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Spontaneous rupture of the iliac veins is a distinctly uncommon problem often misdiagnosed as an arterial rupture because of significant retroperitoneal bleeding. It often occurs with acute left-sided deep vein thrombosis and physical activities that exacerbate acute venous hypertension. A significant number of these patients will have anatomy associated with May-Thurner syndrome. Delayed imaging on computed tomography scanning might suggest a venous etiology for a retroperitoneal hematoma rather than arterial bleeding. We found 53 previously reported cases of iliac vein rupture Our report details two additional cases and the treatment options and outcomes.

An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular graft implantation. We report the short- and long-term outcomes of the procedure. (Level of Difficulty: Advanced.), Graphical abstract, An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular…

The patient was an 84-year-old man who had moderate-to-severe eccentric mitral regurgitation due to a prolapsed P1 segment ([Figures 1A and 1B][1], [Videos 1][2] and [2][3]). MitraClip implantation (Abbott Vascular, Santa Clara, California) was performed via the right femoral vein. When the guiding

Background Peripherally inserted central catheters (PICCs) are critical for good neonatal care, no previous studies have evaluated which insertion method is most appropriate. Split needle technique (SNT), which uses a 20-gauge peelable introducer, is commonly used for PICC insertion. However, the large bore needle can precipitate vein rupture, leading to early expenditure of larger veins and difficulty accessing smaller vessels. Modified Seldinger Technique (MST) is widely used in adult and paediatric practice and his available for neonatal PICC placement. Objectives The objectives of this study were to compare: 1] Success rates of MST and SNT; 2] First-pass successful PICC placement for MST and SNT; 3] Material cost of MST and SNT per successfully inserted PICC. Methods MST, using Vygon Microsite® Insertion Kits, was introduced to St Michael’s neonatal unit. SNT was already in use. Practitioners were able to use their preferred insertion method. The following data were collected for all PICC insertions: weight and gestational age at birth and PICC insertion; number of skin breaks; insertion technique; successful or unsuccessful placement, PICC size and grade of inserting practitioner. Proportions were compared using the χ2. Success rates with increasing numbers of skin breaks were compared using the log rank test and demonstrated with a Kaplan-Meier curve. P-values Results The MST group had significantly lower birth weights and gestational ages at birth than the SNT group. Baseline characteristics were similar between the ≥35 weeks gestation MST and SNT sub-groups. MST had a higher successful insertion rate (72% vs 40%; 95% CI for difference 10–50%; p=0.0046) and first pass success rate (53% vs 26%; 95% CI for difference 6–46%; p=0.014) than SNT. MST required significantly fewer skin breaks on average for every successful PICC than SNT (2.5 vs 5.6; 95% CI for difference 1.15–4.90; p=0.002). The logrank test (figure 1) demonstrated a significantly higher successful insertion rates with MST than SNT as the numbers of skin breaks increased (Logrank test p=0.003). Whilst there was a higher successful insertion and first pass success rate with MST in the ≥35 weeks gestion sub-group, these did not reach statistical significance. However, the logranks test reached statistical significance in favour or MST (p=0.015). The cost of the disposables for one MST attempt was £86.50 for 1Fr (n=10) and £103.90 for 2Fr (n=33) PICCs and for SNT was £38.50 for 1Fr (n=4) and £55.90 for 2Fr (n=31) PICCs. The total cost per successful PICC (or cost of all attempts divided by the number of successful attempts) in the study period were therefore £138.51 for MST and £134.78 for SNT. Conclusions MST is likely superior to SNT for PICC insertion regardless of weight and gestational age at birth. The costs per successful PICC for MST and SNT in this study were similar.

Peripheral venous catheter insertion (PVCI) is one of the most common procedures performed by healthcare professionals but remains technically difficult. To develop new medical simulators with better representativeness of the human forearm, an experimental study was performed to collect data related to the puncturing of human skin and a vein in the antebrachial area. A total of 31 volunteers participated in this study. Force sensors and digital image correlation were used to measure the force during the palpation and puncturing of the vein and to retrieve the kinematics of the practitioner's gesture. The in vivo skin rupture load, vein rupture load, and friction loads for skin only and for both the skin and vein were (mean ± standard deviation) 0.85 ± 0.34 N, 1.25 ± 0.37 N, –0.49 ± 0.19 N, and –0.51 ± 0.16 N, respectively. The results of this study can be used to develop realistic skin and vein substitutes and mechanically assess them by reproducing the practitioner's gesture in a controlled fashion.

Introduction: Spontaneous iliac vein rupture is a rare but lethal disease. Most patients suffer from shock status in the emergency department. Until now, open laparotomy combined with primary suture is the most common treatment of iliac vein rupture. However, there is high mortality and morbidity in the patients who underwent open laparotomy. Case Presentation: A 71-year-old woman denied trauma history and sustained hypovolemic shock. The abdominal computed tomography showed one huge retroperitoneal hematoma. The emergency angiography revealed one obvious rupture point on the left external iliac vein. We repaired the lesion with endovascular stent and open laparotomy for abdominal decompression. The patient progressed well and was discharged. Conclusion: Endovascular repair is an effective and safe treatment. Compared with open laparotomy and primary suture, stent leads to fewer complications and a lower mortality rate.

Spontaneous iliac vein rupture is a relatively rare but fatal disease. Herein, 2 cases are reported. The two middle-aged and elderly females complaining of abdominal pain were admitted without any history of trauma. The computed tomography image both showed one huge hematoma in the lower abdominal cavity and the left external iliac venous thrombus. Venogram showed ruptures of the left external iliac vein and stenosis of the left common iliac vein after percutaneous mechanical thrombectomy. Stent grafts were implanted by endovascular technique. Favorable outcomes were achieved in both cases.

PURPOSE: The purpose of this study is to observe the characteristics of intrachoroidal splitting (ICS) associated with choroidal detachment due to open-globe injury. METHODS: A retrospective, observational case series study of four eyes diagnosed with choroidal detachment exhibited ICS. The in vivo pathologic changes of the ICS were recorded during surgery. Four specimens were obtained from the inner part of the ICS region. One specimen was stained with hematoxylin and eosin; one specimen was examined under scanning electron microscopy, and the other two specimens were examined under transmission electron microscopy. RESULTS: All four patients presented with vortex vein rupture associated with large-scaled mid-peripheral ICS. The histopathologic observations indicated that ICS occurred between the medium-sized and large-sized choroidal vessel layers. Large vascular indentations and medium-sized choroidal vessels were observed on the inner part of the split interface. Postoperative outcomes of the four patients were poor. Vision in all four patients was no light perception before or after surgery. Three eyes became atrophic with silicon oil tamponade and band keratopathy, one eye was eventually enucleated for cosmetic reason. CONCLUSION: Intrachoroidal tissue has the potential to split during trauma. The outcome of ICS with choroidal detachment in open-globe injury was poor.

Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

Spontaneous iliac vein rupture resulting in a retroperitoneal hematoma is extremely rare and can present as a life-threatening emergency. There is often a delay in diagnosis with no established treatment recommendations. We report the case of a 39-year-old woman who presented with hypovolemic shock, a large left retroperitoneal hematoma, and left lower extremity phlegmasia in the setting of a previously asymptomatic May-Thurner syndrome. She was successfully treated with a combined open and endovascular approach. We also reviewed the literature on the evolution of diagnosis and treatment of this rare condition and present our recommendations for management.

Introduction: We report a case of vein rupture by Arrow-Trerotola percutaneous thrombolytic device (Trerotola PTD) during a treatment of thrombosed arteriovenous graft (AVG). Case Description: A 77-year-old woman with a problem of thrombosed AVG underwent an endovascular treatment including a procedure of angioplasty of axillary vein. After angioplasty of axillary vein, we found a newly developed thrombus in axillary vein and performed thrombolysis using an over-the-wire 7F Trerotola PTD. When the rotating cage of the device arrived at axillary vein, it suddenly stopped, fixed at the angioplasty site, and didn’t move at all. Venogram showed an extravasation of contrast media at axillary vein, suggesting vein rupture. The patient underwent an emergency operation. Conclusions: It could be dangerous to use Trerotola PTD in a native vein immediately after angioplasty.

BACKGROUND AND OBJECTIVE: To evaluate the laser power required to rupture both the retinal vein and Bruch’s membrane in a porcine model using a new laser system for treatment of retinal vein occlusion. MATERIALS AND METHODS: The retina was treated in areas with and without an overlying vein. Sections through the laser sites were stained for light and transmission electron microscopy. The percentage of the laser sites with rupture of the retinal vein and Bruch’s membrane, the degree of tissue damage, and the diameter of the rupture in Bruch’s membrane were determined. RESULTS: The rate of vein rupture was 75% at 3 W, and rupture of Bruch’s membrane was achieved at all powers tested. The mean diameter of the rupture in Bruch’s membrane increased with laser power. CONCLUSION: The Integre Duo laser system (Ellex Medical Lasers, Adelaide, Australia) is capable of rupturing the retinal vein and Bruch’s membrane at lower powers than prior laser systems. [ Ophthalmic Surg Lasers Imaging Retina. 2013;44:268–273.]

Summary 1 A case of massive intraperitoneal hemorrhage resulting from rupture of the utero-ovarian vein in the 33rd week of pregnanc- is presented. 2 The survival of both the mother and her infant was attributed to the earl- surgical intervention. 3 The diagnosis of utero-ovarian vein rupture can be made onl- if one keeps in mind the possibilit- of its occurrence.

Iatrogenic Iliac vein rupture is a rare and potentially lethal complication. We present herein two different clinical scenarios of iatrogenic iliac vein rupture that resulted from performing percutaneous endoluminal interventions to treat symptomatic veno-occlusive lesions. The first case was due to the presence of surgical clips from the patient's previous gynecologic surgery, which caused iliac vein compression and eventually led to acute deep vein thrombosis. The second case resulted from central venous outflow obstruction ipsilateral to a lower extremity arteriovenous dialysis access site. Both Iliac vein ruptures were the result of percutaneous attempts to correct the outflow lesion (delayed in the first case and acute in the second case). Hemorrhage was successfully controlled in both cases using a self-expandable Viabahn (W. L. Gore and Associates, Flagstaff, AZ) covered stent while maintaining vessel patency and resolving symptoms related to veno-occlusive disease.

The fourth known case of spontaneous iliac vein rupture is reported. Prodromal symptoms, etiology, and treatment are dis cussed. The three previously reported cases are reviewed.

Purpose: The single major disadvantage of carotid endarterectomy (CEA) patch reconstruction with greater saphenous vein (GSV) is central patch rupture, which has a reported incidence of 0.5% to 4%. This is a prospective evaluation of the selective use of GSV for a CEA patch based on previously established vein diameter criteria.Methods: Between 1988 and mid-1995, 534 of 671 CEAs (80%) were reconstructed with GSVs that had a distended diameter ≥3.5 mm. Thigh veins were used in all 252 women who underwent CEA. Of the 282 men who underwent CEA, 265 GSVs (94%) were harvested from below the knee and 17 from the thigh. During this period four thigh and 13 below-knee veins (3.2%) were rejected because the diameter was 12 mm (mean, 15.3 mm). Eight of these CEAs were reconstructed with thigh veins.Conclusions: Use of GSVs with a distended diameter ≥3.5 mm for CEA patch reconstruction significantly reduces the probability of central patch rupture; however, a few CEAs reconstructed with veins >3.5 mm in diameter and large carotid bulbs have predicted patch rupture pressures

1. 1. A case of massive intra-abdominal hemorrhage resulting from rupture of the utero-ovarian vein in the immediate postpartum period is reported. 2. 2. The survival of the patient was attributed to early surgical intervention. 3. 3. A review of the literature revealed the rarity of this complication and its high mortality. 4. 4. It is felt that the diagnosis of utero-ovarian vein rupture might be made more often if only the possibility of its occurrence were kept in mind.

We present 2 cases of spontaneous idiopathic spermatic cord hematoma and review the literature. These hematomas predominately occur in untraumatized young adults after physically stressful exercise. Surgical exploration was performed in 4 previously reported cases and our own. In each case the preoperative diagnosis was incorrect. Since this clinical entity cannot clearly be distinguished from other causes of an acute scrotum surgical exploration seems warranted. Possible etiologies of spontaneous idiopathic spermatic cord hematoma are spermatic cord vein rupture and tear in the cremasteric muscle.