Anomalies of Inferior Vena Cava: Implications and Considerations in Retroperitoneal Surgical Procedures.

Anomalies of the inferior vena cava pose a great challenge to surgeons. Although uncommon, these congenital vascular malformations may have significant surgical implications. Awareness of their presence is essential to avoid inadvertent injury and major bleeding during retroperitoneal procedures. An accurate preoperative diagnosis and detailed planning play a crucial role to obtain successful outcomes when confronted with them. Several surgical techniques have been recommended to protect these anomalous venous structures. The aim of this review is to contribute to the knowledge of the most common types of anomalies of inferior vena cava encountered during retroperitoneal procedures. With this purpose, a summary of their anatomy, embryology, incidence, diagnosis and intra-operative management is presented.

Ergotism: a change of persepective.

Clinical ergotism is a rare disorder, and clinical and therapeutic implications have continued to attract attention. The Holy Fire or St. Anthony's Fire was the primary vascular manifestation, causing burning pain and gangrene in the feet and hands related to the arterial spasm properties of ergot. The chronic use of ergotamine and migraine has also been associated with ergotism. Severe vasospasm and acute peripheral ischemia of the extremities can develop. However, in modern times, the spectrum of poisoning by alkaloids has broadened to include antiviral therapies in patients with HIV and abuse of stimulants. These changes have made taking an accurate medical history and conducting an accurate detailed differential diagnosis more essential. The purpose of this review is to highlight the importance of ergotism as a cause of peripheral vascular ischemia and analyze changes associated with this poisoning.

Surgical treatment of hemodialysis-related central venous stenosis or occlusion: another option to maintain vascular access.

BACKGROUND: The most common cause of graft failure in patients undergoing hemodialysis is outflow venous stenosis. Long-term compromise of venous central trunks must be resolved. PURPOSE: This study was undertaken to evaluate an unusual surgical option, bypass to decompress a long-term vascular graft to the femoral vein, improving venous outflow, alleviating symptoms of venous hypertension, and restoring vascular integrity for dialysis. PATIENTS AND METHODS: The study included 3 patients with end-stage renal disease with signs and symptoms of dysfunctioning grafts. Angiographic studies showed occlusion or stricture of the central venous tract and venous outflow compromise. All patients had multiple temporary and long-term vascular access sites for hemodialysis, which were revised several times. Venous decompression was performed with a bridge to the ipsilateral femoral vein. A 6 mm reinforced polytetrafluoroethylene graft was tunneled subcutaneously along the thoracoabdominal wall. Patients were released 48 hours after the procedure, and periodic follow-up was carried out to detect changes in graft patency and function. RESULTS: There were no preoperative or intraoperative complications. Clear improvement in signs and symptoms of venous hypertension were observed. Venous pressures decreased. Average follow-up was 16.3 months. In 1 patient the new graft malfunctioned, and it was revised and repaired at 25 months. The presence of deep venous thrombosis and pulmonary embolism required peritoneal dialysis. Two other patients, with no change in graft patency, died of concomitant disease. CONCLUSION: Decompression of the femoral vein enables preservation of vascular graft patency and improves symptoms of venous hypertension.