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PURPOSE: To examine whether there is a significant difference in image quality between the deep learning reconstruction (DLR [AiCE, Advanced Intelligent Clear-IQ Engine]) and hybrid iterative reconstruction (HIR [AIDR 3D, adaptive iterative dose reduction three dimensional]) algorithms on the conventional enhanced and CE-boost (contrast-enhancement-boost) images of indirect computed tomography venography (CTV) of lower extremities. MATERIALS AND METHODS: In this retrospective study, seventy patients who underwent CTV from June 2021 to October 2022 to assess deep vein thrombosis and varicose veins were included. Unenhanced and enhanced images were reconstructed for AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images were obtained using subtraction software. Objective and subjective image qualities were assessed, and radiation doses were recorded. RESULTS: The CT values of the inferior vena cava (IVC), femoral vein ( FV), and popliteal vein (PV) in the CE-boost images were approximately 1.3 (1.31-1.36) times higher than in those of the enhanced images. There were no significant differences in mean CT values of IVC, FV, and PV between AIDR 3D and AiCE, AIDR 3D-boost and AiCE-boost images. Noise in AiCE, AiCE-boost images was significantly lower than in AIDR 3D and AIDR 3D-boost images ( P < 0.05). The SNR (signal-to-noise ratio), CNR (contrast-to-noise ratio), and subjective scores of AiCE-boost images were the highest among 4 groups, surpassing AiCE, AIDR 3D, and AIDR 3D-boost images (all P < 0.05). CONCLUSION: In indirect CTV of the lower extremities images, DLR with the CE-boost technique could decrease the image noise and improve the CT values, SNR, CNR, and subjective image scores. AiCE-boost images received the highest subjective image quality score and were more readily accepted by radiologists.
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Medios de Contraste , Aprendizaje Profundo , Extremidad Inferior , Flebografía , Humanos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Anciano , Flebografía/métodos , Adulto , Algoritmos , Trombosis de la Vena/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Vena Poplítea/diagnóstico por imagen , Várices/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Dosis de Radiación , Angiografía por Tomografía Computarizada/métodos , Anciano de 80 o más Años , Intensificación de Imagen Radiográfica/métodosRESUMEN
Femoral vein is increasingly used for venous cannulation procedures. Its anomalies in the femoral triangle could complicate these procedures. We report an extremely rare type of femoral venous ladder observed during routine cadaveric dissections. The variation was found in the left lower limb of an adult male cadaver aged 70 years. The femoral vein was a single vein in initial 3 cm and terminal 4 cm of its course. The middle part of the vein showed a duplication and a complex ladder pattern and encircled the femoral artery in the femoral triangle. This anomaly could predispose the vein for deep vein thrombosis. Knowledge of this anomaly could be useful during radiological procedures, femoral hernia repair and femoral triangle abscess and lymph node clearance.
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Variación Anatómica , Cadáver , Arteria Femoral , Vena Femoral , Humanos , Masculino , Vena Femoral/anomalías , Vena Femoral/diagnóstico por imagen , Anciano , Arteria Femoral/anomalías , Arteria Femoral/diagnóstico por imagen , DisecciónRESUMEN
An enlarged iliopectineal bursa (IB) can cause pressure on iliofemoral veins. Clinical presentation can manifest as asymmetrical lower extremity edema. This case report demonstrates extensive asymmetrical leg edema caused by femoral vein compression based on iliopectineal bursitis (IB-itis) associated with advanced osteoarthritis (OA) of the left hip joint with an outline of relevant current literature. A female patient presented with left hip pain and edema in the leg. X-ray showed severe OA of the left hip. Computed Tomography (CT) concluded a cystic abnormality at the left iliopsoas muscle associated with the joint consistent with IB-itis, associated with a degenerative left hip joint. Hybrid total hip replacement was performed. At three-month follow-up her left leg showed no longer signs of extensive edema and she walked without the use of walking aids. IB-itis is mostly associated with rheumatoid arthritis (RA). There are no reports which only describe OA as cause of IB-itis. Extensive asymmetrical leg edema can be caused by venous compression of the femoral vein by an IB-itis. If the latter is the consequence of advanced hip OA, a total hip replacement can yield excellent clinical outcomes both functionally and with regard to the edema.
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Artroplastia de Reemplazo de Cadera , Edema , Osteoartritis de la Cadera , Humanos , Femenino , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Cadera/diagnóstico por imagen , Edema/etiología , Artroplastia de Reemplazo de Cadera/métodos , Bursitis/complicaciones , Pierna , Anciano , Vena Femoral/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The aim of this study was to evaluate if the presence of a pulsatile femoral vein pattern is an indicator of venous congestion in the intensive care unit (ICU). DESIGN: Retrospective observational study. SETTING: Three medico-surgical university-affiliated ICUs. PARTICIPANTS: Adult patients who had an ultrasound evaluation at several time points during their ICU stay: at baseline (within 24 hours of admission to ICU), daily during their ICU stay, and within 24 hours before ICU discharge. INTERVENTIONS: At each time point, the hemodynamic, respiratory, and cardiac ultrasound parameters were recorded. The common femoral vein was studied with pulsed-wave Doppler at the level of the femoral trigonum, with high frequency (5-13 MHz) linear array vascular probe and venous vascular mode, in supine patients. MEASUREMENTS AND MAIN RESULTS: One hundred eight patients who underwent 400 ultrasound evaluations (3.7 ± 1 ultrasound evaluations per patient) during their ICU stay were included. Seventy-nine of 108 patients (73%) had a pulsatile femoral vein pattern at least at 1 time point. The multivariable mixed effects logistic regression model demonstrated an association among pulsatile femoral vein pattern, body mass index (OR: 0.91[95% CI 0.85-0.96], p = 0.002), inferior vena cava mean diameter (OR: 2.35 [95% CI 1.18-4.66], p = 0.014), portal vein pulsatility (OR: 2.3 [95% CI 1.2-4.4], p = 0.012), and congestive renal vein flow pattern (OR: 4.02 [95% CI 2.01-8.03], p < 0.001). The results were confirmed by principal component analysis. CONCLUSION: In the ICU, a pulsatile femoral vein pattern is associated with parameters of venous congestion, independently of the patient's volume status, and ventilatory treatment. These results suggest the femoral vein Doppler pulsatility as a parameter of congestion in ICU patients.
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Vena Femoral , Unidades de Cuidados Intensivos , Flujo Pulsátil , Humanos , Femenino , Masculino , Estudios Retrospectivos , Vena Femoral/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Flujo Pulsátil/fisiología , Hiperemia/diagnóstico por imagen , Hiperemia/fisiopatología , Adulto , Cuidados Críticos/métodosRESUMEN
OBJECTIVE: Spontaneous echo contrast (SEC) is a vascular ultrasound finding associated with increased thromboembolism risk. However, identification requires expert determination and clinician time to report. We developed a deep learning model that can automatically identify SEC. Our model can be applied retrospectively without deviating from routine clinical practice. The retrospective nature of our model means future works could scan archival data to opportunistically correlate SEC findings with documented clinical outcomes. METHODS: We curated a data set of 801 archival acquisitions along the femoral vein from 201 patients. We used a multisequence convolutional neural network (CNN) with ResNetv2 backbone and visualized keyframe importance using soft attention. We evaluated SEC prediction performance using an 80/20 train/test split. We report receiver operating characteristic area under the curve (ROC-AUC), along with the Youden threshold-associated sensitivity, specificity, F1 score, true negative, false negative, false positive and true positive. RESULTS: Using soft attention, we can identify SEC with an AUC of 0.74, sensitivity of 0.73 and specificity of 0.68. Without soft attention, our model achieves an AUC of 0.69, sensitivity of 0.71 and specificity of 0.60. Additionally, we provide attention visualizations and note that our model assigns higher attention score to ultrasound frames containing more vessel lumen. CONCLUSION: Our multisequence CNN model can identify the presence of SEC from ultrasound keyframes with an AUC of 0.74, which could enable screening applications and enable more SEC data discovery. The model does not require the expert intervention or additional clinician reporting time that are currently significant barriers to SEC adoption. Model and processed data sets are publicly available at https://github.com/Ouwen/automatic-spontaneous-echo-contrast.
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Redes Neurales de la Computación , Ultrasonografía , Humanos , Ultrasonografía/métodos , Estudios Retrospectivos , Vena Femoral/diagnóstico por imagen , Aprendizaje Profundo , Femenino , Sensibilidad y Especificidad , MasculinoRESUMEN
BACKGROUND: Intravascular fasciitis (IF) is a benign, reactive, myofibroblastic proliferation that originates from the superficial or deep fascia of small / medium-sized arteries and veins. CASE REPORT: An 8-year-old male patient was admitted to a health center with the complaint of swelling in the inguinal region. Lower extremity venous Doppler ultrasonography showed deep vein thrombosis (DVT) of the femoral vein and anticoagulation with low-molecular weight heparin (LMWH) was initiated. The patient was referred to our center for follow-up. The D-dimer level was detected within normal limits. Doppler ultrasonography was repeated and showed an intraluminal expanding mass lesion with increasing vascularity, without distinct borders and LMWH was discontinued. This lesion at the sapheno-femoral junction was excised surgically and the histopathological examination revealed intravascular fasciitis. CONCLUSION: Clinicians should be aware that the clinical findings of IF may mimic sarcoma and thrombosis.
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Fascitis , Trombosis , Trombosis de la Vena , Masculino , Niño , Humanos , Trombosis de la Vena/diagnóstico por imagen , Heparina de Bajo-Peso-Molecular/uso terapéutico , Vena Femoral/diagnóstico por imagen , Fascitis/diagnóstico por imagenRESUMEN
PURPOSE: To report 3-year outcomes from a prospective, multicenter, nonrandomized, single-arm study designed to assess the safety and effectiveness of the Zilver Vena Venous Stent for the treatment of symptomatic iliofemoral venous outflow obstruction. MATERIALS AND METHODS: The VIVO study included patients with symptomatic obstruction of 1 iliofemoral venous segment (ie, 1 limb), characterized by a Clinical, Etiological, Anatomic, Pathophysiology (CEAP) clinical classification of ≥3 or a Venous Clinical Severity Score (VCSS) for pain of ≥2. Patients were retrospectively grouped based on baseline clinical presentation as postthrombotic syndrome (PTS), nonthrombotic iliac vein (NIVL) obstruction, or acute deep vein thrombosis (aDVT). Clinical improvement was assessed by change in VCSS, Venous Disability Score, Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) scores, and CEAP C classification. Stent performance was evaluated by rates of patency by ultrasound (US), freedom from clinically driven reintervention, and freedom from stent fracture. RESULTS: The 3-year results for the 243 patients in the VIVO cohort included a 90.3% rate of patency by US and a 92.6% rate of freedom from clinically driven reintervention. The 3-year rates of patency by US for the NIVL, aDVT, and PTS groups were 100%, 84.0%, and 86.1%, respectively. Sustained clinical improvement through 3 years was demonstrated by changes in VCSS, Venous Disability Score, CIVIQ-20, and CEAP C classification. No stent fractures were observed. CONCLUSIONS: The VIVO study demonstrated sustained high rates of patency and freedom from clinically driven reintervention and improvements in venous clinical symptoms through 3 years. Each patient group (NIVL, aDVT, and PTS) showed clinical improvement and sustained patency through 3 years; some variation existed among groups (eg, only the NIVL group had a 100% patency rate).
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Procedimientos Endovasculares , Vena Femoral , Vena Ilíaca , Síndrome Postrombótico , Diseño de Prótesis , Stents , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Persona de Mediana Edad , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Resultado del Tratamiento , Estudios Prospectivos , Factores de Tiempo , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Síndrome Postrombótico/fisiopatología , Síndrome Postrombótico/terapia , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/etiología , Anciano , Adulto , Trombosis de la Vena/terapia , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/diagnóstico por imagen , Estados Unidos , Calidad de Vida , Evaluación de la DiscapacidadAsunto(s)
Fístula Arteriovenosa , Oclusión con Balón , Arteria Femoral , Vena Femoral , Enfermedad Iatrogénica , Humanos , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/terapia , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/lesiones , Vena Femoral/diagnóstico por imagen , Vena Femoral/lesiones , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/terapia , Masculino , Femenino , Persona de Mediana EdadAsunto(s)
Aneurisma Falso , Fístula Arteriovenosa , Arteria Femoral , Vena Femoral , Enfermedad Iatrogénica , Humanos , Aneurisma Falso/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Arteria Femoral/cirugía , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/lesiones , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Masculino , Angiografía por Tomografía Computarizada , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía , FemeninoRESUMEN
INTRODUCTION/OBJECTIVES: Behçet's disease (BD) affects both arterial and venous vessels. We have previously shown that common femoral vein wall thickness (WT) is increased in BD and can be used as a diagnostic test. However, there is limited data assessing large veins. Therefore, this study seeks to assess inferior vena cava wall thickness (IVC) by transthoracic echocardiography (TTE) in BD compared to healthy controls (HC). METHODS: Age- and gender-matched 70 BD patients and 51 HC were included. IVC wall thickness and common femoral vein WT were measured by TTE and Doppler ultrasonography, respectively. All examinations were performed on the same day as the clinical assessment. RESULTS: The mean IVC wall thickness of BD patients was significantly higher than HC (2.9 mm (0.3) vs 2.6 mm (0.3), p < 0.001). Patients with mucocutaneous involvement (2.8 mm (0.3)) and major organ involvement (2.9 mm (0.3)) had significantly thicker walls compared to HC (p = 0.003, p < 0.001, respectively). IVC wall thickness was higher in patients with vascular involvement compared to those with nonvascular major organ involvement (3.1 mm (0.3) vs 2.8 mm (0.2), p = 0.04). There was a moderate correlation between IVC and common femoral vein WT (r = 0.49 for the right, r = 0.43 for the left, p = 0.01 for both). CONCLUSION: This study shows that venous wall inflammation is not limited to lower extremity veins and is also present in IVC walls of BD patients regardless of IVC involvement. Vascular wall inflammation is probably a widespread vascular event of all venous walls in BD. Key Points ⢠Venous wall inflammation is not limited to lower extremity veins and is present also in IVC wall in Behçet's disease. ⢠Extensive venous wall inflammation in Behçet's disease includes large venous structures despite not being clinically involved.
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Síndrome de Behçet , Humanos , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Inflamación/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Extremidad Inferior/diagnóstico por imagenRESUMEN
PURPOSE: To report 36-month outcomes and subgroup analysis of the ABRE study evaluating the safety and effectiveness of the Abre venous self-expanding stent system for the treatment of symptomatic iliofemoral venous outflow obstruction disease. METHODS: The ABRE study was a prospective, multicenter, nonrandomized study that enrolled and implanted Abre venous stents in 200 participants (mean age 51.5 years [SD ± 15.9], 66.5% women) with symptomatic iliofemoral venous outflow obstruction at 24 global sites. Outcomes assessed through 36 months included patency, major adverse events, stent migration, stent fracture, and quality-of-life changes. Adverse events and imaging studies were adjudicated by independent clinical events committee and core laboratories, respectively. RESULTS: Primary, primary-assisted, and secondary patency through 36 months by Kaplan-Meier estimates were 81.6%, 84.8%, and 86.3%, respectively. The cumulative incidence of major adverse events through 36 months was 10.2%, mainly driven by 12 thrombosis events. Subgroup analyses demonstrated a primary patency of 76.5% in the acute deep vein thrombosis group, 70.4% in the postthrombotic syndrome group, and 97.1% in the nonthrombotic iliac vein lesion group through 36 months. The overall mean lesion length was 112.4 mm (SD ± 66.1). There were no stent fractures or migrations in this study. Quality of life and venous functional assessments demonstrated significant improvements from baseline to 36 months across all patient subsets. CONCLUSIONS: Results from the ABRE study demonstrated sustained patency with a good safety profile after implantation of a dedicated venous stent in patients with symptomatic iliofemoral venous outflow obstruction disease.
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Procedimientos Endovasculares , Vena Femoral , Vena Ilíaca , Diseño de Prótesis , Calidad de Vida , Stents , Grado de Desobstrucción Vascular , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Síndrome de May-Thurner/diagnóstico por imagen , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/fisiopatología , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/fisiopatología , Síndrome Postrombótico/etiología , Síndrome Postrombótico/terapia , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/terapiaRESUMEN
OBJECTIVES: We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. METHOD: We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. RESULTS: Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. CONCLUSIONS: CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD.
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Síndrome de Behçet , Vena Femoral , Posición de Pie , Ultrasonografía Doppler , Humanos , Síndrome de Behçet/diagnóstico por imagen , Masculino , Femenino , Adulto , Posición Supina , Vena Femoral/diagnóstico por imagen , Persona de Mediana Edad , Estudios de Casos y ControlesRESUMEN
BACKGROUND: Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein. OBJECTIVE: This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm. METHODS: In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review. RESULTS: The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence). CONCLUSION: Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken.
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Cateterismo Venoso Central , Venas Yugulares , Metaanálisis en Red , Vena Subclavia , Ultrasonografía Intervencional , Humanos , Cateterismo Venoso Central/métodos , Ultrasonografía Intervencional/métodos , Vena Subclavia/diagnóstico por imagen , Venas Yugulares/diagnóstico por imagen , Cuello/irrigación sanguínea , Cuello/diagnóstico por imagen , Vena Femoral/diagnóstico por imagen , Vena Axilar/diagnóstico por imagen , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Venous thromboembolism (VTE), notably deep venous thrombosis (DVT), represents a significant cardiovascular disease with high morbidity from post-thrombotic syndrome (PTS). Recent advancements in early thrombus removal technologies have prompted randomized controlled trials (RCT) to assess their efficacy and safety, particularly for iliofemoral DVT (IF-DVT), which carries the greatest risk of developing PTS. This narrative review summarizes these trials and introduces upcoming innovations to evaluate acute intervention for IF-DVT. Specific technologies discussed include catheter-directed thrombolysis, pharmacomechanical catheter-directed thrombolysis, ultrasound-accelerated catheter-directed thrombolysis, and non-lytic mechanical thrombectomy. This review underscores the importance of patient selection, with those presenting with extensive, symptomatic IF-DVT likely to benefit most.
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Síndrome Postrombótico , Trombosis de la Vena , Humanos , Terapia Trombolítica/efectos adversos , Vena Femoral/diagnóstico por imagen , Vena Ilíaca/diagnóstico por imagen , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como Asunto , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombectomía/efectos adversos , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/etiología , Síndrome Postrombótico/terapia , Enfermedad AgudaRESUMEN
Endovascular treatment of iliofemoral deep vein thrombosis (IF DVT) can become more complex when thrombus extends below the knee. This article discusses various techniques that can be used to treat IF DVT with distal involvement.
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Cateterismo Periférico , Procedimientos Endovasculares , Trombosis de la Vena , Humanos , Terapia Trombolítica/métodos , Vena Femoral/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Procedimientos Endovasculares/efectos adversos , Vena Ilíaca/diagnóstico por imagen , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aims to investigate the anatomical variations in femoral vasculature and evaluate the clinical value of ultrasound-guided femoral vein puncture in catheter ablation procedures. METHODS: In this retrospective analysis conducted from January 2023 to March 2023, we examined data from patients who underwent catheter ablation with ultrasound-guided femoral venipuncture. We evaluated the anatomy of the femoral vasculature at both high and low inguinal levels. Based on the relationship between the femoral vein and artery, we classified the anatomy into four types: Type I (vein parallel to artery without overlap), Type II (vein medial to artery with lumen overlap ≤50%), Type III (vein posterior to artery with lumen overlap > 50%), and Type IV (vein lateral to artery). Additionally, we assessed procedure-related vascular complications that required interventions or prolonged hospital stays. RESULTS: A total of 254 patients were included in this study. At the upper inguinal level, most cases (92.5%) exhibited Type II, followed by Type I (6.5%), while Type III (0.6%) and IV (0.4%) were less common. At the lower inguinal level, Type II accounted for 70.7%, there was a significantly higher proportion of Type III (23.4%) and Type IV (5.9%). The overall complication rate was 0.4%, no pseudoaneurysm or hematoma was observed in our study. CONCLUSION: Our study revealed significant anatomical variations in the relationship between the femoral vein and femoral artery. Ultrasound-guided femoral venipuncture significantly reduced vascular complication rate, making it a valuable tool for guiding puncture procedures.
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Ablación por Catéter , Flebotomía , Humanos , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Estudios Retrospectivos , Arritmias Cardíacas , Punciones/métodos , Arteria Femoral/cirugía , Arteria Femoral/diagnóstico por imagen , Ultrasonografía IntervencionalRESUMEN
OBJECTIVE: To compare the comparative effects of treatment with contemporary mechanical thrombectomy (MT) or anticoagulation (AC) on Villalta scores and post-thrombotic syndrome (PTS) incidence through 12 months in iliofemoral deep vein thrombosis (DVT). METHODS: Patients with DVT in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) randomized trial and the ClotTriever Outcomes (CLOUT) registry were included in this analysis. Both studies evaluated the effects of thrombus removal on the incidence of PTS. Patients with bilateral DVT, isolated femoral-popliteal DVT, symptom duration of >4 weeks, or incomplete case data for matching covariates were excluded. Propensity scores were used to match patients 1:1 who received AC (from ATTRACT) with those treated with mechanical thrombectomy (from CLOUT) using nearest neighbor matching on nine baseline covariates, including age, body mass index, leg treated, provoked DVT, prior venous thromboembolism, race, sex, Villalta score, and symptom duration. Clinical outcomes, including Villalta score and PTS, were assessed. Logistic regression was used to estimate the likelihood of developing PTS at 12 months. RESULTS: A total of 164 pairs were matched, with no significant differences in baseline characteristics after matching. There were fewer patients with any PTS at 6 months (19% vs 46%; P < .001) and 12 months (17% vs 38%; P < .001) in the MT treatment group. Modeling revealed that, after adjusting for baseline Villalta scores, patients treated with AC had significantly higher odds of developing any PTS (odds ratio, 3.1; 95% confidence interval, 1.5-6.2; P = .002) or moderate to severe PTS (odds ratio, 3.1; 95% confidence interval, 1.1-8.4; P = .027) at 12 months compared with those treated with MT. Mean Villalta scores were lower through 12 months among those receiving MT vs AC (3.3 vs 6.3 at 30 days, 2.5 vs 5.5 at 6 months, and 2.6 vs 4.9 at 12 months; P < .001 for all). CONCLUSIONS: MT treatment of iliofemoral DVT was associated with significantly lower Villalta scores and a lower incidence of PTS through 12 months compared with treatment using AC. Results from currently enrolling clinical trials will further clarify the role of these therapies in the prevention of PTS after an acute DVT event.
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Anticoagulantes , Vena Femoral , Vena Ilíaca , Síndrome Postrombótico , Trombectomía , Trombosis de la Vena , Humanos , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Femenino , Masculino , Persona de Mediana Edad , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/etiología , Síndrome Postrombótico/terapia , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Resultado del Tratamiento , Trombectomía/efectos adversos , Factores de Tiempo , Anciano , Factores de Riesgo , Sistema de Registros , Adulto , Incidencia , Modelos Logísticos , Puntaje de Propensión , Terapia Trombolítica/efectos adversosRESUMEN
Stenting has become the first line of treatment for symptomatic chronic iliofemoral venous obstruction in patients with quality-of-life-impairing clinical manifestations who have failed conservative therapy. Patient selection for such intervention is, however, dependent on clear identification of relevant clinical manifestations and subsequent testing to confirm the diagnosis. In this regard, the physician engaged in management of such patients needs to be well-aware of symptoms and signs of chronic iliofemoral venous obstruction, and instruments used to grade chronic venous insufficiency and determine quality of life, in addition to diagnostic tests available and their individual roles. This review serves to provide an overview of the diagnosis of chronic iliofemoral venous obstruction and patient selection for stenting.