Faculty Bibliography

Background Venous aneurysms of the upper torso are uncommon in contrast to the abdomen and lower extremities. Mostly silent, they can cause significant morbidity. Large or symptomatic venous aneurysms are generally treated with open resection. To our knowledge, there are no documented cases of head and neck venous aneurysms treated by a hybrid endovascular and open approach. Case Presentation A 56-year-old female presented with the complaint of pain and increasing size of a supraclavicular mass. Imaging revealed a large saccular aneurysm of the subclavian vein with the presence of a large intramural thrombus on computed tomography scan with contrast. A covered stent was deployed in order to exclude the aneurysm from circulation. Three weeks later, the symptoms continued, and an aneurysmorrhaphy was performed to excise the stent and aneurysm resection. Discussion A combined endovascular and open approach to resection of symptomatic subclavian vein aneurysms is a viable method with minimal morbidity.

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age +/- standard deviation was 68 +/- 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

BACKGROUND: Accreditation in peripheral venous testing can be obtained based upon femoropopliteal duplex ultrasound evaluation, and many laboratories limit their examination to this segment only. This simplified protocol detects acute femoropopliteal deep venous thrombosis (DVT) but misses calf vein DVT, superficial venous thrombosis, chronic DVT, venous reflux, and other non-venous findings potentially responsible of the patients' presenting conditions. A protocol limited to the femoropopliteal segment results in additional unnecessary testing and can create patient dissatisfaction. We evaluated the differences in the diagnosis between a limited femoropopliteal versus a complete approach to the venous ultrasound evaluation of the lower extremities in patients examined in an outpatient vascular laboratory. METHODS: A data base with the complete ultrasound exams of the lower extremity including the common femoral, deep femoral, popliteal, tibial and peroneal veins, calf muscular veins, great and lesser saphenous veins, performed in 812 consecutive patients over an 8 month period, was queried. RESULTS: Acute femoropopliteal DVT was found in (32/812) = 3.94% of the patients. Chronic femoropopliteal DVT was found in (54/812) = 6.65%. Acute infrapopliteal DVT was found in (33/812) = 4.06%. Chronic infrapopliteal DVT was found in (41/812) = 5.04%. Superficial venous thrombosis of lower extremities (124/812) = 15.27%. In addition, deep venous insufficiency (>500 milliseconds) was found in (404/812) = 49.75% and superficial venous insufficiency in (254/812) = 31.28 % (>500 milliseconds). A mass (cyst, hematoma, solid mass or aneurysm) was found in (23 cysts, 2 Hematomas, 23 solid mass, 4 aneurysms) 52/812 = 6.4%. CONCLUSIONS: Limited femoropopliteal ultrasound examination for acute DVT would have only detected a small percentage of the positive findings. These data suggest that a complete duplex exam can be used to further delineate the cause of outpatients' symptoms as compared to the limited protocol.

INTRODUCTION: We examined the rate of positive findings and the distribution of vascular ultrasounds in the pediatric and adult population. Prior literature has noted a low rate of positive findings in adult vascular ultrasounds but there is little literature on pediatric vascular ultrasound. METHODS: We reviewed our vascular duplex database on inpatients less than 18 years old and compared it to the adult inpatient vascular duplex exams from 2005 to 2010. RESULTS: The adult patients had more extremity vascular exams while the pediatric patients had more abdominal and renal exams. Moreover, the positive rate of adult lower extremity arterial duplex was significantly higher than the pediatric group (p = 0.002). CONCLUSION: We had a higher yield of positive findings in the adult cases. We observed a higher proportion of more complex duplex exams in the pediatric cases suggesting that a higher level expertise is needed to perform the pediatric vascular duplexes.