Anatomical features of a crossing vein connecting left and right internal mammary veins: A preliminary study with computerized tomography or magnetic resonance imaging.

BACKGROUND: In breast reconstruction with free flaps, retrograde venous anastomosis into the internal mammary vein (IMV) is often unavoidable. Utility of a crossing vein between the right and left IMV, one of the anatomical foundations which make retrograde flow possible, has been reported but only with a few detailed features. This study evaluated the presence, actual location, and diameter of the crossing veins using preoperative imaging such as contrast-enhanced computed tomography (CECT), or contrast-enhanced magnetic resonance imaging (CEMRI). Moreover, this is a preliminary non-invasive study to clarify these processes on a larger scale. METHODS: We included 29 cases of unilateral breast reconstruction performed between July 2018 and September 2023 at our institution using unipedicled or bipedicled free deep inferior epigastric artery perforator (DIEP) flaps with retrograde venous anastomosis to only one IMV at the level of anastomosis. No congestion or necrosis was observed. In the final 24 cases with sufficient imaging coverage of preoperative contrast-enhanced images (15 CECT and 9 CEMRI), the crossing veins of IMVs were detected and the number, localization, and diameter were measured. RESULTS: In 20 cases of 24 images, the crossing veins between IMVs were completely identified (83%). In 18 of the cases, only one crossing vein was established immediately ventral to the xiphoid process, averaging 19.3 ± 7.18 mm caudal to the fibrous junction between the sternal body and xiphoid process. The average diameter of the veins was 1.57 ± 0.42 mm. In two other cases, the second crossing vein originated on the dorsal surface of the sternum, but it was a very thin vein of about 0.4 mm. Three images indicated incomplete identification of the crossing vein at the xiphoid process, and in one case, no crossing vein was observed between bilateral IMVs. CONCLUSION: The contrast-enhanced imaging study revealed an anatomic feature that the crossing veins (about 1.5 mm in diameter) connecting the right and left IMVs are located just ventral to the xiphoid process. Furthermore, the crossing veins can be identified on contrast-enhanced images, and refinement of this method is expected to lead to future non-invasive anatomical investigations in an even larger number of cases.

Finger Vein Identification Based on Large Kernel Convolution and Attention Mechanism.

FV (finger vein) identification is a biometric identification technology that extracts the features of FV images for identity authentication. To address the limitations of CNN-based FV identification, particularly the challenge of small receptive fields and difficulty in capturing long-range dependencies, an FV identification method named Let-Net (large kernel and attention mechanism network) was introduced, which combines local and global information. Firstly, Let-Net employs large kernels to capture a broader spectrum of spatial contextual information, utilizing deep convolution in conjunction with residual connections to curtail the volume of model parameters. Subsequently, an integrated attention mechanism is applied to augment information flow within the channel and spatial dimensions, effectively modeling global information for the extraction of crucial FV features. The experimental results on nine public datasets show that Let-Net has excellent identification performance, and the EER and accuracy rate on the FV_USM dataset can reach 0.04% and 99.77%. The parameter number and FLOPs of Let-Net are only 0.89M and 0.25G, which means that the time cost of training and reasoning of the model is low, and it is easier to deploy and integrate into various applications.

Automated hyperspectral imaging for non-invasive characterization of human eye vasculature: A potential tool for ocular vascular evaluation.

The vascular supply to the human eye plays a vital role in maintaining ocular health, making its non-invasive evaluation essential for diagnosing and managing various ocular disorders. This paper presents a novel approach utilizing hyperspectral imaging (HSI) to non-invasively characterize human eye vasculature. The proposed system aims to specifically identify the blood atrium and veins of the human eye at 470 nm and 750 nm, respectively, using quantitative phase analysis and k-means clustering. The study involved capturing diffused reflection spectra and hyperspectral images of the human eye at different wavelengths to reveal distinctive vascular features. The results of ten volunteers demonstrate promising capabilities in automated differentiation of atrium and veins, as well as the potential for mapping varicose veins in the lower limb. This non-invasive and non-contact imaging technique shows great promise in facilitating accurate and detailed evaluation of ocular blood flow, providing valuable information for clinical diagnosis and treatment in ophthalmology and vascular medicine fields.

Outcomes of one-stage and two-stage aneurysm repair in arteriovenous fistulae.

OBJECTIVE: Maintenance of long-term arteriovenous access is important in long-term care for patients with end-stage renal disease. Arteriovenous access is associated in the long term with the development of fistula aneurysms (FAs). This study aims to evaluate the outcomes of staged FA treatment in dialysis access arteriovenous fistulae (AVF). METHODS: A retrospective review of all patients over a 12-year period with primary autogenous AVF was undertaken at a single center. Patients undergoing elective open aneurysm repair were identified and were categorized into three groups: single FA repair (single, control group) and staged and unstaged repair of two FAs (staged and unstaged). A staged repair was a procedure in which the initial intent was to treat both aneurysms in the AVF and in which the most symptomatic aneurysm was treated first. When the incision from the first surgery had healed, the second symptomatic aneurysm in the AVF was treated. An unstaged repair was a procedure in which the initial intent was to repair both symptomatic aneurysms simultaneously. All patients had a fistulogram before the FA repair. Thirty-day outcomes, cannulation failure, line placement, reintervention, and functional dialysis (continuous hemodialysis for 3 consecutive months) were examined. RESULTS: Five hundred twenty-seven patients presented with FA that met requirements for open intervention; 44% underwent single FA repair, whereas the remaining 34% and 22% underwent staged and unstaged repair of two FAs, respectively. The majority of patients were diabetic and Hispanic. Ninety-one percent of the patients required percutaneous interventions of the outflow tract (37%) and the central veins (54%). Thirty-day major adverse cardiovascular events were equivalent across all modalities. Thirty-day morbidity and early thrombosis (<18 days) were significantly higher in the unstaged group (4.3%) compared with the two other groups (1.3% and 2.1%, single and staged, respectively), which led to an increased need for a short-term tunneled catheter (8.9%) compared with the two other groups (3.4% and 4.4%, single and staged, respectively), Unstaged repair resulted in an increased incidence of secondary procedures (5.0%) compared with the two other groups (2.6% and 3.1%, single and staged, respectively). Functional dialysis at 5 years was equivalent in the single and staged groups but was significantly decreased in the unstaged group. CONCLUSIONS: Open interventions are successful therapeutic modalities for FAs, but unstaged rather than staged repair of two concurrent FAs results in a higher early thrombosis, an increased secondary intervention rate, and a need for a short-term tunneled central line. Staged and single FA repairs have equivalent results. In the setting of two symptomatic FAs, staged repair is recommended.

Assessment of skin and associated soft tissue changes with ultrasonography in chronic venous disease.

OBJECTIVE: Chronic venous disease (CVD) is accompanied by a spectrum of skin changes. The aim of this study was to assess skin changes in CVD in different classes of the classifications such as the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification using ultrasound (US). METHODS: This study was conducted from July 2020 to July 2021 after obtaining approval from Institutional Ethical Committee. Patients with chronic venous insufficiency were enrolled after taking informed consent. Assessment of cutaneous layer (CL), subcutaneous layer (SCL), dermo-hypodermal junction (D-HJ), and other significant US findings were noted. RESULTS: Ninety-eight limbs were evaluated. Most common skin finding was dermal edema in 59 (60.2%) legs. Other findings included infiltrates, CL thickening, hyper echogenicity and thickening of SCL, anechoic lacunae, disappearance of D-HJ, and epidermal loss or change in thickness of epidermis. Notably, US detected dermal edema in 15 and infiltrates in five C2 legs (normal on inspection). CONCLUSION: US evaluation of skin changes adds insight to clinical assessment and may reveal skin changes in legs affected with CVD that may appear normal on clinical examination.

Comparison of wireless handheld ultrasound and high-end ultrasound in pediatric patients with venous malformations - First results.

AIM: To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs). MATERIAL AND METHODS: 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus. RESULTS: 10 patients (4-17 years; 10.0±4.32 years; female n = 6, male n = 4) with 10 VMs (4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality. CONCLUSION: Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs.

Overlapping lockup lymphaticovenous anastomosis: A useful addition to supermicrosurgery.

BACKGROUND: Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. This surgical procedure connects the superficial lymphatic vessels to nearby veins to establish lymphatic-venous pathways. One of the most common challenges encountered by lymphatic surgeons when performing LVA is a mismatch in the sizes of the veins and lymphatic vessels, with the effectiveness limited by technical constraints. We conducted a pilot study to evaluate the feasibility of an overlapping lockup anastomosis (OLA) LVA technique to address these problems. METHODS: In this study, we present a novel OLA technique for LVA that addresses the challenges with conventional techniques. The OLA technique was used in 10 lymphedema patients between September 2022 and March 2023 to compare OLA and end-to-end anastomosis. The time required for anastomosis, method of anastomosis, patency rates, and lymphedema volume were evaluated in this study. RESULTS: Of 123 LVAs, 44 were performed using the OLA technique in 10 patients, with indocyanine green lymphangiography revealing unobstructed drainage. A single case of slight fluid leakage occurred, which was resolved by reinforcing the sutures. The average anastomosis time for OLA and the end-to-end technique was 5.55 minutes and 12.1 minutes, respectively. The wounds of the patients healed without infection, and the subjective limb circumference decreased. CONCLUSIONS: The OLA technique could serve as a valuable addition to the current LVA technique, especially for cases with a mismatch in the sizes of the lymphatic vessels and veins. This technique has the potential to promote the broader application of LVA in the treatment and prevention of lymphedema.

Multispectral Imaging for Vein Localization and Contrast Enhancement.

Intravenous (IV) catheterization is a common procedure. Still, there is a 26% chance of the first attempt catheterization failure due to the changing visibility of veins because of the patient's skin tone and body fat content. Ultrasound assistive devices help locate deeper veins but are not practical in emergencies, and transillumination assistive devices have a low field of view. Commercial near-infrared (NIR) imaging devices are effective in vein localization but are expensive and are not used in low-cost clinical settings. To overcome this, NIR Multispectral Imaging (MSI) was used to find the optimal wavelength that provides the enhanced visualization of veins for all skin types and Body Mass Index (BMI). The band with the highest vein-to-skin contrast ratio was selected and contrast enhancement was done using our proposed method. The primary blocks of the proposed method are Gamma correction, Contrast Limited Adaptive Histogram Equalization (CLAHE), Adaptive Thresholding, and image Fusion. The optimal spectral range was found to be 814-876 nm and our method increased the contrast by 0.41, 0.375, and 0.39 for fair, brown, and dark brown skin types, respectively, with different BMI.Clinical relevance- From the study, we can develop a potentially low-cost vein localization assistive device for training medical and nursing students and use it in emergencies for venous access to improve confidence in IV catheterization.

A Finger Vein Liveness Detection System Based on Multi-Scale Spatial-Temporal Map and Light-ViT Model.

Prosthetic attack is a problem that must be prevented in current finger vein recognition applications. To solve this problem, a finger vein liveness detection system was established in this study. The system begins by capturing short-term static finger vein videos using uniform near-infrared lighting. Subsequently, it employs Gabor filters without a direct-current (DC) component for vein area segmentation. The vein area is then divided into blocks to compute a multi-scale spatial-temporal map (MSTmap), which facilitates the extraction of coarse liveness features. Finally, these features are trained for refinement and used to predict liveness detection results with the proposed Light Vision Transformer (Light-ViT) model, which is equipped with an enhanced Light-ViT backbone, meticulously designed by interleaving multiple MN blocks and Light-ViT blocks, ensuring improved performance in the task. This architecture effectively balances the learning of local image features, controls network parameter complexity, and substantially improves the accuracy of liveness detection. The accuracy of the Light-ViT model was verified to be 99.63% on a self-made living/prosthetic finger vein video dataset. This proposed system can also be directly applied to the finger vein recognition terminal after the model is made lightweight.

Fast and Accurate ROI Extraction for Non-Contact Dorsal Hand Vein Detection in Complex Backgrounds Based on Improved U-Net.

In response to the difficulty of traditional image processing methods to quickly and accurately extract regions of interest from non-contact dorsal hand vein images in complex backgrounds, this study proposes a model based on an improved U-Net for dorsal hand keypoint detection. The residual module was added to the downsampling path of the U-Net network to solve the model degradation problem and improve the feature information extraction ability of the network; the Jensen-Shannon (JS) divergence loss function was used to supervise the final feature map distribution so that the output feature map tended to Gaussian distribution and improved the feature map multi-peak problem; and Soft-argmax is used to calculate the keypoint coordinates of the final feature map to realize end-to-end training. The experimental results showed that the accuracy of the improved U-Net network model reached 98.6%, which was 1% better than the original U-Net network model; the improved U-Net network model file was only 1.16 M, which achieved a higher accuracy than the original U-Net network model with significantly reduced model parameters. Therefore, the improved U-Net model in this study can realize dorsal hand keypoint detection (for region of interest extraction) for non-contact dorsal hand vein images and is suitable for practical deployment in low-resource platforms such as edge-embedded systems.

Prevalence of intra-osseous veins and venous lakes in the posterior skull base on 3T MRI.

BACKGROUND: Intra-osseous vessels are normal anatomic structures in the calvarium and skull base. On imaging, these structures-particularly venous lakes-can mimic pathologic abnormalities. This study sought to assess the prevalence of veins and lakes in the skull base on MRI. MATERIALS AND METHODS: A retrospective review was completed of consecutive patients that underwent contrast-enhanced MRI imaging of the internal auditory canals. The clivus, jugular tubercles, and basio-occiput were assessed for the presence of both intra-osseous veins (serpentine and/or branching vessels) and venous lakes (well-circumscribed round or oval enhancing structures). Vessels in the adjacent synchondroses major foramina were excluded. Three board-certified neuroradiologists performed independent blinded reviews, with discrepancies agreed upon by consensus. RESULTS: 96 patients were included in this cohort (58.3% female). Mean age was 58.4 years (range = 19-85). At least one intra-osseous vessel was identified in 71 (74.0%) patients. 67 (70.0%) had at least one skull base vein, and 14 (14.6%) had at least one venous lake. Both vessel subtypes were observed in 8.3% of patients. Vessels were more commonly observed in women, though this did not reach statistical threshold (p = 0.56). Age was not associated with the presence of vessels (0.59) or vessel location (p values ranged from 0.44-0.84). CONCLUSIONS: Intra-osseous skull base veins and venous lakes are relatively common findings on MRI. Both vascular structures should be considered normal anatomy, and care should be taken to not confuse these for pathologic entities.

Finger vein recognition method based on ant colony optimization and improved EfficientNetV2.

Deep learning is an important technology in the field of image recognition. Finger vein recognition based on deep learning is one of the research hotspots in the field of image recognition and has attracted a lot of attention. Among them, CNN is the most core part, which can be trained to get a model that can extract finger vein image features. In the existing research, some studies have used methods such as combination of multiple CNN models and joint loss function to improve the accuracy and robustness of finger vein recognition. However, in practical applications, finger vein recognition still faces some challenges, such as how to solve the interference and noise in finger vein images, how to improve the robustness of the model, and how to solve the cross-domain problem. In this paper, we propose a finger vein recognition method based on ant colony optimization and improved EfficientNetV2, using ACO to participate in ROI extraction, fusing dual attention fusion network (DANet) with EfficientNetV2, and conducting experiments on two publicly available databases, and the results show that the recognition rate using the proposed method on the FV-USM dataset reaches The results show that the proposed method achieves a recognition rate of 98.96% on the FV-USM dataset, which is better than other algorithmic models, proving that the method has good recognition rate and application prospects for finger vein recognition.

Acute venous problems: Integrating medical, surgical, and interventional treatments.

"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.

Surgical and endovascular treatment of pelvic venous disorder: Results of a multicentre retrospective cohort study.

OBJECTIVE: In the present study, we investigated the clinical outcomes after gonadal vein resection (GVR) and gonadal vein embolization (GVE) with coils in patients with pelvic venous disorder (PeVD). We also assessed the rates of procedural complications and disease recurrence. METHODS: Our multicenter retrospective cohort study included 361 female patients with PeVD-related chronic pelvic pain (CPP) and gonadal vein reflux who underwent GVR (n = 184) or GVE with coils (n = 177) from 1999 to 2020. The clinical outcomes (ie, presence and severity of CPP, procedural complications, disease recurrence) were assessed at 1 month and 1, 3, and 5 years after intervention. The pain intensity before and after treatment was assessed using a visual analog scale. All the patients underwent duplex ultrasound after GVR and GVE, and those with persistent CPP and suspected perforation of the gonadal vein by the coils were also evaluated by multiplanar pelvic venography. RESULTS: GVR and GVE was associated with the reduction or elimination of CPP at 1 month after treatment in 100% and 74% of patients and postprocedural complications in 14% and 37% of patients, respectively (Р < 0.01 for both). The most common complication after either GVR or GVE was pelvic vein thrombosis (11% and 22% patients, respectively; P < .01 between groups). GVE was associated with postembolization syndrome in 20%, coil protrusion in 6%, and coil migration in 1% of patients. The long-term recurrence rate after GVR and GVE was 6% and 16%, respectively (P < .01). CONCLUSIONS: Both GVR and GVE were found to be effective in treating patients with PeVD. However, GVR was associated with better efficacy in the relief of CPP and lower rates of procedural complications and disease recurrence.

The athlete's vein: venous adaptations in the lower limbs of endurance athletes.

Endurance exercise induces cardiovascular adaptations; the athletic phenotypes of the heart and arteries are well characterized, but few studies have investigated the effects of chronic exercise on the venous system. The aim of this study was to describe the anatomy and function of lower-limb deep and superficial veins in athletes compared with controls. Endurance-trained athletes and untrained controls (13 males, 7 females per group) were examined using ultrasound to measure vein diameter and flow, and air plethysmography to assess calf venous volume dynamics and muscle pump function at rest, during a single step, ambulation (10 steps) and after acute treadmill exercise (30 min ∼80% age-predicted heart rate maximum). Diameters of three of the seven deep veins assessed were larger in athletes (P ≤ 0.0167) and more medial calf perforators were detectable (5 vs. 3, P = 0.0039). Calf venous volume was 22% larger in athletes (P = 0.0057), and calf muscle pump ejection volume and ambulatory venous volume after 10 steps were both greater in athletes (20 and 46% respectively, P ≤ 0.0482). Following acute exercise, flow recovery profiles in deep and superficial veins draining the leg were not different between groups, despite athletes performing approximately four times more work. After exercise, venous volume and ejection volume were reduced by ∼20% in athletes with no change in controls (interaction, P ≤ 0.0372) and although ambulatory venous volume reduced, this remained greater in athletes. These findings highlight venous adaptations that compensate for the demands of regular endurance exercise, all of which are suited to enhance flow through the lower-limb venous system.NEW & NOTEWORTHY Although much literature exists describing adaptations to the heart and arteries in response to endurance exercise training, less is known about the effects on the venous system. Characteristics of "the athlete's vein" described here include deep and perforator vein remodeling, improved drainage, and greater calf venous volume at rest and on calf muscle pump activation. Following exercise, athletes demonstrated prompt flow recovery and appropriate volume reductions, and veins beneficially adapt to better tolerate the demands of regular physical activity.