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Venous outflow obstruction

Michael Lichtenberg, Rick de Graaf, Christian Erbel
Postthrombotic syndrome (PTS) is the most common complication after iliofemoral deep vein thrombosis. It reduces quality of life and increases deep vein thrombosis (DVT)-related costs. The clinical symptoms and severity of PTS may vary; the most common symptoms include edema, pain (venous claudication), hyperpigmentation, lipodermatosclerosis, and ulceration. PTS is based on the principle of outflow obstruction, which may be caused by venous hypertension and may lead to valvular damage and venous reflux or insufficiency...
March 8, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Anna K Stuck, Thomas Reich, Rolf P Engelberger, Tim Sebastian, Nils Kucher
BACKGROUND: The aim of the study was to investigate venous patency and clinical outcomes for endovascular treatment of iliofemoral venous obstruction in patients with post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) with dedicated self-expanding nitinol stents. PATIENTS AND METHODS: Data were collected from the prospective Swiss Venous Stent Registry, enrolling consecutive patients with a standardized follow-up procedure since January 2008...
March 7, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Akinari Fukuda, Seisuke Sakamoto, Kengo Sasaki, Soichi Narumoto, Toshihiro Kitajima, Yoshihiro Hirata, Tomoro Hishiki, Kasahara Mureo
Hepatic venous outflow obstruction (HVOO) can be a critical complication in pediatric living-donor liver transplantation (LDLT). The aim of this study was to evaluate a modified triangular technique of hepatic vein reconstruction for preventing HVOO in pediatric LDLT. METHODS: A total of 298 pediatric LDLTs were performed using a left lateral segment graft by two methods for reconstruction of the hepatic vein. In 177 recipients, slit-shaped anastomosis were indicated with partial clamp of the inferior vena cava (IVC)...
February 27, 2018: Pediatric Transplantation
Alexis Galloux, Erika Pace, Stephanie Franchi-Abella, Sophie Branchereau, Emmanuel Gonzales, Daniele Pariente
BACKGROUND: Hepatic venous outflow obstruction after paediatric liver transplantation is an unusual but critical complication. OBJECTIVES: To review the incidence, diagnosis and therapeutic modalities of hepatic venous outflow obstruction from a large national liver transplant unit. MATERIALS AND METHODS: During the period from October 1992 to March 2016, 917 liver transplant procedures were performed with all types of grafts in 792 children...
February 21, 2018: Pediatric Radiology
Valérie Vilgrain, Valérie Paradis, Morgane Van Wettere, Dominique Valla, Maxime Ronot, Pierre-Emmanuel Rautou
A variety of vascular liver disorders can induce hepatocellular tumors. They may be related to portal venous deprivation, venous outflow obstruction, or arterial diseases. Their common feature is an imbalance between hepatic arterial and portal venous blood flow leading to an increased hepatic arterial inflow. Consequently, hepatocellular tumors may arise, most commonly focal nodular hyperplasia-like lesions but hepatocellular adenomas and hepatocellular carcinoma may be seen as well. This article will review the most common vascular liver diseases associated with hepatocellular nodules (Budd-Chiari syndrome, congenital portosystemic shunt, hereditary hemorrhagic telangiectasia, and portal cavernoma)...
February 19, 2018: Abdominal Radiology
Catherine Amlie-Lefond
PURPOSE OF REVIEW: This article provides an overview of stroke in neonates, infants, and children. RECENT FINDINGS: Arterial ischemic stroke and cerebral venous sinus thrombosis are increasingly recognized in childhood as important causes of lifelong morbidity and mortality. Diagnosis of arterial ischemic stroke is frequently delayed, as acute neurologic deficits can be challenging to detect in the young child, and stroke is often not considered in the differential diagnosis...
February 2018: Continuum: Lifelong Learning in Neurology
Giuseppe Brancatelli, Alessandro Furlan, Alberto Calandra, Marco Dioguardi Burgio
Hepatic sinusoidal dilatation refers to the enlargement of the hepatic capillaries. Most of the time this condition is caused by hepatic venous outflow obstruction, which results in vascular stasis and congestion of hepatic parenchyma. In this setting, hepatic sinusoidal dilatation can be related to pericardial disease, heart failure, compression or thrombosis of the hepatic veins or inferior vena cava (i.e., Budd-Chiari syndrome) or central veins/sinusoids involvement (i.e., sinusoidal obstruction syndrome)...
February 1, 2018: Abdominal Radiology
Deniz Balci, Menekse Ozcelik, Elvan Onur Kirimker, Arda Cetinkaya, Evren Ustuner, Mehmet Cakici, Bahadir Inan, Zekeriyya Alanoglu, Sadik Bilgic, Ahmet Ruchan Akar
BACKGROUND: Liver resection for intrahepatic cholangiocarcinoma (ICC) with invasion of the inferior vena cava (IVC) and hepatic veins (HV) is a challenging procedure. CASE PRESENTATION: We report a case of a 63-year-old woman with a 6-cm, centrally located liver mass. Her biochemistry results were normal except for a Ca19-9 level of 1199 U/ml. The liver biopsy was consistent with ICC and 60% macrosteatosis. Abdominal CT scans revealed a large central mass invading the left HV, middle HV and right HV, infringing on their junction with the vena cava...
January 31, 2018: BMC Surgery
Rupinder Singh, Vivek Gupta, Chirag Ahuja, Ajay Kumar, Kanchan K Mukherjee, Niranjan Khandelwal
Introduction The present study aimed to evaluate the accuracy of time-resolved-computed tomographic angiography (TR-CTA) on a 128-slice CT scanner vis-à-vis cerebral digital subtraction angiography (DSA) in defining the morphological and haemodynamic characteristics of cerebral arteriovenous malformation (AVM). Methods Twenty-one patients (age range 10-46, mean 24.8 years) with clinical suspicion of AVM and three patients (age range 23-35, mean 24.3 years) with diagnosed AVM who were on follow-up underwent DSA and TR-CTA, on average 1...
January 1, 2018: Neuroradiology Journal
Murali Appukuttan, Senthil Kumar, Kishore Gurumoorthy Subramanya Bharathy, Vijay Kant Pandey, Viniyendra Pamecha
OBJECTIVES: An optimal initial graft function after living-donor liver transplant depends on optimal graft hemodynamics. Nonmechanical impediments to free hepatic venous outflow, due to elevated central venous pressure, may obstruct the "functional" hepatic venous outflow. Here, we evaluated whether central venous pressure affected early graft function and outcomes in adult living-donor liver transplant recipients. MATERIALS AND METHODS: This prospective observational study included 61 living-donor liver transplant recipients without technical complications who received transplants from August 2013 to November 2014...
January 22, 2018: Experimental and Clinical Transplantation
Camila C Simoes, Yezaz A Ghouri, Shehzad N Merwat, Heather L Stevenson
Budd-Chiari syndrome (BCS) is characterised by obstruction of hepatic venous outflow and may be triggered by the prothrombotic state associated with inflammatory bowel disease (IBD). We reported a case of Crohn's disease (CD) that presented with anasarca, ascites, symptomatic hepatomegaly, elevated liver enzymes, increased prothrombin time and low albumin. Oesophagogastroduodenoscopy and colonoscopy confirmed active CD. Abdominal CT showed hepatic vein thrombosis. Liver biopsy revealed severe perivenular sinusoidal dilation with areas of hepatocyte dropout, bands of hepatocyte atrophy and centrizonal fibrosis, suggestive of BCS...
January 17, 2018: BMJ Case Reports
Chunxiao Li, Li Sun, Xiuzhen Zhao, Mingqin Zhu, Ying Zhang
RATIONALE: Cerebral venous thrombosis (CVT) comprises a group of cerebral vascular diseases resulting from cerebral venous outflow obstruction caused by various etiologies. The etiology of CVT is complex, including infectious and noninfectious factors. The diagnosis is difficult. As a result, many patients are misdiagnosed or never diagnosed. This patient was diagnosed with CVT due to unilateral internal jugular vein compression. PATIENT CONCERNS: In this report, we present a case of acute onset CVT in a 15-year-old female patient who presented with a headache, nausea, and vomiting as the main clinical manifestations...
December 2017: Medicine (Baltimore)
Zhi-Yuan Zhang, Long Jin, Guang Chen, Tian-Hao Su, Zhi-Jun Zhu, Li-Ying Sun, Zhen-Chang Wang, Guo-Wen Xiao
AIM: To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction (HVOO) following pediatric liver transplantation. METHODS: A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures (two patients underwent two balloon dilatation procedures) were included in this analysis...
December 14, 2017: World Journal of Gastroenterology: WJG
Mahmood Razavi, William Marston, Stephen Black, Dana Bentley, Peter Neglén
OBJECTIVE: The objective of this study was to assess the safety and efficacy of a dedicated venous stent (the VICI VENOUS STENT; VENITI, Fremont, Calif) for treatment of symptomatic iliofemoral venous outflow obstruction. METHODS: Thirty patients (24 female; median age, 43 years) were enrolled in the feasibility phase of an international, multicenter investigational device exemption trial from June 2014 to February 2015. All patients exhibited unilateral venous disease with ≥50% stenosis in the iliofemoral veins...
December 28, 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Suleyman Koc, Sami Akbulut, Vural Soyer, Mehmet Yilmaz, Bora Barut, Ramazan Kutlu, Sezai Yilmaz
OBJECTIVES: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. MATERIALS AND METHODS: We retrospectively examined the demographic, clinical, and radiologic data of 35 patients who developed hepatic venous outlet obstruction after living-donor liver transplant. Patients were subgrouped on the basis of onset (8 patients with early onset [< 30 days posttransplant] and 27 patients with late onset [≥ 30 days posttransplant]) and postoperative survival (24 survivors, 11 nonsurvivors)...
December 5, 2017: Experimental and Clinical Transplantation
S Y Hong, B-W Kim, H-J Wang, I-G Kim, X-G Hu
INTRODUCTION: Although outcomes of liver transplantation (LT) have improved as the result of progress in surgical procedures, a failure to restore sufficient graft outflow may yield fatal consequences including graft dysfunction and even graft loss to date. In particular, patients with pre-existing obliterated venous drainage, such as those with Budd-Chiari syndrome (BCS), are at high risk of having venous complications followed by conventional LT. In selected cases, the transplant surgeons are compelled to modify the surgical procedures of LT from the conventional procedure...
December 2017: Transplantation Proceedings
Michael Lichtenberg, Houman Jalaie
Current national and international guidelines recommend endovascular therapy of iliofemoral thromboses in young patients, as a treatment option to avoid the post-thrombotic syndrome. Possible techniques include endovascular local lysis therapy, as well as pharmacomechanical or purely mechanical procedures. Endovascular therapy of chronic obstruction of the inferior V. cava or pelvic veins is an effective therapy for patients suffering from post-thrombotic syndrome. If there is involvement of the V. femoralis communis, hybrid operations may be considered in which an AV fistula is formed or endophlebectomy is carried out...
October 2017: Zentralblatt Für Chirurgie
Johnathon C Rollo, Steven M Farley, Juan Carlos Jimenez, Karen Woo, Peter F Lawrence, Brian G DeRubertis
BACKGROUND: Patients with iliofemoral deep venous thrombosis are at risk for development of post-thrombotic syndrome. Iliac vein stenting has been shown to significantly improve clinical outcomes in patients with venous outflow obstruction, although many studies include a heterogeneous population with several different venous pathologic processes. Our objective was to evaluate the results of iliocaval and infrainguinal venous intervention for venous outflow obstruction due to post-thrombotic chronic venous occlusive disease...
November 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Paul J Gagne, Antonios Gasparis, Stephen Black, Patricia Thorpe, Marc Passman, Suresh Vedantham, William Marston, Mark Iafrati
BACKGROUND: Selecting patients for iliofemoral vein stenting has traditionally relied on the identification and quantification of stenotic lesions with imaging such as multiplanar venography. Recently, intravascular ultrasound (IVUS) imaging has become more available. However, to date, the usefulness of these imaging modalities using the customary >50% treatment threshold for diameter (multiplanar venography) and area (IVUS) stenosis of iliofemoral veins has not been validated prospectively within the context of clinical improvement...
October 12, 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Louise Barbier, Maxime Ronot, Béatrice Aussilhou, François Cauchy, Claire Francoz, Prof Valérie Vilgrain, Olivier Soubrane, Valérie Paradis, Jacques Belghiti
BACKGROUND: In patients with polycystic liver disease, development of cysts induces hepatic venous outflow obstruction (HVOO) and parenchymal modifications, challenging the paradigm of a normal non-cystic liver parenchyma. The aims were to reappraise the pathology of the non-cystic parenchyma, by focusing on HVOO lesions; and to investigate the association with outflow obstruction at imaging and perioperative course after liver resection. METHODS: This is a retrospective study conducted in one tertiary center between 1993 and 2014...
October 10, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
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