Syde A. Taheri

Iliocaval compression syndrom

Abstract Iliocaval compression syndrome is a significant disorder in a number of patients who have lower extremity venous complaints. The diagnosis may be suspected by positive findings on exercise strain gauge venous plethysmography and unilaterally increased ambulatory venous pressures. The diagnosis is confirmed by ascending and, in some instances, descending venography which demonstrates the iliocaval compression with or without intraluminal web formation. Transstenosis pressure gradients may be measured to confirm the hemodynamic significance of the lesion. We advocate direct operative repair of the iliocaval junction with rerouting of the iliac artery and excision of the iliocaval webs with cephalic vein patch angioplasty. It provided good results in the present study when coupled with an adjunctive regimen of perioperative subcutaneous heparin and warfarin. Further investigation into the exact prevalence and significance of the iliocaval compression syndrome is needed. Only an aggressive approach to patients with lower extremity venous complaints will help clarify the exact prevalence and natural history of this disorder.

Surgical treatment of postphlebitic syndrome with vein valve transplant.

Sequelae of the postphlebitic syndrome can new be treated by direct valve surgery. The present surgical treatment of stasis ulcer, including removal of the incompetent perforators, ulcer excision, and skin grafting, remains essential. Excision of perforators and ulcer care are effective but are associated with a high rate of ulcer recurrence. Experimental studies to restore venous valve function include autogenous or homologous vein valve transplantation, valvuloplasty, and valve transposition. In 23 cases of vein valve transplantation and two transpositions, a normal autogenous vein valve from the arm was used to restore a normal functioning venous valve in the leg. Pre- and postoperative noninvasive and invasive testing indicates hemodynamic improvement of venous function in these legs. Follow-up direct venous pressure measurements did not show normalization and may indicate that more than one competent valve is necessary. Changes in muscle structure may play a role in the maintenance of venous pressure.

Early results with cryopreserved saphenous vein allografts for infrainguinal bypass

PURPOSE Cryopreserved saphenous vein allografts (CSVA) are available for use in arterial reconstructions; however, patency rates in the infrainguinal position are not well described. METHODS We reviewed our experience with 38 patients who underwent 43 infrainguinal bypasses with CSVA as the conduit. The group includes 21 women and 17 men with a mean age of 69 +/- 11 years. Mean follow-up is 8.2 +/- 5.5 months. Logistic regression was used to analyze five variables in an attempt to identify predictors of success or failure: distal anastomosis to the popliteal artery versus a crural artery, one-vessel versus two- or three-vessel runoff, postoperative anticoagulation versus none, primary reconstructions versus reoperations, and one segment versus two segments of CSVA required. RESULTS The cumulative patency rate at 12 months by life-table analysis is 66%. Logistic regression revealed that primary reconstructions were more likely to succeed than reoperations (p = 0.03) and operations completed with one segment of CSVA were more likely to succeed than those requiring more than one segment of vein (p = 0.03). CONCLUSIONS We conclude that (1) the short-term patency of infrainguinal bypasses with CSVA suggests that they may be acceptable alternatives to prosthetic grafts in the below-knee position, and (2) primary reconstructions performed with one segment of CSVA are more likely to succeed.

Vein valve transplantation

The vein valve transplantation has, in our experience, subjectively relieved symptoms in the majority of patients. More importantly, elevated venous pressure has been decreased in most patients. Thus, patients exhibiting signs of venous insufficiency syndrome as well as elevated venous pressure and proved valvular incompetence should be considered candidates for vein valve transplantation after an unsuccessful trial of medical management.

Experimental prosthetic vein valve

Medical and surgical management of venous insufficiency syndrome (VIS) has produced disappointing results despite the recent introduction of new surgical techniques. This has prompted the investigation of a sutureless prosthetic vein valve. Ten prosthetic sutureless vein valves have been tested to date. The valves are of two types, one constructed of platinum, the other of titanium. Fourteen to eighteen months post-insertion into the femoral vein or vena cava of mongrel dogs, five valves remain patent as shown be venography. The sutureless prosthetic vein valve is a promising development in the treatment of venous insufficiency.

A complication of the greenfield filter: Fracture and distal migration of two struts—A case report ☆

This is a case report of a 41-year-old woman who required surgical removal of a Greenfield filter 7 months after placement. The filter developed several complications. Two struts were noted to be completely separated from the filter and lodged in the infrarenal vena cava. The filter had migrated to a resting position in the right renal, vein with two struts perforating the renal vein and inferior vena caval junction. The perforating struts were intraperitoneal and were found to impinge on the right ureter with seromuscular involvement of the second portion of the duodenum. No free perforation was noted at the time of exploration.

Experimental prosthetic vein valve long-term results

Chronic venous insufficiency is a disease that carries significant morbidity and repre sents a sizeable burden to the health care system. Current medical and surgical therapies are associated with a high incidence of failure. This has prompted the development of a synthetic vein valve for the treatment of chronic venous insufficiency. Nine dogs underwent the implantation of ten valves into the femoral veins. Initial studies showed the valves to be competent and patent. However, over a two-year period dense ingrowth of intimal hyperplasia rendered the valves functionless.

Surgical Treatment of Primary Aortoduodenal Fistula

Primary aortoduodenal fistula is a rare and potentially fatal condition. Awareness of its existence, precise diagnostic evaluation,and early surgical intervention are essential for the survival of the patient. Although early experience indicated that interruption of the fistula, repair of the enteric defect, oversewing of the aorta and extraanatomic bypass was the procedure of choice, in situ aortic replacement with a prosthetic graft seems to be a viable option. This article includes a case report of a primary aortoduodenal fistula and review of the literature.

Retroperitoneal approach for aortic surgery. Experience with 75 consecutive cases.

Presented at the Tenth Annual Meeting of the International College of Angiology, Geneva, Switzerland, July 23-28, 1968. Transabdominal aortic surgery is often associated with considerable morbidity and mortality (3 to 19 per centi, 2) and postoperative complications, such as paralytic ileus, evisceration (14 per cent), atelectasis, bowel obstruction, incisional hernia (27 per cent) and pneumonia (6 per cent) .2 In an effort to avoid these complications, we began, over two years ago, in selected cases, to approach the aorta retroperitoneally for resection, thromboendarterectomy or by-pass, as described by Rob3 in 1963. His series consisted of 500 cases, and he concluded that this approach was associated with less paralytic ileus, atelectasis and wound dehiscence, and shortened the hospital stay. He considered a large or high aneurysm a contraindication for the method. The results in an initial series of selected cases were so gratifying that we have since used this technique in every elective case of aortic surgery, except for ruptured aortas. Rob’s large series consisted entirely of selected cases.

Superficial femoral vein transposition in Klippel-Trenaunay syndrome.

Use of a superficial femoral vein in competent profunda vein transposition is appropriate in selected cases of Klippel-Trenaunay syndrome; this allows for improvement of venous insufficiency and relief of symptoms secondary to venous stasis.