Experimental comparative assay of tensile resistance of greater saphenous vein from ankle and groin.

BACKGROUND: The great saphenous vein is used as patch material in several types of arterial reconstruction, including trauma and carotid and femoral endarterectomy. There have been reports of saphenous patch blowout, particularly of patches constructed with veins harvested from the ankle. There is a need for objective measurement of the resistance of saphenous vein tissues. OBJECTIVES: To measure the tensile strength of the great saphenous vein harvested at the ankle and groin and analyze the correlation between diameter and tissue strength. METHODS: Venous samples were harvested during elective saphenous stripping in patients with symptomatic varicose veins. Only segments without reflux were included. Ten limbs from eight patients were studied, providing 20 samples in total. Venous segments were opened along their longitudinal axis and fitted to electronic traction assay equipment to obtain values for material maximum tension in kilograms-force per square centimeter (kgf/cm2; the maximum force resisted by the segment, divided by its cross-sectional area). RESULTS: The average maximum tension in the ankle saphenous vein group ranged from 74.02 to 190.10 kgf/cm2 and from 13.53 to 69.45 kgf/cm2 in the groin saphenous vein group (p < 0.0001). The Pearson coefficient for the correlation between vein diameter and maximum tension was -0.852 (moderate to strong inverse correlation). CONCLUSIONS: Ankle saphenous vein tissue from female patients operated for varicose veins has significantly higher resistance than saphenous vein tissue from the groin and there is an inverse relation between vein diameter and resistance of tissue from the same population.

Estudo experimental comparativo da resistência tensional da safena magna no tornozelo e na região inguinal / Experimental comparative assay of tensile resistance of greater saphenous vein from ankle and groin

Resumo Contexto A veia safena magna é usada como material de remendo em vários tipos de reconstrução arterial, incluindo no trauma e endarterectomias de carótida e femoral. Houve relatos de ruptura do remendo de safena, particularmente de veias colhidas na região do tornozelo. Há uma necessidade de medição objetiva da resistência tecidual da safena magna. Objetivos Mensurar a força tensional suportada pela veia safena magna e analisar a correlação entre resistência e diâmetro da veia. Métodos As veias foram coletadas durante operações de safenectomia por varizes dos membros inferiores. Foram analisados apenas segmentos sem refluxo. Foram analisados 10 membros de oito pacientes, com um total de 20 espécimes. Os espécimes foram submetidos a ensaio de tração em equipamento eletrônico, obtendo-se os valores de tensão máxima do material em quilogramas-força por centímetro quadrado (kgf/cm2; força máxima dividida pela área de secção transversa do segmento submetido à tração). Resultados A tensão máxima suportada pela veia safena do tornozelo variou de 74,02 a 190,10 kgf/cm2, e a tensão máxima da veia safena da crossa variou de 13,53 a 69,45 kgf/cm2 (p < 0,0001). O coeficiente de correlação de Pearson entre o diâmetro da veia distendida e a tensão máxima suportada foram iguais a -0,852 (correlação inversa moderada a forte). Conclusões A resistência tecidual da veia safena magna do tornozelo é maior do que a da crossa em mulheres submetidas a operação de varizes; há correlação negativa entre o diâmetro da veia e sua resistência tecidual nessa mesma população.

Abstract Background The great saphenous vein is used as patch material in several types of arterial reconstruction, including trauma and carotid and femoral endarterectomy. There have been reports of saphenous patch blowout, particularly of patches constructed with veins harvested from the ankle. There is a need for objective measurement of the resistance of saphenous vein tissues. Objectives To measure the tensile strength of the great saphenous vein harvested at the ankle and groin and analyze the correlation between diameter and tissue strength. Methods Venous samples were harvested during elective saphenous stripping in patients with symptomatic varicose veins. Only segments without reflux were included. Ten limbs from eight patients were studied, providing 20 samples in total. Venous segments were opened along their longitudinal axis and fitted to electronic traction assay equipment to obtain values for material maximum tension in kilograms-force per square centimeter (kgf/cm2; the maximum force resisted by the segment, divided by its cross-sectional area). Results The average maximum tension in the ankle saphenous vein group ranged from 74.02 to 190.10 kgf/cm2 and from 13.53 to 69.45 kgf/cm2 in the groin saphenous vein group (p < 0.0001). The Pearson coefficient for the correlation between vein diameter and maximum tension was -0.852 (moderate to strong inverse correlation). Conclusions Ankle saphenous vein tissue from female patients operated for varicose veins has significantly higher resistance than saphenous vein tissue from the groin and there is an inverse relation between vein diameter and resistance of tissue from the same population.

Spontaneous rupture of superficial femoral artery aneurysm: case report.

Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass.

Ruptura espontânea de aneurisma do segmento médio da artéria femoral superficial: relato de caso / Spontaneous rupture of superficial femoral artery aneurysm: case report

Aneurismas verdadeiros isolados da artéria femoral superficial (AFS) são raros, representando 0,5% dos aneurismas periféricos. Até 2012, existiam relatos na literatura de apenas 103 pacientes com aneurismas verdadeiros isolados da AFS. As principais complicações associadas são: trombose, embolização distal e rotura, sendo a última a mais comum. Os autores relatam o caso de um paciente masculino, de 55 anos, atendido emergencialmente com dor e massa pulsátil em coxa esquerda, condição posteriormente diagnosticada como ruptura de aneurisma da AFS. O paciente foi submetido à correção cirúrgica emergencial com ligadura do aneurisma e revascularização com veia safena magna reversa, com evolução satisfatória

Isolated true aneurysms of the superficial femoral artery (SFA) are rare, accounting for 0.5% of peripheral aneurysms. The literature up to 2012 contains reports of just 103 patients with isolated SFA aneurysms. The main complications are thrombosis, distal embolization, and rupture, which is the most common of the three. The authors report the case of a 55-year-old male patient admitted to the emergency service with pain and a pulsatile mass in the left thigh, subsequently confirmed as rupture of an SFA aneurysm. The patient underwent open aneurysm repair with ligature and revascularization with a reversed saphenous vein bypass

Spontaneous dissection of the renal artery: case report.

Spontaneous renal artery dissection is rare and most cases are considered idiopathic. Previous renal arterial disease may be present in some cases and clinical presentation is often non-specific. Here, the authors present a case of spontaneous renal artery dissection in a 40-year-old male patient with uncontrolled hypertension discovered during investigation of secondary hypertension. Duplex ultrasound initially showed 80% left renal artery stenosis which was shown to be a renal artery dissection during angiography. The patient was successfully managed by percutaneous placement of a renal artery stent.

Anterior tibial artery entrapment syndrome: case report.

Lower extremity intermittent claudication is usually related to atherosclerotic disease. The most common non-atherosclerotic causes are arterites, chronic compartmental syndrome, bone compression, and popliteal entrapment syndrome. The authors report a case of a patient with intermittent claudication related to anterior tibial artery entrapment caused by the interosseous membrane. Magnetic resonance angiography showed compression of the anterior tibial artery during dynamic maneuvers and the patient was managed by releasing the cause of compression, resulting in relief from claudication.

Popliteal vein aneurysm: report of two cases.

Venous aneurysms are rare and often diagnosed incidentally. Popliteal vein aneurysms are the most common type of venous aneurysms and have a strong association with the occurrence of deep vein thrombosis and recurrent pulmonary embolism. This article reports two cases of popliteal vein aneurysms associated with deep vein thrombosis.

Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle.

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Correção endovascular de pseudoaneurisma de tronco tibiofibular secundário a endocardite ­ relato de caso / Endocarditis-related tibioperoneal trunk pseudoaneurysm managed with endovascular treatment ­ case report

Os aneurismas do tronco tibiofibular são raros e consistem principalmente em pseudoaneurismas. Os autores descrevem um caso incomum de pseudoaneurisma do tronco tibiofibular secundário a endocardite bacteriana diagnosticada e tratada vários anos antes. Após a exclusão de um processo infeccioso ativo, o paciente foi tratado com sucesso através do implante percutâneo de um stent recoberto. O tratamento endovascular, neste contexto, apresentou uma alternativa segura e eficaz

ibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment

Tratamento laparoscópico da compressão do tronco celíaco pelo ligamento arqueado do diafragma associado a correção endovascular do aneurisma de artéria pancreatoduodenal: relato de caso / Laparoscopic treatment of celiac axis compression by the median arcuate ligament and endovascular repair of a pancreaticoduodenal artery aneurysm: case report

A compressão do tronco celíaco pelo ligamento arqueado mediano do diafragma pode causar sintomas inespecíficos como dor abdominal, vômitos e emagrecimento. Existe uma associação comprovada entre estenoses ou oclusões do tronco celíaco e aneurismas da artéria pancreatoduodenal. Nas situações em que essa associação ocorre, a estratégia de tratamento deve ser individualizada. Relatamos o caso de uma paciente com aneurisma de artéria pancreatoduodenal associado à compressão do tronco celíaco pelo ligamento arqueado, manejados, respectivamente, por técnicas endovasculares e laparoscópicas

Compression of the celiac axis by the median arcuate ligament of the diaphragm can cause nonspecific symptoms such as abdominal pain, vomiting, and weight loss. There is a known association between stenosis or occlusion of the celiac trunk and aneurysms of the pancreaticoduodenal artery. Treatment strategies for patients who have this association should be selected on a case-by-case basis. We describe the case of a patient with pancreaticoduodenal artery aneurysm associated with compression of the celiac trunk by the arcuate ligament, which were managed with endovascular and laparoscopic techniques, respectively

Dissecção espontânea da artéria renal: relato de caso / Spontaneous dissection of the renal artery: case report

A dissecção espontânea da artéria renal é uma patologia rara que, na maioria dos casos, ocorre de forma idiopática. Em alguns casos, pode estar associada à presença de alterações arteriais prévias. Os sintomas geralmente são discretos e inespecíficos, dificultando o diagnóstico. Os autores relatam o caso de um paciente do sexo masculino, de 40 anos, com quadro de hipertensão arterial não controlada de início recente. Na investigação da etiologia da hipertensão arterial, o eco-Doppler de artérias renais revelou a presença de estenose (> 80%) no terço médio da artéria renal esquerda, e a angiografia evidenciou uma dissecção com dupla luz e redução do calibre do vaso. O paciente foi submetido a tratamento com implante de stent com evolução satisfatória.

Spontaneous renal artery dissection is rare and most cases are considered idiopathic. Previous renal arterial disease may be present in some cases and clinical presentation is often non-specific. Here, the authors present a case of spontaneous renal artery dissection in a 40-year-old male patient with uncontrolled hypertension discovered during investigation of secondary hypertension. Duplex ultrasound initially showed 80% left renal artery stenosis which was shown to be a renal artery dissection during angiography. The patient was successfully managed by percutaneous placement of a renal artery stent.

Síndrome do aprisionamento da artéria tibial anterior: relato de caso / Anterior tibial artery entrapment syndrome: case report

A claudicação intermitente é uma queixa geralmente relacionada com oclusão arterial secundária a doença aterosclerótica. Entretanto, em pacientes jovens com queixa de claudicação, outras causas devem ser pesquisadas, como a síndrome do aprisionamento da artéria poplítea, síndrome compartimental crônica, compressões ósseas e arterites. Os autores relatam o caso de um paciente com claudicação intermitente devido à compressão extrínseca da artéria tibial anterior pela membrana interóssea, diagnosticada através de angiorressonância durante manobras de dorsiflexão do pé. A paciente foi tratada com sucesso através da liberação do fator compressivo, evoluindo com melhora dos sintomas.

Lower extremity intermittent claudication is usually related to atherosclerotic disease. The most common non-atherosclerotic causes are arterites, chronic compartmental syndrome, bone compression, and popliteal entrapment syndrome. The authors report a case of a patient with intermittent claudication related to anterior tibial artery entrapment caused by the interosseous membrane. Magnetic resonance angiography showed compression of the anterior tibial artery during dynamic maneuvers and the patient was managed by releasing the cause of compression, resulting in relief from claudication.

Aneurisma de veia poplítea: relato de dois casos / Popliteal vein aneurysm: report of two cases

Os aneurismas venosos são raros, sendo na maioria das vezes diagnosticados de forma incidental. Os aneurismas de veia poplítea são os mais comuns entre os aneurismas venosos e apresentam uma forte associação com a ocorrência de trombose venosa profunda e embolia pulmonar recorrente. O presente estudo descreve dois casos de aneurisma de veia poplítea associados a trombose venosa profunda.

Venous aneurysms are rare and often diagnosed incidentally. Popliteal vein aneurysms are the most common type of venous aneurysms and have a strong association with the occurrence of deep vein thrombosis and recurrent pulmonary embolism. This article reports two cases of popliteal vein aneurysms associated with deep vein thrombosis.

Compressão da artéria subclávia por pseudoartrose de clavícula: apresentação na quinta década de vida / Late presentation of critical upper limb ischemia caused by pseudarthrosis of the clavicle

A compressão da artéria subclávia no desfiladeiro torácico é um fenômeno amplamente conhecido. Anormalidades ósseas, como a pseudoartrose da clavícula, podem raramente causar compressão arterial a esse nível. A pseudoartrose pode desenvolver-se em decorrência de um trauma, que é a forma mais comum, ou ser congênita. Os autores descrevem o caso de uma paciente de 44 anos com quadro de isquemia crítica de membro superior direito. Apresentava história de fratura não tratada de clavícula direita aos 9 meses de idade que evoluiu com pseudoartrose e compressão extrínseca com oclusão da artéria subclávia. O segmento da clavicula acometido pela pseudoartrose foi ressecado e realizada uma tromboembolectomia tardia das artérias subclávia, braquial e distais, com boa evolução.

Compression of the subclavian artery in the thoracic outlet is a well-known phenomenon. In rare cases, bone abnormalities, such as pseudarthrosis of the clavicle, can cause arterial compression at this level. Pseudarthrosis may develop as a result of trauma, which is the more common form, or it may be congenital. Here, the authors describe the case of a 44-year-old patient with critical ischemia of the right upper limb. She had a history of untreated right clavicle fracture at 9 months of age which had progressed to pseudarthrosis and extrinsic compression of the subclavian artery causing occlusion. The segment of the clavicle involved was resected and late thromboembolectomy of the subclavian, brachial, distal arteries was performed, with good results.

Pseudoaneurisma da artéria temporal superficial: relato de três casos / Pseudoaneurysms of the superficial temporal artery: three case reports

O pseudoaneurisma da artéria temporal superficial é um evento raro. Ocorre principalmente em homens jovens em decorrência de traumatismo craniano fechado. A maioria dos casos é assintomática, podendo eventualmente haver associação com sintomas vagos. A rotura do pseudoaneurisma e o desenvolvimento de déficits neurológicos são complicações esporádicas. Os autores relatam três casos de pseudoaneurisma de artéria temporal superficial pós-traumatismo craniano fechado. Os pacientes foram manejados com sucesso por ligadura e ressecção dos pseudoaneurismas

Pseudoaneurysms of the superficial temporal artery are rare events. They primarily occur in young men as a consequence of blunt head traumas. The majority of cases are asymptomatic, although there are sometimes vague symptoms. Ruptured pseudoaneurysms and development of neurological deficits are occasional complications. The authors describe three cases of pseudoaneurysm of the superficial temporal artery after blunt head trauma. Patients were successfully managed with ligature and resection of the pseudoaneurysms

Laparoscopic treatment of celiac axis compression by the median arcuate ligament and endovascular repair of a pancreaticoduodenal artery aneurysm: case report.

Compression of the celiac axis by the median arcuate ligament of the diaphragm can cause nonspecific symptoms such as abdominal pain, vomiting, and weight loss. There is a known association between stenosis or occlusion of the celiac trunk and aneurysms of the pancreaticoduodenal artery. Treatment strategies for patients who have this association should be selected on a case-by-case basis. We describe the case of a patient with pancreaticoduodenal artery aneurysm associated with compression of the celiac trunk by the arcuate ligament, which were managed with endovascular and laparoscopic techniques, respectively.

Endocarditis-related tibioperoneal trunk pseudoaneurysm managed with endovascular treatment - case report.

Tibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment.

Evaluation with Doppler vascular ultrasound in postoperative endovascular treatment of abdominal aortic aneurysm: a prospective comparative study with angiotomography / Ecocardiografia vascular com Doppler na avaliação pós-operatória do tratamento endovascular de aneurisma da aorta adominal: estudo propspectivo comparativo com a angiotomografia

BACKGROUND:Diagnosis of abdominal aortic aneurysm (AAA) is usually incidental, and surgical treatment, when indicated, may be open or endovascular. The drawbacks of computed angiotomography (CTA) and the advantages of Doppler ultrasonography have led to the development of alternative follow-up protocols, comparing the two methods. OBJECTIVE: To determine validity indices for Doppler ultrasonography and to correlate them with CTA results in a group of patients who had undergone elective endovascular treatment of AAAs. MATERIAL AND METHODS: Thirty-three patients were selected. The following three items were evaluated: 1) presence or absence of endoleak; 2) presence of blood flow in the aortoiliac segment; and 3) maximum AAA diameter. RESULTS: For the detection of endoleak, Doppler ultrasonography showed a sensitivity of 54.5%, a specificity of 92.8%, a positive predictive value of 85.7%, a negative predictive value of 92.8%, and an overall accuracy of 76%. For the evaluation of blood flow in the aortoiliac segment, values were 100, 97.8, 80, 97.8, and 98%, respectively. Maximum AAA diameter was similarly measured by both methods, with statistically significant differences (mean difference: 1.98 mm). Pearson's correlation coefficient was 0.97, showing that Doppler ultrasonography and CTA yielded similar results. CONCLUSION: Doppler ultrasonography showed good validity indices and a moderate correlation with CTA in the postoperative evaluation of patients undergoing endovascular treatment of AAAs. .

The role of transillumination phleboscopy in the planning of cosmetic operations for varicose veins

Background: The cosmetic treatment of varicose veins is the main activity of most vascular surgeons in Brazil. In order to obtain satisfactory cosmetic results, careful planning of varicose vein operations is necessary. Objective: Marking (or "mapping") the varicose veins with indelible ink is an essential step in planning cosmetic surgeries for lower limb varicose veins. In the present study, the role of transcutaneous phleboscopy (TcPh) in planning varicose vein operations is evaluated. Methods: A series of 100 consecutive patients, all female, were evaluated with TcPH as part of their varicose vein operations planning. A total of 171 limbs with varicose veins (71 bilateral and 29 unilateral) were evaluated. The process of marking the varicose veins followed the same protocol in all cases. Firstly, the varicose veins were marked by inspection and palpation, with the patient standing, using an indelible black ink pen. Secondly, with the patients resting in supine and prone positions, the varicose veins detected with TcPh were marked again with red or blue ink. The marks made by the two methods were then compared. Results: In 41 patients, for a total of 80 limbs (46.8 percent), the marks were altered after use of TcPh. Reasons for such changes were: 1) identification of other varicose veins; 2) identification of reticular veins draining complex telangiectasias; and 3) changes in the position of the marks placed with the patient standing. Conclusions: TcPh has altered the planning of varicose vein surgeries in 46.8 percent of all limbs evaluated, especially when the patients had complex telangiectasias, associated with reticular varicose veins.

Contexto: O tratamento estético de varizes é a principal atividade da maioria dos cirurgiões vasculares do Brasil. Para se obter resultados estéticos satisfatórios, é necessário um planejamento adequado da cirurgia de varizes. Objetivo: A marcação (ou "mapeamento") das varizes com tinta indelével é uma etapa essencial do planejamento das cirurgias de varizes dos membros inferiores com finalidade estética. Neste estudo, é avaliado o papel da fleboscopia por transiluminação na marcação pré-operatória de varizes. Métodos: Uma série de 100 pacientes consecutivas, todas do sexo feminino, foram avaliadas através de fleboscopia por transiluminação, como parte do planejamento de suas operações de varizes. Do total de 171 membros com varizes, 71 pacientes tinham varizes bilaterais e 29 tinham varizes unilaterais. Em todos os casos, a marcação das varizes a serem operadas seguiu o mesmo protocolo. Na primeira etapa, as varizes foram marcadas de forma tradicional, por inspeção e palpação, com as pacientes de pé, usando canetas de tinta indelével de cor preta. Na segunda etapa, as pacientes assumiram a posição de decúbito e as varizes foram re-marcadas, com o auxílio da fleboscopia por transiluminação, com tinta de cor vermelha ou azul. Em seguida, foram comparadas as marcações pelos dois métodos. Resultados: Em 41 pacientes, totalizando 80 membros (46,8 por cento), foram alteradas as marcações depois da fleboscopia por transiluminação. Os motivos para as alterações foram: 1) identificação de novos trajetos varicosos; 2) identificação de veias de drenagem de telangiectasias complexas; e 3) mudanças no trajeto de varizes marcadas da forma tradicional. Conclusões: A fleboscopia por transiluminação alterou o planejamento da cirurgia de varizes em 46,8 por cento dos membros avaliados, especialmente quando as pacientes tinham telangiectasias complexas associadas a varizes reticulares.