Real-world short-term VenaSeal ablation outcomes for symptomatic saphenous incompetence.

OBJECTIVE: Chronic venous insufficiency is a common vascular condition with significant resultant patient morbidity. There has been a shift towards minimally invasive treatment modalities with VenaSeal endovenous ablation among the more recent treatment modalities introduced. Long-term outcome data for this treatment modality is not widely available yet. We aim to report 6-week patient outcomes over a 5-year period from a high-volume tertiary vascular centre. METHODS: This is a retrospective, single-centre study reporting short-term outcomes following VenaSeal endovenous ablation for symptomatic saphenous incompetence. Patients were followed-up at 6-weeks post-procedurally by telemedicine or in-person clinic appointment without routine venous ultrasound assessment. RESULTS: We report outcomes for 235 patients during this study period. All patients tolerated the procedure under local anaesthesia. Average age was 60.5 years (29-82 years) with slight male predominance (55.7%). The majority were New Zealand European (63.8%). Mean body mass index was 28.5 (22.2-41.4). We report a 21% rate of self-limiting phlebitis and 33 minor complication events. These include 15 cases of residual varicose veins, 9 saphenous nerve neuropraxia, 6 cases of puncture-site cellulitis and 3 deep vein thromboses. Patient demographics and primary surgeon did not have a statistically significant outcome on development of complications. CONCLUSION: We report that VenaSeal endovenous ablation is a safe and effective method of treatment for symptomatic truncal saphenous vein incompetence. We report safely managing post-operative phlebitis conservatively and find a mixture of clinical and phone clinic follow-up sufficient without requirement for objective duplex ultrasound following the procedure to ensure objective saphenous vein closure.

Partial hepatectomy for treatment of multiple liver abscess in a calf: a case report.

BACKGROUND: Umbilical vein bacterial infections may cause liver abscesses during bacterial ascent. A single liver abscess can be surgically treated by marsupialization, but a risk of recurrence or non-healing remains. Moreover, there is no effective treatment for multiple abscesses. CASE PRESENTATION: A 17-day-old Holstein female calf exhibited reduced general condition, swelling and drainage of the umbilicus, and pressure sores in the area of the carpus, resulting in reluctance to stand up. The umbilicus showed pain at palpation; deep abdominal palpation indicated a swollen umbilical vein coursing from the umbilicus toward the liver. Ultrasonography confirmed a swollen umbilical vein with pus accumulation and multiple abscesses in the liver. Contrast-enhanced computed tomography (CT) examination confirmed that the swollen umbilical vein with fluid continued to the liver, and multiple unenhanced lesions, most likely abscesses, were confirmed in the liver. Partial hepatectomy was performed to remove as many abscesses as possible. For the resection, a vessel sealing device (LigaSureTM) was used to excise a part of the left liver lobe. As we could not remove all the abscesses in the liver during the operation, cefazolin sodium (5 mg/kg) was administered for 14 days after surgery. Post-operatively, blood accumulation was observed in the abdominal cavity, but no signs of peritonitis were found. The calf returned to the farm on day 38 after surgery. Follow-up information was obtained after 1 year, and complications were not reported. CONCLUSIONS: To our knowledge, this is the first report of partial hepatectomy using a vessel sealing device for a calf with multiple liver abscesses. This case report suggests that the combination of partial hepatectomy and long-term administration of antibacterial drugs may restore the health of calves with multiple liver abscesses.

Surgical Management of Omphalophlebitis and Long Term Outcome in Calves: 39 Cases (2008-2013).

OBJECTIVE: To describe and evaluate the surgical management of omphalophlebitis and to report the short and long term outcomes in calves. STUDY DESIGN: Retrospective case series. ANIMALS: Calves (n = 39). METHODS: Medical records (2008-2013) of calves diagnosed with omphalophlebitis and that underwent surgical correction were reviewed. Short term (hospital discharge) and long term (≥6 months after surgery) survival rates were obtained. Descriptive statistics were used to describe the population and a Fisher's exact test was used to evaluate the relationship between clinical signs, surgical management, and outcome. RESULTS: Thirty-nine calves (median age 30 days) were included in the study. Eleven calves had septic arthritis associated with omphalophlebitis and 18 had evidence of liver abscesses on ultrasound. Complete surgical en bloc resection was achieved in 18 calves and umbilical vein marsupialization was performed on the other 21 calves. Thirty-five calves were discharged from the hospital and long term followup was obtained for 30 of them. Twenty-nine animals were performing according to the owner's expectation at least 6 months after surgery (14 for marsupialization and 15 for en bloc resection). A better prognosis was detected when en bloc resection was performed (100% survival); however, when marsupialization was performed, the prognosis was good (74%; P = .05). Septic arthritis had a significant negative effect on overall survival (P < .001). CONCLUSION: The overall survival is good with both surgical options, and even calves with liver involvement and septic arthritis associated can be successfully treated with a combination of long term antibiotics and umbilical vein marsupialization.

Segmental colitis caused by idiopathic myointimal hyperplasia of mesenteric veins.

Diseases causing colonic ischemia may be mistaken with other causes of segmental colitis such as inflammatory bowel disease, especially in young patients. The authors present the case of a 47-year-old male with severe proctosigmoiditis. Assessment excluded infectious causes, thrombophilia and systemic vasculitis. The initial histological specimen was suggestive of inflammatory bowel disease and therapy was initiated with intravenous steroids and, at day 5, infliximab, with no response. The patient was proposed for surgery. Pathological examination of the surgical specimen revealed an idiopathic myointimal hyperplasia of mesenteric veins, a rare entity exhibiting necrotizing phlebitis with rapid progression to segmental necrosis in the rectosigmoid colon. In this paper the authors discuss the differential diagnosis of proctosigmoiditis in young ages and the approach to this exceptionally rare ischemic entity.

MANAGEMENT OF OMPHALOPHLEBITIS AND UMBILICAL HERNIA IN THREE NEONATAL GIRAFFE (GIRAFFA CAMELOPARDALIS).

Umbilical disorders, including omphalophlebitis, omphaloarteritis, external umbilical abscesses, urachal abscesses, patent urachus, and umbilical hernias, represent a significant challenge to the health and well-being of a neonate. The three neonatal giraffe (Giraffa camelopardalis) in this report were evaluated for umbilical swellings. Two developed omphalophlebitis, and one had an uncomplicated umbilical hernia. Omphalophlebitis is an inflammation and/or infection of the umbilical vein. Giraffe calves with a failure of passive transfer may be predisposed and should be thoroughly evaluated for the condition. Umbilical hernias result from a failure of the umbilical ring to close after parturition or from malformation of the umbilical ring during embryogenesis. These problems were surgically corrected for all three individuals, although one died due to postsurgical complications. The risks involved include anesthetic complications, surgical dehiscence, and maternal rejection. Early detection and surgical intervention are recommended for the correction of omphalophlebitis and umbilical hernias in neonatal giraffe.

Abdominal wall phlebitis due to Prevotella bivia following renal transplantation in a patient with an occluded inferior vena cava.

Pre-existing occlusion of the inferior vena cava may complicate renal transplantation. Suppurative abdominal wall phlebitis following renal transplantation was diagnosed in a patient with pre-existing thrombosis of the inferior vena cava of unknown cause. The phlebitis developed in the subcutaneous collateral veins of the abdominal wall contra-laterally to the renal transplant. Cultures from abdominal wall micro-abscesses yielded Prevotella bivia as the causative agent. This complication has not been described before in the context of renal transplantation. The pathogenesis and management of this serious complication are discussed in this paper.

Enterocolic lymphocytic phlebitis with marked myointimal hyperplasia and perivenous concentric fibrosis.

Enterocolic lymphocytic phlebitis (ELP) is a rare enteropathy characterized by lymphocytic phlebitis of the mesenteric veins without arteritis. Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare disease similar to ELP, characterized by myointimal hyperplasia that constricts the lumen of veins, causing mucosal injury. A 62-year-old man with chief complaint of abdominal pain was treated by partial resection of the ileum after 3 months of conservative therapy. The pathologic diagnosis was ELP with prominent myointimal hyperplasia. Histologically, the lesion consisted of lymphocytic infiltration into the vein accompanied by prominent myointimal hyperplasia and perivenous concentric fibrosis, which are characteristics shared by ELP and IMHMV. The observations in this case suggest that some of ELP and IMHMV may belong to the same disease spectrum. Furthermore, perivascular concentric fibrosis was a remarkable observation that may contribute to differential diagnosis between ELP and "true" IMHMV.

Enterocolic lymphocytic phlebitis: statistical analysis of histology features in viable and ischemic bowel.

Enterocolic lymphocytic phlebitis is a rare cause of segmental ischemic enterocolitis. This artery-sparing transmural vasculitis is classically a circumferential phlebitis with perivenular lymphocyte cuffing and thrombi in the absence of systemic manifestations. Myointimal hyperplasia may represent a chronic phase of enterocolic lymphocytic phlebitis. Subclinical or early stage enterocolic lymphocytic phlebitis is not well delineated. We analyzed 600 submucosal and subserosal veins from both ischemic and intact bowel segments to discern if vascular morphology varied between sites. Crescentic and circumferential lymphocytic phlebitis is more common in viable bowel than in the ischemic segment. A nonsignificant trend was found for increased crescentic morphology between intact bowel remote from the ischemic focus compared with that adjacent to the ischemic focus. Hallmarks of ischemic bowel are necrotizing phlebitis and thrombi formation. Thrombophlebitis morphology is distinctly different in viable and ischemic bowel, changing from the classic lymphocytic to necrotizing lesions respectively.

[Phlegmasia caerulea dolens: therapeutic considerations]. / Flegmasia cerulea dolens: considerações terapêuticas.

Phlegmasia caerulea dolens is a rare complication of a deep venous thrombosis and is the result of a massive occlusion of all venous outflow of the extremity. Diagnosis must be made early in the course of the process for treatment effectiveness although it can only produce modest results. The authors analyse retrospectively 3 cases that were treated between 2001 and 2005. The three patients suffered from malignancies (2 from lung and one fom prostate). In all patients a venous thrombectomy was performed and the method employed was described, which includes the systematic use of a caval filter. Two patients coursed with good results, with complete resolution or minor amputation. However, one patient needed an above knee amputation. The authors concluded that the time that mediate to the precise diagnosis and the best option of treatment are important determinations on the results, that however are very dependent on the etiology of this clinical situation.

Intramural mesenteric venulitis. A new cause of intestinal ischaemia.

Venous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel. Extramural mesenteric veins appeared dilated and congested, without evidence of thrombotic occlusion or of inflammatory involvement. The patient, who was not taking any long-term medication and had no clinical evidence of collagen-vascular disease, promptly recovered after surgery. Follow-up for 7 months with no recurrences suggested a self-limited or indolent process. We propose the name 'intramural mesenteric venulitis' for this condition and believe that it could represent one extreme (the microscopic variant or intramural phase) of the spectrum comprising entero-colic phlebitis and mesenteric inflammatory veno-occlusive disease. The immunohistochemical evidence of a marked preponderance of T phenotype in the perivenular lymphocytes suggests lymphocyte-mediated vascular damage as the pathogenesis of the lesion.

The substitute "valve" operation by technique II in patients with postthrombotic syndrome.

The substitute "valve" operation with use of a silicone tendon designed to produce a valvelike mechanism in the popliteal veins of 29 patients with 31 postphlebitic limbs caused by reflux in the deep veins is described. The results have been assessed by measurements, taken during ambulation, of venous pressure before operation, 1 week after operation, and 1 year after operation and by phlebography. In 29 limbs there was clinical improvement associated with improvement in the venous pressure assessed during ambulation and phlebographic evidence of a functioning substitute valve.

Superior vena cava bypass: use of the azygos vein.

Unexpected involvement of the superior vena cava with dense inflammatory and fibrous tissue was encountered during right pneumonectomy for a T3 N0 M0 squamous cell carcinoma. After expeditiously completing the lung resection, the azygos vein was utilized for a successful superior vena cava bypass.

[Evaluation of the extension of iliac or iliocaval phlebitis. Value of tomodensitometry]. / Bilan d'extension des phlébites iliaques ou ilio-caves. Apport de la tomodensitométrie.

Before operating on a case of iliac or ilio-caval phlebitis with or without pulmonary embolism, three questions need to be asked about the condition of the inferior vena cava: is it involved? is there a local cause? where is the superior pole of the thrombus in relation to the renal veins? The study of 10 cases of recent phlebitis benefitting from phlebography and C.T. scan reveals the value of this investigation. In 7 cases the condition of the lumen of the inferior vena cava was defined and in the 3 cases in which it was thrombosed, the position of the thrombus in relation to the renal veins was visualised. In 2 cases, the inferior vena cava was laminated by an extrinsic compression which was defined by the C.T. In only one case was the vena cava not seen, due to the presence of a large collateral channel. The indications for C.T. scan should remain selective: cases where direct ilio-cavography is impossible and where descending cavography is undesirable or impossible.

Enterocolic lymphocytic phlebitis: a case report.

We report the case of a patient with intestinal ischaemia and necrosis resulting from vasculitis of mesenteric veins and their intramural tributaries. This patient was otherwise healthy, had no prior history of inflammatory bowel disease nor clinical evidence of extra intestinal involvement or systemic vasculitis, and since four years, was treated with hydroxyethyl rutoside (Venoruton). He recovered completely after segmental resection of the affected portion of the bowel and had no recurrence of intestinal symptoms on follow-up of up to three years. The histopathological diagnostic hallmarks of this clinical entity are extensive lesions of lymphocytic phlebitis associated with thrombi of different ages and focal fibrinoid necrosis while arteries and arterioles are not affected. This unusual form of vasculitis affecting veins only is very rare and its etiology unknown.

[Heparin-induced thrombocytopenia. Practical management of vascular complications]. / Thrombopénies induites par l'héparine. Attitude pratique face aux complications vasculaires.

The authors report 23 cases of heparin-induced thrombocytopenia with vascular complications. The clinical presentation consisted of arterial ischaemia in 16 cases, hemiplegia in 1 case, 4 cases of blue thrombophlebitis, 1 case of bilateral thrombophlebitis, 1 case of pulmonary embolism. The vascular surgeon faced with such emergency complications must be aware of the difficulties of clinical (atypical forms) and laboratory diagnosis (unreliability of platelet aggregability tests). Arterial occlusions are generally accessible to treatment with a Fogarty catheter during an operation performed without the use of heparin. The excessively frequent delay in diagnosis explains the severity of these complications and 2 deaths, 1 case of paraplegia, 4 cases of amputation secondary to arterial occlusion, 4 cases of severe postphlebitis disease, including 2 cases requiring transmetatarsal amputation and one case of pulmonary sequelae after pulmonary embolism were observed in our series of 23 patients. The diagnosis of heparin-induced thrombocytopenia requires immediate discontinuation of heparin therapy. Replacement by low molecular weight heparin is not devoid or risks and can only be considered with a negative platelet aggregability test (in the presence of low molecular weight heparin). As these test can be rarely performed as an emergency procedure, the use of rapid-acting oral anticoagulants appears to be the most reliable solution. The place of platelet antiaggregants and partial interruption of the inferior vena cava is discussed.

[A case of Mondor's disease of the penis].

A case of Mondor's disease of the penis in a 40-year-old man is reported. The patient complained of a small subcutaneous induration (0.5 x 1.0 cm) with slight tenderness in the dorsal region of the penile shaft. On examination, the linear cord was palpated running both distally and proximally from the induration. This lesion was removed under local anesthesia, and the induration and the cord were found to be part of the superficial dorsal vein of the penis. The venous wall was thick and the thrombus was packed in it. Histological findings showed the proliferation of connective tissue of the vessel wall and partially granulating thrombus in the canal. From these findings, we confirmed the diagnosis of Mondor's disease of the penis. The etiology of this disease, especially in comparison with non-venereal sclerosing lymphangitis of the penis (N.S.L.P.) is discussed.

[Surgical indications in the phlebopathic patient. The role of air plethysmography]. / L'indicazione chirurgica nel paziente flebopatico. Ruolo della pletismografia ad aria.

A previous history of deep venous thrombosis (DVT) must be carefully evaluated in every patient affected by chronic venous insufficiency (CVI); the assessment of deep venous system patency is the goal of preoperative diagnosis. Air plethysmography examination allows an outpatient noninvasive testing of calf pump function and deep venous outflow. The authors report the results of a study on 37 patients (40 limbs) with a previous history of DVT, suffering from CVI; in 18 limbs air plethysmography showed a marked increase of calf volume on test exercise, suggesting residual venous obstruction. The authors believe that air plethysmography examination is mandatory before operation in patients with a previous history of DVT.