Leg Varices Originating from the Pelvis: Diagnosis and Treatment

Vascular ◽  
2007 ◽  
Vol 15 (2) ◽  
pp. 70-78 ◽  
Author(s):  
Milka Greiner ◽  
Geoffrey L. Gilling-Smith
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Varicose Veins ◽  
Diagnosis And Treatment ◽  
Repeat Surgery ◽  
Recurrent Reflux ◽  
Venous Circulation ◽  
Platinum Coils

This article reports the investigation and treatment of 24 women presenting with recurrent lower limb varicosities secondary to reflux within the pelvic venous circulation. Diagnosis based on selective retrograde pelvic phlebography enabled precise identification and classification of sites of incompetence. A total of 74 veins were treated by embolization with platinum coils and glue prior to repeat surgery to the lower limb veins. At 4-year follow-up, signs of stasis had disappeared in all patients. Repeat phlebography revealed no evidence of recurrent reflux at the sites of treatment. One patient developed recurrent varices due to incomplete embolization of incompetent pelvic veins. Endovascular occlusion of incompetent pelvic veins is an effective treatment for varicose veins secondary to pelvic venous incompetence.

scholarly journals OPTIMIZATION OF DIAGNOSIS AND TREATMENT FOR PERIPROSTHETIC KNEE INFECTION

2017 ◽  
pp. 14-19
Author(s):  
S. P. Shpinyak ◽  
A. P. Barabash ◽  
Yu. A. Barabash
Keyword(s):  
Public Health ◽  
Periprosthetic Infection ◽  
Public Health System ◽  
Diagnosis And Treatment ◽  
Surgical Interventions ◽  
Knee Infection ◽  
Long Period ◽  
Periprosthetic Knee Infection

Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) – two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.

The Outcome of Treatment for Pelvic Congestion Syndrome

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 74-77 ◽  
Author(s):  
P Coleridge Smith
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Vein ◽  
Computed Tomographic ◽  
Computed Tomographic Venography ◽  
Clinical Series ◽  
Pelvic Varices ◽  
Pelvic Congestion

Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.

scholarly journals DETERMINANTS OF RECURRENCE RATE DURING MIDTERM FOLLOW-UP OF PATIENTS AFTER ENDOVENOUS LASER ABLATION OF PRIMARY LOWER LIMB VARICOSE VEINS

2020 ◽  
Vol 71 (2) ◽  
pp. 457-470
Author(s):  
Mohammed Hatem ◽  
Mahmoud Sobhy ◽  
Wageh Fawzy ◽  
Karem Sabry ◽  
Ahmed Al-Taher
Keyword(s):  
Laser Ablation ◽  
Recurrence Rate ◽  
Lower Limb ◽  
Varicose Veins ◽  
Endovenous Laser Ablation

scholarly journals Minimally-invasive procedure for pelvic leak points in women

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Roberto Delfrate ◽  
Massimo Bricchi ◽  
Claude Franceschi
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lower Limb ◽  
Varicose Veins ◽  
Absorbable Suture ◽  
Pelvic Congestion Syndrome ◽  
Minimally Invasive Surgical ◽  
Hemodynamic Assessment ◽  
Pelvic Congestion

Pelvic leak points (PLP) may be responsible for vulvar, perineal and lower limb varicose veins, in women during and/or after pregnancy. The accurate anatomical and hemodynamic assessment of these points, the perineal (PP), inguinal (IP) and clitoral points (CP) and their surgical treatment under local anesthetics as defined by Claude Franceschi is a new therapeutic option. The aim of this study was to assess the reliability and durability of the PLP reflux ablation using a minimally-invasive surgical disconnection at the PLP level in women with varicose veins of the lower limbs fed by the PLP. In this open-label trial 273 pelvic leak points free of pelvic congestion syndrome, with at least a 12-month follow- up, were assessed. 273 PLP treated: PP (n=177), IP (n =91) and CP (n=5). Followup: Period =12 to 92 months (mean =30.51 months). Age from 29 to 77 years (mean=45). The only 3 patients over 70 years (71, 74, 77) showed a high-speed reflux from a I point that fed symptomatic varicose veins of the lower limb. Exclusion criteria: pelvic congestion syndrome, BMI>24, venous malformations, a post thrombotic varicose vein. Diagnosis was performed using echo duplex and PLPs selected for treatment when refluxing at Valsalva + Paraná + squeezing maneuvers. A surgical skin marking of the PLP had been performed using echo duplex before surgery. Surgery consisted of minimally invasive dissection and selective division and ligation with non-absorbable suture of the refluxing veins and fascias at the PP, IP and CP pelvic escape points, under local anesthesia in a single center. The follow-up consisted of an echo duplex ultrasound, searching for reflux at the PLP treated thanks to the Valsalva maneuver, within 2 weeks, after 6 and 12 months and then yearly. The main endpoint of the study was the immediate elimination of the reflux at the PLP treated. The second endpoint was the long-term durability of the reflux ablation at the PLP treated. 267 (97.8%) without PLP reflux redo. 6 (2.2%) PLP reflux recurrences (PP=4, IP=1, CP 1). 3 patients with PLP reflux recurrence undergo a redo surgery (1.1%) where PP=2 (0.7%) and IP=1 (0.3%). This study shows the feasibility and durability of reflux ablation at the PLP level thanks to a minimally-invasive surgical treatment of the PLP and it demonstrates that there is no need for pelvic varicose embolization in patients without clinical signs of pelvic congestion syndrome. The accurate ultrasound assessment of each specific pelvic leak as well as a special surgical technique (vein division, non-absorbable suture of veins and fascias) seems to be the key for satisfactory outcomes.

Prevention of Sapheno-Femoral and Sapheno-Popliteal Recurrence of Varicose Veins by Forming a Partition to Contain Neovascularization

1998 ◽  
Vol 13 (1) ◽  
pp. 3-9 ◽  
Author(s):  
G. M. Glass
Keyword(s):  
Effective Treatment ◽  
Outcome Measures ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Morphological Examination ◽  
Surgical Exploration ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To test the hypothesis that sapheno-femoral recurrence of varicose veins may be prevented by containment of neovascularization. Design: Prospective minimum 4-year follow-up by surgical exploration and morphological examination of recurrent vessels in all limbs with clinical or phlebographic evidence of sapheno-femoral recurrence. Setting: Varicose vein clinic of a teaching hospital. Interventions: Sapheno-femoral ligation and multiple ligation (group 1); sapheno-femoral ligation, interposition of cribriform fascia and multiple ligation (group 2); sapheno-femoral ligation, interposition of artificial implant and stripping (group 3). Main outcome measures: Incidence of sapheno-femoral recurrence. Results: The incidence of sapheno-femoral recurrence through neovascularization was lower ( p < 0.001) in groups 2 and 3 after containment of neovascularization at the sapheno-femoral junction by cribriform fascia or artificial implant than in group 1 after ligation alone (3% and 1% vs 25%, respectively). The incidence of recurrent or persistent varices distal to the groin was lower ( p < 0.001) after stripping (group 3, 57%) than after multiple ligation (group 1, 93%; group 2, 81%). Conclusions: Sapheno-femoral ligation, interposition of cribriform fascia or artificial implant at the sapheno-femoral junction, and stripping is a more effective treatment of varicose veins than sapheno-femoral ligation and multiple ligation.

scholarly journals Distal bypass with a varicose vein graft for critical limb ischemia: report of a case

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Atsushi Guntani ◽  
Ryosuke Yoshiga ◽  
Shinsuke Mii
Keyword(s):  
Varicose Vein ◽  
Lower Limb ◽  
Vein Graft ◽  
Bypass Surgery ◽  
Varicose Veins ◽  
Graft Infection ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Case Presentation

Abstract Background A saphenous vein complicated with varicose veins is generally thought to be unsuitable for bypass grafting. Case presentation A patient who developed sepsis due to lower limb gangrene was successfully treated by endovascular treatment and bypass surgery using a varicose vein graft. There were no complications, such as occlusion or aneurysm, of the varicose vein graft during the 2-year follow-up period. Conclusions We herein report a case in which bypass surgery with a varicose vein graft was used to avoid major amputation of the lower limb, and the patient recovered markedly from sepsis. If there are no other appropriate autologous veins for revascularization of lower limb gangrene, a varicose vein graft may be useful as a conduit for bypass surgery at risk of graft infection.

scholarly journals Surgical Treatment of Primary Intracranial and Extracranial Communicating Leiomyosarcoma with One Case Recurred

2021 ◽  
Author(s):  
zeyi wang ◽  
kuairong pu ◽  
wencai zhang ◽  
peng chen ◽  
dongchuan shao ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Effective Treatment ◽  
Hospital Discharge ◽  
Clinical Features ◽  
Clinical Data ◽  
Diagnosis And Treatment ◽  
Treatment Experience ◽  
Medical University ◽  
Surgical Operations

Abstract backgroundTo analyze and summarize the clinical features and diagnosis and treatment experience on primary intracranial and extracranial communicating leiomyosarcoma to deepen clinicians’understanding of the rare disease.Cases presentationThe clinical data and recurrence of a patient who was diagnosed with primary intracranial and extracranial communicating leiomyosarcoma admitted to the Neurosurgery Department, The Affiliated Ganmei Hospital of Kunming Medical University in May 2015 were retrospectively analyzed. According to the patient data, two successful surgical operations were performed and the surgeries went well, with more than 2-year and 8-month follow-up so far. No obvious complications were found after hospital discharge, and follow-up was continued.ConclusionsSurgical removal is the most important and effective treatment means for primary intracranial and extracranial communicating leiomyosarcoma currently.

scholarly journals Optimization of Diagnosis and Treatment for Periprosthetic Knee Infection

2017 ◽  
Vol 24 (3) ◽  
pp. 14-19
Author(s):  
Sergey P. Shpinyak ◽  
A. P Barabash ◽  
Yu. A Barabash
Keyword(s):  
Public Health ◽  
Periprosthetic Infection ◽  
Public Health System ◽  
Diagnosis And Treatment ◽  
Surgical Interventions ◽  
Knee Infection ◽  
Long Period ◽  
Periprosthetic Knee Infection

Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) - two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.

Embolization is essential in the treatment of leg varicosities due to pelvic venous insufficiency

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 81-85 ◽  
Author(s):  
O Hartung
Keyword(s):  
Local Anesthesia ◽  
Lower Limb ◽  
Varicose Veins ◽  
Iliac Vein ◽  
Additional Treatment ◽  
Venous Disease ◽  
Secondary Patency ◽  
Pelvic Venous Insufficiency ◽  
Pelvic Congestion

Purpose Pelvic venous insuffiency (PVI) can be responsible for pelvic congestion syndrome (PCS) and also lower limb varicose veins. Material and methods Charts of all women who had pelvic venography for PVI from September 2013 to August 2014 were reviewed. The procedure was performed under local anesthesia through left femoral approach. In case of reflux without associated obstructive lesions, embolization with coils and polidocanol foam was performed during the same procedure. Results 119 women, with median age 39 years were explored (86 with PCS and 102 with lower limb venous disease). Of these, 78 had an isolated reflux and were embolized and 41 had an obstructive disease (29 iliocaval obstructive lesions (ICOL), 4 nutcracker syndrome (NCS), and 8 with an association of both). Median follow-up was 4 months. Of the 12 NCS, 5 had surgical treatment and 7 had stenting of the left iliac vein without embolization. All patients with ICOL without NCS were treated by stenting in 28 and by a Palma procedure in 1 (failure to recanalize). Primary and secondary patency rates were 97% at 12 months. Embolization led to improvement of PCS in 91% (60% without any pain) and of lower limb varicose veins in 51% by itself. If 82% need an additional treatment of lower limb varicose veins, embolization allowed a switch of strategy from surgery to sclerosis. Conclusion PVI can cause lower limb symptoms. In most cases, it is due to reflux and can be treated under local anesthesia by embolization. This technique is safe and efficient. Obstructive lesions must be recognized and treated.

Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

2017 ◽  
Vol 33 (4) ◽  
pp. 242-250 ◽  
Author(s):  
Krishna Prasad BP ◽  
Binu Joy ◽  
Ajith Toms ◽  
Teena Sleeba
Keyword(s):  
Lower Limb ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Symptom Relief ◽  
Venous Occlusion ◽  
Complete Healing ◽  
Clinical Severity ◽  
Venous Clinical Severity Score ◽  
Occlusion Rate

Recurrent lower limb venous insufficiency is often a challenge in clinical practice and is most commonly due to incompetent perforators. Many of these patients do not have adequate symptom relief with compression and require some form of treatment for incompetent perforator interruption. Various treatment methods have been tried with different efficiencies. Objective To evaluate the feasibility, efficiency and safety of an outpatient combined cyanoacrylate adhesion–sodium tetradecyl sulphate sclerotherapy for treatment of patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators. Methods Eighty-three limbs of 69 patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators were treated with cyanoacrylate embolization of incompetent perforators and sclerotherapy of dilated collateral veins (surface branch varicose veins). Technical success, procedural pain, perforator occlusion, venous occlusion, clinical improvement and ulcer healing were assessed. Follow-up was done three- and six-month post-procedure. Results Procedure could be successfully performed in all patients. One hundred and ninety-one perforators were treated in total. Perforator and varicose veins occlusion rate was 100%. Deep venous extension of cyanoacrylate occurred in four (4.8%) patients, with no adverse clinical outcome. Venous clinical severity score improved from a baseline of 8.18 ± 3.60 to 4.30 ± 2.48 on three-month follow-up and 2.42 ± 1.52 on six-month follow-up (p < 0.0001). All ulcers showed complete healing within three months. Significant prolonged thrombophlebitis occurred in 38.5% of limbs. Conclusion Combined cyanoacrylate adhesion and setrol sclerotherapy is technically easy, has a lot of advantages including being an outpatient procedure and highly efficacious but with a guarded safety profile.

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