jugular graft literature search

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

jugular graft literature search

Postby Cece » Wed Dec 29, 2010 8:37 pm

Surgery Today
Volume 25, Number 4, 378-380, DOI: 10.1007/BF00311265
Case Reports

Portal vein reconstruction using an internal jugular vein as a graft: Report of a case
Yutaka Takayama, Hitoshi Kanamaru, Hidetaro Yokoyama, Harumitsu Hashimoto, Goro Yoshino, Hiroyuki Toyoda, Yasuyo Osawa, Mitsuhiro Ito, Shoichi Uenoyama and Yasujiro Koda

Abstract
We report the case of a 41-year-old man with pancreatic carcinoma invading the portal vein who was successfully treated by portal vein resection combined with pancreatoduodenectomy and reconstruction using an autointernal jugular vein. The internal jugular vein is an ideal graft for portal vein replacement because it has sufficient length, a well-matched diameter, and there is no venous insufficiency after unilateral resection. Nevertheless, this is the first report of portal vein reconstruction using the internal jugular vein as a graft.


In a search for any papers, anywhere, on the grafting in of IJVs (using the saphenous vein in the leg), all that ever comes up is sectioning out a piece of IJV to use as a graft elsewhere in the body. Here the author goes so far as to say there is no venous insufficiency afterwards. Maybe if he'd run cerebral perfusion studies before and after, he could say that with certainty. 8O
Last edited by Cece on Wed Dec 29, 2010 8:50 pm, edited 1 time in total.
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Postby Cece » Wed Dec 29, 2010 8:42 pm

Here we go, I did find a report of a sinus-to-IJV graft!

Acta Neurochirurgica
Volume 59, Numbers 3-4, 187-193, DOI: 10.1007/BF01406348

Sino-jugular venous graft in otitic hydrocephalus

E. R. Hitchcock and R. A. Cowie

Abstract
A case of otitic hydrocephalus, or intracranial hypertension secondary to inflammatory thrombosis of the left lateral sinus is described. Persistently elevated intracranial pressure, which did not respond to medical treatment, led to visual deterioration. A venous bypass graft was inserted between the left lateral sinus and jugular vein and was followed by rapid resolution of the raised intracranial pressure. The indications for this procedure are discussed.

http://www.springerlink.com/content/k24410t284g35201/
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Postby Cece » Wed Dec 29, 2010 8:46 pm

Another one!
Surgery Today
Volume 23, Number 10, 936-938, DOI: 10.1007/BF00311377
How To Do It

Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts
Hiroshi Urayama, Syouichi Katada, Isao Matsumoto, Fumio Ishida, Kenji Ohmura, Yoh Watanabe and Toshimi Muroki

Abstract
Remodeled great saphenous vein grafts were used to reconstruct both jugular and portal veins. The great saphenous vein was split longitudinally and sutured side-to-side to construct a vessel twice the diameter and one half the length of the original vessel. This graft was used with good results for reconstruction of the jugular veins in a patient after a bilateral neck dissection for tongue cancer and for a portal vein in a patient after resection for cancer in the head of the pancreas.

http://www.springerlink.com/content/qu8222258wt46642/
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Postby Cece » Wed Dec 29, 2010 8:49 pm

Spiral Saphenous Vein Graft for Replacement of Internal Jugular Vein: A Series of Case Reports
Stuart W. Leafstedt
Richard B. Rubenstein
John F. Pallanch
William H. Wilder

Abstract
Bilateral radical neck dissection with internal jugular vein extirpation, be it simultaneous or staged, results in severe cephalic venous hypertension. Symp toms remit with time, however, acutely contribute to the morbidity of the proce dure. Internal jugular vein replacement using autogenous saphenous vein that is fashioned into a spiral conduit has been used in three patients undergoing bilat eral or second side radical neck dissection.

The technique entails construction of a large vein conduit by wrapping saphenous vein around a chest tube in a spiral fashion. Patients treated had objective relief of the acute venous hypertension based on cephalic venous pres sure measurements. The three patients undergoing the spiral vein grafting were notable for the lack of any expected symptoms derived from venous hyperten sion, and postoperative venograms demonstrate graft patency at one to two weeks.


http://ang.sagepub.com/content/36/11/827.short
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Postby Cece » Wed Dec 29, 2010 8:57 pm

J Vasc Surg. 1986 Feb;3(2):322-9.

Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection.

Comerota AJ, Harwick RD, White JV.

Abstract
Disfiguring facial edema and elevated intracranial pressure often accompany ligation and excision of the internal jugular veins (IJV) during simultaneous or staged bilateral radical neck dissection. To minimize this morbidity, unilateral reconstruction of the IJV was undertaken at the time of second-side neck dissection in 11 patients. Five patients underwent reconstruction with the spiraled saphenous vein (SVG) and in six patients 10 mm externally supported polytetrafluoroethylene (e-PTFE) was used. Prebypass jugular venous stump pressures (JVPs) were measured and ranged from 28/17 to 75/54 mm Hg with mean pressures of 17 to 62 mm Hg. Two patients had simultaneous neck dissections and nine had staged dissections. The staged interval ranged from 0.3 to 33 months. Six of nine staged reconstructions were right-sided and three of nine were left-sided. Low molecular weight dextran was started intraoperatively, regional heparinization was used in all but two cases, and platelet inhibitors were continued postoperatively in all patients. Additional time in the operating room was 45 minutes (mean). All patients have been followed up 2 to 18 months postoperatively. B-mode ultrasonography, Doppler spectrum analysis, CT scan with contrast, and magnetic resonance imaging were used to assess patency. Four of five SVGs and three of six e-PTFE grafts have remained functional, which resulted in an overall patency rate of 64%. Four grafts (one SVG, three e-PTFE) failed in the immediate postoperative period. All grafts in patients who had a mean JVP greater than 30 mm Hg remained patent, whereas those in patients with lower stump pressures thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)

http://www.ncbi.nlm.nih.gov/pubmed/3511304

The patency rate of 64% is not as good as I'd want for any CCSVI patients considering IJV reconstruction surgery with grafting. But it sounds like the JVP values and Hg values are what made the difference. I bolded their definition of JVP and Hg but don't have a clue what that means. It does sound like the saphenous vein grafts performed much better than the PTFE grafts. PTFE is polytetrafluoroethylene. Plastic tubing? 8O
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Postby Cece » Wed Dec 29, 2010 9:01 pm

Laryngoscope. 1998 Nov;108(11 Pt 1):1692-6.

Bilateral radical neck dissection with unilateral internal jugular vein reconstruction.
Dulguerov P, Soulier C, Maurice J, Faidutti B, Allal AS, Lehmann W.

Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Switzerland.

Abstract
OBJECTIVE: To describe and evaluate the functional and oncologic results of one internal jugular vein replacement after bilateral radical neck dissection (RND).

STUDY DESIGN: A retrospective historical cohort study.

METHODS: Since 1972 all patients (n = 9) undergoing bilateral RND with resection of both internal jugular veins had a reconstruction of one internal jugular vein. In six cases the RNDs were staged, and in three cases the RNDs were performed simultaneously. In every case a vascular reconstruction was performed with an autologous vein graft. All patients received radiation therapy, in five patients before and in four patients after the vein grafting. Functional results were evaluated in terms of postoperative head and neck and neurologic complications. In some patients a Doppler scan was performed to assess vein patency. Oncologic results are reported as relapse-free survival and mortality intervals.

RESULTS: In all patients the postoperative course was uneventful, without neurologic complications. Facial edema was noted in four patients, mild in three and moderate in one. Two patients are alive, with follow-ups of 8 and 18 years. Seven patients are dead, two without evidence of recurrence, four with cervical recurrence after a mean survival of 10 months, and one after distant metastasis after a survival of 7 years. In patients with long-term survival a Doppler scan confirmed the patency of the vein graft.

CONCLUSION: The lack of operative complications and the absence of postoperative neurologic complications make a unilateral internal jugular vein replacement after bilateral RND attractive, although the oncologic results remain poor.

http://www.ncbi.nlm.nih.gov/pubmed/9818828
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Postby Lyon » Wed Dec 29, 2010 9:09 pm

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Last edited by Lyon on Sun Nov 20, 2011 4:46 pm, edited 1 time in total.
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Postby Cece » Wed Dec 29, 2010 9:12 pm

J Vasc Nurs. 2009 Jun;27(2):46-7.

Solitary internal jugular vein invasion by thyroid carcinoma: resection and reconstruction.
Fotis T, Konstantinou E, Mariolis-Sapsakos T, Mitsos A, Restos S, Katsenis K, Elefsiniotis I, Kapellakis G.

University of Athens, Evgenidion Hospital, Athens, Greece.

Abstract
Thyroid carcinoma usually presents as asymptomatic thyroid nodule. Thyroid cancer may show microscopic vascular invasion; however, internal jugular vein (IJV) invasion is a rare complication of thyroid cancer. We present a case of unilateral invasion of IJV caused by local nodal recurrence of the primary thyroid carcinoma. The patient had undergone a near total thyroidectomy, followed by modified left lymph node resection with left IJV resection. In this case, the infiltrated part of the right IJV was resected, and the vessel was reconstructed using saphenous vein autograft. In locally advanced, well-differentiated thyroid cancers, only the radical resection relieves symptoms and increases survival.

http://www.ncbi.nlm.nih.gov/pubmed/19486854
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Postby Cece » Wed Dec 29, 2010 9:17 pm

Lyon, you've read the fine print on that?
For use with Life/form® Venatech IV Simulators.

It's for a teaching simulator:
http://www.aristotlecorp.net/product/LF ... =nasco_exc

But this is worse, I just googled polytetrafluoroethylene
http://pslc.ws/mactest/ptfe.htm

It says it's Teflon?!?!
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Postby Lyon » Wed Dec 29, 2010 9:33 pm

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Last edited by Lyon on Sun Nov 20, 2011 4:45 pm, edited 1 time in total.
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Postby Cece » Thu Dec 30, 2010 12:34 am

I don't know, Lyon, that's always between the doctor and the patient and their risk/benefit analysis. In Dr. Mehta's talk, along with Dr. Dake, that was posted on ccsvi.org, he talked about venous grafts as a real possibility.

Here's another one, in this one the saphenous vein, taken from the leg, is put within the teflon tube, because the teflon tube will protect it from kinking. This one was another success. This was quite an extensive bypass but it began at the jugular.
Superior vena cava syndrome: Relief with a modified saphenojugular bypass graft

Presented at the Twenty-seventh Annual Symposium of the Society for Clinical Vascular Surgery, Lake Buena Vista, Fla, Mar 24-28, 1999.

Jean M. Panneton, MDa, James C. Andrews, MDb, Jan M. Hofer, RN, BSNa

Abstract
Superior vena cava (SVC) syndrome is a disabling and potentially life-threatening complication. SVC revascularization can be achieved by means of endovascular or direct surgical reconstructions. In the patient on whom we report, these two options were not possible, and a peripheral venous bypass grafting procedure was done with a technical innovation. Right upper-extremity swelling developed in a 55-year-old woman after radiation therapy for lung carcinoma. A left subclavian vein Port-A-Cath induced extensive thrombosis of the left innominate, axillosubclavian, and jugular veins. She was referred to our institution with very symptomatic SVC syndrome after two failed endovascular interventions. The occlusion of both innominate veins and chronic thrombus extending into the left axillosubclavian and internal jugular veins was confirmed by means of a venogram. A third endovascular attempt failed. The presternal skin had severe radiation-induced damage precluding direct SVC reconstruction. A bypass grafting procedure from the right internal jugular to the femoral vein was performed with spliced bilateral greater saphenous veins tunneled inside an externally supported expanded polytetrafluoroethylene graft. Postoperatively, the patient had no symptoms, and graft patency was confirmed by means of duplex ultrasound scanning. A saphenojugular bypass grafting procedure can offer prompt and durable relief of SVC syndrome when endovascular or direct surgical reconstructions are not possible. This rarely used peripheral venous bypass grafting procedure was modified by tunneling the vein graft inside an externally supported polytetrafluoroethylene graft to prevent kinking or compression. (J Vasc Surg 2001;34:360-3.)

http://www.jvascsurg.org/article/S0741-5214(01)99674-0/abstract
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Postby Lyon » Thu Dec 30, 2010 9:11 am

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Last edited by Lyon on Sun Nov 20, 2011 4:45 pm, edited 1 time in total.
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Postby HappyPoet » Thu Dec 30, 2010 9:15 am

Wow, Cece, what fantastic, fine, fruitful finds for us! [not J, +5]
I can't wait for cheer to weigh in on this thread.
Cece, You're terrific at digging up these studies, just like cheer, marie, Sharon, and a few others. It will take me days to read and understand all these studies. Threads and posts like these are the major part of what makes TIMS great. Thank you!

Lyon, "compassionate use" goes through my mind at least once a day, and now I'm thinking about how far I'd go with vein grafts. Risk vs. benefit. It's just like I was saying to a friend earlier today -- the MS population is willing to take greater risk for less benefit than other patient populations.

Looking into my future, I see myself almost ready to become a guinea pig in this area, assuming I could find the right doctor with the right plan -- my dural sinuses (the brain's built-in drainage pipes) are malformed which I think hampered my liberation. There seem to be many anecdotal reports from pwMS mentioning deformed sinuses, so I think this is an important area for research.

I'm not suggesting that the MS population has more of an incidence of such venous deformities than the normal population, but our disabilities and conditions, I believe, would make any such deformities more hazardous for pwMS than normals, whether those venous deformities be intracranial or extracranial (Dr. Zamboni).

The last time I asked Dr. Sclafani about the effect of dural sinus malformations on CCSVI, he told me the doctors he met with in Italy did not come to a consensus. He did mention to someone once, though, that he would defer to one of his colleagues about working so high up near the area where the sinus drains into the jugular vein.
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Postby Lyon » Thu Dec 30, 2010 9:31 am

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Postby dlb » Thu Dec 30, 2010 9:34 am

Cece wrote:Lyon, you've read the fine print on that?
For use with Life/form® Venatech IV Simulators.

It's for a teaching simulator:
http://www.aristotlecorp.net/product/LF ... =nasco_exc

But this is worse, I just googled polytetrafluoroethylene
http://pslc.ws/mactest/ptfe.htm

It says it's Teflon?!?!


Teflon is what they used in my son to repair a constriction in his aorta. It endothelialized in a short matter of time. He had a successful repair of his aorta when he was 5-6. He is now 29. Scares me because he has so many of the same symptoms I have - migraines, cold feet/cold intolerance....

When they diagnosed his problem & knew he needed surgical correction, they told us they would be considering 3 options: 1) basically cut out the constricted section & stitch it back together - good for a short length of constriction, 2) remove the constricted section and replace with a section of artery from his leg or 3) open a section of the aorta & repair with a teflon patch, which a body will not reject - used if the constriction was too large to repair in the other ways. We were told this was higher in risk but higher in reward long term b/c either previous scenarios would have left him with scar tissue in his aorta that would not have grown as he did & would most likely have required angioplasty when he was an adult to stretch the scar tissue.
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