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  • ISSN: 2378-9344
    Volume 4, Issue 2
    Research Article
    Domingos de Morais Filho*, Rodrigo Gomes de Oliveira, Carlos Alberto Engelhorn, and Sergio Xavier Salles-Cunha
    Objectives: Demonstrate alterations of measurements in the vascular ultrasound exam for varicose veins when performed in standing or decubitus exam positioning.
    Method: Varicose veins patients (67 limbs) were examined using vascular ultrasound first in 30° reverse Trendelemburg (decubitus) and then in a standing position in the same patient. The results of the measured parameters (diameter and velocities) and reflux type were then compared.
    Results: Measurements changed very much from decubitus to standing examining positions. All measured parameters values increased when examined in the standing position compared to the decubitus. The venous diameter augmented from 41 to 44%; reflux time increased from 75 to 97% and maximal velocity of reflux (MVR) increased from 2, 8 to 3,5 times. Also, in 33 of the examined limbs (49,25% of the total), a change in reflux pattern occurred.
    Conclusions: Standardization of ultrasound varicose veins exam is imperative.
    Vidyasagar Casikar*, Gorur Sudarshan Ramaswamy, and Minal Bhagat
    The anatomy of the Arterio-venous malformations is described generally with reference to adult anatomy. These malformations occur due to developmental anomalies in the embryological stage. It is possible to describe the anatomy with reference to embryonic segmental origins.
    The flow pattern in an AVM is unique because two fluid systems of different pressures and flows are interconnected. There are numerous published reports on the flow characteristics of AVMs based on the assumption that the equations for flow in a linear tube are also applicable to AVMs. We have demonstrated by experimental evidence and computational fluid dynamic studies that the flow is extremely complex. We hypothesize that AVMs in the brain are abnormal communications between definite embryonic arteries and veins.
    Dinc N*, Eibach M, Quick-Weller J, Tritt S, Konczalla J, Seifert V, and Marquardt G
    Background: Arteriovenous malformation is currently classified by their size, location (eloquent/non-eloquent) and depth of the drainage to appreciate the risk of bleeding and treatment choice.
    Objective: We hypothesized that in addition to the so far used classification of Spetzler Martin the number of draining veins implies a significant predicting risk factor, too.
    Methods: 238 patients with AVMs admitted to our department between 2006 and 2016 were included in the study and their angioarchitecture was analyzed. In doing so, size and quantity of draining veins and sinuses, hemorrhage status, Spetzler Martin grading, supra- and infratentorial location were taken into account.
    Results: Hemorrhage was found in 99 patients (41.6%), mostly with Spetzler-Martin 3 grading. AVMs with less than 3 draining veins into the sinus were more frequently associated with hemorrhage (56.4% vs. 22.9% with 3 or more draining veins, p<0.0001, OR 4.36). Bleeding occurred in 62.8% of patients with an infratentorial AVM whereas this was the case in only 36.9% of patients with a supratentorial AVM (62.8% vs. 36.9%, p=0.002; OR 2.88). Location and associated aneurysms were not related to the number of draining veins significantly (p>0.05).
    Conclusion: More than half of the AVMs with lower numbers of draining veins show more frequently a hemorrhage than AVMs with higher numbers of draining veins. In addition to the classification criteria used so far, such as AVM size, drainage depth, the number of the draining veins should be included in the AVM grading to assess the hazardousness and treatment option.
    Case Report
    Musa Silahli*, Zeynel Gokmen, and Enver Arpaci
    Umbilical catheter placement is frequently used in the neonatal intensive care unit. Umbilical vein is a very useful venous route to the usage of drugs, intravenous fluids and to obtain blood samples. It is a lifesaver for an emergency state in neonates. This application has several complications such as sepsis, hepatic injury, extravasation, cardiac tamponade, air embolism. We present a gluteal necrosis case associated with umbilical catheter misplacement which is seen very rarely.
    Elias Hellou, Akram Abu-Ful, Victor Assaf, Fadi Abu-Zhaya, William Nseir, Monir Hamza and Zaher Armaly*
    This report describes a unique case of a patient with end stage renal disease treated with hemodialysis via brachio-cephalic arterio-venous (AV) shunt in the right arm, while having the old brachio-cephalic arterial venous shunt in the left arm abandoned. The left shunt was complicated with acute upper limb ischemia and treated with endovascular means. A 77-year-old male was referred to our hospital due to severe pain of abrupt onset, accompanied with cyanosis and cold temperature in the left arm and wrist, distally to the dialysis shunt. Immediate vascular assessment revealed a big thrombus in the shunt, and total pulse absence distally to the dialysis shunt, which was confirmed on hand held Doppler scan. This article describes and illustrates an endovascular approach for diagnosis, curing and management of the acute upper limb ischemia to the abandoned brachio-cepahic AV shunt. With a salvage of the limb, with emphasis at the usage of retrograde distal sheath for evacuation of thrombi, and treatment of the outflow of the abandoned shunt with stent. Open the link for viewing video record of the entire procedure https://www.dropbox.com/s/e7n5glo4t5wjfth/AV%20SHUNT%20THROMBUS.mp4?dl=0
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