Lee H. Greenwood

Inferior Vena Cava: Translumbar Catheterization for Central Venous Access

In six patients who required long-term central venous access, translumbar catheterization of the inferior vena cava was performed seven times after the usual sites of access had become thrombosed. Four of the patients were male and two were female, and they ranged in age from 2 to 76 years. Placement of a 12-F Silastic catheter in one procedure, a 10-F catheter in three, a 9-F catheter in one, and a 7-F catheter in two was successful and uncomplicated. Of the three surviving patients, two had a functioning catheter at 1 week and 32 months, respectively; in the third patient the catheter was removed after 3 weeks, a few days after successful bowel surgery. Two patients with functioning catheters died, one of metastatic breast cancer after 12 months and the other of acquired immunodeficiency syndrome after 5 weeks. One patient twice required removal of a functioning catheter due to sepsis, the first after 3 weeks and the second after 6 weeks. These results show this technique to be safe and successful for selected patients.

Peripheral venous aneurysms with recurrent pulmonary embolism: report of a case and review of the literature.

This clinical report deals with a femoral venous aneurysm as a source of recurrent pulmonary embolism. The literature concerning venous aneurysms is reviewed with emphasis on those cases which were complicated by venous thrombosis and pulmonary embolism. This case demonstrates that lower leg venous aneurysms can occur in either sex and in different age groups. Venography was shown to be important in diagnosing these lesions. Surgical resection may be necessary to prevent potential thrombosis and life-threatening pulmonary embolism.

Lower extremity arterial disease in young adults. A systematic approach to early diagnosis.

General and vascular surgeons are consulted occasionally to evaluate young adults with ischemia of the lower extremity. Between 1975 and 1985, 51 adults under 40 years of age who had arterial occlusive disease of the lower limb were managed. Although premature atherosclerosis was the most common problem (50%), claudication or limb-threatening ischemia also resulted from other sources (thromboembolism, popliteal artery entrapment, Buergers disease, collagen vascular disease, and Takayasus arteritis). Identifying the exact cause was sometimes difficult. The authors were impressed with the number of young adults who had delay in diagnosis and treatment (30 patients, 59%) before referral for a surgical opinion. In this paper, the attempt has been made to uncover the reasons for delayed diagnosis and to suggest a systematic approach that should lead to early recognition of lower extremity ischemia in this age group.

The angiographic evaluation of lower-extremity arterial disease in the young adult

The angiographic evaluation of 38 patients younger than 40 years of age with lower-extremity arterial disease is reviewed. Although atherosclerosis was the most common diagnosis, other etiologies included thromboembolism, popliteal artery entrapment, Buergers disease, collagen vascular disease, and arteritis. The two features of the angiographic workup that proved most helpful in establishing an accurate diagnosis were biplane aortography and runoff exams designed to demonstrate possible popliteal artery entrapment.

Liver transplant rejection arteritis: Serial hepatic arteriography

Two liver transplant recipients underwent serial hepatic arteriography, demonstrating a severe, rapidly progressive arteritis involving the hilar hepatic arteries. Liver biopsies in these patients demonstrated ischemic necrosis as a prominent feature. The angiographic appearance and therapeutic implications of liver transplant rejection arteritis are presented.