Journal Article Congenital intrarenal arteriovenous fistula Get access J C M Currie, J C M Currie Departments of Surgery, Radiodiagnosis, and Pathology of St. Thomas's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar M Lea Thomas, M Lea Thomas Departments of Surgery, Radiodiagnosis, and Pathology of St. Thomas's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar J L Pinniger J L Pinniger Departments of Surgery, Radiodiagnosis, and Pathology of St. Thomas's Hospital, London Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 51, Issue 1, January 1964, Pages 40–44, https://doi.org/10.1002/bjs.1800510108 Published: 08 December 2005
A study has been made of the size of normal arteries supplying the lower limbs by measuring their circumferences at fixed points in cadavers and their diameters and lengths on aortographs. The arteriographs of a group of patients with dilated and elongated arteries have also been studied and a definition produced for the arteriographic condition known as arteriomegaly.
Abstract A study has been made of the accuracy of clinical assessment, the fluorescein test, and phlebography in the localization of incompetent perforating veins using an extensive subfascial exploration as the method of assessing the results. Clinical assessment was found to be 48 per cent accurate, the fluorescein test 39 per cent accurate, and phlebography 69 per cent accurate. Although phlebography is the most useful investigation we do not feel that it can be used to restrict a full surgical exploration of the medial side of the leg. However, it is valuable in drawing attention to the presence of incompetent perforating veins on the lateral aspect of the legs which in this series occurred in I of every 2 patients.
We have studied patients with recurrent varicose veins which were incompletely controlled by a thigh tourniquet. We used varicography, (a phlebogram via the varices), to detect sites of incompetence. Thirty patients (mean age 46 years) were investigated, 38 limbs being subjected to varicography and surgery. A primary operation had been performed between 3 months and 30 years earlier. A non-thrombogenic contrast medium, sodium meglumine ioxaglate 320 (Hexabix 320) was used. Metal markers were placed alongside the limb to identify the site of perforating veins on the phlebograms. The principal value of the technique was in the identification of mid-thigh perforator incompetence (MTPI) as we cannot diagnose this accurately by clinical or Doppler-ultrasound examination. Varicography demonstrated MTPI in 15/38 limbs (39%) and in only one thigh was this not confirmed at exploration. Varicography can demonstrate short saphenous incompetence and this was mainly of value in 3 patients who had previously undergone attempted short saphenous ligation; in all 3 the short saphenous vein was present and had not been ligated. The technique was less useful in demonstrating recurrence in the groin. Overall varicography influenced the operation performed in 17/38 limbs (45%), its main value being in the diagnosis of MTPI.
Seven patients with atrial fibrillation had acute unilateral renal pain associated with suppression of function in the affected kidney. This was ascribed to renal embolism. Arteriography performed in four patients showed abnormalities in the renal arterial tree in three, though thrombus in a main artery was present in only one. Considerable function returned spontaneously to the affected kidney in six patients as judged by intravenous pyelography or renography. In two patients the sole functioning kidney was affected, leading to acute oliguric renal failure, but renal function recovered in each case. The routine use of anticoagulants in persistent atrial fibrillation is justified by such cases.
SUMMARY Forty two patients with suspected abdominal aneurysms were examined by contrast enhanced infusion computed tomography. Of these 17 also had ultrasound and 8 had additional aortography. It is concluded that C.T. scan and ultrasound are accurate methods of diagnosing abdominal aortic aneurysms and should be used for the initial diagnosis and follow up. Aortography, although invasive, provides information about the exact relationship of the aneurysm to the renal and visceral arteries and shows any vascular abnormality of importance to the surgeon. It is suggested that C.T. and ultrasound complement rather than replace aortography in the diagnosis and management of abdominal aortic aneurysms.
ABSTRACT Two patients with retroperitoneal fibrosis whose initial presentation was with leg swelling are described. The findings on phlebography and computed tomography are described and the value of these two investigations discussed.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
