Abstract:
BACKGROUND:Symptoms of pelvic venous congestion (chronic pelvic pain, dyspareunia, dysuria, and dysmenorrhea) have been attributed to massive gonadal reflux. However, obstruction of the gonadal outflow may produce similar symptoms. Mesoaortic compression of the left renal vein (nutcracker syndrome) produces both obstruction and reflux, resulting in symptoms of pelvic congestion. We describe the diagnosis and management of nine patients studied in our institutions. MATERIALS AND METHODS:From a group of 51 female patients with pelvic congestion symptoms studied at our institutions, there were nine patients with symptoms of pelvic congestion, microscopic hematuria, and left-sided flank pain. The diagnosis of the nutcracker syndrome was suspected based on clinical examination, Doppler scan, duplex ultrasound scan, computed tomography scan, and magnetic resonance imaging. The diagnosis was confirmed by retrograde cine-video-angiography with renocaval gradient determination and catheterization of both internal iliac venous systems. All patients had a renocaval pressure gradient >4 mm Hg (normal, 0-1 mm Hg). Renal compression was relieved by external stent (ES) in two patients, internal stent (IS) in one patient, and gonadocaval bypass (GCB) in three. GCB was preceded by coil embolization of internal iliac vein tributaries connecting with lower-extremity varicose veins in three patients. Three patients deferred surgery and are under observation. Mean follow-up time was 36 months (range, 12-72 months). RESULTS:Hematuria disappeared postoperatively in all patients. ES and IS normalized the renocaval gradient and resulted in significant alleviation of symptoms (90% improvement on a scale of 0-10 where 0 = no improvement and 10 = greatest improvement). Two patients with GCB had a residual gradient of 3 mm Hg. The third patient normalized the gradient. In this group, improvement of symptoms was 60%. Patients awaiting surgery are being treated conservatively (elastic stockings, hormones, and pelvic compression). They have shown only moderate improvement. CONCLUSION:The nutcracker syndrome should be considered in women with symptoms of pelvic venous congestion and hematuria. The diagnosis is suspected by compression of the left renal vein on magnetic resonance imaging or computed tomography scan and confirmed by retrograde cine-video-angiography with determination of the renocaval gradient. Internal and external renal stenting as well as gonadocaval bypass are effective methods of treatment of the nutcracker syndrome. IS and ES were accompanied by better results than GCB. Surgical and radiologic interventional methods should be guided by the clinical, radiologic, and hemodynamic findings.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Scultetus AH,Villavicencio JL,Gillespie DLdoi
10.1067/mva.2001.118802subject
Has Abstractpub_date
2001-11-01 00:00:00pages
812-9issue
5eissn
0741-5214issn
1097-6809pii
S0741-5214(01)96183-Xjournal_volume
34pub_type
杂志文章abstract:OBJECTIVE:For peripheral arterial disease, infrainguinal bypass grafting (BPG) carries a higher perioperative risk compared with peripheral endovascular procedures. The choice between the open and endovascular therapies is to an extent dependent on the expected periprocedural risk associated with each. Tools for estima...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.01.042
更新日期:2012-08-01 00:00:00
abstract:PURPOSE:The purpose of this study was to assess the accuracy of intravascular ultrasound (IVUS) parameters of abdominal aortic aneurysm, used for endovascular grafting, in comparison with computed tomographic angiography (CTA). METHODS:This study was designed as a descriptive study. Between March 1997 and March 1998, ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70308-3
更新日期:1999-04-01 00:00:00
abstract::We report the vascular surgical strategies and results in 13 patients with heparin-associated thrombocytopenia and describe useful in vitro techniques for the evaluation of anticoagulant therapy. Thirteen of 40 patients with heparin-associated thrombocytopenia had 18 cardiovascular procedures done to save life or limb...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVES:The principal aim of this study was to demonstrate that significant sac retraction (SSR) was a predictive marker of durable success after endovascular aortic repair (EVAR). If verified, follow-up (FU) of patients with SSR may become unnecessary. In addition, the clinical features of the patients and aneurysm...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.04.069
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to investigate the effects of gene transfection of endothelial cells with vascular endothelial growth factor (VEGF) on re-endothelialization and inhibiting in-stent restenosis. METHODS:Stents coated with human umbilical vein endothelial cells (HUVECs) transfected with VEGF(121)...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.08.020
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVES:A variety of endovascular specialists perform carotid artery stenting (CAS), but little data exist on outcomes and resource utilization among these specialists. We analyzed differences in outcomes after CAS was performed by radiologists (RAD), cardiologists (CRD), and vascular surgeons (VAS). METHODS:Second...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.12.006
更新日期:2009-05-01 00:00:00
abstract:BACKGROUND:Psoas abscess is an uncommon disease, and its presenting features are usually nonspecific. Infected aortic aneurysms could be complicated by psoas abscess. METHODS:A retrospective chart review was conducted to examine the incidence, clinical presentations, microbiology, and outcomes of psoas abscess in pati...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.04.017
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:Successful adaptation of a vein graft to an arterial environment is incompletely understood. We sought to investigate whether early vein graft remodeling is predictive of subsequent patency. METHODS:A prospective longitudinal study was conducted of 67 patients undergoing lower extremity bypass with autogenou...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.06.098
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:The purpose of our study was to investigate the effect of adipose-derived stem cells (ASCs), endothelial-differentiated ASCs (EC/ASCs), and various conditioned media (CM) on wound healing in a diabetic swine model. We hypothesized that ASC-based therapies would accelerate wound healing. METHODS:Diabetes was ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.01.065
更新日期:2018-12-01 00:00:00
abstract::Compartment syndrome of the leg is a well-recognized complication known to follow urgent revascularization done for acute limb ischemia, but compartment syndrome of the foot has not been reported after the ischemia-reperfusion sequence. Herein we report a case of foot fasciotomy done for compartment syndrome that occu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.01.043
更新日期:2016-03-01 00:00:00
abstract::We present three novel techniques for creation of (1) a steerable sheath, (2) a 4F snare device, and (3) dual anterograde and retrograde double-wire percutaneous transluminal angioplasty access technique using a single femoral puncture. These techniques were conceived and bench-tested in our institution, allowing the ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.03.271
更新日期:2012-09-01 00:00:00
abstract:PURPOSE:The purpose of this study was to determine whether endogenous basic fibroblast growth factor (bFGF) production contributes to the intimal hyperplastic response to injury in a model of rabbit femoral artery balloon injury. Inhibition of de novo production of bFGF protein was targeted by intramural adenoviral gen...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70299-x
更新日期:1998-01-01 00:00:00
abstract:PURPOSE:This study evaluated perioperative variables to predict death in nonruptured and ruptured abdominal aortic aneurysm (AAA) surgery. METHODS:A consecutive review of all patients who underwent AAA surgery from January 1984 to December 1993 was carried out. Perioperative variables were analyzed with univariate and...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(96)70077-0
更新日期:1996-10-01 00:00:00
abstract:PURPOSE:The purpose of this study was to investigate the hypothesis that abdominal aortic aneurysm (AAA) expansion may be slowed by beta-adrenergic antagonists. METHODS:One hundred twenty-one patients with infrarenal AAA were monitored with serial aortic ultrasound examinations. Eighty-three patients received no beta-...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(94)70048-6
更新日期:1994-04-01 00:00:00
abstract:PURPOSE:External pneumatic compression (EPC) is an effective means of prophylaxis against deep venous thrombosis. However, its mechanism remains poorly understood. Understanding of the biological consequences of EPC is an important goal for optimizing performance of the EPC-generating device and providing guidance for ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2000.110357
更新日期:2000-11-01 00:00:00
abstract::This study was performed to evaluate the results of peripheral vascular reconstruction for arterial occlusive disease in patients with juvenile-onset diabetes mellitus. The results of 67 bypass procedures performed on 60 patients with juvenile-onset diabetes mellitus between Jan. 1, 1984 and Dec. 31, 1989, were review...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1992-02-01 00:00:00
abstract:OBJECTIVE:Repair of saccular aortic aneurysms (SAAs) is frequently recommended based on a perceived predisposition to rupture, despite little evidence that these aneurysms have a more malignant natural history than fusiform aortic aneurysms. METHODS:The radiology database at a single university hospital was searched f...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2012.07.002
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:Accurate measurements of abdominal aortic aneurysms (AAAs) are required for surgical planning and monitoring over time. We have examined the feasibility of using a three-dimensional (3-D) ultrasound imaging system to derive quantitative measurements of interest from AAAs. METHODS:A normal aorta, a small AAA,...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.112812
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:To evaluate our initial experience with hypogastric artery occlusion using a nitinol vascular plug during endovascular aortic aneurysm repair (EVAR). METHODS:We reviewed the records and images of 23 consecutive patients who underwent transluminal vessel occlusion of the hypogastric artery with a nitinol plug...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.06.002
更新日期:2008-11-01 00:00:00
abstract:INTRODUCTION:Although lower-extremity bypass grafting has been the gold standard for infrainguinal revascularization, endovascular therapies have been increasingly applied to avoid operative morbidities. This study addresses the initial results of an implementation of infrainguinal percutaneous transluminal angioplasty...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.06.024
更新日期:2005-11-01 00:00:00
abstract::Thrombolysis for the treatment of occluded bypass grafts is used in selected clinical circumstances. Unfortunately, a minority of these procedures are technical failures because of the inability to access the occluded graft. We describe a technique that greatly increases the chances of technical success. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70328-9
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:When an autogenous vein is harvested and used for arterial bypass, it suffers physical and biologic injuries that may set in motion the cellular processes that lead to wall thickening, fibrosis, stenosis, and ultimately graft failure. Whereas the injurious effects of surgical preparation of the vein conduit h...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2018.03.436
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:Fenestrated and branched endovascular devices are increasingly used for complex aortic diseases, and despite the challenging nature of these procedures, early experiences from pioneering centers have been encouraging. The objectives of this retrospective study were to report our experience of intraoperative a...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.02.065
更新日期:2014-09-01 00:00:00
abstract::Bungee jumping is a popular recreational activity in which participant experiences transient freefall while connected to a bungee cord. The rapid freefall and the resultant rebound force created by the bungee cord can result in a variety of bodily injuries. We report herein a case of traumatic carotid artery dissectio...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.06.026
更新日期:2007-11-01 00:00:00
abstract::Prostacyclin (PGI2) and thromboxane A2 (TxA2) formation by whole-tissue segments of nine carotid endarterectomy specimens (CES), five normal aortic specimens (NAS), six saphenous vein specimens (SVS), and four platelet samples were determined by incubation with 10 mumol/L 1-14C-radiolabeled prostaglandin endoperoxide ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-10-01 00:00:00
abstract:OBJECTIVE:Studies have shown that a sizable percentage of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is performed outside the instructions for use (IFU). We report our long-term outcomes after EVAR with respect to device-specific IFU. METHODS:Computed tomography angiography data from a c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.01.034
更新日期:2016-07-01 00:00:00
abstract:PURPOSE:The role of arterial stenting in the treatment of femoral and popliteal arterial disease is controversial and has been hampered by recommendations for patients to be given anticoagulants (oral warfarin) for several months or more. This study was undertaken to evaluate the immediate and midterm outcomes of vascu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(95)70268-7
更新日期:1995-02-01 00:00:00
abstract::We present a case report of simultaneous pulmonary emboli and paradoxical embolism to the cerebellum causing a stroke and severe ischemia to the left leg. This patient had risk factors for thromboembolic events that included autoimmune disease, cancer, and recent pelvic surgery. The presence of a perforate foramen ova...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.03.063
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated because symptoms vary and can be nonspecific. A meta-analysis identified 18F-fluoro-d-deoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) as the most valuable tool for diag...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2020.05.065
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Early failure (within 6 weeks of construction) of prosthetic arteriovenous access (AVA) is traditionally treated by surgical revision rather than endovascular intervention because it is assumed to be related to technical factors related to the surgery. This premise is not evidence based and our results for s...
journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.jvs.2007.10.047
更新日期:2008-03-01 00:00:00