Central venous occlusive disease is commonly seen in patients undergoing hemodialysis and can threaten the viability of the arteriovenous access. Majority of cases are related to central venous catheter placement. This paper reports on three patients on chronic hemodialysis who presented with signs and symptoms of upper extremity venous hypertension and underwent three different therapeutic modalities, all with successful relief of symptoms. A review of the existing literature on past and current treatment options is done.

OBJECTIVE: To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor.
METHODS: Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls.
RESULTS: Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019).
CONCLUSIONS: In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.

OBJECTIVE: To compare femoral endovenectomy with the creation of an arteriovenous fistula (FE + AVF), versus iliofemoral endovenous stenting with the concurrent extended femoral vein (FV-S) stenting in patients with chronic iliofemoral venous obstruction (IFVO).
METHODS: In a randomized prospective single-center study, 48 received (FV-S), while the other 54 had (FE + AVF).
RESULTS: There were no statistically significant differences in the primary outcomes between the two groups (FV-S) and (FE + AVF) (59% vs 56.8%, 75% vs 79.1%, respectively). At a median of 13 months after the treatment. However, the FV-S group\'s patients experienced fewer postoperative problems (p = .012), shorter procedures (p = .001), and shorter stays in the hospital (p = .025).
CONCLUSIONS: There is no difference between the efficacy and symptomatic resolution of the FV-S group and the FE + AVF group at the same time, FV-S has lower postoperative complications and a shorter procedure duration and hospital stay.

Purpose: Blood-Flow-Restriction (BFR) training provides the ability to achieve hypertrophy effects even though only light mechanical loads are applied. However, its impact on venous pressures and function are still unknown. Therefore, the present study investigates the influence of BFR-training on intravascular venous pressure and venous function in comparison to control exercises with low or high mechanical loads. Methods: In a randomized cross-over design, ten healthy men (27.6 ± 6.4 years) underwent three trials of unilateral knee-extensor exercise with three different training protocols, low-load- (LL-RT, 30% of the individual 1-repetition-maximum, 1RM), low-load BFR- (LL-BFR-RT, 30% 1RM, 50% limb occlusion pressure, LOP) and high-load resistance exercise (HL-RT, 75% 1RM). Exercise protocols contain about four sets of knee extension exercise (Range-of-Motion: 0-0-95°), separated by 60 s of rest. Each set was performed until volitional muscle failure. For analysis of changes in intravascular venous pressures and venous function, a venous catheter was placed at the exercising leg before each trial. Whereas venous pressures were recorded throughout the exercise trials, phlebodynamometric investigations were performed before and after each trial. Furthermore, subjective pain perception during and after exercise was accessed by visual analogue scale. One-way ANOVA was used to assess mean differences between training protocols, while two-way repeated-measures ANOVA (rANOVA; time x condition) was performed to compare changes in measures over time among conditions. Data were given as means ± standard deviation (SD). Results: In comparison to the exercise trials without venous occlusion, total workload was significantly lower in the LL-BFR-RT (LL-RT: 1745 ± 604 kg vs LL-BFR-RT: 1274 ± 237 kg vs HL-RT: 1847 ± 367 kg, p = 0.004) without indicating statistical differences in venous pressures during the exercise sets (interaction: p = 0.140) or pain perception (interaction: p = 0.574). Similarly, phlebodynamometric assessment of venous function (e.g. refill-time of the venous system pre-vs. post exercise trials-LL-RT: 29.7 ± 11.0 s vs 25.5 ± 9.6 s, LL-BFR-RT: 26.6 ± 13.0 s vs 27.3 ± 13.8 s, HL-RT: 25.9 ± 10.9 s vs 23.1 ± 8.2 s) revealed no time (p = 0.156), condition effect (p = 0.802) or their interactions (p = 0.382). Conclusion: The present study is the first one describing the acute effects of LL-BFR-RT to muscle failure on venous pressures and function in comparison to a LL- and HL-RT in the lower limbs. In contrast to the existing literature, LL-BFR-RT does not elevate the venous pressures during exercise higher than a comparative exercise without BFR and does not show any adverse effects on venous function after the exercise.

BACKGROUND: Venous sinus stenosis has been implicated in intracranial hypertension and can lead to papilledema and blindness. The authors report the unique case of a cerebellar transtentorial lesion resulting in venous sinus stenosis in the torcula and bilateral transverse sinuses that underwent resection.
METHODS: A 5-year-old male presented with subacute vision loss and bilateral papilledema. Imaging demonstrated a lesion causing mass effect on the torcula/transverse sinuses and findings of increased intracranial pressure (ICP). A lumbar puncture confirmed elevated pressure, and the patient underwent bilateral optic nerve sheath fenestration. Cerebral angiography and venous manometry showed elevated venous sinus pressures suggestive of venous hypertension. The patient underwent a craniotomy and supracerebellar/infratentorial approach. A stalk emanating from the cerebellum through the tentorium was identified and divided. Postoperative magnetic resonance imaging showed decreased lesion size and improved sinus patency. Papilledema resolved and other findings of elevated ICP improved. Pathology was consistent with atrophic cerebellar cortex. Serial imaging over 6 months demonstrated progressive decrease in the lesion with concurrent improvements in sinus patency.
CONCLUSIONS: Although uncommon, symptoms of intracranial hypertension in patients with venous sinus lesions should prompt additional workup ranging from dedicated venous imaging to assessments of ICP and venous manometry.

BACKGROUND: A glomus vagale tumor is an infrequent paraganglioma primarily characterized by auditory symptoms, cranial nerve involvement, or autonomic symptoms. However, visual involvement is not commonly observed, and to date, no cases have been reported in the literature.
METHODS: The case involves a 62-year-old female patient with a history of right carotid body tumor resection. She presented to the emergency department with a sudden decrease in visual acuity and bitemporal hemianopsia, accompanied by a left parietal headache. Initial brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, which was completely resected. However, postoperatively, the patient developed left amaurosis. Subsequent brain MRI showed the presence of hemostatic material mixed with blood in the sellar region, causing displacement of the optic chiasm. A repeat intervention was performed, identifying bleeding from both cavernous sinuses. Head and neck angiography demonstrated a right glomus vagale tumor with abundant blood drainage into the right cavernous sinus. Embolization of the glomus vagale tumor was performed, resulting in no further bleeding and improvement of symptoms.
CONCLUSIONS: The aim of this case report is to describe a rare occurrence of bilateral visual disturbances caused by bleeding in both cavernous sinuses due to venous hypertension caused by a right glomus vagale tumor.

Healing of skin wounds of the lower extremities can be complicated by concomitant vascular disease. Dysfunction of the arterial, venous, and/or lymphatic systems can compromise the healing of skin ulcers of the legs, creating a burden for patients from painful, draining wounds and placing patients at risk for infection, amputation, and even death. Insights into vascular pathophysiology and an understanding of the processes of wound healing permit an evidence-based approach to patients with vascular leg ulcers. Clinical trials have demonstrated opportunities to improve the care of patients with vascular leg ulcers, thereby reducing morbidity and mortality and easing patients\' burdens.

More than 1 million people are estimated to have lower limb venous ulceration in the UK. Such wounds are predominantly caused by sustained venous hypertension, as a result of chronic venous insufficiency, often due to venous valve incompetence or an impaired calf muscle pump. Compression therapy is key to venous leg ulcer management and the majority of nurses are aware of the importance of starting patients on compression therapy as early as possible. However, there appears to be a lack of awareness of the importance of venous assessment and that more patients could benefit from endovenous correction of superficial venous incompetence.

Spinal dural arteriovenous fistula (SDAVF) is also known as a type 1 spinal arteriovenous malformation, representing the most frequent vascular malformation of the spine. A high suspicion index is often required for the initial diagnosis of SDAVF because of subtle magnetic resonance imaging signs. We present the case of a patient with SDAVF associated with syringomyelia of the thoracic spinal cord and hypothesize that a fistula might induce intramedullary fluid accumulation due to venous hypertension, which leads to syrinx formation.

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