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Adductor Hiatus

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S Savvidis – 1st expert on this subject based on the ideXlab platform

  • Operative technique and morbidity of superficial femoral vein harvest.
    Gefasschirurgie : Zeitschrift fur vaskulare und endovaskulare Chirurgie : Organ der Deutschen und der Osterreichischen Gesellschaft fur Gefasschirurgi, 2016
    Co-Authors: A Neufang, S Savvidis

    Abstract:

    The use of autologous superficial femoral veins (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery with versatile indications. The SFV autografts exhibit excellent control of infection and durable long-term results in terms of graft patency in prosthetic or arterial infections. In cases of elective use of the SFV, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein.
    The SFV can be harvested distal to the Adductor Hiatus with a proximal portion of the popliteal vein but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema.
    Early postoperative swelling of the donor leg can be expected but resolves spontaneously in most cases. Chronic mild edema of the leg with a possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare if the anatomical borders for vein harvesting are respected. Temporary therapeutic anticoagulation after vein harvest is subject to individual decision making.
    Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system in the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated.

  • Operative technique and morbidity of superficial femoral vein harvest
    Gefässchirurgie, 2016
    Co-Authors: A Neufang, S Savvidis

    Abstract:

    Hintergrund Die Verwendung der autologen V. femoralis superficialis (VFS) als arterieller oder venöser Gefäßersatz stellt ein wertvolles Instrument in der modernen Gefäßchirurgie mit vielfältigen Indikationsmöglichkeiten dar. Insbesondere in der septischen Gefäßchirurgie führt die Verwendung der VFS zu ausgezeichneten Resultaten in Hinsicht auf die Beherrschung der Infektion und die langfristigen Graftfunktion. Materialien und Methoden Bei elektiver Indikationsstellung zur Verwendung der VFS sollte eine duplexsonographische Evaluation des tiefen Beinvenensystems erfolgen und speziell die Offenheit der V. profunda femoris überprüft werden. Die VFS kann auch über den Adduktorenschlitz hinaus mit einem proximalen Anteil der V. poplitea entnommen werden. Die Entnahme sollte dabei das Niveau des Kniegelenks nicht überschreiten. Eine Stumpfbildung der proximalen VFS ist immer zu vermeiden. Die simultane Entnahme der gleichseitigen V. saphena magna soll zur Vorbeugung einer persistierenden chronischen Schwellneigung nicht erfolgen. Ergebnisse Eine vorübergehende frühpostoperative Schwellneigung des Beines bedarf in der Regel keiner spezifischen Therapie. In bis zu 20 % der Fälle kann als Folge der Entnahme ein anhaltendes mäßiges Ödem mit Indikation zur Kompressionstherapie entstehen. Gravierende Komplikationen am tiefen Venensystem sind aber bei Einhaltung der anatomischen Begrenzungen im Rahmen der Entnahme nicht zu erwarten. Eine temporäre therapeutische Antikoagulation nach Venenentnahme muss individuell entschieden werden. Schlussfolgerung Das residuelle tiefe und oberflächliche Venensystem kann im Langzeitverlauf verlässlich mittels Duplexsonographie beurteilt werden. Die exzellente Graftfunktion und die angesichts der langfristigen Ergebnisse eher seltenen und tolerierbaren negativen Auswirkungen auf den venösen Rückstrom rechtfertigen den Einsatz der VFS in der arteriellen und venösen Gefäßchirurgie bei sorgfältiger Indikationsstellung. Background The use of autologous superficial femoral veins (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery with versatile indications. The SFV autografts exhibit excellent control of infection and durable long-term results in terms of graft patency in prosthetic or arterial infections. In cases of elective use of the SFV, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein. Material and methods The SFV can be harvested distal to the Adductor Hiatus with a proximal portion of the popliteal vein but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema. Results Early postoperative swelling of the donor leg can be expected but resolves spontaneously in most cases. Chronic mild edema of the leg with a possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare if the anatomical borders for vein harvesting are respected. Temporary therapeutic anticoagulation after vein harvest is subject to individual decision making. Conclusion Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system in the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated.

  • Technik und Morbidität der Entnahme der V. femoralis superficialis
    Gefässchirurgie, 2016
    Co-Authors: A Neufang, S Savvidis

    Abstract:

    The use of the autologous superficial femoral vein (SFV) as an arterial or venous substitute represents a valuable technique in modern vascular surgery for numerous indications. Implantation of the SFV in case of prosthetic or arterial infection is characterized by excellent control of the infection and durable long-term results with regard to graft patency. In case of elective SFV use, duplex ultrasound evaluation of the deep leg vein system should be implemented to confirm the patency of the profunda femoris vein. The SFV may be harvested distal to the Adductor Hiatus with a proximal portion of the popliteal vein, but should not exceed the level of the knee joint. Formation of a stump of the proximal SFV must be avoided. Simultaneous harvesting of the ipsilateral greater saphenous vein should be avoided to reduce the risk of significant chronic edema. Early postoperative swelling of the donor leg can be expected and resolves spontaneously in most cases. Chronic mild edema of the leg with possible indication for compression therapy may occur in up to 20 % of cases but severe complications are very rare, if the anatomic borders for the vein harvest are respected. Temporary therapeutic anticoagulation after vein harvest must be decided individually. Duplex ultrasound is a reliable tool to assess the residual deep and superficial venous system over the long term. Excellent graft function and the tolerable adverse effects of vein harvest on the donor leg justify the use of the SFV in arterial and venous vascular surgery if indicated. Die autologen V. femoralis superficialis (VFS) kann in der modernen Gefäßchirurgie als arterieller oder venöser Gefäßersatz für vielfältige Indikationen genutzt werden. Insbesondere in der septischen Gefäßchirurgie führt die Verwendung der VFS zu ausgezeichneten Resultaten hinsichtlich der Beherrschung einer Infektion und der langfristigen Graftfunktion. Bei Verwendung der VFS sollte eine duplexsonographische Evaluation des tiefen Beinvenensystems erfolgen und speziell die Offenheit der V. profunda femoris überprüft werden. Die VFS kann auch über den Adduktorenschlitz hinaus mit einem proximalen Anteil der V. poplitea entnommen werden. Die Entnahme sollte dabei das Niveau des Kniegelenks nicht überschreiten. Eine Stumpfbildung der proximalen VFS ist immer zu vermeiden. Auch sollte die simultane Entnahme der gleichseitigen V. saphena magna zur Vorbeugung einer persistierenden chronischen Schwellneigung unterbleiben. Eine frühpostoperative Schwellneigung des Beines bedarf in der Regel keiner spezifischen Therapie. In bis zu 20 % der Fälle kann als Folge der Entnahme ein anhaltendes mäßiges Ödem mit Indikation zur Kompressionstherapie entstehen. Gravierende Komplikationen am tiefen Venensystem sind aber bei Einhaltung der anatomischen Begrenzungen im Rahmen der Entnahme nicht zu erwarten. Eine temporäre therapeutische Antikoagulation nach Venenentnahme muss individuell entschieden werden. Das residuelle tiefe und oberflächliche Venensystem kann im Langzeitverlauf verlässlich mittels Duplexsonographie beurteilt werden. Die exzellente Graftfunktion und die angesichts der langfristigen Ergebnisse eher seltenen und tolerierbaren negativen Auswirkungen auf den venösen Rückstrom rechtfertigen den Einsatz der VFS in der arteriellen und venösen Gefäßchirurgie bei sorgfältiger Indikationsstellung.

Jason N. Mactaggart – 2nd expert on this subject based on the ideXlab platform

  • limb flexion induced axial compression and bending in human femoropopliteal artery segments
    Journal of Vascular Surgery, 2017
    Co-Authors: William Poulson, Alexey Kamenskiy, Andreas Seas, Paul Deegan, Carol Lomneth, Jason N. Mactaggart

    Abstract:

    Abstract Background High failure rates of femoropopliteal artery (FPA) interventions are often attributed in part to severe mechanical deformations that occur with limb movement. Axial compression and bending of the FPA likely play significant roles in FPA disease development and reconstruction failure, but these deformations are poorly characterized. The goal of this study was to quantify axial compression and bending of human FPAs that are placed in positions commonly assumed during the normal course of daily activities. Methods Retrievable nitinol markers were deployed using a custom-made catheter system into 28 in situ FPAs of 14 human cadavers. Contrast-enhanced, thin-section computed tomography images were acquired with each limb in the standing (180 degrees), walking (110 degrees), sitting (90 degrees), and gardening (60 degrees) postures. Image segmentation and analysis allowed relative comparison of spatial locations of each intra-arterial marker to determine axial compression and bending using the arterial centerlines. Results Axial compression in the popliteal artery (PA) was greater than in the proximal superficial femoral artery (SFA) or the Adductor Hiatus (AH) segments in all postures ( P  = .02). Average compression in the SFA, AH, and PA ranged from 9% to 15%, 11% to 19%, and 13% to 25%, respectively. The FPA experienced significantly more acute bending in the AH and PA segments compared with the proximal SFA ( P Conclusions The FPA experiences significant axial compression and bending during limb flexion that occur at even modest limb angles. Moreover, different segments of the FPA appear to undergo significantly different degrees of deformation. Understanding the effects of limb flexion on axial compression and bending might assist with reconstructive device selection for patients requiring peripheral arterial disease intervention and may also help guide the development of devices with improved characteristics that can better adapt to the dynamic environment of the lower extremity vasculature.

  • three dimensional bending torsion and axial compression of the femoropopliteal artery during limb flexion
    Journal of Biomechanics, 2014
    Co-Authors: Jason N. Mactaggart, Carol S Lomneth, Iraklis I. Pipinos, Jason M. Johanning, Anastasia Desyatova, Nicholas Y Phillips, Robert Bowen, Timothy B Baxter, Matthew G Longo, Michael J Moulton

    Abstract:

    Abstract High failure rates of femoropopliteal artery reconstruction are commonly attributed to complex 3D arterial deformations that occur with limb movement. The purpose of this study was to develop a method for accurate assessment of these deformations. Custom-made stainless-steel markers were deployed into 5 in situ cadaveric femoropopliteal arteries using fluoroscopy. Thin-section CT images were acquired with each limb in the straight and acutely bent states. Image segmentation and 3D reconstruction allowed comparison of the relative locations of each intra-arterial marker position for determination of the artery’s bending, torsion and axial compression. After imaging, each artery was excised for histological analysis using Verhoeff–Van Gieson staining. Femoropopliteal arteries deformed non-uniformly with highly localized deformations in the proximal superficial femoral artery, and between the Adductor Hiatus and distal popliteal artery. The largest bending (11±3–6±1 mm radius of curvature), twisting (28±9–77±27°/cm) and axial compression (19±10–30±8%) were registered at the Adductor Hiatus and the below knee popliteal artery. These deformations were 3.7, 19 and 2.5 fold more severe than values currently reported in the literature. Histology demonstrated a distinct sub-adventitial layer of longitudinally oriented elastin fibers with intimal thickening in the segments with the largest deformations. This endovascular intra-arterial marker technique can quantify the non-uniform 3D deformations of the femoropopliteal artery during knee flexion without disturbing surrounding structures. We demonstrate that 3D arterial bending, torsion and compression in the flexed lower limb are highly localized and are substantially more severe than previously reported.

  • Abstract 252: Method to Quantify Femoropopliteal Artery Deformation During Knee Flexion
    Arteriosclerosis Thrombosis and Vascular Biology, 2013
    Co-Authors: Alexey Kamenskiy, Carol S Lomneth, Iraklis I. Pipinos, G. Matthew Longo, Jason M. Johanning, B. Timothy Baxter, Jason N. Mactaggart

    Abstract:

    Introduction High failure rates of femoropopliteal reconstructions are commonly attributed to deformations and forces exerted on the artery during movement. The purpose of this study was to develop a method to better quantify these deformations. Methods Custom-made stainless steel markers were deployed in an in situ cadaveric femoropopliteal artery. The artery was then infused with contrast and CT images of the straight and bent (45°, 90°, 135°) leg were acquired. 3D reconstructions of the leg were created using Mimics and identification of the marker position and geometry enabled measurements of axial extension, compression, bending and torsion. After imaging, the artery was surgically exposed, photographed and excised for histological analysis. Results The femoropopliteal artery deformed non-uniformly along its length. No changes with knee flexion were seen proximal to the Adductor Hiatus and radial compression was minimal throughout the length of the artery. At the Adductor Hiatus the artery experienced 45° angle of twist, but no axial compression or bending. Distally, buckling and axial compression (36%) were demonstrated, but no torsion. Histology demonstrated intimal thickening corresponding to areas with the largest deformations (Figure 1). Conclusions This method allows quantification of non-uniform arterial deformation in the femoropopliteal artery with knee flexion. This information may assist in the design of better reconstruction techniques and devices for treatment of femoropopliteal arterial disease.

Zeliha Kurtoğlu – 3rd expert on this subject based on the ideXlab platform

  • Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects
    Surgical and Radiologic Anatomy, 2014
    Co-Authors: İsmail Yağmurhan Gilan, Gökçe Deniz Külekçi, Zeliha Kurtoğlu

    Abstract:

    Objective Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. Material and method During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. Results The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the Adductor magnus muscle 56.2 mm above the Adductor Hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the Adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. Conclusion In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.

  • Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects
    Surgical and Radiologic Anatomy, 2013
    Co-Authors: İsmail Yağmurhan Gilan, Gökçe Deniz Külekçi, Zeliha Kurtoğlu

    Abstract:

    Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the Adductor magnus muscle 56.2 mm above the Adductor Hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the Adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.