Present and future options for treatment of infrainguinal deep vein disease.

OBJECTIVE: Management of chronic deep vein disease focuses on the alleviation of reflux and obstruction. For the suprainguinal veins, the main underlying pathologic process is obstruction, which has been recognized as a significant contributor to chronic venous insufficiency. This is currently being addressed with venous stenting and the development of dedicated stents designed for this segment of the venous system. Treatment of the femoropopliteal vein (FPV) is far more challenging because of the idiosyncratic anatomy, the hemodynamic physiology, and the technical aspects of size mismatch and valve flow dynamics in managing deep venous reflux. This review article discusses traditional and emerging technologies to treat infrainguinal disease. METHODS: Previous and current articles addressing this issue were reviewed. Emphasis was placed on emerging techniques and technologies. RESULTS: Significant bench work, in vitro and in vivo studies, have been conducted over the last 40 years addressing the issue of infrainguinal reflux and obstruction. Historically, open procedures to address FPV reflux and obstruction have had variable success in a few centers around the world. The significant increase of emerging endovascular therapies may allow more appropriate, reproducible, widespread treatment of infrainguinal deep venous disease. CONCLUSIONS: Adequate and durable therapies for infrainguinal venous disease represent one of the greatest challenges for a vein specialist. Recently, a cluster of interest and techniques/technologies have been developed. The endovascular management of arterial disease is mature. The endovenous management of infrainguinal disease is on the cusp of meaningful innovation. The purpose of this evidence summary is to describe the options for the management of chronic FPV disease, with emphasis on emerging technologies and techniques.

Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases.

Venous diseases are highly prevalent, mostly caused by valve incompetence and/or obstruction of the vein lumen. Signs and symptoms are diverse and unspecific. Careful clinical assessment and imaging interpretation are crucial to diagnosis. Duplex ultrasound is the first choice and often the gold standard imaging technique for this purpose, providing information on the anatomy and function of the veins. This article describes the sonographic anatomic and hemodynamic criteria used for the diagnosis of venous reflux, venous obstruction, and the most frequent complications after interventions in the superficial, perforating, and deep venous systems.

Diverse management of isolated calf deep venous thrombosis in a university hospital.

BACKGROUND: The management of patients with isolated deep venous thrombosis (DVT) is controversial, leading to overtreatment and undertreatment with several complications and increased cost. The aim of this study was to describe the management of isolated calf DVT (ICDVT) in a university hospital. METHODS: Data on patients with acute DVT in our hospital are prospectively entered in a database through our venous thromboembolism team. All patients had an objective diagnosis with duplex ultrasound (DU) in our accredited vascular laboratory. A retrospective analysis was performed on patients with ICDVT from July 2015 to June 2016. Patients with proximal DVT were excluded. The management of the patients was assessed for use of different types of anticoagulation, use of sequential compression devices, serial follow-up with ultrasound, or any combination. Patients' demographic information, risk factors, calf DVT anatomic location, DVT extension into calf deep veins, DVT propagation to proximal deep veins, and pulmonary embolism were collected as well. RESULTS: There were 159 patients diagnosed with ICDVT in 1 year, of whom 52% were female with a mean age of 59 years. Nearly half of the patients were smokers (48%), 62% had limited or no mobility, 36% had surgery within the past 30 days, and 23% were considered readmissions. Anticoagulation was given to 121 patients who received seven different types of treatment varying from prophylactic dosing to thrombin inhibitors. In the rest of the 38 patients, 28 had a contraindication to anticoagulation and two had an inferior vena cava filter placed. Eighty-six patients had one DU follow-up study, 39 patients had two follow-up studies, and 21 had three follow-up studies. In the 86 patients with one DU study, seven propagated within the calf (8.1%) and two to the proximal veins (2.3%). Two patients developed nonfatal pulmonary embolism (1.2%). Sequential compression devices were applied in 75 patients despite that the majority were receiving anticoagulation and having serial DU examinations. CONCLUSIONS: Significant variation in the management of ICDVT was found on the basis of the physician's preference. The type of treatment overall did not follow a plan based on the patient's risk. Such an approach may increase the cost in the management of these patients without ensuring benefit.

A rare case of idiopathic bilateral ovarian vein thrombosis.

Ovarian vein thrombosis (OVT) is a rare medical disorder most often diagnosed in the peripartum period and maybe associated with other risk factors for thrombosis. Rarely, OVT is considered idiopathic. It occurs in the right ovarian vein alone in two-thirds of patients. In this report, we present a case of idiopathic and bilateral OVT in a 35-year-old woman who presented with 2-day history of left flank pain. Duplex ultrasound imaging and computed tomography confirmed the diagnosis. Oral anticoagulation achieved a favorable outcome.

Hernografia perineal primaria libre de tension: presentacion de un caso / Primary tension-free perineal hernia repair, case presentation

Presentamos un paciente con hernia perineal primaria posterior que fue operado por vía abdominal con una técnica libre de tensión. Se encontraron asociadas hernias inguinocrurales bilaterales recidivantes que fueron tratadas por la técnica de Stoppa. El material protésico utilizado fue el mersilene. Se revisa la bibliografía disponible de esta rara enfermedad