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BMC Cardiovascular Disorders Oct 2021Currently, the accepted effective method for assessing blood volume status, such as measuring central venous pressure (CVP) and mean pulmonary artery pressure (mPAP), is... (Comparative Study)
Comparative Study
BACKGROUND
Currently, the accepted effective method for assessing blood volume status, such as measuring central venous pressure (CVP) and mean pulmonary artery pressure (mPAP), is invasive. The purpose of this study was to explore the feasibility and validity of the ratio of the femoral vein diameter (FVD) to the femoral artery diameter (FAD) for predicting CVP and mPAP and to calculate the cut-off value for the FVD/FAD ratio to help judge a patient's fluid volume status.
METHODS
In this study, 130 patients were divided into two groups: in group A, the FVD, FAD, and CVP were measured, and in group B, the FVD, FAD, and mPAP were measured. We measured the FVD and FAD by ultrasound. We monitored CVP by a central venous catheter and mPAP by a Swan-Ganz floating catheter. Pearson correlation coefficients were calculated. The best cut-off value for the FVD/FAD ratio for predicting CVP and mPAP was obtained according to the receiver operating characteristic (ROC) curve.
RESULTS
The FVD/FAD ratio was strongly correlated with CVP (R = 0.87, P < 0.0000) and mPAP (R = 0.73, P < 0.0000). According to the ROC curve, an FVD/FAD ratio ≥ 1.495 had the best test characteristics to predict a CVP ≥ 12 cmHO, and an FVD/FAD ratio ≤ 1.467 had the best test characteristics to predict a CVP ≤ 10 cmHO. An FVD/FAD ratio ≥ 2.03 had the best test characteristics to predict an mPAP ≥ 25 mmHg. According to the simple linear regression curve of the FVD/FAD ratio and CVP, when the predicted CVP ≤ 5 cmHO, the FVD/FAD ratio was ≤ 0.854.
CONCLUSION
In this study, the measurement of the FVD/FAD ratio obtained via ultrasound was strongly correlated with CVP and mPAP, providing a non-invasive method for quickly and reliably assessing blood volume status and providing good clinical support.
Topics: Aged; Arterial Pressure; Blood Pressure Determination; Blood Volume; Blood Volume Determination; Central Venous Pressure; Feasibility Studies; Female; Femoral Artery; Femoral Vein; Humans; Hypovolemia; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Pulmonary Artery; Reproducibility of Results; Ultrasonography
PubMed: 34670503
DOI: 10.1186/s12872-021-02309-7 -
Medicine Oct 2022This study aimed to detect the correlation of central venous pressure (CVP) with the internal jugular vein (IJV), common carotid artery (CCA), femoral vein (FV), and...
BACKGROUND
This study aimed to detect the correlation of central venous pressure (CVP) with the internal jugular vein (IJV), common carotid artery (CCA), femoral vein (FV), and femoral artery (FA) diameters measured with ultrasound (USG) in patients under mechanical ventilation to evaluate whether they are suitable to be used as an alternative low-cost and noninvasive method for the detection of CVP.
METHODS
A total of 40 patients aged from 18 to 90 who had been receiving therapy in the intensive care unit (ICU) were included in the study. Central venous catheter was placed into the patients through right IJV or subclavian vein in their first 24-hour of hospitalization and the right atrium pressure (RAP) was measured from the catheter, the tip of which was confirmed to reach right atrium. In the same session, CCA, IJV, FA, and FV diameters were measured with USG and their correlations with CVP were calculated. In addition, correlations of the measured venous and artery diameters between each other were detected as well.
RESULTS
There was a significantly high correlation between CVP and CCA diameter (R = 0.603, P < .000). There was a significantly low correlation between CVP and IJV diameter (R = 0.352, P = .026), a significantly low correlation between FA and FV diameters (R = 0.317, P = .047), a significantly low correlation between FA and CCA diameters (R = 0.330, P = .038), and a significantly low correlation between IJV and CCA diameters (R = 0.364, P = .020).
CONCLUSION
CVP and CCA diameters exhibited a high correlation. For detection of CVP, the ultrasonographic CCA diameter measurement can be used as an alternative noninvasive method which is easy to use and minimally affected by measurement errors of individuals and which has low learning curve compared with the other measurement methods.
Topics: Humans; Jugular Veins; Central Venous Pressure; Femoral Vein; Femoral Artery; Carotid Artery, Common; Ultrasonography; Catheterization, Central Venous
PubMed: 36316929
DOI: 10.1097/MD.0000000000031207 -
Interactive Cardiovascular and Thoracic... Jun 2021Adventitial cystic disease of the femoral vein is an extremely rare condition; therefore, diagnosis, treatments, surgical approaches and long-term prognosis are not well...
Adventitial cystic disease of the femoral vein is an extremely rare condition; therefore, diagnosis, treatments, surgical approaches and long-term prognosis are not well defined. We report the case of a 67-year-old man with femoral vein adventitial cystic disease complicated with deep vein thrombosis. He presented with right leg oedema. Ultrasound, computed tomography and magnetic resonance imaging revealed a mass in the femoral vein, and deep vein thrombosis was not detected at the time. However, venous return disorder worsened due to the mass causing a deep vein thrombosis in the femoral vein, and anticoagulation therapy with edoxaban was administered. Subsequently, deep vein thrombosis in the femoral vein disappeared, but remained in the lower calf. The mass and femoral vein were completely resected and reconstructed with an expanded polytetrafluoroethylene graft. No recurrence was observed over 3 years and 3 months.
Topics: Adventitia; Aged; Cysts; Femoral Vein; Humans; Male; Vascular Diseases; Venous Thrombosis
PubMed: 33575741
DOI: 10.1093/icvts/ivab040 -
Medicina (Kaunas, Lithuania) Nov 2022: To investigate whether ultrasound (US)-guided femoral vein (FV) and inferior vena cava (IVC) measurements obtained before spinal anesthesia (SA) can be utilized to... (Observational Study)
Observational Study
: To investigate whether ultrasound (US)-guided femoral vein (FV) and inferior vena cava (IVC) measurements obtained before spinal anesthesia (SA) can be utilized to predict SA-induced hypotension (SAIH) and to identify risk factors associated with SAIH in patients undergoing non-obstetric surgery under SA. : This was a prospective observational study conducted between November 2021 and April 2022. The study included 95 patients over the age of 18 with an American Society of Anesthesiologists (ASA) physical status score of 1 or 2. The maximum and minimum diameters of FV and IVC were measured under US guidance before SA initiation, and the collapsibility index values of FV and IVC were calculated. Patients with and without SAIH were compared. : SAIH was observed in 12 patients (12.6%). Patients with and without SAIH were similar in terms of age [58 (IQR: 19-70) vs. 48 (IQR: 21-71; = 0.081) and sex (males comprised 63.9% of the SAIH and 75.0% of the non-SAIH groups) ( = 0.533). According to univariate analysis, no significant relationship was found between SAIH and any of the FV or IVC measurements. Multiple logistic regression analysis revealed that having an ASA class of 2 was the only independent risk factor for SAIH development ( = 0.014), after adjusting for age, sex, and all other relevant parameters. : There is not enough evidence to accept the feasibility of utilizing US-guided FV or IVC measurements to screen for SAIH development in patients undergoing non-obstetric surgery under SA. For this, multicenter studies with more participants are needed.
Topics: Male; Humans; Adult; Middle Aged; Female; Anesthesia, Spinal; Hypotension, Controlled; Femoral Vein; Ultrasonography; Ultrasonography, Interventional
PubMed: 36363572
DOI: 10.3390/medicina58111615 -
Cardiovascular and Interventional... Dec 2021To assess safety and patency of the Venovo venous stent for the treatment of iliofemoral vein obstruction.
PURPOSE
To assess safety and patency of the Venovo venous stent for the treatment of iliofemoral vein obstruction.
MATERIALS AND METHODS
Twenty-two international centers enrolled 170 patients in the VERNACULAR study (93 post-thrombotic syndrome; 77 non-thrombotic iliac vein lesions). Primary outcome measures were major adverse events at 30 days and 12-month primary patency (freedom from target vessel revascularization, thrombotic occlusion, or stenosis > 50%). Secondary outcomes included the Venous Clinical Severity Score Pain Assessment and Chronic Venous Quality-of-Life Questionnaire assessments (hypothesis tested). Secondary observations included primary patency, target vessel and lesion revascularization (TVR/TLR), and assessment of stent integrity through 36 months.
RESULTS
Freedom from major adverse events through 30 days was 93.5%, statistically higher than a pre-specified performance goal of 89% (p = 0.032) while primary patency at 12 months was 88.6%, also statistically higher than a performance goal of 74% (p < 0.0001). Mean quality-of-life measures were statistically improved compared to baseline values at 12 months (p < 0.0001). Primary patency at 36 months was 84% (Kaplan-Meier analysis) while freedom from TVR/TLR was 88.1%. There was no stent embolization/migration, and no core laboratory assessed stent fractures reported through 36 months. Six deaths were reported; none adjudicated as device or procedure related.
CONCLUSION
The Venovo venous stent was successfully deployed in obstructive iliofemoral vein lesions and met the pre-specified primary outcome measures through 12 months. At 3 years, primary patency was 84%, reintervention rates were low, standardized quality-of-life and pain measures improved from baseline, and there was no stent migration or fractures.
LEVEL OF EVIDENCE
Level 2-prospective, multicenter, controlled clinical study without a concurrent control or randomization. Pre-specified endpoints were hypothesis-tested to performance goals derived from peer-reviewed clinical literature. REGISTRATION CLINICALTRIALS.GOV: Unique Identifier NCT02655887.
Topics: Femoral Vein; Humans; Iliac Vein; Prospective Studies; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 34545448
DOI: 10.1007/s00270-021-02975-2 -
Acta Clinica Croatica Sep 2020The aim of the study was to investigate if preoperative blood flow velocity in femoral vein in different positions of the hip during total hip arthroplasty (THA) is a...
The aim of the study was to investigate if preoperative blood flow velocity in femoral vein in different positions of the hip during total hip arthroplasty (THA) is a predictor of postoperative deep vein thrombosis (DVT). In patients undergoing THA, blood flow velocity and diameter of proximal femoral vein on THA side were measured preoperatively in four flexion positions of the hip. After THA, patients were followed up for 42 days for DVT occurrence, and clinical features of patients with and without postoperative DVT were compared. The mean blood flow velocity in maximal flexion (90º+) preoperatively was significantly lower in patients with postoperative DVT (19/103) compared to patients without it (8.4±2 cm/s . 10.6±2.3 cm/s; p<0.001). Using the receiver operating characteristic curve analysis, the cut-off value for blood flow velocity during maximal flexion was 8.24 cm/s. In addition, anesthesia duration, duration of surgical position of the patient, body mass index, amount of blood transfused after surgery, and clinical signs of DVT were markedly different between patients with and those without postoperative DVT. Blood flow velocity in femoral vein in maximal flexion of the hip (90º+) measured prior to THA is an independent predictor of postoperative DVT.
Topics: Arthroplasty, Replacement, Hip; Femoral Vein; Humans; Postoperative Complications; Venous Thrombosis
PubMed: 34177050
DOI: 10.20471/acc.2020.59.03.04 -
PloS One 2017The risk of complications associated with femoral venous catheterization could be potentially reduced if the procedure was performed at the location where the...
PURPOSE
The risk of complications associated with femoral venous catheterization could be potentially reduced if the procedure was performed at the location where the cross-sectional area (CSA) of the vessel is the largest. The diameter of the femoral vein depends on leg position as well as the distance from the inguinal ligament. We determined the CSA of the right femoral vein in three different leg positions at two distances from the inguinal ligament.
SUBJECTS AND METHODS
Informed consent was given by 205 healthy volunteers aged 19-39 years, mean: 23±3 years (108 women, 97 men). Ultrasonographic examinations were performed using a linear 14-MHz transducer with CSA measurements in three leg positions: abduction, abduction+external rotation, abduction+external rotation+90° knee flexion/frog-leg position; at levels 20 mm caudally to the inguinal ligament, and 20 mm caudally to the inguinal crease.
RESULTS
We found significant differences in mean values of CSA in three leg positions regardless of the measurement level. The largest mean CSA (114 mm2±35 mm2) was found at the proximal level in the frog-leg position. There was a significant association of the CSA with sex and height. The CSA in males was greater than in females in all leg positions at the level of 20 mm caudally to the inguinal crease, while 20 mm caudally to the inguinal ligament the CSA was larger in females. The CSA of 25% of the femoral vein was smaller than 45.0 mm2 at the proximal level, and 31.5 mm2 at the distal level, which refers to diameters of 5.3 mm, and 4.5 mm, respectively.
CONCLUSIONS
The cross-sectional area of the femoral vein is the largest in the frog-leg position, and depends on gender.
Topics: Adult; Demography; Female; Femoral Vein; Humans; Ligaments, Articular; Male; Posture; Young Adult
PubMed: 28806411
DOI: 10.1371/journal.pone.0182623 -
The Western Journal of Emergency... Jun 2022Deep vein thrombosis (DVT) is a common vascular problem seen in the emergency department (ED) and is commonly identified using ultrasound performed by a vascular lab,...
BACKGROUND
Deep vein thrombosis (DVT) is a common vascular problem seen in the emergency department (ED) and is commonly identified using ultrasound performed by a vascular lab, the radiology department, or at the point of care. Previous studies have assessed the utility of a two-point vs sequential technique to identify the presence of a thrombus. One particular study reported a concerning rate of isolated femoral vein thrombi that would be missed by a two-point technique.
OBJECTIVES
In this study we sought to determine whether the two-point technique misses isolated femoral vein thrombi.
METHODS
We conducted a retrospective review of patients who had a new diagnosis of DVT in the ED diagnosed with vascular lab, radiology, or point-of-care ultrasound to assess for the presence and rate of thrombi that would be missed using a two-point scanning technique.
RESULTS
We included in our study 356 patients with a diagnosis of new DVT. In our population, 21 (5.9%; 0.95 confidence interval: 3.7%, 8.9%) patients were identified with thrombi isolated to the femoral vein.
CONCLUSION
The two-point technique for lower extremity vascular ultrasound is insufficient for ruling out proximal DVTs in ED patients.
Topics: Femoral Vein; Humans; Lower Extremity; Point-of-Care Systems; Ultrasonography; Venous Thrombosis
PubMed: 35980403
DOI: 10.5811/westjem.2022.2.53830 -
Journal of Vascular Surgery Jul 2021The number and longevity of patients with end-stage renal disease requiring dialysis access have continued to increase, leading to challenging situations, including...
BACKGROUND
The number and longevity of patients with end-stage renal disease requiring dialysis access have continued to increase, leading to challenging situations, including exhausted upper extremity access and severe central venous stenosis. This has led to an increase in the use of alternative access sites, including the lower extremities. The transposed femoral vein arteriovenous fistula for dialysis access is a previously described alternative, although limited data are available on its long-term patency.
METHODS
Patients treated with a transposed femoral vein fistula were retrospectively reviewed. A transposed femoral vein fistula was created by harvesting the femoral vein and transposing it to the distal superficial femoral artery at the level of the adductor canal. The demographic information, perioperative characteristics, complications, and long-term outcomes were recorded and analyzed.
RESULTS
A total of 21 patients had undergone transposed femoral vein fistula for dialysis access after an average of 5.3 ± 2.8 failed dialysis access procedures and a duration of 6.1 ± 4.9 years from the initiation of dialysis. The average age at the procedure was 53.5 ± 12.8 years. Ten patients (47.6%) had a history of diabetes mellitus and nine (42.9%) had a history of coronary artery disease. Technical success was achieved in 100% of cases, and 16 patients (76.2%) were discharged with anticoagulation therapy. The primary patency at 1, 3, and 5 years was 93%, 74%, and 74%, respectively. The secondary patency at 1, 3, and 5 years was 100%, 89%, and 89%, respectively. Two patients had compartment syndrome requiring fasciotomy, and six patients experienced wound complications.
CONCLUSIONS
Transposed femoral vein fistula for dialysis access is a viable alternative for patients with an exhausted upper extremity access, with good long-term patency.
Topics: Adult; Aged; Arteriovenous Shunt, Surgical; Female; Femoral Vein; Graft Occlusion, Vascular; Humans; Kidney Failure, Chronic; Lower Extremity; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States; Upper Extremity; Vascular Patency
PubMed: 33348002
DOI: 10.1016/j.jvs.2020.12.065 -
International Angiology : a Journal of... Jun 2023Graduated compression stocking (GCS) is one the most widely used intervention methods in decreasing venous stasis and preventing deep venous thrombosis in hospital...
The comparison of graduated compression stockings of different length and pressure gradients combined with ankle pump movement on femoral vein blood velocity: a pilot study.
BACKGROUND
Graduated compression stocking (GCS) is one the most widely used intervention methods in decreasing venous stasis and preventing deep venous thrombosis in hospital patients. However, changes of femoral vein speed after using GCS, combining ankle pump movement or not, and the efficacy difference of GCS among brands are still unclear.
METHODS
In this single-center cross-sectional study, healthy participants were assigned to wear one of the three different GCSs (type A, B and C) on both legs. Type B was with lower compressions at popliteal fossa, middle thigh and upper thigh, compared with type A and C. Blood flow velocity of femoral veins was measured with a Doppler ultrasound scanner in the following four conditions: Lying, ankle pump movement, wearing GCS, and GCS combining ankle pump movement. The differences of femoral vein velocity between conditions in each GCS type, and differences of femoral vein velocity changes between GCS type B and type C were compared, respectively.
RESULTS
A total of 26 participants enrolled and 6 wore type A, 10 wore type B and 10 wore type C GCS. Compared with lying, participants wearing type B GCS had significant higher left femoral vein peak velocity (PV
L ) and left femoral vein trough velocity (TVL ) (absolute difference [AD] 10.63, 95% confidence interval [95% CI] 3.17-18.09, P=0.0210; AD 8.65, 95% CI: 2.84-14.46, P=0.0171, respectively). Compared with ankle pump movement only, TVL significantly increased in participants wearing type B GCS and so did right femoral vein trough velocity (TVR ) in in participants wearing type C GCS. Comparing with lying, the AD of PVL was significantly higher in participants wearing type B GCS than those wearing type C GCS (10.63±12.03 vs. -0.23±8.89, P<0.05).CONCLUSIONS
GCS with lower compressions at popliteal fossa, middle thigh and upper thigh was related with higher femoral vein velocity. Femoral vein velocity of left leg increased much more than that of right leg in participants wearing GCS with/without ankle pump movement. Further investigations are needed to translate the herein reported hemodynamic effect of different compression dosages into a potentially different clinical benefit.
Topics: Humans; Femoral Vein; Ankle; Stockings, Compression; Pilot Projects; Cross-Sectional Studies
PubMed: 36795456
DOI: 10.23736/S0392-9590.23.04944-1