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Common femoral vein occlusion (CFVO) is frequently found in patients with chronic venous insufficiency. The iatrogenic form, secondary to either central catheter or surgery, is very rare but highly symptomatic. Classical compression therapy barely improves the clinical status of these patients, making them suitable candidates for an interventional procedure for venous recanalization.We report here three consecutive cases of iatrogenic CFVO referred to our outpatient clinic because the disease had an impact on daily life activities. We detail the recanalization procedure, the Doppler control and the short-term outcome.In each case, endovascular recanalization required rigid material (rigid guide or Colapinto needle) to cross the fibrous adhesions before angioplasty could be performed with stenting. The procedure required two attempts in each case, underlining its complexity, but eventually enabled effective recanalization. No major complication occurred per- or post-procedure. One month later, a duplex Doppler control confirmed the permeability of the common femoral vein. The patients had experienced rapid and significant symptom improvement.Patients suffering from severe chronic venous insufficiency caused by iatrogenic CFVO can benefit from endovascular recanalization. Although these procedures may be complex due to the extensive fibrosis at the Scarpa and require specialized equipment, no major complications were observed. Patency of the recanalization persisted at least one month after the procedure. Symptom relief was good.

Nearly half of patients with acute lower limb deep vein thrombosis (DVT) develop a post-thrombotic syndrome (PTS). This risk is particularly high in case of proximal DVT of the common femoral and iliac vein, the major lower limbs venous outflow vessel. Several studies have demonstrated that PTS incidence can be reduced with early vein recanalisation. Currently, catheter-based recanalisation therapies can be offered to selected patients with acute ilio-femoral deep vein thrombosis. Aim of the present article is to summarize current knowledge on these catheter-based recanalisation therapies.

Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia.A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia. Doppler ultrasound revealed bilateral and proximal deep vein thrombosis (sural and superficial femoral veins of the right leg; sural and iliac veins of the left leg) without any distal arterial flow. We concluded on a diagnosis of bilateral phlegmasia cerulea dolens.Phlegmasia cerulea dolens is a particular type of deep venous thrombosis in which a proximal venous thrombus is combined with arterial ischaemic signs due to brutal and massive oedema and slowing down of arterial flow. In most cases, the lower limbs are involved, with malignancy being the most common cause. It should be suspected in the presence of the classical triad of "pain, oedema and cyanosis", with confirmation by Doppler ultrasound. There is no general consensus regarding standard management. Traditionally, systemic anticoagulation has been the mainstay of treatment for this condition. Endovascular surgery may be a possibility in some cases. Prompt diagnosis and rapid treatment initiation are paramount in order to improve the prognosis of this severe condition with ominous prospects.

The quality standards of the French Society for Vascular Medicine for the ultrasound assessment of the superficial venous system of the lower limbs are based on the two following requirements: technical know-how (mastering the use of ultrasound devices and the method of examination); medical know-how (ability to adapt the methods and scope of the examination to its clinical indications and purpose and to rationally analyze and interpret its results).To describe an optimal method of examination in relation to the clinical question and hypothesis; to achieve consistent practice, methods, glossary terminologies and reporting; to provide good practice reference points and to promote a high quality process.The three levels of examination. Their clinical indications and goals. The reference standard examination (level 2) and its variants according to clinical needs. The minimal content of the examination report, the letter to the referring physician (synthesis, conclusion and management suggestions) and iconography. Commented glossary (anatomy, hemodynamics, semiology). Technical basis. Ultrasound devices settings. We discuss of use of Duplex ultrasound for the assessment of the superficial veins of the lower limbs in vascular medicine practice.

Amniotic fluid embolism is a relatively rare clinical entity and with difficult medical recognition. However, it is the second leading cause of maternal mortality. We report here the case of a 32-year-old patient who underwent elective caesarean section complicated by an amniotic fluid embolism with cardiac arrest. The presence of a major disseminated intravascular coagulation favored the occurrence of a retroperitoneal hematoma of iatrogenic origin on attempt of femoral venous catheterization and that of hemoperitoneum on bleeding of an hepatic adenoma. The diagnostic of amniotic fluid embolism was confirmed by the presence of amniotic cells in the bronchoalveolar lavage. The patient survived without sequelae.

To describe the perioperative management, from the point of view of the anesthesia-intensive care unit specialist, of patients with aortic stenosis who undergo transcatheter aortic valve implantation (femoral or apical TAVI).The PubMed database (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) was queried, using the following keywords: aortic stenosis, transcatheter aortic valve implantation TAVI, outcome, complications, anesthesia.TAVI is performed in patients suffering from aortic stenosis and presenting with numerous comorbidities, high-predicted perioperative mortality and/or contraindications to conventional cardiac surgery. TAVI is performed either by percutaneous transfemoral or transapical puncture of the left ventricle (LV) apex. These patients are older, have more comorbidities than those undergoing aortic valve replacement surgery and perioperative mortality predicted by risk scores is higher. While transapical TAVI is performed with general anaesthesia, transfemoral TAVI can be performed with either general or locoregional anaesthesia and/or sedation. The choice of the anaesthetic technique for transfemoral TAVI depends on the patient's medical history, the technique chosen for valve implantation, the type of monitoring and the anticipated hemodynamic problems. The incidence of complications following TAVI is high, some are common to surgical aortic valve replacement, and others are specific to this technique. Because of the prevalence of comorbidities, the hemodynamic-specific constraints of this technique and the incidence of complications, anaesthetic and perioperative management (evaluation, anaesthetic technique, monitoring, post-surgery care) requires the same level of expertise as in cardiac surgery anaesthesia.TAVI expands treatment options for patients with aortic valve stenosis. The anaesthesia team must be involved in the care of these patients with the same level of expertise and care as in heart surgery on critical patients.

We report the case of a 61-year old man in whom a deep venous thrombosis was the presenting feature of disseminated lung carcinoma. A few days later, an arterial thrombosis occurred necessitating amputation. Within a few weeks, the lung cancer progressed dramatically and the patient died. While the association between venous thrombosis and cancer is well known, the relationship between cancer and arterial thrombosis has been less explored. This observation allows discussion of the pathophysiological and clinical aspects of this association, as well as the implications for patient care.

The authors report a case of orbital cellulitis complicating bacteremia on central catheter infection. A 51-year-old man, with a history of diabetes and end-stage renal disease, was admitted for left exophthalmos with inflammatory chemosis, fever, and worsening of his general state. The CT scan showed exophthalmos with thickening of soft tissues and infiltration of the ocular fat without collection or sinus impairment. Orbital cellulitis was diagnosed. The etiological investigations showed Staphylococcus aureus bacteremia on femoral catheter infection. Progression was favorable with antibiotics and nursing care. The authors discuss the compromised prognosis of this disease and the need for rapid diagnosis and prompt therapeutic management.

The most frequent manifestation of exercise deep vein thrombosis (DVT) is the one occurring in upper limbs, in some specific and stereotypic conditions, sometimes complicated by pulmonary embolisms. A few cases of lower limbs DVT are reported in athletes. Some pathophysiologic arguments (rheological modifications, parietal lesions and coagulation abnormalities) suggest a link between DVT and exertion, but the causality is sometimes difficult to establish. We report three cases of pulmonary embolism occurring after a prolonged effort of running in trained marathon athletes. To our knowledge, very few similar cases have ever been reported. The possible responsibility of such physical efforts is discussed, as well as other potential cofactors such as coagulation abnormalities and hormonal contraception.

International audience; The diagnosis of pulmonary embolism (PE) is challenging because the symptoms are unspecific and an objective confirmation of the disease is required. Clinical symptoms and physical examination can be used to estimate the clinical probability of the disease used to interpret the results of the diagnostic tests. In patients with low or moderate clinical probability most quantitative D-dimer tests allow to exclude PE safely. A positive proximal venous ultrasound enables to confirm PE but the sensitivity is too low to exclude the diagnosis. In patients with a positive D-dimer test, multidetector spiral CT allows to confirm or exclude PE with confidence in most of the cases. Lung scanning is still useful in patients with renal impairment or allergy to contrast medium.

Large B-cell lymphoma of the leg in elderly subjects, of intermediate prognosis according to the new EORTC classification, may present as nodular or ulcerated forms. There has been relatively little study of the various etiological hypotheses advanced, including venous insufficiency. We report the case of an elderly man with chronic leg ulcer, recently undergoing modification, in which microscopy revealed large B-cell lymphoma (CD20-).A 78 year-old man presented chronic ulcer of the right leg of mixed origin with severe venous insufficiency and arteritis. In the previous 2 months, 2 nodules appeared in the centre of the ulcer. Histological examination of a skin biopsy revealed the presence of large B-cell lymphoma and immunohistochemical analysis showed positive anti-CD79a+, CD20- antibody labeling of cells. Staging studies showed only locoregional invasion. Because of the positive CD20- labeling, ZEM chemotherapy (idarubicine, cyclophosphamide, prednisolone) was given, resulting in disappearance of the nodules after four months and preliminary epidermal healing of the ulcer. Several months later, severe infectious complications necessitated amputation. Examination of the excised sample showed no residual tumor.Many causal links have been proposed between large B-cell lymphoma of the leg and aetiologies such as infectious agents, Koebner phenomenon and chronic lymphedema, as well as various other vascular factors. A number of hypotheses were proposed in the present case. It may have been leg ulcer cutaneous B-cell lymphoma, or, more likely, development of lymphoma on a chronic mixed ulcer, with the respective roles of vascular disease, local immunosuppression and antigenic stimulation subject to debate.

Later vascular injury after central venous catheterization is not common. In literature, there are only cases reporting jugular or subclavian vein catheterization territories with a higher significative risk if the catheter is larger and in left position. We report a case of inferior vena cave perforation, nine days following femoral vein catherization for parenteral nutrition in a 72-year-old patient. This vascular perforation induced an infusion in the peritoneal and the retroperitoneal cavity with abdominal and pelvic pain. This case report may ask the question of recommendations about femoral catherization.

Posttraumatic arteriovenous fistulas are not a rare event in military facilities during periods of armed conflicts, but are seldom seen in the civilian health care system.We report our approach to the management of 26 cases of posttraumatic limb arteriovenous fistulas colligated from 1996 to 2006.The main cause of our posttraumatic arteriovenous fistulas is the penetrating traumatism. Arteriography was the mostly used imaging exploration. The treatment was surgical for 24 patients. One case of thrombosis was reported.Our series of posttraumatic fistulas is characterized by a particularly high rate of penetrating trauma, in which case intervention is the rule. Our study shows that, in our experience, surgical treatment is still a safe and efficient therapeutic attitude.

Patients who undergo surgery involving the groin and the popliteal fossa often develop recurrent varices which require careful management. Several surveys using various classification systems have estimated the prevalence of recurrent varices after groin and popliteal surgery. Patients may seek medical care for various reasons: unsightly recurrent varicose veins, vein-related symptoms, appearance of cutaneous or subcutaneous changes, concerns about the health risk related to their veins or limitation of activity. Recurrent varices may also be found at routine follow-up examinations. An analysis of recurrence at this location reveals three main mechanisms: incomplete resection of the saphenofemoral or saphenopopliteal junctions in patients with an initially incompetent terminal valve. The persisting reflux feeds the tributaries connected at the saphenous stump; the second mechanism is related to neovascularisation that reconnects the deep venous system with the superficial network; the neo-veins are valveless. This phenomenon appears to be more frequent when the resection of the saphenous vein ending has been complete; the third mechanism is due to a tactical error; the refluxive pelvic veins that had not been diagnosed feed the varices. Duplex scanning identifies the different possible mechanisms and provides anatomical and hemodynamic data. Interventional treatment methods after varices recurrence are redosurgery, sclerotherapy and pelvic vein embolization when they are at issue. All these methods are described in details. Results provided by these treatments are analysed. Unfortunately no randomized control study enables grade A or B recommendations. Personally we suggest that ultrasound guided foam sclerotherapy should be the first-line treatment except when duplex scanning reveals an intact incompetent saphenous stump at the saphenofemoral junction or/and saphenopopliteal junction with a massive reflux filling the varicose network.

The superficial femoral vein (SFV) is a well-established alternative conduit for infra-inguinal reconstructivenous hypertension after SFV harvest may however result in significant morbidity. This study reports the efficiency of SFV as conduit for infra-inguinal reconstructions and characterize the anatomic and physiologic changes in harvest limbs and their relationship to the development of venous complications.From May 1999 through November 2003, 23 SFV were harvested from 21 patients undergoing infra-inguinal reconstructions. Bypasses were controlled by regular duplex-ultrasound. The venous morbidity was assessed by measurements of leg circumferences, strain-gauge plethysmography and quality of life, investigated by the VEINES-QOL scale.At a mean follow-up of 10.4 months (range 1-56), primary, secondary patency and limb salvage rates of infra-inguinal bypasses using SFV are 71.4%, 76.2% and 85.7% respectively. No patient had major venous claudication. Oedema was significantly present in nine patients. Strain-gauge plethysmography showed outflow obstruction in all patients. The VEINES-QOL assessment showed no limitation in social and domestic activity, moderate complain about leg heaviness despite presence of oedema.The SFV harvest is a reliable conduit for infra-inguinal reconstructions and results in moderate venous morbidity in terms of functional consequences and quality of life.

The arch of the great saphenous vein cross receives numerous tributaries from the abdominal wall, male external genitalia and pelvic limbs. These collaterals present many variations relating to their number and mode of anastomosis. Their misappreciation may lead to post operative recurrences after surgical treatment of varices. For a last study of these variations, we dissected 40 inguinofemoral regions in fresh black african corpes. The conventional type in a "vein strar" shape was present in 4 cases. An abdominal common vein produced through the merging of the superficial epigastric and superficial circumflex iliac veins was found in 5 cases. A genital common vein summarising the external pudendal veins was present in 19 cases. In 8 cases the abdominal and genital common vein was simultaneously present. An anterior saphenous vein was found in 15 cases, and a posterior saphenous vein in 5 cases. These results, confirm the importance of anatomic variations. Their knowledge is necessary to avoid recurrences after surgery of varicose veins.

A direct or tubular communication between the systemic venous system and the systemic atrium, generally called fenestration, is surgically created to improve the postoperative period of patients undergoing total cavopulmonary connection. However, a fenestration prompts a potentially deleterious right to left shunt, and is generally closed after the postoperative period. Direct fenestrations can be closed using coils, or devices designed for atrial septal defect closure. However, no devices have been designed for closure of extracardiac fenestrations. We report our experience concerning the closure of extracardiac Fontan fenestration by the Amplatzer duct occluder (ADO).From January 2001 to December 2002, we closed extracardiac Fontan fenestrations using the ADO device in 10 consecutive patients. Indications to fenestration closure were: low velocity shunt through the fenestration, mild desaturation, and absence of effusions.All patients had a successful closure of the fenestration. The procedure was performed through the femoral vein in 7 cases and through the right jugular vein in 3. Mean central venous pressure increased not significantly from 12 to 13-mmHg. Mean oxygen saturation increased significantly from 90 to 97% (p0.001). Immediate shut abolition was obtained in 9 cases. No complications were observed. At a median follow-up of 12 months (range 6-18 months), all patients are free of symptoms and have a normal oxygen saturation at rest as well as at exertion.The ADO device allowed closing the extracardiac Fontan fenestration in all patients with no mortality, no morbidity and a rate of 100% of complete closure at mid-term follow-up.

Subcutaneous tunnelling of short-term catheters and the choice of site of catheter insertion are the two factors which influence the risk of catheter-related infection. Catheters inserted into a femoral vein have been associated with a higher risk of infection than those inserted into a subclavian vein. However, a meta-analysis comparing the internal jugular and subclavian sites did not report any difference. Regarding tunnelling, two randomized studies showed a benefit in terms of infection rates for the jugular and femoral sites when the blood sampling was not performed via the catheters. For the subclavian site tunnelling does not seem to bring any advantage compared to conventional insertion.

We report a iatrogenic case of retroperitoneal haematoma consecutive to an emergency femoral venous catheterization. The indication of the catheterisation was a hemorrhagic shock after a dilapidating traumatism of leg in an obese patient in whom peripheric venous access was impossible and vascular filling urgent. In spite of the existence of an initial reassuring blood backward flow, a retroperitoneal haematoma had been constituted gradually and explained an absence of haemodynamic improvement in spite of the surgical haemostasis and an adapted intravascular filling. The CT scan showed an iatrogenic lesion of the right iliac vein and justified the immediate infusion stop. The femoral catheter was withdrawn at the 48th hour and the patient discharged at the 6th day.

A case of leiomyosarcoma of the superficial femoral vein detected in the follow-up of a non resolving deep venous thrombosis is presented. A short review of the literature focused on this unusual entity is presented.

The anterolateral thigh free flap is a cutaneous or fasciocutaneous flap vascularised by one or several perforating arteries arising from the descending branch of the lateral circonflex femoral artery. Venous drainage occurs via the perforators or a similar route to the deep femoral system or the femoral vein. This flap is commonly used in Asia (China, Japan) where for certain teams, it replaces the classical radial forearm flap or the rectus abdominis myocutaneous flap for the reconstruction of head and neck defects after tumor ablation. We briefly describe the anatomy and vascularization of this flap and present the harvesting technique as well as the properties of the flap.

We report the case of a female patient admitted for acute renal failure who required hemodialysis treatment using a tunneled femoral catheter. Abdominal ultrasound showed isolated gas in the hepatic veins. It was related to manipulation of the catheter, which allowed the passage of gas bubbles from the inferior vena cava into the hepatic veins.

Publications of central veins stenoses were still frequently related though improvements of the catheter quality and the catheterism procedures since the 1980's. The review of the literature during the period of 1980-2000 helped us in observations as following: Global incidence was 15.6% in subclavian vein stenoses (SVSC), 2.7% in jugular stenoses (SVJ) and 0-3.8% in femoral stenoses (SVF). The "non-symptomatic" SVSC, detected by Venograms, represented only 23-33% of all SVSC publications but they showed higher incidence in the patients than "symptomatic" SVSC: 41% versus 3.3% just as for non-symptomatic SVJ: 9% versus 1.6% in symptomatic SVJ. Venograms with "in-arm-injections" mostly used by authors should underevaluated the incidence of SVJ. Mecanisms were betterly detailed with SVSC than SVJ and SVF (Catheter quality, venous lesions by portions and artérialisation by fistulas, anatomic constraints of the subclavian vein in the triangle space behind the clavicular, fibrin sleeve, thrombus and microtraumatism of the Veins walls...). Global results of the treatment, though improvement with angioplasty-Stent, remained disappointing by early recurrences. Worsened dialysis adequacy and life quality of the patients should be the issues. The number of the catheters currently used in temporary accesses, including the subclavian veins, and in permanent accesses was still higher than DOQI/NKF recommendations. Anticipated creations of Fistulas should be one efficient prevention.

The femoral vascular access may be the only alternative when the upper limbs venous capital is exhausted. Five patients benefited from the setting up of a tunneled femoral catheter, for a median period of three months (three months minimum, eleven months maximum). No early complication has been observed. The infectious and thrombotic problems were late to appear and with no serious consequences. The new generation of biocompatible and flexible catheters can keep in place for a long time in femoral.

Since 1982, we realized 2538 apheresis sessions in 142 different patients. We analyzed the vascular access of these patients. According to the estimate number of sessions we divided this population in 6 groups: group I: less than 5 sessions = femoral vein catheter, group II: subclavian vein catheter less than 5 sessions; group III: 6 to 21 sessions with same catheter, group IV: internal jugular vein catheter (IJVC) for same session number, group V: patients on IJVC undergoins more than 21 session or treated during more than 3 months, group VI long term treated patients with arterio-venous fistula. We analyse the number of patients in each groups, the mean number of session and the absolute number of recorded adverse events such as local of systemic infection, clotting, catheter dysfunction. Results are as follow: [table: see text] Our study shows clearly the advantage of IJVC compared to either subclavian way in middle duration apheresis as in long term when compared to arterio venous fistula.

STUDY AIM: The aim of this prospective multicentric non-randomised trial was to report the complications of the central venous catheter insertion with different techniques and to assess the advantages of the low lateral approach to the internal jugular vein, according to the technique originally described by Jernigan et al, with our own modifications. PATIENTS AND METHOD: From January 1993 to August 1997, 2,290 CVC (2,286 by percutaneous puncture and 4 by surgical approach) were placed. The following complications were analysed prospectively: pneumothorax, accidental arterial puncture, more than two punctures of the same vein, necessity to shift to another venous approach, complete failure, malposition of catheter. RESULTS: The veins the most frequently used were internal jugular vein (48.7%), femoral vein (27%) and subclavian vein (24.2%). Internal jugular vein was punctured especially by low lateral approach (75%) and subclavian vein by infraclavicular approach (92%). With these two placements, the rate of pneumothorax was 0% and 3.1% respectively (p < 0.001), the rate of accidental arterial puncture was 1% and 2.7% respectively (p < 0.03) and the rate of more than two consecutive punctures was 3.1% and 6.3% respectively (p < 0.008). CONCLUSION: On our experience, we advocate the low lateral approach to the internal jugular vein as first choice technique for venipuncture in both adults and children for both short and long-term central venous approach, because it is associated to high rate of outcome and to low rate of complications in comparison with other techniques.

Venous aneurysms are usually difficult to diagnose, especially when they are located in the inguinal area where they can be misinterpreted as inguinal or femoral hernias. We report the case of a 70-year-old man with a painful thrombosed aneurysm of the femoral vein that was clinically undistinguishable from a strangulated hernia. The ultrasonogram, performed 2 months before the acute pain when the femoral swelling was painless, seemed to confirm the incorrect diagnosis of femoral hernia, and the aneurysm was finally labeled as such during surgical exploration. Massive embolism to the lungs and heart occurred peroperatively and resulted in death.

Permanent endocavitary cardiac pacing is a widely used therapeutic method. The implantation of pacing catheters is usually performed by the supracardiac veins, the epicardial approach being the classical alternative. The ilio-femoral approach is a third possibility. The authors report three cases in which this approach was used. The implantations were performed under general anaesthesia with an abdominal pacemaker. In two cases, atrial and ventricular catheters were implanted. After an average of 19 months' follow-up, no short or long-term complications were observed: displacement or fracture of the pacing catheter, infection, venous thrombosis, threshold elevation. These results show that this is a safe and feasible alternative to implantation by the traditional or epicardial techniques when these approaches cannot be used.

From 1976 to 1999 a total of 8,849 surgical procedures for vascular access prior to dialysis were performed in the Department of nephrology at Skopje hospital (Macedonia). Cases included 3,114 native arteriovenous fistula (AVF), 715 arteriovenous shunts and 4,964 temporary or indwelling catheters (4,411 (88.86%) in the femoral vein, 410 (8.26%) in the subclavian vein, 143 (2.88%) in the jugular vein and 56 PTFE vascular grafts). Femoral catheterization is the favoured solution for repeated dialysis (90.50% of the 3,440 procedures for indwelling vascular access). Subcutaneous indwelling catheters were used in 270 (7.90%) cases, with vascular access taking place in either the femoral (99 cases), subclavian (123 cases) or jugular vein (48 cases). Biosynthetic vascular grafts represent only 1.6% of all procedures for vascular access. The number of preventive AVFs has been increasing steadily from 14% in the 1980s to 20.8% in the 1990s and 31.50% in 1999. The majority of preventive AVFs (71.80%) and a large number of other surgical procedures for vascular access (44.40%) are performed in day hospital.

"Minimal invasive" surgical closure of an atrial septal defect (ASD) is performed under femoro-femoral CPB, the superior vena cava being (IVC) drained by a supplementary cannula placed directly through the thoracic opening. We present a new technique where both vena cavae are drained by a single 2 stage femoral cannula.The cannula is introduced through the femoral vein and its distal holes are directed into the superior vena cava (SVC) while the proximal holes are maintained into the IVC. A centrifugal pump is placed on the venous line between the cannula and the venous reservoir in order to improve the venous return. Both IVC and SVC are clamped around the cannula to isolate the right atrium before opening it and repairing the ASD.We recently operated on a 60 years old man using this technique. Passive venous drainage was 2.6 l/min whereas the perfusion theoretical flow was 5.4 l/min. But adding the centrifugal pump increased the flow to 5.4 l/min which ensured an optimal perfusion flow. CPB time was 38 minutes and operative time was 140 minutes. There were no complications and the patient returned home at day 5 following the operation.Using a single venous cannula for drainage of both vena cavae simplifies the technique and therefore contributes to the development of "minimally invasive" cardiac surgery.

The aim of this study was to determine the impact of cryopreservation on the competency of human femoral vein valve.Nine superficial femoral veins bearing 24 valves were harvested in brain death patients (5 men, mean age 32 years, range 16 to 63 years). Veins were divided in 24 segments bearing only one valve. Each segments was tested for reflux by using a pressure column filled with heparinized saline. After harvest, vein segments were kept in Belzer solution with antibiotics (gentamycin, colistin, lincomycin and amphotericin B). Histological study was undertaken in a fresh valve segment (n = 9). The remaining segments (n = 15) were stored in 15% dimethyl sulfoxide (DMSO) and cryopreserved in liquid nitrogen vapor for 120 days. Afterwards the 15 cryopreserved vein segments were thawed in 37 degrees C water bath and were studied for mechanical and histological changes.All the 24 valve segments initially tested were competent. Off the 15 cryopreserved segments only 4 (26%) were found to be non refluxive after cryopreservation. Histological study performed before cryopreservation showed a normal appearance of the vein wall (n = 9). On the contrary after cryopreservation, microscopic examination showed that in the incompetent veins, the endothelium surface was either absent or poor with a marked decrease in elastic fibres.This preliminary study indicates that DMSO cryopreservation must be improved in order to preserve vein valve competency: 26% of the cryopreserved valves remained competent. Histological findings also suggest that elastic fibres play a major role in the failure of the vein competency.

Peripheral venous tumors are uncommon and their delayed clinical expression leads to poor prognosis. We report a series of 7 cases including 6 leiomyosacromas and 1 hemangioendothelioma. Duplex Doppler and MR imaging appeared to be best suited for diagnosis, allowing an evaluation of extension and an analysis of associated endoluminal thrombi. These imaging techniques help guide surgery and improve prognosis.

We report 2 cases of primary muscular hydatosis of the thigh in a 30-year-woman and a 75-year-man. The clinical picture was a benign soft tissue tumor. The ultrasound and C.T. scan exams confirmed the diagnosis and showed precisely the intimacy of the lesion with the femoral vascular axe. Preoperative diagnosis of this affection is mandatory in order to prevent any rupture of the cyst so as to avoid anaphylactic shock and local recurrence. Percystectomy is the treatment of choice for this lesion.

Seven hundred patients operated consecutively by the same surgical team for atheromatous stenosis of the aortic bifurcation were followed up for 20 years with only 5 patients lost to follow-up. There were 94.5% of men with a mean age of 58 years. The operative mortality was 2.7% with few deaths due to true cardiovascular causes (0.7% of patients). The secondary mortality was very high with two main causes: cancer (39% of patients) and cardiovascular diseases (37%). Other causes were responsible for only 24% of deaths. The principal complications of the prostheses were: infection (0.6% of operated patients), thrombosis (6.7%), pseudo-aneurysm of the aorta (1.57%) and pseudo-aneurysm of Scarpa's triangle (4%). The benefits of surgery are unquestionable both on terms of survival, as amputation, bed confinement and invalidity are avoided, and in terms of function, as amputation was avoided in 84% of the 32% of patients in Stages III or IV before surgery. Only 5% of patients were amputed during the observation period. Moreover, 79% of survivors had a good functional result at 15 years. Improvement of results depends on better hygienic measures, systematic screening for high risk cancers and a better management of the arterial disease with early treatment of other arterial diseases (coronary, carotid) in order to reduce postoperative and mostly medium- and long-term cardiovascular mortality.

Perforating veins in the femoral canal, which establish a communication, on the medial aspect of the thigh, between the deep venous system and: either the trunk of the long saphenous vein, single or double, or one or several separate trunks, follow three anatomical patterns which clinical examination, phlebography and, now, echo-doppler, can identify clearly. When they are incompetent, they increase the natural progress of the varicose disease, after surgery of the long saphenous vein. Often, they are associated with a redux at the level of the saphenofemoral junction and also, sometimes, with an incompetence, primary or recurrent, at the short sapheno-popliteal junction, or, furthermore, with an incompetence of the medial gastrocnemial veins and their accompanying perforators, within the popliteal venous complex. Anastomotic networks between the different superficial venous territories in the inguino-genital region, the femoral canal and the supero-medial aspect of the leg, explain the cross-evolution between different systems. Sclerotherapy is effective when the perforators are not too large and their reflux not too important. If it fails, it is necessary to operate after precise localization of the sites of reflux through good imaging. A good picture is obtained with B mode ultrasound examination and hemodynamic studies with pulsed doppler and, even more reliably, with color Doppler. Thus, in recurrences in the femoral region, color Doppler will show up certain perforators which, despite being dilated, are nevertheless competent and do not need to be dealt with.

Intracranial aneurysms occur frequently with the risk of major damage. Neurosurgery or endovascular techniques can be used for treatment. Current techniques are not well adapted for aneurysms with a wide implantation (or neck). The aim of this experimental work was to study a technique for treating aneurysms which can be used for wide neck aneurysms. A metal stent is implanted facing the neck of the aneurysm to allow occlusion. In the first part of the study, the stent was inserted alone. Ten aneurysms were created surgically in five dogs. The stents were positioned facing seven of the ten aneurysms. The stent led to immediate occlusion of the aneurysm in six of the cases. One aneurysm remained patent despite the correct position of the stent. One dog developed secondary thrombosis of the carotid. Three dogs have been followed for sixty days after insertion of the stent. Two aneurysms thrombosed and one was patent. Since these results were less than satisfactory, a second part of the study was undertaken to cover the stent with a fragment of the autologous vein. Results in five aneurysms, evaluated three and eight weeks after treatment, showed partial or total repermeabilization of the aneurysms. In the third part of the study, we associated stents and detachable coils. Twelve aneurysms of the carotid artery in pigs were thrombosed and two aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms remained patent despite the stent and treatment was then completed with a coil. Six of the animals have been followed for thirteen weeks. One carotid artery thrombosed. In the five other cases, the carotid arteries were patent and the aneurysms were occluded at the control angiogram. Histology results showed the presence of a fibromuscular endothelialized neointima at the neck of the aneurysm in four of the five cases. The technique described here could be proposed for the treatment of wide-neck aneurysms implanted low on the carotid artery in man. Improvements should render the system more flexible.

A patent lumen after deep vein thrombosis can be achieved but at the cost of valve destruction which occurs in 50 to 75% of the cases within 6 to 12 months after the thrombotic event. The diagnosis of post-thrombotic valve destruction is made on the basis of direct consequences of venous back flow. Photoplethysmographic measurement of venous filling pressure while walking or after a Valsava manoeuvre lacks specificity and is insufficiently sensitive, especially in case of minimal back flow. Retrograde femoral phlebography can miss distal back flow if the femoral valves functions correctly. Dynamic popliteal phlebography in the upright position could be the reference examination. Ultrasonography-Doppler is however widely used as the first intention investigation providing a positive diagnosis, recognizing the localization and quantifying the back flow. The patient is placed in the upright position and reflux is checked after standardized distal compression. The ultrasonographic aspect (fibrosis, thick wall, tributary vessels) gives further arguments for differential diagnosis. The consequences of valve destruction on skin trophicity appear to be worse than non-repermeation after a thrombotic event. Surgical repair (transposition, transplantation, valvuloplasty) should be proposed for young patients with severe trophicity disorders which resist well-conducted medical treatment. The rate of failure is approximately 50% i.e. higher than for primary valve destruction.

Cystic adventitial disease is an uncommon vascular anomaly first described in 1947 in the external iliac artery. The preferential localization is the popliteal artery although other arteries and veins may also be involved though not always recognized. There have been 45 extra-popliteal localizations of adventitial cysts reported in the literature. Thirty cases involved an artery an 15 a vein. The iliofemoral axis, with 33 reported cases, is the preferential localization of these extra-popliteal adventitial cysts (including 22 arteries and 11 veins). All the other cases also involved a vessel near an articulation (knee, ankle, elbow, wrist). Despite a preferential popliteal arterial localization only one case involved the popliteal vein. The diagnosis is rarely made before surgery, probably because of the nonspecific clinical presentation. Ultrasonography should allow better recognition of these adventitial cysts, eliminating an aneurysm or a synovial cyst, and evidencing the localization of the cyst within the vessel wall.