Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.
Diagnosis ; Humans ; Ischemia ; Lower Extremity* ; Postthrombotic Syndrome ; Pulmonary Embolism ; Thrombectomy ; Thrombosis ; Venous Thrombosis ; Venous Valves

The conventional surgery method of thrombectomy of venous thrombi from the deep veins of the lower extremity was the use of Forgarty balloon catheter. The catheter is inconvenient due to the presence of the balloon and prohibiting venous valves within the venous trees. With the use of a stone-forceps(Fig. 1), thrombi within iliofemoral vein could be easily removed without the obstacle of the valves because the instrument keeps valves open. This instrument is also useful in monitoring the back-flow from the iliac vein. Thrombi within the veins below the level of inguinal incision are removed successfully only by effective manual compression of the calf and thigh muscles. I recommend operating on the iliac vein first rather than the lower venous tree.
Catheters ; Iliac Vein ; Lower Extremity* ; Muscles ; Thigh ; Thrombectomy ; Veins* ; Venous Thrombosis ; Venous Valves

Three cases of human embryo of Carnegie stage 13 were described. The CR length of these embryos were 3.0-5.3mm. The authors made a reconstruction model using photograph, photocopy and computer. These embryos were characterized externally by 4 limb buds and 4 pairs of branchial arches, and internally closed otic pits, appearance of venous valves, septum primum and foramen primum in the heart, beginning of the right and left lung buds, appearance of lens disk.
Branchial Region ; Embryonic Structures* ; Heart ; Humans* ; Limb Buds ; Lung ; Venous Valves

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.
Agar ; Animals ; Atrial Appendage ; Diverticulum ; Embryonic Structures ; Fetus ; Heart ; Heart Atria ; Isomerism ; Mice* ; Venous Valves

PURPOSE: Developmental processes of atria in embryos or fetuses of the iv/iv mouse were studied to find the differences between right and left atrial chambers and to identify the characteristics of atrial isomerism in the abnormal laterality syndrome. METHODS: Seventy-three embryos from SI/Col iv/iv mice (Jackson's laboratory, USA) or fetuses at the 10th-13th day were used. They were examined using stereomicroscope, scanning electronmicroscope, serial section, and thick slicing in the agar block. RESULTS: Thirty-three cases (45%) had usual arrangement but 40 cases (55%) had abnormal laterality, which included 29 cases of mirror-imaged appendages, seven with left isomerism, two with right isomerism and two with undeterminate appendages. Embryonic right atrium was initially composed of a large conspicuous appendage, which was a thin walled diverticulum and small venous component. As development progressed, venous valves and septum spurium became prominent. The embryonic left atrium was composed of the less conspicuous appendage but the major part of embryonic left atrium was the primitive atrium merging into the atrioventricular canal. The atrial chamber in the right isomerism had a bilateral big appendage and small venous component and the atrioventricular orifice was located in the center of the atrial outlet. Atrial chambers in the left isomerism had a bilateral small appendage and the central venous component was wide. CONCLUSION: The atrial morphology is the best marker in the determination of the atrial laterality. The appendages in hearts with isomerism had bilateral symmetrical arrangement of the appendages.
Agar ; Animals ; Atrial Appendage ; Diverticulum ; Embryonic Structures ; Fetus ; Heart ; Heart Atria ; Isomerism ; Mice* ; Venous Valves

PURPOSE: Many descriptions of the digital arterial anatomy including skin territory of the finger have been published. Relatively few studies on venous architecture of the finger have been performed in this area, in part, attributable to the technical difficulties encountered in dissecting small vessels. The purpose of this study is to present the precise microsurgical anatomy of the vein related to the digital artery and venae comitantes of the components. METHODS: Arterial and venous anatomy of their relation to the fingers were examined in 38 specimens of two fresh cadavers and 36 clinical cases. All specimens were evaluated grossly, surgical microscopically, or/and light microscopically to observe the three & two-dimensional structure of the artery and joining vein, evidence of the venae comitantes, and venous valve. RESULTS: No longitudinal venae comitantes along the digital artery were found in any specimens. The size of the venae comitantes of each digital artery was much smaller than other vein, but always existed any level of digital artery. One or two venae comitantes in the digital artery ran spiral, oblique, helical, fibrillar, or irregular branched shape. The authors also found the vein of the finger, that had bicuspid valves, but not in venae comitantes. CONCLUSION: Recently, venous outflow problem rather than arterial circulation is the most common cause tissue failure after microvascular surgery in the hand. Sometimes, if it is not recognized early, there is an increased risk of tissue damage and loss. The authors concluded that this study presents a useful knowledge for the characterization of the venous structure and evidence for venae comitantes like a venule in the digital artery at varying levels of the finger.
Arteries ; Cadaver ; Fingers ; Hand ; Light ; Microsurgery ; Mitral Valve ; Skin ; Veins ; Venous Valves ; Venules

Anticoagulation therapy is widely used to prevent thromboembolism in patients with atrial fibrillation, venous thromboembolism, and mechanical heart valves. The temporary interruption of anticoagulants is common to reduce the bleeding risk during peri-procedures. Traditionally, warfarin was held for several days before procedures with heparin bridging therapy. However, recent data showed that stopping warfarin was not necessary before procedures with a low bleeding risk, such as a gastrointestinal endoscopy, cataract eye surgery, and dental procedures when the thromboembolic risk of the patient is moderate-to-high. This review article outlines the estimation of the thromboembolic and bleeding risk before procedures, and determines the timing of anticoagulant interruption.
Anticoagulants ; Atrial Fibrillation ; Cataract ; Endoscopy ; Endoscopy, Gastrointestinal ; Heart Valves ; Hemorrhage ; Heparin ; Humans ; Thromboembolism ; Tooth Extraction ; Venous Thromboembolism ; Warfarin

Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.
Angioplasty ; Catheters ; Extremities ; Female ; Heparin ; Humans ; Lower Extremity ; Pregnancy ; Pregnancy Complications, Cardiovascular ; Pregnancy Trimester, First ; Stents ; Thrombosis ; Veins ; Venous Thrombosis ; Venous Valves

OBJECTIVETo analyze anatomy data of popliteal veins (PV), with the purpose of selection of popliteal venous valves construction segment via venography, and to evaluate the surgical results.

METHODSFrom February 1998 to November 2010, after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases, 102 patients (69 male and 33 female patients, aged from 48 to 71 years, mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures. Doppler ultrasound, continuous dynamic venography, and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre- and postoperatively. Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.

RESULTIn the 102 patients, 93.7% patients had one pair of valves in popliteal vein (PV), locating in the distal 1/3 segment of PV, with gastrocnemius veins (GV) joining with PV above PV valves. Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs. 150.2 ml/min, t = 8.979, P < 0.001). The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H(2)O vs. (15 ± 3) cm H(2)O, 1 cm H(2)O = 0.098 kPa, t = 8.049, P < 0.001). VCSS score was significantly lower after the surgery ((34 ± 15) cm H(2)O vs. (41 ± 14) cm H(2)O, t = 59.780, P < 0.001). Pre- and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs. 1.8 ± 1.0, t = 59.780, P < 0.001). Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%, and a 3.7% ulcer recurrent rate.

CONCLUSIONSPopliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection, which stayed proximal to the communications of GV and PV. Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.

Aged ; Female ; Hemodynamics ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Popliteal Vein ; anatomy & histology ; surgery ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery ; Venous Valves ; surgery

The determination of arterial pressure wave-derived cardiac output (APCO) and central venous O2 saturation (ScvO2) has been introduced as a less invasive procedure for monitoring cardiac function and oxygen delivery. We have used an APCO sensor (FloTracTM) and a monitor for ScvO2 (Vigileo(TM)) in two cases of cardiac valve surgery, where placement of pulmonary artery catheter (PAC) was not applicable due to unfavorable cardiac structure (case 1) and was contraindicated due to an unstable cardiac conduction disorder and arrhythmia (case 2). In case 1, monitoring of APCO was started from the beginning of anesthesia induction and a ScvO2 monitoring central venous catheter was inserted just after anesthesia induction. APCO, ScvO2 and other hemodyanamic information such as arterial BP, CVP, and data obtained from transesophageal echocardiography (TEE) during the pre- cardiopulmonary bypass (CPB) period were measured. APCO and ScvO2 during the post-CPB period showed a reliable correspondence with continuous cardiac output (CCO) and mixed venous O2 saturation (SvO2) as measured by PAC at the end of CPB. In case 2, APCO and ScvO2 were monitored instead of CCO and SvO2. The values of APCO showed a good correlation to intraoperative COs indirectly calculated by the velocity-time integral of the aortic outflow determined in the TEE examination. We experienced that monitoring APCO and ScvO2 is useful for anesthesia management in cardiac valve surgery and can be an alternative to CCO and SvO2 if the placement of PAC and the thermodilution method are not applicable.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure* ; Cardiac Output* ; Cardiopulmonary Bypass ; Catheters ; Central Venous Catheters ; Echocardiography, Transesophageal ; Heart Valves ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*