Instrumental diagnosis of pelvic congestion syndrome

Santiago ZUBICOA EZPELETA1; Javier LEAL MONEDERO1; Assila T. ELKASHISHI2 1 Ruber Internacional Hospital, Angiology and Vascular Surgery Unit, Madrid, Spain 2 Al Salam Hospital, Cairo, Egypt Abstract Pelvic congestion syndrome (PCS) is a multifactorial medical condition that is characterized by the absence of specific symptoms, and therefore, it needs very precise imaging for an accurate diagnosis. Diagnostic techniques can be noninvasive (duplex ultrasound) or minimally invasive (magnetic resonance, CT, and phlebography). Duplex ultrasound is regarded as a first-line investigation for PCS because it is noninvasive, easily accessible, and inexpensive. This procedure provides essential hemodynamic information, and when combining transvaginal and…

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Role of duplex ultrasound investigation in the management of postthrombotic syndrome

Role of duplex ultrasound investigation in the management of postthrombotic syndrome Olivier PICHOT, MD Caroline MENEZ, MD Service de Médecine Vasculaire, CHU de Grenoble, France Abstract Duplex ultrasound is a method for analyzing the anatomy and hemodynamic profile of lower-limb veins; it can also be used for pelvic and abdominal examinations. For postthrombotic syndrome, duplex ultrasound can recognize specific anatomical abnormalities in the venous lumen, wall, and valves. Reflux can be easily diagnosed with duplex ultrasound, although some controversy is present concerning the extent of the reflux detected compared with descending venography. Venous obstruction is more challenging to quantify; nevertheless,…

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Lymphatic system dysfunction in pediatric populations

Christoph M. PAPENDIECK Angiopediatria, Buenos Aires, Argentina SUMMARY Lymphatic system dysfunction in children has many presentations and syndromes and may affect all parts of the body. It can be classified according to the type of abnormality present as dysplasia of the lymphatics (LAD I), dysplasia of the lymph nodes (LAD II), or dysplasia of the lymphatics and lymph nodes (LAAD). Lymphatic dysplasias can be clinically represented by peripheral lymphedema alone or be associated with more and complex dysfunction in different locations, eg, intestinal lymph vessels, thoracic duct, and others. Primary lymphedema has for many years been the least understood form…

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Investigations in postthrombotic syndrome according to clinical status

Michel PERRIN Vascular Surgery, France INTRODUCTION Many angiologists and vascular surgeons consider that postthrombotic syndrome (PTS) should only be managed noninterventional treatment. Unaware of the real possibilities provided by operational treatment, they limit investigation to color duplex scanning (CDS), which in this perspective is logical and reasonable. Compression, drugs, and lifestyle recommendations do not call for level III investigation according to the CEAP classification.1 Conservative treatment as far as etiology is concerned relies mainly on the signs and symptoms, independently of the location, extension of anatomical lesions, and pathophysiological abnormality. Conversely, when surgical or endovenous treatment is considered, the CEAP…

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Incompetent venous valves: ultrasound imaging and exo-stent repair

Rodney James LANE1-3 Joseph Anthony GRAICHE1 Michael Luciano CUZZILLA1 John Christopher CORONEOS1-3 1 Dalcross Private Hospital 2 Mater Private Hospital 3 North Shore Private Hospital Sydney, AUSTRALIA SUMMARY Background: Lower limb venous disease remains a significant problem in our community today. The condition has been treated mainly with ablative procedures such as stripping and/or sclerotherapy. The aim of this study was to assess external valvular stenting (EVS) of incompetent venous valves as a reparative alternative to the management of patients with varicose veins. In addition, ultrasound examination of the superficial venous valves prior to surgery was also assessed for its…

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Premenstrual symptoms in lower limbs and Duplex scan investigations

Jerry G. NINIA Clinical Associate Professor SUNY – Stony Brook School of Medicine ABSTRACT Objectives: Approximately 40% of menstruating women experience luteal phase symptoms that are bothersome. Although the distinguishing characteristic is irritability, symptoms typically are a mix of cognitive and physical disturbances. Leg swelling and discomfort are one such physical symptom. The goal of the study is to define the clinical entity of a late luteal phase vasodilation syndrome in symptomatic patients. Methods: Duplex venous scans were performed in the standing position on 12 premenopausal women (age range 19-46 years) who described premenstrual symptoms of bilateral leg swelling, pressure,…

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Iliac vein outflow obstruction in ‘primary’ chronic venous disease

Seshadri RAJU Emeritus Professor of Surgery and Honorary Surgeon, University of Mississippi Medical Center and River Oaks Hospital, Flowood, MS, USA ABSTRACT The nonthrombotic iliac vein lesion (NIVL) was first described in 1908. Since then, it has become clear that the lesion is present in over half the general population in silent form. A clinical syndrome variously known as May- Thurner syndrome, Cockett syndrome, or “iliac vein compression syndrome”, caused by NIVL, is thought to be a rare form of chronic venous disease (CVD). However, with liberal use of intravascular ultrasound (IVUS), the lesion is found in over 90% of…

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Towards a better understanding of lymph circulation

Olivier STÜCKER*, Catherine PONS-HIMBERT*, and Elisabeth LAEMMEL** *CEROM **Université Paris 7 Paris, France SUMMARY The lymphatic system was for years considered an “accessory” system and was neglected in comparison with the vascular system, which appeared much more crucial. In the last decade, researchers have become interested in lymphatic function since many diseases seem to interact with it (cancer, inflammation, infection, auto-immunity). The lymphatic system is harder to study than its vascular counterpart as its vessels are ill-defined, almost invisible. Intravital microscopy alone correctly visualizes these structures, thus shedding light on their function and quantifying their movements. This paper focuses on…

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New computer tools for virtual dissection to study the anatomy of the vascular system

Jean-François UHL1,2 Sylvain ORDUREAU2,3 1 – Centre de Chirurgie des Varices, 113 Avenue Charles De Gaulle, Neuilly/Seine, France 2 – Unité d’anatomie numérique – Biomédicale des Saints-Pères, Université Paris 5 Descartes France 3 – Useful Progress – 45 rue des Saints Pères, Paris, France SUMMARY The aim of this paper is to demonstrate the major role played by the new computerized imaging tools available today in the fields of morphology and vascular anatomy. For anatomical studies or educational purposes, they enhance classic techniques. Three-dimensional reconstruction, which is already used in daily clinical practice, will be the basis for computation of…

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