Article

Varicose ulcer of the upper extremity

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Serious complications of local venous hypertension occur rarely in the upper extremity. These are most frequently the result of a dysfunctional arteriovenous fistula and may produce changes indistinguishable from those of chronic lower-extremity venous insufficiency. A combination of arterial and venous contrast imaging is essential for identifying major venous outflow obstruction and for planning appropriate surgical therapy.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... The treatment of varicosities due to the upper limb arterio-venous fistulae is usually surgical and entails either ligation of distal venous limb of a side to side fistula or division of the fistula itself. [9] On review of literature, few reports of localized varicosities were found which were more so on the dorsal aspect of hand and digits. Some surgeons preferred sclerotherapy followed by compression, which yielded good results. ...
Article
Late occurrence of arterial aneurysms following ligation of a hemodialysis arteriovenous fistula (AVF) is rare. Here, we report the case of 51-year-old male patient with an AVF in which arterial aneurysms developed. The patient had undergone left arm radiocephalic (RC) AVF creation for hemodialysis in 2000. He had received a living related donor kidney transplantation from his father in the same year. His RC AVF was ligated in 2009. However, his arm continued to gradually grow in size even after ligation and he visited a hospital for acute pain and erythema around the left elbow in 2017. Since his renal allograft function had been deteriorating, duplex ultrasonography was performed. It revealed 2 giant aneurysms in the distal brachial artery and proximal radial artery with diameters of 3.0 and 2.8 cm, respectively. The superficial veins of the left upper arm showed varicosity and had multifocal thrombi. Microfistula between the artery and vein was revealed by contrast-enhanced ultrasonography and the contrast agent microbubbles flowed from the artery toward the superficial veins. The aneurysms were resected and the arteries were reconstructed with great saphenous vein. There were no perioperative complications and the patient was discharged on postoperative day 3. No complications in the arm or bypass conduit have occurred at 6 months after the surgery.
Article
Peripheral arteriovenous (AV) malformations may present with a plethora of clinical symptoms such as paradoxical emboli, severe hypertension, nerve palsies or pain syndromes. Hemodynamically compromising lesions of the limbs are rare and involve high-flow AV fistulae with marked arteriovenous shunting. A female patient with a high-flow arteriovenous malformation of the left upper-extremity is presented. Preoperative assessment by magnetic resonance imaging and magnetic resonance angiography together with a color duplex investigation revealed a hemodynamically compromising arteriovenous fistula (shunt volume 30%) involving the entire left forearm and hand. The lesion was managed operatively with a combination of selective ligation and sclerosing of the feeding artery. There was marked clinical improvement postoperatively. Magnetic resonance angiography confirmed a drastic decrease in the number and size of the arteriovenous fistulae. The shunt ratio was diminished to 10%. Although surgical treatment of arteriovenous fistulae is known to have high complication and recurrence rates, thorough preoperative planning and intraoperative monitoring, can supply the prerequisites for a favorable outcome in severe symptomatic cases.
Article
Stasis ulcers of the upper limbs are rare, and only 30 cases have been reported, all of which were due to rheological abnormalities. A 59-year-old woman sustained an injury to her right upper limb, resulting in incomplete transections of the brachial artery and the brachial vein. Emergent reconstruction of the brachial artery was performed. Raynaud's phenomenon was observed postoperatively, followed by extreme edema, eczematization and the development of ulcers on the forearm. She was referred to our hospital for treatment. 3-D computed tomography (CT) revealed end-to-end anastomosis of the brachial artery and the brachial vein. An additional brachial-radial artery bypass and closure of the anastomosis dramatically improved her skin symptoms. Vascular anomalies including surgery should be suspected when patients present with stasis dermatitis of the upper limbs.
Article
Full-text available
Leiomyomas are benign neoplasms of smooth muscle that are rarely seen in the duodenum. They are usually asymptomatic and detected incidentally either on routine radiological investigations or at laparotomy or on autopsy. We present the case of a patient with leiomyoma arising from the third part of the duodenum who underwent pancreas-sparing duodenectomy for removal of the tumour.
Article
Primary varicose veins are a common affliction of the lower extremities whereas the upper extremities are rarely affected for reasons not clearly understood. The literature has little reference as regards the number of cases and management of upper limb varicose veins. Treatment of upper limb varicosities is similar to that of lower extremity, that is the ligation and stripping of the varicose veins. Here we present a case of a 21-year-old male with this unusual condition of primary varicose veins of the upper extremity. Diagnosis in our case was made by means of physical examination and venography. The patient was surgically treated by ligation and stripping of the varicose cephalic vein from elbow to wrist with excellent functional and cosmetic outcome.
Article
The postthrombotic syndrome consists of clinical features which follow thrombosis of deep venous return of the limb. Patterns of postthrombotic changes remain difficult to predict and once established, difficult to contain and reverse. Following a thrombotic event of the lower limb, 3 clinical stages can be observed which may be followed by intervening quiescent intervals. Stage I, or the early phase, is characterized by the residual obstructive process following acute venous occlusion. This can be manifested by either a bursting type of pain (venous claudication) or edema of the leg. A thrombotic process can involve the calf veins, thigh veins, pelvic veins, or any combination of the three. Specific clinical syndromes develop depending on the venous pump system involved. The venous pump system consists of the plantar calf pump and the thigh pump. These serve to propel blood upward. Involvement of any one or more of the 3 in the thrombotic processes can result in a relative obstruction with a specific pattern of clinical symptoms. Optimally, the venous thrombotic process should be treated during this early phase to prevent the subsequent events which may render the process irreversible. The second stage of the postthrombotic syndrome consists of the development of fat sclerosis. At this stage, the process becomes progressively irreversible as the extravasation of fibrin into the interstitial space results in progressive fibrosis and sclerosis. This results in damage to the skin and subcutaneous tissues which render the process irreversible. Specific treatment, while still introducible at this stage, can halt the progress of the syndrome, but rarely results in complete reversal.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The brown pigmentation of the skin associated with venous ulceration is caused by increased local iron deposition. Diagnostic x-ray spectrometry, a method based on x-ray fluorescence analysis, was used for the noninvasive determination of iron levels in the skin of patients with venous ulceration. The mean (+/- SEM) iron concentration in the skin around the venous ulcer was elevated, compared with control values of nonulcerated skin (250 +/- 54 vs 128 +/- 39 micrograms) and compared with normal skin from the forearm (250 +/- 54 vs 14 +/- 2.5 micrograms). These data suggest that dermal iron deposition may not be an incidental by-product of increased venous pressure, but may actively perpetuate tissue damage in venous ulcerations.
Article
Primary varicose veins of the upper extremity are extremely rare. We present three cases and discuss cause, diagnosis, and treatment. Three patients, a 23-year-old man, a 31-year-old woman, and a 39-year-old man, were referred with symptomatic varicose veins of the arm. None of the patients had lower extremity varicosities. Diagnosis was made by physical examination, noninvasive and invasive procedures, and excluded vascular malformations. Surgical treatment, similar to that for lower extremity varicose veins, entailed ligation and stripping of the varicose veins. Ligation and stripping were performed and successfully eliminated the varicosities with prevention of recurrence with a mean follow-up of 17 months. Although primary varicose veins of the upper extremity are extremely rare, they can be readily diagnosed and successfully treated, similar to lower extremity varicose veins. Although not proven, the cause is likely identical to lower extremity varicose veins. Excellent functional and cosmetic results can be obtained with surgical treatment.
ResearchGate has not been able to resolve any references for this publication.