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Background: Leiomyosarcoma (LMS) of vascular origin is a rare entity of soft tissue sarcomas. Although they arise mostly from retroperitoneal major vascular structures, some encountered cases may arise from the smaller vascular structures of the thigh as the femoral vein. Due to their origin from the vascular structures, they represent a diagnostic challenge as they may be misdiagnosed as deep vein thrombosis (DVT). Case presentation: We present a case of a 45-year-old woman with left femoral and iliac vein LMS that was previously described in the vascular ultrasound (US) report as extensive DVT involving the femoral and external iliac veins. The patient did not improve after receiving the prescribed anticoagulants. Seven months later, the patient underwent computerized tomography (CT) with contrast, revealing a soft tissue mass in the anatomical site of the left common femoral and external iliac veins. The patient underwent both US-guided tru-cut biopsy and incisional biopsy from the iliac lymph nodes which revealed leiomyosarcoma. Materials and methods: The patient underwent both vascular ultrasound and magnetic resonance imaging of the pelvis and the left thigh at the time of the first presentation. Seven months later, she underwent contrast-enhanced CT of the abdomen and pelvis. Outcome: The patient was referred to the oncology department to receive the appropriate chemotherapy protocol as the tumor was inoperable. Conclusions: Although leiomyosarcoma of vascular origin is a rare entity of neoplasms, it is usually underestimated. A high index of suspicion would help the clinician to suspect such a neoplasm and save time for early diagnosis and management. Special caution should be taken for patients with venous thrombosis not improving on anticoagulants. When there is suspicion, other modalities such as computerized tomography and magnetic resonance imaging help confirm the diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate if the presence of a pulsatile femoral vein pattern is an indicator of venous congestion in the intensive care unit (ICU). Retrospective observational study. Three medico-surgical university-affiliated ICUs. Adult patients who had an ultrasound evaluation at several time points during their ICU stay: at baseline (within 24 hours of admission to ICU), daily during their ICU stay, and within 24 hours before ICU discharge. At each time point, the hemodynamic, respiratory, and cardiac ultrasound parameters were recorded. The common femoral vein was studied with pulsed-wave Doppler at the level of the femoral trigonum, with high frequency (5-13 MHz) linear array vascular probe and venous vascular mode, in supine patients. One hundred eight patients who underwent 400 ultrasound evaluations (3.7 ± 1 ultrasound evaluations per patient) during their ICU stay were included. Seventy-nine of 108 patients (73%) had a pulsatile femoral vein pattern at least at 1 time point. The multivariable mixed effects logistic regression model demonstrated an association among pulsatile femoral vein pattern, body mass index (OR: 0.91[95% CI 0.85-0.96], p = 0.002), inferior vena cava mean diameter (OR: 2.35 [95% CI 1.18-4.66], p = 0.014), portal vein pulsatility (OR: 2.3 [95% CI 1.2-4.4], p = 0.012), and congestive renal vein flow pattern (OR: 4.02 [95% CI 2.01-8.03], p < 0.001). The results were confirmed by principal component analysis. In the ICU, a pulsatile femoral vein pattern is associated with parameters of venous congestion, independently of the patient's volume status, and ventilatory treatment. These results suggest the femoral vein Doppler pulsatility as a parameter of congestion in ICU patients. [ABSTRACT FROM AUTHOR]

Vascular access in neonates and small infants is often challenging. Ultrasound (US) screening and guidance improves its safety and efficacy. The advantages of a pre-implantation ultrasound examination are intuitive; it is a practical and safe technique that doesn't use radiation, allowing static and dynamic evaluations to be carried out and identifying anatomical variations, the caliber and depth of the vessel, the patency of the entire course and attached structures (nerves, etc.). Optimization of the image is a crucial aspect in achieving a clear view of all anatomical structures while avoiding complications. The goal of this review was to look into the benefits of using US in invasive catheter insertion procedures, especially in pediatric patients. Ultrasonography is used to visualize vessels and related structures in two dimensions (2D), sometimes with the help of color Doppler to detect the presence of intraluminal thrombi by applying gentle compression to assess vessel collapse and evaluate morphologic changes in the internal jugular vein (IJV) who had undergone central venous catheter (CVC) insertion during the neonatal period (Montes-Tapia et al. in J Pediatr Surg 51:1700–1703, 2016). [ABSTRACT FROM AUTHOR]

A 43‑year‑old male diagnosed with end‑stage renal disease on hemodialysis with extensive thrombosis in the inferior vena cava and bilateral iliofemoral vein underwent renal transplantation at our institute. Thrombosis in the major vein can have serious consequences for the success of the transplantation. The common anastomosing vein during renal transplantation is the right external iliac vein, but due to extensive thrombosis, left native nephrectomy with the orthotopic placement of the donor kidney was done. During surgery, the donor renal vein was anastomosed with the left renal vein, and the donor renal artery was anastomosed with the aorta. Postsurgery, the creatinine level showed a progressive decline over time and the patient was discharged home. [ABSTRACT FROM AUTHOR]

Background: The management of feline hindlimb full-thickness skin defects is challenging. On the other hand, the use of a semitendinosus (ST) myocutaneous flap for their coverage has not been reported. Objectives: To describe the ST flap and compare it with second intention healing for managing hindlimb full-thickness skin defects. Methods: In 12 purpose-bred laboratory domestic short-haired cats, two wounds were made on each tibia. The wounds in group A (n = 12) were covered with ST flaps, and those in group B (n = 12) were left to heal by second intention. In both groups, clinical assessment scoring and planimetry were performed between one-30 d postoperatively. Computed tomographyangiography (CTA) was performed on days zero, 10, and 30, and histological examinations were performed on days zero and 14 and at 6 and 12 mon postoperatively. Results: Statistically significant differences in the clinical assessment scores were observed between groups A and B on days 14 (p = 0.046) and 21 (p = 0.016). On the other hand, the time for complete healing was similar in the two groups. CTA revealed significant differences in the muscle width (day 0 compared to days 10 and 30 [p = 0.001, p = 0.026, respectively], and days 10 to 30 [p = 0.022]), ST muscle density, and the caliber of the distal caudal femoral artery and vein (day 0 compared to day 10 [p < 0.001], and days 10 to 30 [p < 0.001]). Histologically significant differences in inflammation, degeneration, edema, neovascularization, and fibrosis were observed on day 14 compared to zero and 6 mon, but no differences were found between the time interval of 6 and 12 mon. Conclusions: An ST flap can be used effectively to manage hindlimb full-thickness skin defects. [ABSTRACT FROM AUTHOR]

Femoral central venous catheter (CVC) placement is a common procedure performed in the pediatric intensive care unit. Femoral CVCs have a relatively low intraprocedural complication rate compared with other access sites. We describe a case of guidewire-induced transient complete heart block during femoral CVC insertion. This complication is rare in the pediatric population. The incidence of its occurrence and guidance to prevent this complication are discussed. [ABSTRACT FROM AUTHOR]

Aim: Pediatric femoral central venous catheter insertion is sometimes difficult due to small vein size. External iliac vein (EIV) compression may provide a tourniquet effect to the femoral vein (FV) and may facilitate catheterization. This study was conducted to determine the effect of EIV compression on FV size and femoral venous catheterization success rates. Methods: This study had 2 parts. The first part was a single-arm experimental study. The second part was a randomized controlled trial. Children weighing 2.5–15.0 kg were included. First part: All patients received the same intervention and measurements. FV anteroposterior and medial-lateral diameters were measured by ultrasound without EIV compression, after which EIV was compressed using the assistant’s finger, and FV diameters were measured. Second part: Patients were randomized into compression and control groups. The compression group received EIV compression during femoral venous catheterization. The control group did not receive the compression. Results: A total of 30 patients (15 in each group) participated. EIV compression significantly increased FV anteroposterior diameter (3.36 ± 1.01 mm with compression, 2.39 ± 0.76 mm without compression, mean difference = 0.97 mm, 95% CI = 0.73, 1.21, P < 0.001) and medial-lateral diameter (4.58 ± 1.40 mm with compression, 3.86 ± 1.32 mm without compression, mean difference = 0.72 mm, 95% CI = 0.43, 1.01, P < 0.001). Catheterization success rates were not different between groups. Conclusions: EIV compression increased FV size, but the effect on femoral venous catheterization success rates was inconclusive due to a small sample size. [ABSTRACT FROM AUTHOR]

Ipsilateral acute iliofemoral deep venous thrombosis (DVT) after a renal transplantation, although rare, has a high morbidity, causing complications such as allograft failure, rupture, or death. Treatment modalities are limited due to the risk of bleeding and impaired renal function. We report successful treatment of a case of iliofemoral DVT in a 58-year-old male recipient of a living donor renal transplantation. The immediate postoperative course of the patient was uneventful, and he was discharged on 6th postoperative day (POD) with serum creatinine of 0.8 mg/dl. On POD 26, the patient was admitted with diarrhea, dehydration, and decreased urine output. His serum creatinine rose from 0.8 mg/dl to 2.6 mg/dl and he developed pain and swelling of the right lower extremity. Duplex ultrasonography was suggestive of acute DVT with noncompressible right distal external iliac vein, common femoral, superficial femoral and popliteal veins, absence of color flow from the right femoral vein to the common iliac vein, dilatation of allograft renal vein and an increased renal graft resistive index of 0.97. After inferior vena cava filter insertion, initial treatment with percutaneous balloon angioplasty and catheter-directed thrombolysis could not restore blood flow. Subsequently, percutaneous transluminal pharmacomechanical aspiration was performed with complete removal of the thrombus leading to restored renal allograft vein patency and normalization of allograft function and Duplex findings. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis (DVT) is a medical condition, occurs when a blood clot forms in a deep vein and pulmonary embolism (PE) occurs when a blood clot gets lodged in an artery in the lung, affecting blood flow to part of the lung. The frequencies of using computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose deep venous thrombosis and pulmonary embolism is increasing day by day. Both the technics are noninvasive and provide prompt results. But there are a good number of alternative technics for the same purposes. That is why, till now scholars and respective professionals are interested to know more about the justification and comparative effectiveness of CT and MRI in detecting DVT and PE. This review aimed to analyze the history of several detecting methods for DVT and PE and to dig out the clear concepts about the effectiveness and patient compliances of CT and MRI in detecting deep venous thrombosis and pulmonary embolism. For proper analysis a lot of research as well as meta-analysis had been studied. From this article besides scholars and professionals, general readers will get a clear concept about the features, effectiveness and justifications of CT and MRI in treating DVT and PE. [ABSTRACT FROM AUTHOR]

Background Venous ulcers of the lower limbs affect 1 to 3% of the Western population; at present, elastic compression is the first line of therapy. Some authors have found that insufficient deep venous circulation may delay ulcer healing during compression therapy. Hypothesis/aim In a group of patients with venous ulcers, we verified whether or not deep venous insufficiency (DVI) associated with superficial venous insufficiency (SVI) may worsen the outcomes of four-layer elastic compression bandage (4LB). Methods A total of 124 patients participated in the study. Ecocolordopper results of superficial and deep venous circulation examinations and the patient's data, including age, sex and clinical history, were collected in an Excel database. A 4LB was applied, and patients were checked twice per week at our clinic, where therapeutic outcomes were recorded. Results/Findings In 62 patients, we found only SVI (66.9%), DVI in 42 patients (33.9%, 38 popliteal veins, 17 femoral veins) and both SVI and DVI conditions in 26 patients (20.9%). In patients with SVI alone, the mean healing time was 81 ± 91 days, and in patients with DVI associated with SVI, it was 108 ± 123 days; the difference between the two groups was not statistically significant (p> 0.2). Ulcer healing was achieved in 90 patients-- 41 with SVI alone, 21 with SVI combined with DVI; the difference was not statistically significant. Conclusions Using 4LB allows ulcer healing with no difference in outcome between patients with SVI alone and those with SVI associated with DVI. Implication for clinical practice A 4LB is effective in varicose ulcer therapy; the caregivers' skills are critical, and home assistance for elderly patients is needed because too many live far from the hospital and cannot follow the therapy protocols on their own. [ABSTRACT FROM AUTHOR]

Thick soft-tissue and redundant skin folds seen in obese patients may lead to difficulties during central venous catheter (CVC) insertion. Here, we describe the case of a morbidly obese patient (298 kilograms) in respiratory failure and shock in whomwe performed central venous catheterization via the mid-thigh femoral vein to administer fluids and drugs, while also executing a tracheostomy. We found that CVC insertion via the mid-thigh femoral vein is a fast and feasible alternate procedure in cases where catheterization of the internal jugular vein or the subclavian vein are challenging or contraindicated. Importantly, we show that dressings were clean and easy to maintain. [ABSTRACT FROM AUTHOR]

Background: With more than 10 million cases occurring annually in India, varicose veins can sometimes result in severe discomfort and pain besides disfiguration of skin. The objective of the study was to assess the most viable treatment options for varicose veins between the traditional Trendelenburg procedure and microphlebectomy. Methods: This was an interventional study conducted at a tertiary center in South India. Patients above 18 years of age, presenting with varicose veins due to saphenofemoral junction (SFJ) incompetence and scheduled for surgical management, were included in a sample size of 46. Subjects were randomized into two groups - Group 1 underwent micro phlebectomy and Group 2 underwent Trendelenburg operation with stripping of great saphenous vein (GSV). Postoperative pain was assessed on day of surgery, day after, and postoperative day 7. A venous Doppler ultrasound was conducted 6 weeks after the surgical procedure, to look for reflux at SFJ. Results: Group 1 subjects reported lesser immediate postoperative pain and incurred significantly less cost as determined by an independent sample t-test. Chi-square test found no significant difference in the rate of occurrence of local complications (P > 0.05), and no recurrence was noted among both groups. Conclusion: Microphlebectomy is a more feasible treatment option than Trendelenburg operation with GSV stripping on account of lower costs. It is also a patient friendly alternative due to immediate reduction in pain. [ABSTRACT FROM AUTHOR]

Background: There are anatomical differences in the femur and acetabulum on the dysplastic hips. Yet, although there are detailed researches on bony structure differences, studies regarding anatomical differences for the vascular structure are insufficient. The study aimed to determine the relationship between the femoral artery and vein with acetabulum in computed tomography evaluation of Crowe type 4 hips and to compare with normal hip femoral vein and artery anatomic position.Methods: Forty patients with one side hip Crowe type 4 deformity and opposite side normal hip were found suitable for the study. Pelvis CT was previously applied to all patients for the planning of total hip arthroplasty surgery. Normal hip acetabulum and the true acetabulum of the dysplastic hip were marked with the Ranawat's triangle and were then divided into quarters with four axial slices of the acetabulum; as dome, proximal one-fourth, center, and distal three-fourths. The shortest distance from the femoral vessels to the pelvis was measured at these 4 axial slices at the dysplastic side and compared with the healthy side.Results: The distance of the vein to the acetabulum is closer to the dysplastic side. At distal three-fourths of Ranawat's triangle axial images, both femoral artery and femoral vein are closer to acetabulum at the dysplastic side.Conclusion: The analysis of preoperative images in cases of Crowe type 4 hip shows that the femoral vessels are closer to the anterior wall of the dysplastic true acetabulum at the level of the center of the hip (vein, mean: 2.7 mm closer) and below the center of the hip (vein, mean: 3 mm; and artery, mean: 3.3 mm closer) when compared with the normal acetabulum. Anatomic relationships knowledge can be used intraoperatively to avoid iatrogenic vascular injury during Crowe type 4 dysplastic hip arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Background: Venous bleeding complication is often observed after catheter ablation of atrial fibrillation (AF), but the risk factors remain unclear. Methods: We retrospectively evaluated 570 consecutive patients who underwent catheter ablation of AF from April 2012 to March 2017. After the procedure, the sheaths were removed, and hemostasis was obtained by manual compression followed by application of rolled gauze with elastic bandage and continuous pressure to the puncture site. We evaluated the risk factors for venous bleeding complications defined as hemorrhage from the puncture site that needed recompression after removal of the elastic bandage and rolled gauze. Results: After excluding 11 patients because of missing data, 559 patients (395 [70.7%] men, mean age: 65.6 ± 8.7 years) were included for analysis. Venous bleeding complication was observed in 213 patients (38.1%). In the multivariate logistic regression analysis, low body mass index (BMI; odds ratio [OR] 0.95, 95% CI 0.90‐1.00, P =.04), short compression time (OR 0.77, 95% CI 0.68‐0.88, P <.001), and antiplatelet therapy (OR 1.86, 95% CI 1.09‐3.16, P =.02) were independent risk factors for venous bleeding complication. Conclusions: Low BMI, short compression time, and antiplatelet therapy were independent risk factors for venous bleeding complication after catheter ablation of AF. Longer compression time may be needed for patients with low BMI and/or those receiving antiplatelet therapy. [ABSTRACT FROM AUTHOR]

Background: Pediatric patients undergoing cardiac catheterization procedures are required to lie flat for 4 hours for femoral venous access and 6 hours for femoral arterial access. Authors of research in adults suggest the flat time for the same access can be safely reduced to 1.5 to 2 hours post procedure. No literature was found that flat times could be safely reduced for pediatric patients. Objective: The purpose of this study was to determine whether decreased flat time for the post--cardiac catheterization pediatric patient would impact the incidence of site bleeding, additional sedation, and the need for a critical care admission. Methods: A randomized controlled trial was designed and participants were randomly assigned to experimental or control group. The experimental group reduced flat times to 2 hours for venous and 4 hours for arterial. The control group was standard care of 4 hours for venous and 6 hours for arterial. Results: A total of 119 participants were enrolled, 60 in the experimental group and 59 in the control group. Results suggest no difference in the incidence of site bleeding (P = .999), additional sedation (P = .653), or need for a critical care admission. Conclusions: For pediatric patients undergoing arterial or venous cardiac catheterizations, flat times can safely be reduced without increasing site bleeding, additional sedation, or critical care admissions. [ABSTRACT FROM AUTHOR]

FRACTURES ARE A COMMON FINDING IN TRAUMA DEPARTMENTS WORLDWIDE AND THEY CAN BE TREATED CONSERVATIVELY OR SURGICALLY. IN BOTH TYPES OF FRACTURE TREATMENT, DEEP VEIN THROMBOSIS (DVT) AND PULMONARY EMBOLISM (PE) ARE LIFETHREATENING COMPLICATIONS. AN ANIMAL MODEL WAS USED TO STUDY THE INFLUENCE OF TREATMENT TYPE ON DVT AND PE INCIDENCE. THIRTY RATS WERE EQUALLY DIVIDED INTO THREE GROUPS AS FOLLOWING: GROUP I (BILATERAL FEMORAL VEIN THROMBOSIS), GROUP II (BILATERAL VEIN THROMBOSIS AND UNILATERAL TIBIA FRACTURE TREATED SURGICALLY) AND GROUP III (BILATERAL VEIN THROMBOSIS AND UNILATERAL TIBIA FRACTURE TREATED CONSERVATIVELY). THE TOTAL OBSTRUCTION OF THE FEMORAL VEIN IPSILATERAL TO THE FRACTURE WAS FOUND IN 60% OF CASES IN GROUP I, 50% OF CASE IN GROUP II AND 100% OF CASES IN GROUP III. REGARDING THE FEMORAL VEIN THROMBOSIS IN THE NON-FRACTURED LIMB, THE TOTAL OBSTRUCTION OF THE FEMORAL VEIN WAS OBSERVED IN 50% FOR GROUP I, 60% FOR GROUP II AND 11% FOR GROUP III. COMPLETE OBSTRUCTION OF THE PULMONARY ARTERIES WAS 50% IN GROUP I, 10% IN GROUP II AND 9% IN GROUP III. FAT PULMONARY EMBOLISM OCCURRED IN 6 OUT OF 10 CASES IN GROUP II. CONSERVATIVE TREATMENT HAS A HIGHER RISK OF DEEP VEIN THROMBOSIS COMPARED TO SURGICAL TREATMENT. FURTHERMORE, PULMONARY FAT EMBOLISM IN THE INTRAMEDULLARY NAIL TREATED GROUP IS FOUND IN MOST CASES, WITHOUT CLINICAL SYMPTOMS. [ABSTRACT FROM AUTHOR]

BACKGROUND: A wireless pulmonary artery pressure sensor (CardioMEMS) is approved for implantation via the femoral vein. The internal jugular vein (IJ) is an attractive alternative access route commonly used in pulmonary artery catheterization. METHODS AND RESULTS: Retrospective chart review was performed for all sensor implants from 10 providers at 4 centers from September 2016 to June 2018. To compare procedural outcomes and discharge efficiency between groups, multivariate analyses incorporating potential confounders were performed. Seventy-three (28%) patients had femoral access, and 189 (72%) had IJ access; demographics were similar between the groups. Complications, including one case of hematoma and 4 cases of mild hemoptysis, and 30-day mortality (2%-3%) did not differ between groups. Provider preference for IJ access substantially increased over time, with IJ accounting for 90% of cases in 2018. After risk-adjustment, IJ cases had 20% (5%-33%) shorter fluoroscopy time (P=0.01) and 24% (7%-38%) lower contrast volume (P=0.008). Compared with outpatient femoral cases, outpatient IJ cases had 62% (52%-69%) faster needle-to-door time and were 34 times (6-235) more likely to have same-day discharge (P<0.001 for both). CONCLUSIONS: IJ access for CardioMEMS implant is a safe alternative associated with superior procedural and discharge outcomes. Implanters at 4 high-volume centers adopted IJ access as the preferred implant approach. [ABSTRACT FROM AUTHOR]

In neonatal intensive care units, a percutaneous central venous catheter (PCVC) is inserted peripherally and threaded into a central venous location, when intravenous access is anticipated for an extended period of time. The tip location of PCVCs should be checked by an X-ray after the procedure. The present study aimed to determine an equation to estimate the optimal insertion length of PCVCs in neonates prior to the procedure. The data of all neonates who had PCVC insertion between May 1st 2015 and April 30th 2016 was reviewed. Their gender, body weight and body length at the insertion date, any complications and the tip culture of their PCVCs were recorded. The tip location of the PCVC, which was confirmed by X-ray, was either in the inferior vena cava near to the diaphragm or in the superior vena cava before the right atrial junction, depending on the insertion site. We analyzed the correlation among inserted length of PCVCs, body weight and body length by linear regression to determine an equation for estimating the optimal insertion length of PCVCs. The accuracy of the equations was evaluated prospectively by Pearson's correlation analysis, and the adjusting rate of PCVCs after the initial insertion was compared between the traditional method and using the equation. The equation of PCVCs inserted in the foot was "insertion length (cm) = 16 + 4.27 × body weight (kg)", in the femoral vein was "inserted length (cm) = 9.8 + 1.7 × body weight (kg)", in the popliteal vein was "inserted length (cm) = −0.3 + 0.45 × body length (cm)", in the hand was "inserted length (cm) = 4.46 + 0.32 × body length (cm)", and in the axillary vein was inserted length (cm) = 1 + 0.18 × body length (cm). The adjusting rate of PCVCs after initial insertion was decreased from 73.5% to 53% following use of the equation. Equations provided a convenient and accurate method to estimate the optimal insertion length of PCVCs before their placement. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intermittent pneumatic compression (IPC) is an effective method for preventing deep vein thrombosis (DVT) and is comparatively low risk for hemorrhaging compared with anticoagulant therapy. IPC is easily administered, and severe complications are rare. The patient was a 69-year-old male with no underlying diseases related to hemorrhaging of hemostasis. He was hospitalized for treatment of a third-degree burn injury to the upper body. Because the treatment included surgical debridement and skin grafting, there was substantial concern regarding the potential of hemorrhagic complications; hence, IPC was initiated to prevent DVT rather than standard anticoagulant therapy. On the ninth day of hospitalization, a femoral venous catheter initially placed to manage hydration was removed. Manual compression was performed for 15 minutes, and after confirming hemostasis at the insertion site, a hemostasis band was applied for an additional hour. At 90 minutes after confirming hemostasis, there was a secondary hemorrhage at the site of catheter removal. The secondary hemorrhage was stopped with manual compression, and IPC was discontinued. It was concluded that IPC might result in increased blood flow in the femoral vein. This may have contributed to the secondary hemorrhage after the removal of the catheter. Clinicians need to be aware of the fact that IPC may promote secondary hemorrhage after removal of a femoral venous catheter. [ABSTRACT FROM AUTHOR]

The article describes the case of a 45-year-old woman with aortocaval fistula who was examined using caudocranial scanning to synchronize data acquisition with optimal arterial opacification. It is noted that the woman had no history of diabetes. She underwent post-procedure hydration protocol after computed tomography angiography examination. She suffered a myocardial infarction three weeks after being released from the hospital.

Background Bedside vascular access options have been limited to the short peripheral intravenous, midline catheter, peripherally inserted central catheter, and central venous catheter (CVC) insertion sites such as the jugular, subclavian, and femoral vein. Many patients with limited options for upper extremity, subclavicular, supraclavicular, and cervical limitations have traditionally received a femoral CVC in the inguinal region. This insertion site is considered a high risk for infection because of its location in the inguinal region and associated difficulties with maintaining the dressing integrity. An alternative location was selected for the insertion of a femoral vein central venous catheter in the midthigh to reduce the risk of infection. Methods After a multiple-year implementation process, midthigh femoral (MTF) insertions were performed on a select group of patients. The case studies that are included in this report outline the indications, procedures, and other pertinent aspects of the MTF placement. Patients at this institution with contraindications to upper extremity and thoracic catheter insertion received a MTF vein CVC in place of a traditional common femoral vein catheter insertion in the inguinal area. All procedural consents include permission for photography of procedure sites. Results All but a single patient completed their therapy without complication; 1 intentional dislodgement by a patient was recorded. There were no MTF catheter-related bloodstream infections and 2 confirmed central line associated bloodstream infections ( n  = 2 of 100) with the second noted as probable contaminated specimen. Outcomes reflected no procedural complications (eg, expanding hematoma or femoral nerve injury or any other femoral artery or vein injuries) and 1 nonocclusive deep vein thrombosis ( n  = 1 of 100). Conclusions The MTF CVC provides an alternative to traditional common femoral vein catheter placement for nonemergent patients with upper extremity and thoracic contraindications to central line placement. [ABSTRACT FROM AUTHOR]

In consideration of the 3-R-rule (Refine-Replace-Reduce) as a guideline for promoting ethical use of animals for surgical training, we present a novel training model for microvessel anastomosis. In a rat cadaveric study, we evaluated the surgical anatomy of the common carotid artery (CCA), external jugular vein (EJV) and femoral vessels (FV) which were then used as templates for the present investigation. Anatomical dissection of 30 rat cadavers was performed. Two residents without prior microsurgical experience were included in the study and performed 5 CCA, 5 femoral artery, 5 EJV and 5 femoral vein anastomoses. Patency and leakage served as qualitative variables and operation time as a quantitative variable for efficiency control. The average time improved for arterial and venous anastomoses (45 min–22 and 60 to 32 min, respectively) for both surgeons. While both surgeons experienced patency failure or leakage within the first half of performed arterial and venous anastomoses, they could improve to a 100% patency rate without the occurrence of leakage for the last half of trials. The rat head & neck anatomy presents various characteristics related to the harvest of the vessels of interest. We provide anatomical knowledge about the topography related to the harvest of the CCA, EJV, and FV. Our model is an easily accessible, low-cost microsurgical simulation model, allowing a realistic and instructive performance of anastomoses. Since cadaveric vessels are used, an approval of the local ethics committee is not needed. [ABSTRACT FROM AUTHOR]

Background: Common risk factors for developing deep vein thrombosis (DVT) are prolonged immobilisation, surgery, leg trauma or fracture, pregnancy, hormone therapy, heart failure, cancer, obesity, age, and smoking. The incidence of DVT in HIV-infected patients shows a two- to tenfold increase in comparison with a healthy population of similar age. This retrospective descriptive study evaluated the presence of risk factors for DVT and the prevalence of HIV infection in patients with confirmed DVT treated at Kimberley Hospital Complex, a regional/tertiary hospital in the Northern Cape Province, South Africa, from January 2010 to December 2014. Methods: Patients were identified from the ultrasound register from the Radiology Department, and all adult patients with Doppler-proven DVT during the five-year period were included in the study. The data were extracted from the patient files and captured on data sheets. Results: Of the 852 patients included in the study, most were female (n = 536, 62.9%). The median age was 45 years (range 5-94 years, interquartile range 34-58 years). More than half (n = 443, 52.0%) of the patients were HIV-positive, 333 (39.1%) HIV-negative, while 76 (8.9%) did not have a known HIV status. The most common association with DVT was HIV infection (52.0%) followed by tuberculosis (12.4%), cancer (10.9%), and smoking (9.0%). The least common risk factors were long-distance travel (0.4%) and thrombophilia (0.4%). The left popliteal vein was the most frequently affected site (42.0%) followed by left superficial femoral vein (40.8%) and left common femoral vein (34.7%). The location of the DVT was not associated with the HIV status of the patients. Conclusion: At Kimberley Hospital Complex, the most common risk factor in patients presenting with DVT was HIV infection, with more than half of the patients being HIV-positive. Other risk factors included tuberculosis, cancer and smoking. [ABSTRACT FROM AUTHOR]

We had the opportunity to implant the first leadless pacemakers in Hawai'i. This device represents a major change in pacemaker technology. This is a report of the first five cases and a review of the literature. All these devices were implanted via femoral venous access (versus conventional upper chest axillary/subclavian/cephalic routes), with an unique fixation mechanism allowing direct attachment to the ventricular myocardium (dispensing the usage of long transvenous electrode leads). The miniature generator can is over an order of magnitude smaller and lighter than the currently available ones. This article provides an understanding of the device design, implantation technique, the advantages and limitations, and the potential of this new pacemaker. [ABSTRACT FROM AUTHOR]

Background The aim was to assess the clinical and anatomical outcomes of iliofemoral stenting, with concomitant femoral stenting or balloon angioplasty alone, in patients with severe post-thrombotic syndrome (PTS) and compromised inflow. Methods A database of patients with severe PTS who successfully underwent endovascular iliofemoral stenting was reviewed retrospectively. Patients with impaired inflow with chronic post-thrombotic obstructive lesions in the femoral vein (FV), but patent profunda vein, were selected and divided into two groups: the FV stenting (FV-S) group and the FV angioplasty (FV-A) group. Patients in the FV-S group were treated with concomitant iliofemoral and FV stenting, and patients in the FV-A group were treated with iliofemoral stenting and balloon angioplasty alone of the obstructed femoral vein. The clinical and stent outcomes were recorded and compared in the two groups. Results There were 45 patients in the FV-S group and 69 patients in the FV-A group. The groups were well matched for age, gender, and diseased limbs. The pre-procedural symptoms, CEAP classifications, VCSS scores, Villalta scores, and prevalence of active ulcers were also similar between the two groups. Immediate failure (<30 days post-procedure) in the femoral segment occurred more frequently in the FV-A group (70% in FV-A group vs. 24% in FV-S group, p < .001); however, all treated femoral vein segments had occluded at 12 months. There was no significant difference between the FV-S and FV-A groups in cumulative primary and secondary patency rates of the iliofemoral stent at 3 years (55% vs. 52%, p = .71, and 77% vs. 85%, p = .32, respectively). Complete pain relief, swelling relief, VCSS score, Villalta score, and freedom from ulcers at a median of 22 months (1–48 months) following the procedure were similar in the two groups. Conclusions Stent placement to treat post-thrombotic iliofemoral obstruction with concomitant obstructed femoral vein but patent profunda vein shows cumulative patency rates and clinical outcomes similar to previous reports. Adjunctive femoral stenting or angioplasty of the obstructed femoral vein does not appear to improve clinical or stent outcomes in patients with severe PTS. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)