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1.
Tech Vasc Interv Radiol ; 22(4): 100630, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864535

RESUMO

Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.


Assuntos
Procedimentos Endovasculares , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Tomada de Decisão Clínica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Humanos , Seleção de Pacientes , Fatores de Risco , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia
3.
BMC Neurol ; 19(1): 218, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481008

RESUMO

BACKGROUND: There are no established theories regarding the role of the cerebellum in dystonia. We report a case of focal limb dystonia secondary to a vasogenic edema of the dentate nucleus caused by a symptomatic developmental venous anomaly. CASE PRESENTATION: A 44-year-old woman presented with sudden onset dystonia in her left arm for 1 week. Brain imaging revealed vasogenic edema in the deep white matter of the left cerebellar hemisphere, including the left dentate nucleus, secondary to a developmental venous anomaly. 18F-fluorodeoxyglucose positron emission tomography images showed hypometabolism in the corresponding cerebellar deep nuclei without the involvement of other brain regions. She was treated with a steroid. At the one-month follow-up, computed tomography scan demonstrated remission of the cerebellar edema, which was thought to be the cause of dystonia. CONCLUSIONS: This case demonstrates that the cerebellum has an important role in the development of dystonia. Further studies are needed to elucidate the relationship between dystonia and cerebellar dysfunction.


Assuntos
Doenças Cerebelares/etiologia , Distonia/etiologia , Distúrbios Distônicos/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Cerebelo/anormalidades , Feminino , Humanos , Tomografia por Emissão de Pósitrons/efeitos adversos , Tomografia Computadorizada por Raios X , Veias/anormalidades
4.
Cardiol Young ; 29(6): 833-834, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159905

RESUMO

We present the case of a 17-year-old boy with a cardiac venous malformation. This case highlights the diagnostic challenges of such tumours and demonstrates the potential efficacy of a watch-and-wait management approach.


Assuntos
Cardiopatias Congênitas/diagnóstico , Malformações Vasculares/diagnóstico , Veias/anormalidades , Adolescente , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos , Ventrículos do Coração , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Veias/diagnóstico por imagem
5.
Int. j. morphol ; 37(2): 682-684, June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1002276

RESUMO

Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.


La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Veias/anormalidades , Canal Inguinal/irrigação sanguínea , Testículo/irrigação sanguínea , Varicocele/etiologia , Veia Cava Inferior/anormalidades , Gônadas/irrigação sanguínea , Hérnia Inguinal/etiologia
7.
J Vasc Interv Radiol ; 30(6): 813-821, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31060770

RESUMO

PURPOSE: The purpose of this study was to evaluate the management, outcomes, and technical and clinical safety of coil-assisted dominant outflow vein (DOV) occlusion for the ethanol embolization of high-flow arteriovenous malformations (AVMs) in the hands. MATERIALS AND METHODS: Between March 2013 and October 2016, 12 consecutive patients with AVMs with DOVs underwent ethanol embolization combined with detachable and pushable coil-assisted DOV occlusion. All patients completed the course of clinical follow-up (range: 14-57 months; mean: 36.7 months), and imaging follow-up (range: 8-25 months; mean: 16.6 months) results from the final treatment session were available for 8 patients. The therapeutic effects, degree of devascularization, and complications at the time of follow-up arteriography were evaluated as the clinical outcomes. RESULTS: The patients underwent 23 ethanol embolization procedures (range: 1-3; mean, 1.9) with 24 detachable coils and 223 pushable coils. The average stretched length of the total coils per patient was 320.17 cm. Seven of 12 patients (58.3%) exhibited complete responses, and 5 patients (41.7%) exhibited partial responses. Minor complications, including blistering and focal swelling, occurred in all 12 patients (100%) but showed spontaneous and complete recovery. No major complications occurred. CONCLUSIONS: Ethanol embolization has the potential to control high-flow hand AVMs by using coil-assisted DOV occlusion with an acceptable risk of minor and major complications.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/instrumentação , Etanol/administração & dosagem , Mãos/irrigação sanguínea , Veias/fisiopatologia , Adolescente , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Velocidade do Fluxo Sanguíneo , Criança , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Etanol/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Veias/anormalidades , Veias/diagnóstico por imagem , Adulto Jovem
8.
Medicine (Baltimore) ; 98(13): e14678, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921180

RESUMO

RATIONALE: Intermuscular hemangioma (IH) usually occurs in the muscles of the limbs and trunk, but can rarely occur in the occipital region. IH in the occipital region is easily misdiagnosed as arteriovenous malformation (AVM). PATIENT CONCERNS: A 31-year-old woman had a right occipital mass for 5 months without pulsation. DIAGNOSIS: Head computered tomography angiography (CTA) and digital substraction angiography (DSA) examinations showed that the lesion was mainly vascular, approximately 3 × 5 cm in size, and supplied by occipital arteries and the muscular branches of vertebral arteries. The venous drainage of the lesions communicated with the suboccipital vein plexus and the paravertebral vein in the venous phase, indicating AVM. Postoperative histological investigation showed the lesion was a hemangioma. INTERVENTIONS: It was recommended for surgical removal. The surgery was carried out under general anesthesia. The lesion showed a clear boundary. The occipital artery touched the anterior margin of the lesion, was exposed and ligated, and was removed around the lesion. The lesion consisted of massive blood vessels, and the surrounding muscles were swollen, indicating IH.After the lesion was removed, the normal muscle tissue around the lesion was also removed. OUTCOMES: The patient achieved a good recovery after surgery, and pathology confirmed IH. A postoperative 1-year CTA review was performed and showed partial residual, then the radiotherapy was recommended. She refused further radiotherapy, follow-up 2 years later showed no enlargement of the lesion. LESSONS: Although IH rarely occurs in the occipital region, this can occur. Due to the complexity of the drainage veins in the occipital region, these IH are prone to misdiagnosis as AVM.


Assuntos
Hemangioma/patologia , Malformações Arteriovenosas Intracranianas/patologia , Músculo Esquelético/patologia , Lobo Occipital/patologia , Adulto , Angiografia por Tomografia Computadorizada/métodos , Erros de Diagnóstico , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Lobo Occipital/irrigação sanguínea , Lobo Occipital/diagnóstico por imagem , Resultado do Tratamento , Veias/anormalidades , Veias/patologia
10.
Pediatr Int ; 61(4): 358-363, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30742735

RESUMO

BACKGROUND: Klippel-Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. METHODS: A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth. RESULTS: Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post-procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. CONCLUSIONS: Endovenous laser ablation therapy is a well-tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long-term study to determine its efficacy.


Assuntos
Procedimentos Endovasculares/métodos , Síndrome de Klippel-Trenaunay-Weber/cirurgia , Terapia a Laser/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Síndrome de Klippel-Trenaunay-Weber/complicações , Imagem por Ressonância Magnética , Estudos Retrospectivos , Resultado do Tratamento , Veias/anormalidades , Veias/cirurgia
11.
Surg Radiol Anat ; 41(5): 535-538, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778672

RESUMO

We report an unusual and multiple variation involving the right head and neck veins which were found during routine dissection in a 50-year-old male cadaver, facial vein draining into both external and internal jugular veins, fenestration in external jugular vein transmitting the supraclavicular nerve trunk, the anterior division of the retromandibular vein draining into anterior jugular vein and the absence of the common facial vein. The knowledge about these variations is important during various surgical and diagnostic procedures involving head and neck region.


Assuntos
Cabeça/irrigação sanguínea , Pescoço/irrigação sanguínea , Veias/anormalidades , Anormalidades Múltiplas , Variação Anatômica , Cadáver , Dissecação , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Surg Oncol ; 119(6): 801-806, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30697735

RESUMO

BACKGROUND AND OBJECTIVES: To clarify the correlation of variant venous anatomy with adrenal tumor phenotype and surgical outcomes. PATIENTS AND METHODS: This retrospective study included 303 consecutive minimally invasive adrenalectomies from 301 patients. All adrenal veins were identified. We compared the preoperative, intraoperative, and postoperative data between patients with and without variant adrenal venous anatomy. We also explored the factors associated with venous variants. RESULTS: We found variant venous anatomy in 62 of 303 adrenalectomies (20.5%). Compared with patients with normal anatomy, those with variant anatomy were associated with larger tumor size, larger adrenal veins, more adrenal medullary tumors, longer operation time, more estimated intraoperative blood loss, longer length of hospitalization, and more transfusion. Computed tomography (CT) images may improve the identification of venous anatomy. Tumor size and diagnosis of pheochromocytoma were independently related to variant venous anatomy, whereas sex, tumor size, and venous variant influenced hemorrhage. For pheochromocytoma with variant venous anatomy operated on by a single surgeon, robot-assisted laparoscopic adrenalectomy was associated with shorter postoperative hospitalization. CONCLUSIONS: Adrenal vein variants are associated with worse outcomes in adrenal tumors and an optimized surgery strategy should be applied to this group of patients.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Adrenalectomia , Laparoscopia , Veias/anormalidades , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos
13.
Urology ; 126: 195-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30682466

RESUMO

Ureteropelvic junction obstruction (UPJO) is a common cause of upper urinary tract obstruction and consequent hydronephrosis. We present a case of right UPJO caused by a crossing vessel suspected to be the right second lumbar vein. While crossing vessels are a common cause of UPJO in older children and adults, they are usually attributed to lower pole vessels. We believe that this is the first case report of UPJO caused by a lumbar vein. Recognition of crossing vessels requires knowledge of variant vasculature anatomy around the kidneys. Due to this unusual crossing vessel origin, our case likely represented an anatomical variant that would be of interest to both fields of urology and radiology.


Assuntos
Pelve Renal , Obstrução Ureteral/etiologia , Veias/anormalidades , Adolescente , Humanos , Masculino
14.
Clin Imaging ; 54: 25-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30500456

RESUMO

Omphalopagus twins are joined ventrally in the umbilical region. In omphalopagus twins, liver's fusion is very frequent, being present in about 80% of cases. Two conjoined twins born in our Hospital were evaluated using plain x-rays, ultrasound (US), gastrointestinal xrays, Tc-99 hepatobiliary scintigraphy (SC) and contrast enhanced computed tomography (CT). There was no bony connection on conventional xrays, neither bowel communication on GI x-rays study. US demonstrated the fusion of left hepatic lobes and a not-quantifiable vascular shunt. Normal biliary function was demonstrated by Tc-99 SC. The first CT scan (twin A) showed irregular lobules in the site of hepatic fusion, a portoportal shunt and a venous vessel to the inferior vena cava of twin B. Only the second CT scan (twin B) showed an arterio-arterial partiallyextrahepatic shunts. The double CT scan allows to increase the probability of a correct individuation and description of vascular shunts for an effective preoperatory assessment. The omphalopagus twins in our case underwent planned surgical separation at 5 months of age. The surgery lasted 5 h and was not affected by any intraoperative complications.


Assuntos
Artérias/anormalidades , Fígado/anormalidades , Gêmeos Unidos , Veias/anormalidades , Sistema Biliar , Humanos , Recém-Nascido , Tomografia Computadorizada por Raios X , Gêmeos Unidos/cirurgia , Ultrassonografia , Umbigo
15.
World Neurosurg ; 122: 287-292, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30447460

RESUMO

BACKGROUND: Orbital arteriovenous fistula (AVF) is a rare entity with only 17 cases reported so far. An arteriovenous hemangioma is a distinct entity of an angioma that most frequently affects the skin. However, to our knowledge, there has not been a case arising in the orbit. CASE DESCRIPTION: A previously healthy, 73-year-old man had progressive proptosis for 1 month. At presentation, the patient showed considerable proptosis, hyperemia in the lower eyelid, chemosis, and total ophthalmoplegia on the right side. Computed tomography and magnetic resonance imaging revealed a round retro-orbital mass, 23 mm in maximal dimension, and lying in the inferomedial aspect of the orbit with an irregular-shaped lesion in the orbital apex. Cerebral angiography detected an orbital AVF fed by the ipsilateral maxillary and ophthalmic arteries and draining into the inferior ophthalmic vein. Stain of the retro-orbital mass was not identified. A transvenous coil embolization via the facial and superior ophthalmic veins achieved complete isolation of the AVF with satisfactory outcome. Two months later, the orbital mass, well circumscribed and lacking perilesional hemosiderin deposition, was microsurgically resected via a lateral orbitotomy. Histological diagnosis was consistent with an arteriovenous hemangioma. CONCLUSIONS: An AVF and arteriovenous hemangioma may simultaneously develop in the same orbit. In patients with symptomatic orbital AVF and coexisting other orbital pathology, strategies should be carefully planned before setting about the treatment.


Assuntos
Fístula Arteriovenosa/complicações , Hemangioma/complicações , Artéria Oftálmica/anormalidades , Órbita/irrigação sanguínea , Neoplasias Orbitárias/complicações , Veias/anormalidades , Idoso , Fístula Arteriovenosa/terapia , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Exoftalmia , Humanos , Masculino
16.
Radiologia ; 61(2): 124-133, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30292466

RESUMO

Vascular malformations and tumors, also known as "vascular anomalies", comprise an extensive variety of lesions involving all parts of the body. Due to a lack of a complete understanding of the origin and histopathology of such lesions, this field has been traditionally obscured by the use of an unclear nomenclature. Knowledge of the classification and clinical and imaging characteristics of this group of lesions is paramount when managing these patients. The objective of this series of two articles is to review the current classification of vascular anomalies, to describe the role of imaging in their diagnosis, to summarize their distinctive histopathologic, clinical and imaging features, and to discuss the treatment options. High-flow lesions were discussed in the first article of this series. In this second article, we will focus on low-flow lesions, including complex syndromes with associated low-flow malformations.


Assuntos
Sistema Linfático/anormalidades , Neoplasias de Tecidos Moles/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/diagnóstico por imagem , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Sistema Linfático/diagnóstico por imagem , Nevo Azul/diagnóstico por imagem , Mancha Vinho do Porto/diagnóstico por imagem , Mancha Vinho do Porto/terapia , Síndrome de Proteu/patologia , Fluxo Sanguíneo Regional , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias de Tecidos Moles/classificação , Neoplasias de Tecidos Moles/terapia , Síndrome de Sturge-Weber/diagnóstico por imagem , Malformações Vasculares/classificação , Malformações Vasculares/terapia , Veias/anormalidades
17.
Vasc Med ; 24(1): 56-62, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30340449

RESUMO

Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.


Assuntos
Extremidade Inferior/irrigação sanguínea , Dor/etiologia , Extremidade Superior/irrigação sanguínea , Malformações Vasculares/complicações , Veias/anormalidades , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/prevenção & controle , Medição da Dor , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia , Veias/diagnóstico por imagem , Adulto Jovem
18.
J Vasc Access ; 20(3): 270-275, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30306819

RESUMO

INTRODUCTION: The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation. METHODS: A total of 494 venograms were performed on 251 patients for primary access creation from June 2014 to June 2017 in this single-center, retrospective study. The venograms were classified into eight subtypes, based on the anatomical relationship between the basilic and brachial veins. The presence of bifid cephalic arches and brachial-basilic ladders was also examined. RESULTS: The presence of bifid cephalic arches and brachial-basilic ladders was identified in 8.7% and 14.0% of cases, respectively. Paired brachial veins joined separately with the basilic vein in 67.4% of venograms, whereas these veins merged into a common brachial vein before connecting to the basilic vein in 13.1% of cases. A single brachial vein was present in 19.3% of cases. 15.7% of cases were considered unsuitable for basilic vein transposition due to the early confluence of the brachial-basilic vein, posing a risk of obliterating the deep venous drainage if transposed. CONCLUSION: There are significant anatomical variations of upper arm veins, and the recognition of certain variants can affect surgical planning and outcomes of access placement. It is important to identify anatomical variants of the upper arm veins during preoperative vein mapping.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cuidados Intraoperatórios/métodos , Flebografia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/anormalidades , Veias/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , República da Coreia , Estudos Retrospectivos , Veias/cirurgia , Adulto Jovem
19.
Clin J Gastroenterol ; 12(2): 135-141, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30182162

RESUMO

A 60-year-old man with an unruptured cerebral aneurysm and family history of moyamoya disease was admitted to our hospital with epigastric pain since the previous day. Serum levels of pancreatic enzyme were elevated and abdominal contrast-enhanced computed tomography showed localized enlargement of the pancreatic tail in the arterial phase and revealed numerous areas of fine mesh-like vascular hyperplasia consistent with an enlarged pancreatic tail. We diagnosed pancreatic arteriovenous malformation (P-AVM) with acute pancreatitis. Furthermore, in the pancreatic body, endoscopic ultrasonography showed lobularity (honeycombing type) and hyperechoic foci (non-shadowing), which suggests chronic pancreatitis. Acute management was performed with conservative treatment including administration of replacement fluids and proteolytic enzyme inhibitor. Distal pancreatectomy for P-AVM was performed because P-AVM is associated with acute pancreatitis recurrence, development of portal hypertension, progression of chronic pancreatitis, and refractory duodenal bleeding. Histological findings on the resected specimens revealed the anastomosis of abnormal arteries and veins, which suggested P-AVM. In addition, inflammation accompanied by fat necrosis due to ischemic infarction in the pancreatic tail, which suggested acute pancreatitis, and mild fibrosis in the pancreatic body, which suggested chronic pancreatitis, were shown. Although P-AVM is associated with various complications, symptomatic P-AVM should be considered a chronic and progressive disease.


Assuntos
Malformações Arteriovenosas/complicações , Pâncreas/irrigação sanguínea , Pancreatite Crônica/complicações , Dor Abdominal/etiologia , Doença Aguda , Artérias/anormalidades , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Progressão da Doença , Endossonografia , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/enzimologia , Pâncreas/cirurgia , Pancreatectomia , Pancreatite/complicações , Pancreatite/terapia , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/terapia , Tomografia Computadorizada por Raios X , Veias/anormalidades
20.
Phlebology ; 34(5): 355-361, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30336759

RESUMO

PURPOSE: To present a case series of percutaneous sclerotherapy of para-orbital and orbital venous malformations. METHOD: Seven patients with venous malformations in the orbital and para-orbital region were reviewed. Puncture venogram was performed on all patients and image guided bleomycin injections using biplane digital subtraction in angiography suite. RESULTS: Average age of patients at the time of the procedure was 22 years old with the youngest being five years of age and the oldest being 50 years. Follow-ups ranged from 3 months to 18 months and the average follow-up duration was 13 months. The patients had no intraprocedural complications and reported symptomatic relief of pain as per the last follow-up. Patients have shown no symptoms or signs of recurrence of lesions with uneventful recovery so far. CONCLUSIONS: Percutaneous sclerotherapy of orbital Venous Malformations with bleomycin is a safe and well-controlled procedure done in real time; it has no major systemic adverse side effects and higher efficacy than other sclerosing agents.


Assuntos
Bleomicina/administração & dosagem , Escleroterapia , Malformações Vasculares/terapia , Veias/anormalidades , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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