OBJECTIVE: To compare the objective and subjective image quality indicators and radiation doses of computed tomography (CT) venography performed using model-based iterative reconstruction (MBIR) at 80 kVp and adaptive statistical iterative reconstruction (ASIR)-V at 70 kVp. MATERIALS AND METHODS: Eighty-three patients who had undergone CT venography of the lower extremities with MBIR at 80 kVp (Group A; 21 men and 20 women; mean age, 55.5 years) or ASIR-V at 70 kVp (Group B; 18 men and 24 women; mean age, 57.3 years) were enrolled. Two radiologists retrospectively evaluated the objective (vascular enhancement, image noise, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR]) and subjective (quantum mottle, delineation of contour, venous enhancement) image quality indicators at the inferior vena cava and femoral and popliteal veins. Clinical information, radiation dose, reconstruction time, and objective and subjective image quality indicators were compared between groups A and B. RESULTS: Vascular enhancement, SNR, and CNR were significantly greater in Group B than in Group A (p ≤ 0.015). Image noise was significantly lower in Group B (p ≤ 0.021), and all subjective image quality indicators, except for delineation of vein contours, were significantly better in Group B (p ≤ 0.021). Mean reconstruction time was significantly shorter in Group B than in Group A (1 min 43 s vs. 131 min 1 s; p < 0.001). Clinical information and radiation dose were not significantly different between the two groups. CONCLUSION: CT venography using ASIR-V at 70 kVp was better than MBIR at 80 kVp in terms of image quality and reconstruction time at similar radiation doses.
Female ; Humans ; Image Enhancement ; Image Processing, Computer-Assisted ; Lower Extremity ; Male ; Noise ; Phlebography ; Popliteal Vein ; Retrospective Studies ; Signal-To-Noise Ratio ; Veins ; Vena Cava, Inferior ; Venous Thrombosis

Popliteal vein aneurysms (PVAs) represent a rare form of venous aneurysms and necessitate prompt management because of their well-established risk of pulmonary embolism (PE). Herein, we report a rare case of PVA without PE, successfully treated with open surgical repair. A 27-year-old man presented to our vascular clinic with chronic pain and swelling in his left lower limb. He had a long history of facial surgeries for the removal of congenital multiple osteomas. Physical examination revealed varicosities with an abnormal distribution. Duplex ultrasound showed a left PVA measuring 2.3 cm in diameter and 4 cm in length. Open surgical excision of the PVA with lateral venorrhaphy was performed through a medial approach. Prophylactic anticoagulation was performed postoperatively. In this case, the PVA was detected, with a high degree of suspicion by the clinician, before it caused fatal PE. The patient was successfully treated with aneurysm excision and lateral venorrhaphy.
Adult ; Aneurysm ; Chronic Pain ; Humans ; Lower Extremity ; Osteoma ; Physical Examination ; Popliteal Vein ; Pulmonary Embolism ; Ultrasonography ; Varicose Veins

PURPOSE: Deep vein thrombosis (DVT) is the third most common cause of cardiovascular morbidity and mortality. Anticoagulation has been the primary treatment modality for acute DVT. However, catheter-directed thrombolysis (CDT) has recently become widely accepted as an additional therapy to anticoagulation. We assessed comparative outcomes in patients with acute DVT who underwent anticoagulation therapy alone (ACA) group and those treated with CDT group. MATERIALS AND METHODS: We retrospectively reviewed medical records of 149 patients with DVT from January 2011 to December 2015. We compared patients who received ACA group (n=120) and those who received CDT plus anticoagulation (CDT group, n=29). We analyzed the prevalence of lesions, thrombus removal rate in each lesion, and recurrence-free rate between the two groups. RESULTS: We found thrombus involvement in a total of 281 lesions in the ACA group and 85 lesions in the CDT group. For the distribution of lesions in each group, those in the femoral vein accounted for 34.2% of all lesions and those in the popliteal vein accounted for 31.7%. During follow-up, the overall thrombus removal rate was 91.1% in the ACA group and 87.0% in the CDT group (P=0.273). The recurrence-free rate was higher in the CDT group in a log-rank test; however, there was no statistically significant difference between the two groups (P=0.594). CONCLUSION: According to our results, there was no significant difference in thrombus removal and recurrence-free rates between the CDT and ACA groups. ACA still has an important role in the treatment of DVT.
Anticoagulants ; Femoral Vein ; Follow-Up Studies ; Humans ; Lower Extremity ; Medical Records ; Mortality ; Popliteal Vein ; Prevalence ; Retrospective Studies ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis

PURPOSE: The clinical characteristics and results of femoropopliteal artery injury (FPAI) remain unclear. In this study, we evaluated the outcomes and risk factors of limb loss in patients treated for FPAI. MATERIALS AND METHODS: We retrospectively reviewed data from a database of patients who underwent revascularization for an FPAI at a single institution between January 2013 and December 2017. We reviewed and analyzed the characteristics, postoperative results, and factors that influence amputation rates. RESULTS: Twenty-four femoropopliteal arterial reconstructions in 24 patients were included in this study. Among the patients were 20 (83.3%) male with a first-quartile age of 28 years and a third-quartile age of 45 years (range, 15–68 years). The mean injury severity score (ISS) was 16 (range, 4–55), and 5 patients (20.8%) had ISSs of >20 points. The mean mangled extremity severity score (MESS) was 3.8 (range, 1–11), and 8 patients (33.3%) had MESSs of >5 points. In terms of arterial reconstruction methods, autogenous saphenous vein grafting, vein patching, and primary closure were performed in 9 patients (37.5%), 4 patients (16.7%), and 11 patients (45.8%), respectively. Despite arterial reconstruction, 5 patients (20.8%) underwent above-knee amputation. ISSs of >20, MESSs of >7, and orthopedic fixation were statistically significant factors associated with amputation. CONCLUSION: In cases of FPAI with ISSs of >20, MESSs of >7, and orthopedic fixation, amputations should be considered. We were also careful to attempt limb salvage in such cases.
Amputation ; Amputation, Traumatic ; Arteries ; Extremities ; Femoral Artery ; Humans ; Injury Severity Score ; Limb Salvage ; Lower Extremity ; Male ; Orthopedics ; Popliteal Artery ; Retrospective Studies ; Risk Factors ; Saphenous Vein ; Transplants ; Vascular System Injuries ; Veins

A 58-year-old male patient with severe claudication due to thrombosis of the left ilio-femoro-popliteal artery aneurysm. He also had a venous stasis ulcer with a history of multiple embolotherapy of arteriovenous malformation. Duplex sonography revealed reflux and varicose veins of the left great saphenous vein (GSV). A sequential bypass surgery was performed that consisted of excision of the left external iliac and common femoral artery aneurysm, external iliac to deep femoral interposition with an expanded polytetrafluoroethylene graft, and femoro-posterior tibial artery bypass with the reversed left GSV. Symptoms of claudication were alleviated and the chronic ulcer was healed in time. To our knowledge, this is the first report of successful bypass in a patient with arterial aneurysm, arteriovenous malformation, and venous insufficiency that can be diagnosed as an atypical case of Parkes Weber syndrome. Long-term follow-up is needed to define the fate of aneurysms and varicose vein graft.
Aneurysm ; Arteries ; Arteriovenous Fistula ; Arteriovenous Malformations ; Embolization, Therapeutic ; Femoral Artery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Polytetrafluoroethylene ; Popliteal Artery ; Saphenous Vein ; Sturge-Weber Syndrome ; Thrombosis ; Tibial Arteries ; Transplants ; Ulcer ; Varicose Ulcer ; Varicose Veins ; Venous Insufficiency

BACKGROUND: This study examined the role of superficial vein surgery in patients with combined superficial venous reflux and segmental popliteal vein reflux. METHODS: We retrospectively reviewed 42 limbs in 38 patients with combined superficial venous reflux and segmental popliteal vein reflux who underwent saphenous vein ablation between January 2014 and February 2017. Patients underwent outpatient follow-up duplex ultrasonography at 3, 6, and 12 months postoperatively. Resolution of deep vein reflux was defined as reversed blood flow in a popliteal segment for less than 1.0 second and a decrease in the reflux time of more than 20% of the preoperative reflux time. RESULTS: The mean follow-up period was 9 months (range, 3–23 months). Saphenous vein ablations were performed by stripping in 24 limbs and radiofrequency ablation in 18 limbs. Preoperative segmental popliteal vein reflux resolved in 21 of the 42 limbs (50%). CONCLUSION: This study demonstrated that superficial venous surgery corrected segmental popliteal vein reflux in 50% of limbs with combined superficial venous reflux and segmental popliteal vein reflux. Other prospective studies are necessary to elucidate the etiology of the non-reversible cases.
Catheter Ablation ; Extremities ; Follow-Up Studies ; Humans ; Outpatients ; Popliteal Vein* ; Prospective Studies ; Retrospective Studies ; Saphenous Vein* ; Ultrasonography ; Veins ; Venous Insufficiency

Popliteal venous aneurysms can be a cause of fatal pulmonary thromboembolism. We report a case of a 47-year-old woman who suddenly died of fatal pulmonary thromboembolism. Deep vein thrombosis was not observed, but a venous aneurysm with intraluminal thrombi formation was identified on the left popliteal vein. This case illustrates that venous aneurysms can be presented as fatal pulmonary thromboembolism, and that they should be considered as a rare cause of pulmonary thromboembolism.
Aneurysm ; Female ; Forensic Pathology ; Humans ; Middle Aged ; Popliteal Vein ; Pulmonary Embolism ; Venous Thrombosis

We report a case of 53-year-old woman with an injured popliteal artery due to excessive drilling with a drill bit during medial opening wedge high tibial osteotomy (MOWHTO). Pseudoaneurysm was diagnosed three days after surgery and confirmed by urgent computed tomography (CT) angiography. Open vascular surgery with resection of the perivascular hematoma and end-to-end anastomosis using ipsilateral saphenous vein interposition graft was performed. CT angiography at 8 months postoperatively showed that blood flow was maintained without obstruction of the graft site and active dorsiflexion of the foot was possible. To reduce neurovascular injury during MOWHTO, it is important not to drill the far cortex at the proximal part of the osteotomy site when using a drill bit, and the metal should be positioned posteromedially as much as possible.
Aneurysm, False ; Angiography ; Female ; Foot ; Hematoma ; Humans ; Knee ; Middle Aged ; Osteotomy ; Popliteal Artery ; Saphenous Vein ; Transplants

A 48-year old man presented with left popliteal pain. A 2.2×1.6 cm sized saccular aneurysm at the level of the left popliteal fossa was diagnosed by ultrasonography. Tangential aneurysmectomy and popliteal vein repair was performed uneventfully. The patient fared well for a year without symptoms. Popliteal vein aneurysms are rare and typically found in patients with fatal thromboembolic features without warning symptoms. Fortunately, our patient had localized pain which was helpful in its early diagnosis and treatment.
Aneurysm* ; Early Diagnosis ; Humans ; Popliteal Vein* ; Ultrasonography

PURPOSE: Deep vein thrombosis (DVT) is a risk factor of pulmonary thromboembolism (PTE), however it is not clear who should be evaluated for a PTE and a DVT at the same time. The purpose of this study is to determine the clinical characteristics of PTE in patients with DVT who visited the emergency department (ED). METHODS: This was a retrospective cohort study of ED patients who visited with DVT and were simultaneously evaluated for a PTE from January 2012 to December 2013. We compared clinical characteristics between non-PTE and PTE patients with confirmed DVT in the ED. RESULTS: Of these 166 patients, 96 patients (57.8%) were confirmed PTE by computed tomography. In multivariate analysis, patients with PTE had more systemic neoplasm (OR 2.03, 95% CI 1.04-3.93, p=0.037) and right heart strain pattern in electrocardiography (OR 5.29, 95% CI 1.71-16.36, p=0.004) than patients without PTE. Femoral DVT was more likely in the non-PTE group (87.1% vs. 65.6%, p=0.002) and popliteal DVT was more likely in the PTE group (62.9% vs. 80.2%, p=0.013). However the number of DVT sites including both femoral and popliteal vein was not statistically different. CONCLUSION: In patients with systemic neoplasm or right heart strain patterns in electrocardiography, simultaneous PTE evaluation may be required in patients with DVT.
Cohort Studies ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart ; Humans ; Multidetector Computed Tomography ; Multivariate Analysis ; Popliteal Vein ; Pulmonary Embolism* ; Retrospective Studies ; Risk Factors ; Thromboembolism ; Venous Thrombosis*