Degenerative venous aneurysm of a reverse saphenous vein femoral artery to femoral artery cross over graft: Case report and literature review of saphenous vein graft aneurysm

A true aneurysm formation in an arterialized vein graft used for lower limb arterial occlusive disease is a rare complication. The saphenous vein is the preferred conduit for infrainguinal bypass. For extra-anatomical bypass-like femorofemoral crossover, a synthetic graft is preferred. A successful outcome of femorofemoral crossover bypass with autogenous vein is well described. This case report is regarding a 67-year-old male who underwent femorofemoral crossover bypass with reversed saphenous vein graft 15 years ago for arterial occlusive disease, who now presented with degenerative aneurysm of the graft with an incidental infrarenal Abdominal Aortic Aneurysm. He underwent aortobifemoral bypass with jump graft to right internal iliac artery and resection of aneurysms. Histopathology of venous aneurysmal wall showed graft wall calcification with fibrin and collagen deposits. The causes of saphenous vein graft aneurysm have been described to be mostly atherosclerotic but it may be a part of systemic dilating pathology

Analysis of risk factors and complications in postpartum lower extremity deep vein thrombosis patients at a single center

Objective: The objective of this study is to elucidate circumstances surrounding postpartum patients with lower extremity deep vein thrombosis (DVT) including demographics, risk factors, comorbidities, clinical presentation, and outcomes presenting to our tertiary care center. Introduction: Postpartum is a period of increased risk of venous thromboembolism (VTE). Several risk factors such as previous history of VTE, increased maternal age, varicose veins, mode of delivery, and family history of VTE have been suggested, but data supporting these are inconsistent. In this study, we have described circumstances surrounding postpartum lower extremity DVT including demographics, risk factors, comorbidities, and clinical presentation. Materials and Methods: In this retrospective study, all women with lower extremity duplex confirmed DVT during postpartum period, presented at Jain Institute of Vascular Sciences (JIVAS), Bengaluru, from January 2010 to December 2016 were enrolled. Baseline characteristics recorded were age of the patient, index lower extremity involved, segment of the vein involved and comorbidities. Risk factor evaluated were mode of delivery, history of varicose veins, previous history of thrombophilia, VTE, abortions/miscarriages, and tobacco use. Complications and treatments received in the hospital were documented. Results: Postpartum DVT was seen in 42 out of 1276 DVT patients (497 female patients) treated at JIVAS. The average age was 25.57 ± 5.73 years and left side (29 [69.04%]) being more commonly involved. Risk factors associated in patients were anemia 16 (38.09%), postlower segment cesarean section (LSCS) delivery 16 (38.09%) while tobacco use was seen in 2 (4.76%) patients, and varicose vein in 1 (2.38%). There were no patients with history of VTE, abortions, or thrombophilia. None of the patients had symptomatic pulmonary embolism (PE). All patients were treated with low-molecular-weight heparin and bridged to Vitamin K antagonists. Conclusion: The most common risk factors were anemia and post-LSCS delivery. There was no incidence of symptomatic PE or mortality

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.)