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1.
Angiol Sosud Khir ; 27(3): 68-76, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528590

RESUMO

AIM: The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. PATIENTS AND METHODS: During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry. RESULTS: Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 - 4.5%, C1 - 60.6%, C2 - 27.2%, C3 - 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May-Thurner syndrome) was confirmed in 1 case only. CONCLUSION: In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.


Assuntos
Varizes , Insuficiência Venosa , Estudos Transversais , Feminino , Humanos , Flebografia , Varizes/complicações , Varizes/diagnóstico , Veias , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/etiologia
2.
Yonsei Med J ; 62(10): 928-935, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34558872

RESUMO

PURPOSE: In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). MATERIALS AND METHODS: We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system. RESULTS: One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). CONCLUSION: Remnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.


Assuntos
Cordão Espermático , Varicocele , Humanos , Masculino , Flebografia , Estudos Retrospectivos , Cordão Espermático/diagnóstico por imagem , Cordão Espermático/cirurgia , Testículo , Varicocele/diagnóstico por imagem , Varicocele/cirurgia , Veias/diagnóstico por imagem , Veias/cirurgia
3.
Br J Radiol ; 94(1127): 20201309, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34379491

RESUMO

The objective of this Pictorial Review is to describe the use of colour-coded Dual-Energy CT (DECT) to aid in the interpretation of CT Venography (CTV) of the head for emergent indications. We describe a DE CTV acquisition and post-processing technique that can be readily incorporated into clinical workflow. Colour-coded DE CTV may aid the identification and characterization of dural venous sinus abnormalities and other cerebrovascular pathologies, which can improve diagnostic confidence in emergent imaging settings.


Assuntos
Encefalopatias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Neuroimagem/métodos , Flebografia/métodos , Intensificação de Imagem Radiográfica/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Encéfalo/diagnóstico por imagem , Cor , Meios de Contraste , Emergências , Humanos , Iodo
4.
Childs Nerv Syst ; 37(10): 3021-3032, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34430999

RESUMO

PURPOSE: To evaluate the anatomical variations of dural venous sinuses in children with external hydrocephalus, proposing a radiological grading of progressive anatomic restriction to venous outflow based on brain phase-contrast magnetic resonance venography (PC-MRV); to evaluate the correlation between positional plagiocephaly and dural sinuses patency; and to compare these findings with a control group to ascertain the role of anatomical restriction to venous outflow in the pathophysiology of external hydrocephalus. METHODS: Brain MRI and PC MRV were performed in 97 children (76 males, 21 females) diagnosed with external hydrocephalus at an average age of 8.22 months. Reduction of patency of the dural sinuses was graded as 1 (stenosis), 2 (complete stop) and 3 (complete agenesis) for each transverse/sigmoid sinus and sagittal sinus. Anatomical restriction was graded for each patient from 0 (symmetric anatomy of patent dural sinuses) through 6 (bilateral agenesis of both transverse sinuses). Ventricular and subarachnoid spaces were measured above the intercommissural plane using segmentation software. Positional plagiocephaly (PP) and/or asymmetric tentorial insertion (ATI) was correlated with the presence and grading of venous sinus obstruction. These results were compared with a retrospective control group of 75 patients (35 males, 40 females). RESULTS: Both the rate (84.53% vs 25.33%) and the grading (mean 2.59 vs mean 0.45) of anomalies of dural sinuses were significantly higher in case group than in control group. In the case group, sinus anomalies were asymmetric in 59 cases (right-left ratio 1/1) and symmetric in 22. A significant association was detected between the grading of venous drainage alterations and diagnosis of disease and between the severity of vascular anomalies and the widening of subarachnoid space (SAS). Postural plagiocephaly (39.1% vs 21.3%) and asymmetric tentorial insertion (35.4% vs 17.3%) were significantly more frequent in the case group than in the control group. When sinus anomalies occurred in plagiocephalic children, the obstruction grading was significantly higher on the flattened side (p ≤ 0.001). CONCLUSION: Decreased patency of the dural sinuses and consequent increased venous outflow resistance may play a role in the pathophysiology of external hydrocephalus in the first 3 years of life. In plagiocephalic children, calvarial flattening may impact on the homolateral dural sinus patency, with a possible effect on the anatomy of dural sinuses and venous drainage in the first months of life.


Assuntos
Hidrocefalia , Angiografia por Ressonância Magnética , Criança , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Flebografia , Estudos Retrospectivos
5.
Am J Case Rep ; 22: e932123, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34224551

RESUMO

BACKGROUND Diagnosing cerebral venous thrombosis (CVT) poses significant challenges owing to a nonspecific clinical presentation, poorly correlated laboratory biomarkers, and low sensitivity of non-contrast head computed tomography (CT). We describe a case of missed CVT diagnosis, due to low clinical suspicion and nonrecognition of anemia as a prothrombotic factor, especially during an ulcerative colitis (UC) flare. A recently proposed CVT clinical probability score can guide clinicians in pursuing further neurovascular imaging. CASE REPORT A 35-year-old man, with treatment-naive UC, presented to the Emergency Department (ED) with new-onset diffuse headache, 4 weeks of bloody diarrhea, and weight loss. Initial ED laboratory studies revealed severe anemia and unremarkable non-contrast head CT. Two days later, the patient returned to the ED for worsening headache. Non-contrast head CT revealed a left temporal hypodensity. This was later confirmed as acute ischemia on magnetic resonance imaging (MRI). MR venogram revealed thrombosis of the left transverse and sigmoid sinuses, leading to initiation of therapeutic subcutaneous anticoagulation. Repeat MRI, secondary to worsening headache, revealed the development of petechial hemorrhages within the core of venous ischemia in the left temporal lobe. Therapeutic anticoagulation, along with symptomatic management of UC, led to clinical stabilization. CONCLUSIONS CVT should be suspected in patients with UC, especially in the context of anemia, presenting with new-onset or worsening headaches. Recognizing anemia as a thrombogenic factor is crucial. Diagnosis of CVT is challenging due to non-focal symptoms and poorly correlating diagnostic tests. We endorse implementing the CVT clinical probability score into AHA/ASA CVT guidelines to enhance diagnostic accuracy.


Assuntos
Trombose Intracraniana , Trombose Venosa , Adulto , Cefaleia/etiologia , Humanos , Trombose Intracraniana/diagnóstico , Masculino , Neuroimagem , Flebografia , Trombose Venosa/diagnóstico
6.
Eur J Vasc Endovasc Surg ; 62(4): 622-628, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34244092

RESUMO

OBJECTIVE: Presently, the prone position is necessary for popliteal vein puncture access, but it makes the patients uncomfortable and does not allow traditional femoral or jugular access. To address these deficiencies, this study introduces two new methods, anterior and medial access carried out in the supine position. METHODS: Venous interventions with punctures in the popliteal vein of 120 limbs in 97 patients were performed during the period from February 2017 to April 2019. After puncture, venographic guidance was achieved by dorsal vein injection of contrast medium. Interventional therapy was performed after puncture and insertion of the introducer sheath. RESULTS: In all, 120 limbs were punctured in the popliteal vein, with technical success in 118 (98.3% in total) cases: 100%, 96.1%, and 100% successful punctures in, respectively, 32 anterior, 49 medial, and 37 posterior access cases. A comparison of the three groups revealed that the fluoroscopy time and duration of puncture were longer in the medial and anterior access groups than in the posterior access group. The rate of intra-operative and post-operative complications was 7.5% (9/120), with no statistically significant difference between the three access groups. Compared with the pre-operative median score of 2.5, the post-operative SVS (Society of Vascular Surgery) score of the popliteal vein was reduced to 1.5 in the anterior and 0.5 in the medial groups. CONCLUSION: Medial and anterior puncture of the popliteal vein in the supine position can be used as a safe alternative in venous endovascular therapy. The two new methods can mitigate frailty or respiratory problems resulting from the prone position and facilitate traditional femoral and jugular access.


Assuntos
Cateterismo Periférico , Posicionamento do Paciente , Flebografia , Veia Poplítea/diagnóstico por imagem , Radiografia Intervencionista , Decúbito Dorsal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Adulto Jovem
7.
J Clin Neurosci ; 89: 43-50, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119293

RESUMO

Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.


Assuntos
Anticoagulantes/uso terapêutico , Revascularização Cerebral/tendências , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/cirurgia , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Coeficiente Internacional Normatizado/tendências , Trombose Intracraniana/diagnóstico por imagem , Imageamento por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Flebografia/tendências , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Adulto Jovem
8.
Methodist Debakey Cardiovasc J ; 17(1): 13-18, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104315

RESUMO

Catheter ablation is an effective treatment method for ventricular arrhythmias (VAs). These arrhythmias can often be mapped and targeted with ablation from the left and right ventricular endocardium. However, in some situations the VA site of origin or substrate may be intramural or epicardial in nature. In these cases, the coronary venous system (CVS) provides an effective vantage point for mapping and ablation. This review highlights situations in which CVS mapping may be helpful and discusses techniques for CVS mapping and ablation.


Assuntos
Ablação por Cateter , Vasos Coronários/cirurgia , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Ablação por Cateter/efeitos adversos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Flebografia , Valor Preditivo dos Testes , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
10.
J Stroke Cerebrovasc Dis ; 30(7): 105845, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33964546

RESUMO

PURPOSE: This study aims to test the validity of a new quantitative scoring instrument-the Venous Occlusion Image Score (VOIS), and assess the diagnostic and prognostic value of VOIS for cerebral venous sinus thrombosis (CVST). METHODS: The VOIS divided the major cerebral venous sinuses and internal jugular veins into nine parts of interest. CT venography and DSA source images and reconstruction were extracted from the database, then interpreted and scored independently according to VOIS by a panel of three reviewers. Inter-observer and intra-observer reliability were determined using the intraclass correlation coefficient (ICC) and the kappa coefficient (κ). The primary outcome was the 3-month functional outcome and evaluated by modified Rankin Scale (mRS). The sensitivity and specificity of VOIS for the primary outcomes were computed. Logistic regression was applied to evaluate the association between the score on VOIS and the primary outcomes. RESULTS: Fifty-six patients with CVST were included in the study. For 16 patients underwent cerebral CTV and DSA, excellent interobserver agreement was observed for DSA (ICC=0.90, 95%CI = 0.87 - 0.92, P < 0.001), and CTV (ICC = 0.92, 95%CI = 0.84 - 0.93, P < 0.001). The κ coefficient of agreement for the two radiology measures was 0.88 (95%CI = 0.79-0.92), indicating good inter-method agreement. For 56 patients followed up by CTV, baseline VOIS value correlated inversely with the severity of stroke on the National Institutes of Health Stroke Scale (r = -0·53, P < 0·001), and modified Rankin Scale (r = -0·59, P < 0·001). Baseline CTV-VOIS value predicted functional outcome (P < 0·05). CONCLUSION: VOIS may serve as a convenient and reliable method in the treatment guidance and outcome prediction of patients with CVST.


Assuntos
Angiografia Cerebral , Veias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada Multidetectores , Flebografia , Trombose dos Seios Intracranianos/diagnóstico por imagem , Adulto , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombose dos Seios Intracranianos/fisiopatologia , Trombose dos Seios Intracranianos/terapia , Adulto Jovem
12.
Diagn Interv Radiol ; 27(3): 372-377, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34003124

RESUMO

PURPOSE: We aimed to investigate the incidence, etiology, treatment, and clinical course of atypical iliac vein compressions (AIVCs) among patients with May-Thurner syndrome (MTS). METHODS: A total of 173 patients who presented with MTS were retrospectively analyzed at a single center. Computed tomographic venography (CTV) was used to diagnose MTS. An AIVC was defined as the compression of the left common iliac vein (LCIV) by structures other than the right common iliac artery (RCIA) or the compression of other venous structures in the pelvic cavity instead of the LCIV. The patients with AIVC were categorized into the LCIV compression group (category A) and non-LCIV compression group (category B). RESULTS: Ten patients with AIVC were identified (5.8%; male/female, 5/5), five in category A and five in category B. The median age of patients was 76 years (range, 51-94 years), and the median follow-up duration was 388 days (range, 12-4694 days). In category A, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), uterine leiomyoma (n=1), LCIA aneurysm (n=1), and RCIA aneurysm (n=1). In category B, the right common iliac veins were compressed by the RCIA (n=4) and L5 osteophyte (n=1). Endovascular treatment, including balloon angioplasty and stent placement, was performed in six patients, three from each group. Three patients underwent conservative treatment due to their advanced age and comorbidities. Endovascular aneurysm repair was performed in one patient with RCIA aneurysm. Follow-up images were available for six patients, and all of them had patent venous flow. CONCLUSION: The AIVC had an incidence of 5.8% (10/173) among symptomatic MTS patients and wide spectrum of etiologies. Pathogenesis-tailored endovascular treatments are safe and effective.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Síndrome de May-Thurner , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/epidemiologia , Pessoa de Meia-Idade , Flebografia , Estudos Retrospectivos , Stents
13.
J Thromb Haemost ; 19(8): 1973-1980, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34018662

RESUMO

BACKGROUND: Compression ultrasonography (CUS) is the first-line imaging test for diagnosing upper extremity deep vein thrombosis (UEDVT), but often yields inconclusive test results. Contrast venography is still considered the diagnostic standard but is an invasive technique. OBJECTIVES: We aimed to determine the diagnostic accuracy of magnetic resonance noncontrast thrombus imaging (MR-NCTI) for the diagnosis of UEDVT. METHODS: In this international multicenter diagnostic study, we prospectively included patients with clinically suspected UEDVT who were managed according to a diagnostic algorithm that included a clinical decision rule (CDR), D-dimer test, and diagnostic imaging. UEDVT was confirmed by CUS or (computed tomography [CT]) venography. UEDVT was excluded by (1) an unlikely CDR and normal D-dimer, (2) a normal serial CUS or (3) a normal (CT) venography. Within 48 h after the final diagnosis was established, patients underwent MR-NCTI. MR-NCTI images were assessed post hoc by two independent radiologists unaware of the presence or absence of UEDVT. The sensitivity, specificity, and interobserver agreement of MR-NCTI for UEDVT were determined. RESULTS: Magnetic resonance noncontrast thrombus imaging demonstrated UEDVT in 28 of 30 patients with UEDVT and was normal in all 30 patients where UEDVT was ruled out, yielding a sensitivity of 93% (95% CI 78-99) and specificity of 100% (95% CI 88-100). The interobserver agreement of MR-NCTI had a kappa value of 0.83 (95% CI 0.69-0.97). CONCLUSIONS: Magnetic resonance noncontrast thrombus imaging is an accurate and reproducible method for diagnosing UEDVT. Clinical outcome studies should determine whether MR-NCTI can replace venography as the second-line imaging test in case of inconclusive CUS.


Assuntos
Trombose Venosa Profunda de Membros Superiores , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Flebografia , Ultrassonografia , Extremidade Superior/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem
14.
Urologiia ; (2): 46-50, 2021 05.
Artigo em Russo | MEDLINE | ID: mdl-33960156

RESUMO

OBJECTIVE: to study the effectiveness of methods of endovascular treatment of May-Turner syndrome and nutcracker syndrome as a cause of varicose veins of the pelvis in men with chronic pelvic pain syndrome. MATERIALS AND METHODS: a comprehensive examination was carried out in 445 men with chronic pelvic pain syndrome. The patients age ranged from 20 to 68 years (mean age 39.5 years). The diagnosis of varicose veins of the pelvis was established in 49 patients, of which 25 had primary varicose veins of the pelvis, in 24 - secondary varicose veins of the pelvis (13 patients with May-Turner syndrome, 11 patients with nutcracker syndrome). The patients with the nutcracker syndrome underwent embolization of the testicular and pelvic veins using the combined sandwich technique. Patients with May-Turner syndrome underwent stenting of the left common iliac vein. RESULTS: In order to assess the technical efficiency of endovascular treatment, control ultrasound was performed at 1, 3, 6 and 12 months. In 100% of cases, throughout the observation period, the patency of venous stents was maintained; in all cases of embolization of the left testicular vein, there was no blood flow in the embolized vein. In order to assess the clinical efficacy of endovascular treatment after 1, 3, 6, 9 and 12 months. after it, patients were questioned using the NIH-CPSI scale and VAS. The most significant changes in clinical manifestations and ultrasound data were observed after 3 months. after endovascular treatment. CONCLUSIONS: Balloon angioplasty and iliac vein stenting in May-Turner syndrome and left gonadal vein embolization in nutcracker syndrome are minimally invasive treatments with a favorable patient safety profile.


Assuntos
Dor Crônica , Embolização Terapêutica , Varizes , Adulto , Idoso , Dor Crônica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/etiologia , Dor Pélvica/terapia , Pelve/diagnóstico por imagem , Flebografia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia , Adulto Jovem
15.
World Neurosurg ; 152: e201-e204, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34052454

RESUMO

BACKGROUND: Preoperative venogram of the superior sagittal sinus (SSS) is helpful to plan the surgical resection strategy in patients with parasagittal meningiomas invading the SSS. METHODS: Catheter 3-dimensional rotational venography (3D-RV) allows for SSS patency assessment and detection of alternative venous cortical drainage routes in patients with contraindication for magnet resonance venography. It is unknown if separate bilateral internal carotid artery 3D-RV followed by postprocessing 3D-3D fusion (technique 1) achieves the same imaging results as simultaneous bilateral internal carotid artery 3D-RV without postprocessing fusion (technique 2) needed. RESULTS: In this report we were able to confirm in 2 patients that both techniques achieve comparable imaging quality with similar amount of contrast use. CONCLUSIONS: Although technique 2 requires less radiation, technique 1 is favored due to the need for only 1 vessel access site and catheter with reduced risk for access site and ischemic complications.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Flebografia/métodos , Seio Sagital Superior/diagnóstico por imagem , Idoso , Artéria Carótida Interna/cirurgia , Meios de Contraste/administração & dosagem , Humanos , Injeções , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Seio Sagital Superior/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Medicina (Kaunas) ; 57(3)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33804526

RESUMO

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.


Assuntos
Síndrome de May-Thurner , Trombose Venosa , Adulto , Cesárea , Feminino , Humanos , Veia Ilíaca , Flebografia , Gravidez , Trombose Venosa/diagnóstico por imagem
17.
Am J Case Rep ; 22: e928957, 2021 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-33895771

RESUMO

BACKGROUND May-Thurner syndrome, also known as Cockett's syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. CASE REPORT A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultrasound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. CONCLUSIONS May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.


Assuntos
Síndrome de May-Thurner , Idoso , Constrição Patológica , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Síndrome de May-Thurner/complicações , Síndrome de May-Thurner/diagnóstico por imagem , Flebografia
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(2): 332-336, 2021 Mar 04.
Artigo em Chinês | MEDLINE | ID: mdl-33879907

RESUMO

OBJECTIVE: To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. METHODS: Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. RESULTS: After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. CONCLUSION: The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.


Assuntos
Ablação por Cateter , Varizes , Humanos , Extremidade Inferior/diagnóstico por imagem , Flebografia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Varizes/diagnóstico por imagem , Varizes/cirurgia
19.
Angiol Sosud Khir ; 27(1): 48-51, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825728

RESUMO

Analysed in the article are the results of ultrasonographic examination of patency of venous stents implanted in 86 patients with obstructive lesions of the iliofemoral segment of deep veins. The authors proposed an algorithm of triplex scanning, making it possible to optimize ultrasonographic examination, as well as increasing the accuracy of assessing the state of the stent and patency of the stented segments of veins. The first stage was to examine the state of the stented venous segment in the mode of grey-scale scanning (B-mode), for which purpose the study was performed in the longitudinal and transverse projections. This made it possible to determine the qualitative state of the stent as either presence or absence of its migration and deformation, completeness of expansion, extravasal compression. The second stage was to locate the venous stent in the mode of colour Doppler mapping (CD-mode), thus making it possible to assess stent patency. The third stage was examination in the spectral Doppler mode with the use of the distal compression test. Ultrasonographically detected phasic, respiration-synchronized blood flow with an increase of its linear velocity proximal to the stent in distal compression (positive compression test) is suggestive of no obstructive alterations in the stent's lumen. Determination of the blood flow velocity makes it possible to evaluate the stent patency or stenotic alterations. Monophasic low-velocity blood flow in the ipsilateral common femoral artery may also be indirectly indicative of impaired stent patency (pronounced stenosis, thrombosis, occlusion). The proposed algorithm of ultrasonographic triplex study of patency of venous stents may be used in out-patient conditions repeatedly and safely for the patient.


Assuntos
Veia Ilíaca , Trombose Venosa , Algoritmos , Veia Femoral , Humanos , Veia Ilíaca/diagnóstico por imagem , Flebografia , Estudos Retrospectivos , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Eur J Radiol ; 139: 109722, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33894642

RESUMO

Pulsatile tinnitus (PT) can be a mild or debilitating symptom. Following clinical examination and otoscopy, when the underlying aetiology is not apparent, radiological imaging can be used to evaluate further. CT arteriography-venography (CT A-V) of the head and neck has recently been introduced as a single 'one catch' modality for identifying the many causes of PT including those which are treatable and potentially serious whilst also providing reassurance through negative studies or studies with benign findings. CT A-V is performed as a single phase study allowing both arterial and venous assessment, hence limiting radiation exposure. Additional multiplanar reformats and bone reconstructions are desirable. Understanding the limitations of CT A-V is also required, with an awareness of the scenarios where other imaging modalities should be considered. The causes of PT can be divided into systemic and non-systemic categories. Non-systemic aetiologies in the head and neck should be carefully reviewed on CT A-V and include a variety of vascular causes (arteriovenous malformations/fistulas, venous or arterial aetiologies) and non-vascular causes (tumours and bony dysplasias). Venous causes (dominant, aberrant, stenosed or thrombosed venous vessels) are more common than arterial aetiologies (aberrant or stenosed internal carotid artery, aneurysms or a persistent stapedial artery). Glomus tumours that are not visible on otoscopy and osseous pathologies such as bony dehiscence and otospongiosis should also be excluded. Careful assessment of all the potential vascular and non-vascular causes should be reviewed in a systematic approach, with correlation made with the clinical history. A structured reporting template for the reporting radiologist is provided in this review to ensure all the potential causes of PT are considered on a CT A-V study. This will help in providing a comprehensive radiological evaluation, hence justifying the radiation dose and for patient assessment and prognostication.


Assuntos
Aneurisma , Fístula Arteriovenosa , Zumbido , Angiografia , Humanos , Flebografia , Zumbido/diagnóstico por imagem , Zumbido/etiologia
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