Background It is generally accepted that a significant portion of our population harbors asymptomatic compression of the left iliac vein by the right iliac artery. This was demonstrated originally in autopsy studies by McMurrich in 1908 (33% of 107 cadavers) and more recently by the analysis of Contrast CT scans 1 (66% of 50 patients). Authors have found that Venography may lack the sensitivity to be considered a true “gold standard” (66% sensitive) while IVUS is over 90% sensitive 2. No studies have addressed the physiologic difference in flow hemodynamics between the left and right lower extremities in normal individuals. We use Doppler ultrasound to demonstrate asymmetric flow in the lower extremities of normal individuals. Methods Maximum venous outflow velocity (MVOV) in the Common femoral veins were recorded using Doppler ultrasound on 30 volunteers. Inclusion criteria included age 18–30, BMI <30, female sex and no history of venous disease or leg swelling. All studies were preformed by the same experienced vascular technologist. Volunteers were instructed to lay supine while a blood pressure cuff was inflated to 100 mmhg around the mid-thigh. Presence of arterial flow was confirmed with color duplex after cuff inflation. Prior to rapid cuff release at 1 minute patients were instructed to exhale and hold their breath to augment venous outflow. Flow velocities in the left and right common femoral veins were recorded. Results The average age was 20.9 years (range 19–28 years) and the average BMI was 21.9 (range, 18–25). MVOV was slower on the left side in 22, slower on the right in 7 and equal in one volunteer. The mean right MVOV was 117.23 cm/sec, SD 46.95 and the mean left MVOV was 95.44 cm/sec, SD 32.94 ( P = 0.0095). There was no correlation between left and right MVOV with respect to age, BMI or height. Conclusions Significant differences in lower extremity venous flow are present in normal individuals at rest. This finding correlates with anatomic studies demonstrating a predilection towards narrowing of the left iliac vein in normal subjects. This simple, non-invasive method of quantifying venous hemodynamics may aid in selecting patients for further diagnostic testing or intervention.

Percutaneous mechanical thrombectomy can be an effective procedure performed with low morbidity. We have observed clinically significant pancreatitis after successful clot extraction by percutaneous; thrombectomy. Pancreatitis developed postoperatively in four patients who underwent thrombectomy at our hospital. Each patient experienced abdominal symptoms with serologic and radiographic evidence of pancreatitis <= 24 hours after thrombectomy. The presence of renal failure and extensive dot degradation seemed to be related. Two of the patients underwent surgery that potentially could have been avoided had the etiology of pancreatitis been known preoperatively.

ialysis access steal syndrome (DASS) occurs in 2% to 8% of atients after hemodialysis access surgery and affects thouands of people in the United States each year. Dialysis ccess steal syndrome occurs when blood that normally suplies a distal arterial bed reverses flow and is redirected hrough the AV fistula. Factors such as high fistula flow rates, ative vessel stenosis or occlusions, and poor collateral flow ct synergistically to cause DASS. Diabetics are particularly rone to developing a steal because of their diffuse calcific icrovascular disease. Fistulas that originate from the brachial rtery are the most at risk for DASS because they lack the ollateral flow found in radial-based fistulas. Autogenous vein rafts dilate slowly and typically result in DASS symptoms that evelop gradually over time while exogenous (PTFE) grafts evelop early ( 24 h) symptoms because of their immediate igh flow rate. Studies of tapered PTFE grafts designed to ncrease resistance, and hypothetically to reduce DASS, have hown little benefit. The symptoms of DASS range from mild, intermittent ain or numbness to tissue loss, motor dysfunction, and ontracture. Frequently, a patient’s symptoms are worse on emodialysis because dialysis lowers the mean arterial presure exacerbating the steal. It is difficult to determine which atients will benefit from early revascularization because ild symptoms often resolve over time and there are no eliable predictors of progression. Valintine et al prospecively performed preoperative finger pressures on 72 patients n an effort to classify patients at risk for DASS. They found n increased incidence of DASS in patients with lower preperative finger pressures but no absolute pressure below hich a steal was inevitable. Digital photoplethysmography, ressure indices, and nerve conduction studies are good ethods to quantitatively follow patients with DASS in the