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Internal thoracic vein draining into the extrapericardial part of the superior vena cava: a case report
Vollala, Venkata Ramana;Pamidi, Narendra;Potu, Bhagath Kumar;
Jornal Vascular Brasileiro , 2008, DOI: 10.1590/S1677-54492008000100015
Abstract: the internal thoracic veins are venae comitantes of each internal thoracic artery draining the territory supplied by it and usually unite opposite the third costal cartilage. this single vein enters the corresponding brachiocephalic vein. we present a variation of right internal mammary vein draining into superior vena cava in a 45-year-old male cadaver. likely development and clinical significance of the vein are discussed.
Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats  [cached]
Wen-Gang Li, Yong-Liang Chen, Jing-Xi Chen, Lei Qu, Bin-Dang Xue, Zhi-Hai Peng, Zhi-Qiang Huang
World Journal of Gastroenterology , 2008,
Abstract: AIM: To explore the influence of portal vein hemo-dynamic changes after portal venous arterialization (PVA) on peribiliary vascular plexus (PVP) morphological structure and hepatic pathology, and to establish a theoretical basis for the clinical application of PVA.METHODS: Sprague-Dawley rats were randomly divided into control and PVA groups. After PVA, hemodynamic changes of the portal vein and morphological structure of hepatohilar PVP were observed using Doppler ultrasound, liver function tests, ink perfusion transparency management and three-dimensional reconstruction of computer microvisualization, and pathological examination was performed on tissue from the bile duct wall and the liver.RESULTS: After PVA, the cross-sectional area and blood flow of the portal vein were increased, and the increase became more significant over time, in a certain range. If the measure to limit the flow in PVA was not adopted, the high blood flow would lead to dilatation of intrahepatic portal vein and its branches, increase in collagen and fiber degeneration in tunica intima. Except glutamic pyruvic transaminase (GPT), other liver function tests were normal.CONCLUSION: Blood with a certain flow and oxygen content is important for filling the PVP and meeting the oxygen requirement of the bile duct wall. After PVA, It is the anatomic basis to maintain normal morphology of hepatohilar bile duct wall that the blood with high oxygen content and high flow in arterialized portal vein may fill PVP by collateral vessel reflux. A adequate measure to limit blood flow is necessary in PVA.
Orthotopic Kidney Transplantation in Mice: Technique Using Cuff for Renal Vein Anastomosis  [PDF]
Hao Chen, Ying Zhang, Donghang Zheng, Raaj Kumar Praseedom, Jiahong Dong
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077278
Abstract: Mouse renal transplantation is a technically challenging procedure. Although the first kidney transplants in mice were performed over 34 years ago and refined some years later, the classical techniques of mouse renal transplantation required clamping both vena cava and aorta simultaneously and carry out suture anastomoses of the renal artery and vein in a heterotopic position. In our laboratory, we have successfully developed mouse orthotopic kidney transplantation for the first time, using a rapid “cuffed” renal vein technique for vessel anastomosis, wherein the donor’s renal vein was inserted through an intravenous catheter, folded back and tied. During grafting, the cuffed renal vein was directly inserted into the recipient’s renal vein without the need for the clamping vena cava and suturing of renal vein. This technique allowed for the exact transplantation of the kidney into the original position, compared to the classical technique, and has significantly shortened the clamping time due to a quicker and precise anastomosis of renal vein as described. This also allowed for a quicker recovery of the lower extremity activity, reduction in myoglobinuria with resultant kidney graft survival of 88.9%. Thus we believe that the cuffed renal vein technique simplifies microvascular anastomoses and affords important additional benefits.
New device for saphenous vein-to-aorta proximal anastomosis without side-clamping
Ernesto Tappainer
Journal of Cardiothoracic Surgery , 2007, DOI: 10.1186/1749-8090-2-22
Abstract: We developed a simple object that helps to perform a manual proximal anastomosis without the need to clamp the side of the aorta. This device is a steel bar which blocks the aortic hole and simultaneously it provides a slit to receive the needle. Through the slit comes out a thin, sharp, straight, but also well directed and predictable jet of blood which could be easily controlled during the suture.The function of the object is quite different from other devices. Nothing is deployed in the aorta. The object is only placed on the aorta with the small appendage slipped into the hole. The main advantage of the device is that while manipulation of the aorta is avoided no foreign bodies are incorporated in the suture and – most importantly – the aortic intima is not touched at all. The main drawback of the device is the blood jet coming from the slit so that the blood pressure has to be lowered by vasodilators during the anastomosis. Moreover, the suture has to change direction and the needle has to enter the aortic wall first to slip out through the slit.The object was named "Slit Device" and is not a routine instrument. It would be only an alternative to other anastomotic devices with the same surgical indications. In the case of ascending aortic disease and saphenous vein grafting, the Slit Device avoids aortic clamping thereby preventing atheroembolism and also avoiding the need for hypothermic circulatory arrest in patients with unclampable aorta.Coronary artery revascularization is the most important treatment of coronary artery disease. Coronary artery bypass grafting is the surgical way to accomplish this. Revascularization by arterial grafts – i.e. bilateral internal mammary arteries – is the gold standard surgical technique and it is performed more often today than in the past [1-3]. Nevertheless, for many reasons, saphenous vein grafting is still the norm and is a widespread technique in elderly patients or in emergency situations. Thus, even though total arte
Sutureless technique to support anastomosis during thoracic aorta replacement
Efstratios E Apostolakis, Vassilios N Leivaditis, Constantinos Anagnostopoulos
Journal of Cardiothoracic Surgery , 2009, DOI: 10.1186/1749-8090-4-66
Abstract: The technique reduces substantially the preparation time of the aortic stumps by the use of ligation clips and a surgical sealant.Suturing is the standard method for the aortic-teflon double-layer formation prior to Dacron anastomosis. In this study, instead of suturing, 5-6 ligation clips are primarily applied on the exterior of the double layer to facilitate proper cooptation. Secondarily, in order to fuse the two layers together, a sealant is injected in between the Teflon and aortic wall. Thus each stump is delivered quickly sutureless for the Dacron anastomosis.Between January 2003 and March 2009 this modified operative technique was performed in 14 cases (group A) with a mean age of 50 ± 16 years. This was contrasted against 24 controls (group B), with a mean age of 40 ± 28 years, treated with the conventional method, where only continuous sutures were used during the anastomosis. All patients were cases of ascending aorta replacement and/or aortic hemi-arch replacement, for acute aortic dissection or aortic dilatation.The pure anastomosis time (stump preparation and Dacron connection) was shortened by approximately 25 minutes depending on surgeon's experience. The anastomosis blood-loss was also significantly reduced in the sutureless group A, as evident by the dry operative field and the limited use of blood products, post-prosthetic graft anastomosis. This reflected to a faster post-operative recovery, faster extubation and fewer complications. At a mean follow-up of 21 ± 7 days, there were no post-operative deaths being related to acute aortic dissection or rupture of the anastomotic site.Aortic replacement with the combination of ligation clips and a surgical sealant vs. sutures alone allows easy manipulations of the aorta and adaptation of the diameters, thus optimizing aortic operational timings and hemostasis. Moreover, it prevents blood loss and aortic wall trauma from multiple sutures.All types of thoracic aorta replacement carry a significant risk o
Safety of Single Vein Anastomosis versus Double Venous Anastomosis in ALT Perforator Flap in Foot and Leg Reconstruction  [PDF]
Mohamed Abdelaal, Ahmed Gaber
Modern Plastic Surgery (MPS) , 2019, DOI: 10.4236/mps.2019.94009
Abstract: Introduction: Single or double venous anastomosis in free flap in general and ALT, in particular, is still a matter of debate between micro vascular surgeons. In this study, we will present our experience in single vein anastomosis versus double venous anastomosis in ALT perforator flap used in leg and foot reconstruction as regarding flap outcome, complications, operation time and the need for re-exploration. Patient and Methods: We retrospectively evaluate 60 patients with post traumatic foot and leg defects in the period between January 2014 and January 2018 where free ALT flap was done. The patients were divided into two groups, Group 1 where single vein anastomosis was done and Group 2 where double venous anastomosis was done; we utilize the deep venous system for the anastomosis in all cases. Results: Complete flap survival noticed in 56 cases (93.3%), defect size ranged from 70 to 200 cm (mean 126.35 ± 33.78). There was no difference between the 2 groups as regarding Flap survival, hospital stay, flap complications, donner site morbidity and vascular insufficiency. There is statistically significant difference between both groups as regarding Ischemia time, Operation time, and overall re-exploration rate. Conclusions: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is as safe and feasible as the two veins anastomoses.
Accelerated intimal hyperplasia in aortocoronary internal mammary vein grafts in minipigs
Aron Popov, Hilmar Dorge, Jose Hinz, Jan Schmitto, Tomislav Stojanovic, Ralf Seipelt, Vassilios Didilis, Friedrich Schoendube
Journal of Cardiothoracic Surgery , 2008, DOI: 10.1186/1749-8090-3-20
Abstract: Six minipigs underwent aortocoronary bypass grafting using standard cardiopulmonary bypass and cardioplegic arrest. Mammary vein were grafted in a reversed manner from ascending aorta to left anterior descending coronary artery (LAD). The proximal LAD was ligated, rendering the anterior left ventricle vein graft-dependent. Minipigs were killed after 4 weeks, and vein grafts were harvested. Histological and immunohistological investigation were performed with respect to morphometric analysis, endothelial damage/dysfunction (v-Willebrand-factor (vWF)), smooth muscle cells (α-smooth actin) and proliferation rate (proliferation marker Ki 67).Mean intimal area of vein grafts was increased compared to ungrafted mammary veins. Intimal hyperplasia in vein grafts was characterized by massive accumulation of smooth muscle cells with a high proliferation rate and endothelial perturbation. Significant (p = 0.001) intimal hyperplasia of the grafted mammary vein compared to the ungrafted mammary vein was found. These changes were absent in ungrafted mammary veins.The present study demonstrates a pig model of aortocoronary vein graft intimal hyperplasia which is characterized by an accelerated progression within internal mammary veins. The model is suitable to investigate the pathophysiology of aortocoronary vein graft intimal hyperplasia as well as therapeutic approaches.The saphenous vein is still a conduit of choice for coronary artery bypass grafting. Following arterializations, vein grafts undergo immediate injury like ischemia and wall stress. The histological changes associated with vein graft failure are defined as intimal hyperplasia. They include acute thrombosis or early medial and intimal thickening that may be focally progressive. Further reason is late artheroma formation, which is the most important cause of failure beyond five years after implantation [1]. This vein graft failure is result of progressive thickening of the intima and media acting over the first mont
Living Donor Liver Transplantation with Renoportal Anastomosis for a Patient with Congenital Absence of the Portal Vein
Hajime Uchida,Seisuke Sakamoto,Takanobu Shigeta,Ikumi Hamano,Hiroyuki Kanazawa,Akinari Fukuda,Chiaki Karaki,Atsuko Nakazawa,Mureo Kasahara
Case Reports in Surgery , 2012, DOI: 10.1155/2012/670289
Abstract: A congenital absence of the portal vein (CAPV) is a rare disorder that may lead to an intrapulmonary shunt. A 14-year-old male with CAPV underwent living donor liver transplantation with a left lobe graft from his father. The portal vein reconstruction was achieved with a renoportal anastomosis using an interpositional graft from the native collateral vein, because portal venous system directly drains to the left renal vein without constructing the confluence of superior mesenteric vein and splenic vein. The patient is doing well with a normal liver function and mild hypoxemia.
Esophageal Anastomosis Medial to Preserved Azygos Vein in Esophageal Atresia with Tracheoesophageal Fistula: Restoration of Normal Mediastinal Anatomy  [cached]
Kumar Abdul Rashid,Madhukar Maletha,Tanvir Roshan Khan,Ashish Wakhlu
Journal of Neonatal Surgery , 2012,
Abstract: Objective: We intended to prospectively study the technical feasibility and advantages of esophageal anastomosis medial to the preserved azygos vein in neonates diagnosed with esophageal atresia with tracheoesophageal fistula (EA/TEF). The results were compared to the cases where azygos vein was either not preserved, or the anastomosis was done lateral to the arch of preserved azygos vein.Material and methods: A total of 134 patients with EA/TEF were admitted between January 2007 and July 2008 of which 116 underwent primary repair. Eleven patients with long gap esophageal atresia with or without tracheoesophageal fistula and 7 patients who expired before surgery were excluded. Patients were randomly divided in three groups comparable with respect to the gestational age, age at presentation, sex, birth weight, associated anomalies and the gap between the pouches after mobilization: Group A (azygos vein ligated and divided), Group B (azygos vein preserved with esophageal anastomosis lateral to the vein), and Group C azygos vein preserved with esophageal anastomosis medial to the vein). All the patients were operated by extra-pleural approach. The three groups were compared with respect to operative time and early postoperative complications like pneumonitis, anastomotic leaks and mortality. Odds ratio and Chi square test were used for the statistical analysis.Results: Group A, B and C had 35, 43 and 38 patients respectively. No significant difference was observed in average operative time in the 3 groups. Though incidence of postoperative pneumonitis was higher in group A (28%) as compared to group B (13.95%) and group C (11.62%), it was not statistically significant (p > 0.005). Anastomotic leak occurred in 7 patients in group A (20%), 6 patients in group B (13.95%) and 4 patients (10.52%) in group C (p > 0.005). Group A had 3 major and 4 minor anastomotic leaks; group B had 2 major and 4 minor leaks and group C had 1 major and 3 minor leaks. There were10 deaths in the series- 5 in group A, 3 in group B and 2 in group C (p > 0.005). Patients with major anastomotic leaks in all 3 groups expired after re-exploration. The minor leaks were managed conservatively and all of them healed spontaneously. Severe pneumonitis and septicemia in patients having major associated anomalies also contributed to the mortality.Conclusions: Although esophageal anastomosis medial to the preserved azygos vein restores the normal mediastinal anatomy without technical difficulty or increased operative time, the study could not prove a statistically significant advantage in terms
Laser Chorioretinal Venous Anastomosis for Progressive Nonischemic Central Retinal Vein Occlusion  [PDF]
Chih-Hsin Chen,Chien-Hsiung Lai,Hsi-Kung Kuo
Chang Gung Medical Journal , 2005,
Abstract: The use of high or medium-intensity lasers to create an anastomotic connection betweena retinal vein and a choroidal vein for the treatment of nonischemic central retinal veinocclusion (CRVO) has shown encouraging results. We established communication betweenan obstructed retinal vein and the choroid using a modified laser application in the eye of a17-year-old boy with progressive nonischemic CRVO with macular edema and achievedexcellent anatomic and visual results. The macular edema totally resolved and visual acuitysignificantly improved from 6/60 to 6/6.
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