Inadvertent cardiac phlebography

We are reporting a case of a 80-year-old lady with effort angina who underwent coronary angiography through the right radial artery, using a dedicated radial multipurpose 5 French Optitorque Tiger catheter. The catheter was advanced into the left ventricle and a left ventriculogram was obtained, while the catheter appeared optimally placed at the centre of the ventricle and the pressure waveform was normal. A large posterior interventricular vein draining into the right atrium was opacified, presumably because the catheter's end hole inadvertently cannulated an endocardial opening of a small thebesian vein, with subsequent retrograde filling of the epicardial vein. Our case suggests that caution is needed when a dedicated radial catheter with both an end-hole and a side hole is used for a ventriculogram, as a normal left ventricular pressure waveform does not exclude malposition of the end-hole against the ventricular wall.

Penile venous anatomy：application to surgery for erectile disturbance

AIM: The structure of the human penile venous system has been well studied, but disappointing outcomes of penile venous surgery in certain patients have called into question on the anatomy. We planned to extend the anatomic knowledge with the ultimate goal of improving operative success. METHODS: Thirty-five patients, who had undergone penile venous surgery, complained of poor erection developed gradually 6 months to 7 years postoperatively. Cavernosography was performed again during their return visit. Seven new patients underwent spongiosography followed by immediate cavernosography. Eleven male cadavers were carefully dissected. The anatomical findings were applied to venous surgery in 155 patients, who were then followed with the International Index of Erectile Function Questionnaire-5 (IIEF-5). RESULTS: Imaging observation demonstrated that the deep dorsal vein served as a common vessel of the corpora cavernosa and corpus spongiosum. A prominent cavernosal vein was found coursing along each corpus cavernosum distally to the glans, in contrast to its reported description as a short segment at the penile hilum. All cadavers had two sets of para-arterial veins sandwiching the dorsal artery. In 148 men available for follow-up, their mean IIEF-5 score was 9.3 preoperative and increased to 22.7 after the operation. The 88.5% (131/148) of the patients believed that venous stripping was a worthy treatment modality. Five cases required sildenafil to maintain their potentia, which was not working preoperatively. CONCLUSIONS: The failure of penile venous surgery has traditionally been ascribed to penile vein regeneration. However, our finding of a long and independent cavernosal vein and an independent set of para-arterial veins may be the principal cause in patients experiencing poor postoperative results.

C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome

Background:C-arm-based flat-panel detector cone-beam computed tomography(CBCT)venography has never been used in the management of iliac vein compression syndrome(IVCS).This study aimed to determine the technical feasibility and safety of CBCT venography in the diagnosis of IVCS compared with conventional venography(CV).Methods:Twenty patients with clinical manifestations of lower extremity venous insufficiency were prospectively enrolled between May 2018 and December 2018.Each patient underwent both CV and CBCT venography.The feasibility and safety of CBCT venography were assessed by technical success rate and complication rate.The relationships between the clinical indexes and the results of CBCT venography and CV were analyzed with correlation analysis.The consistency of the diagnosis of IVCS using each modality was analyzed by the kappa test.Results:The technical success rate was 100%for CBCT venography and for CV,without any complications.Compared with CV,CBCT venography was able to show more details of adjacent tissues which might be helpful for making etiological diagnosis.The stenosis rate under CBCT venography had excellent consistency with that under CV(kappa=0.78,Chi-square test).The stenosis rate under CBCT venography was positively correlated with the presence of collateral veins(odds ratio 1.12,95%confidence interval:[1.00,1.26],P=0.049),while the stenosis rate under CV was not.Unexpectedly,only one patient had a venous pressure gradient of more than 2 mmHg(1 mmHg=0.133 kPa).Conclusions:For the diagnosis of IVCS,C-arm-based CBCT venography was technically feasible,with good safety.The presence of collateral veins on CBCT was clinically significant.A C-arm fluoroscopy-based technique that combines CV and CBCT might be a promising protocol for the management of IVCS during a single session.