journal of Surgery 2002;40(12):909-911
OBJECTIVETo screen the genes related to the occurrence and development of varicosis of the great saphenous vein in the patients with primary deep vein valve insufficiency.
METHODSUsing mRNA fluorescent differential display reverse transcriptive polymerase chain reaction (FDD-RTPCR), different genes expressed in the varicose great saphenous veins in patients with primary deep vein valve insufficiency and corresponding normal human tissues were compared. Differentially expressed cDNA fragments confirmed by Northern blot were compared and then cloned into the pGEM-Teasy vector. Positive clones were selected and sequenced. All the sequences were put into GenBank and analyzed by BLASTN software to search for their genetic origins.
RESULTSAltogether 37 different cDNA fragments were obtained and 30 of which were confirmed by Northern blot. Analysis of the sequences by BLASTN software showed that C(610) fragment (NO. 18 cDNA clone) shared 96% homology with the mRNA sequence of the human Mckusick-Kaufman syndrome gene (MKKS gene).
CONCLUSIONC(610) fragment is highly homologous with the mRNA sequence of the human MKKS gene and is closely related to the development of varicosis of the great saphenous vein in patients with primary deep vein valve insufficiency.
Base Sequence ; Blotting, Northern ; Cloning, Molecular ; Group II Chaperonins ; Humans ; Lower Extremity ; blood supply ; Molecular Chaperones ; genetics ; Molecular Sequence Data ; RNA, Messenger ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Saphenous Vein ; Sequence Homology, Nucleic Acid ; Varicose Veins ; etiology ; genetics ; Venous Insufficiency ; complications ; genetics