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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

High-flow AVFs are a challenging problem in the pediatric age group. Venous occlusive changes develop as part of the dynamic response to these fistulas. The development of adequate venous collateral flow circumvents the destructive sequelae of longstanding venous hypertension. Without adequate collaterals, venous hypertension develops. Venous hypertension interferes with CSF resorption, resulting in increased brain water. Ventriculomegaly and tonsillar prolapse commonly develop and are reversible if therapeutic intervention is done in a timely fashion. If left untreated, chronic venous ischemic changes develop, which result in delay in important developmental milestones.
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PMID:Hydrovenous disorders in pediatric intracranial arteriovenous fistula. 1280 40

Venous hypertension is a significant problem for the patient on chronic hemodialysis. This condition can result in impairment of arteriovenous access function, disabling upper extremity edema with bluish discoloration and pigmentation of the skin, and, in advanced cases, ulceration of the finger tips and neuralgias. Venous hypertension usually results from central vein stenosis or valvular incompetence in the arteriovenous access outflow vein. A high index of suspicion is required to identify patients at risk for venous hypertension. A history of ipsilateral central venous catheter placement, or physical signs such as visible distended shoulder venous collaterals, and upper extremity edema are suggestive. Diagnosis is confirmed with Duplex ultrasound or contrast venography. The primary goal of diagnosis and therapy of venous hypertension is symptomatic relief while maintaining the functionality of the access. Treatment includes percutaneous catheter-based and open surgical techniques. Open surgical techniques, while more invasive, remain the gold standard as long-term patency after angioplasty, with or without covered stents, remains unproven.
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PMID:Venous hypertension associated with arteriovenous hemodialysis access. 1501 Nov 80

Peripheral edema develop as a consequence of imbalance in the processes of filtration, resorption and lymphatic transport in the capillary bed. Venous hypertension and impaired lymphatic function belong to the most important underlying pathomechanisms. Chronic venous insufficiency as a result of valve degeneration as well as venous obstruction in acute deep thrombosis lead to venous hypertension and to an increase of filtration pressure. As venous diseases are frequent, they are one of the most reasons for a swollen leg in clinical everyday life. Primary and secondary disturbances of the lymphatic system are another important reason for interstitial liquid retention. Although there are about 140 millions of people suffering from lymphedema worldwide, the disease is still underdiagnosed.
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PMID:[Venous and lymphatic reasons for edema--the swollen leg from the angiologist's point of view]. 1560 55

Patients with venous leg ulcers usually have extensive symptoms both related to their venous insufficiency and to the wound itself, often combined with a reduced quality of life. Prevalence of venous leg ulcers varies from 0.1 to 1.0%. Treatment costs are high and may amount to 1.5% of a nation's total spending on health care. Venous hypertension is the common denominator for all patients with venous leg ulcers. Isolated superficial as well as deep or combined venous insufficiency with or without insufficient perforators may cause ulceration. In the microcirculation, inflammation is involved, but the exact mechanisms behind the ulcer formation remain unresolved. During the examination, a presence of superficial venous insufficiency accessible for superficial resection must be established. In addition to a clinical examination, venous pressure measurements/plethysmography and colour duplex scanning is recommended in order to locate and evaluate the significance of the venous insufficiency. The key element in the treatment of venous ulcers is to reduce oedema and venous hypertension by adequate compression and elevation. If primary superficial venous insufficiency is established, venous resection is recommended. This may improve healing and reduce recurrences. In selected patients, deep venous reconstruction is an alternative approach.
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PMID:[Venous leg ulcers]. 1581 37

Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.
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PMID:Chronic venous insufficiency and the therapeutic effects of Daflon 500 mg. 1619 22

Venous hypertension from failure of proper venous valve function in the veins of thelower extremities causes changes over time in the microcirculation of the skin of the distal extremity. These changes set the stage for the development of a chronic nonhealing ulceration, which typically occurs at the ankle. The mainstay of treatment has been conservative, with compression dressings and elevation of the extremity. However, results have been less than satisfactory because of delay in healing and high recurrence rates after successful healing. Elimination of the venous hypertension should be the goal of therapy using more recent minimally invasive surgical techniques, including ablation of incompetent truncal veins with laser or radiofrequency energy and use of ultrasound-guided foam sclerosant injections to close incompetent perforator veins that are frequently found in or near the ulcer bed. This approach will shorten ulcer healing time and reduce recurrence rates as well as patient suffering and expense.
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PMID:The treatment of venous ulcers of the lower extremities. 1794 10

Venous hypertension due to proximal central venous outflow obstruction coexisting with a functioning arteriovenous fistula in the ipsilateral arm presents with a complex management problem in hemodialysis patients. Ligation of the arteriovenous communication is the simplest procedure to relieve symptoms; however, this sacrifices the patient's hemodialysis access, which may be the only available access in that patient. Surgical bypass of the occlusion is a potential option as it obviates the symptoms of venous hypertension while preserving dialysis access. Our objective was to evaluate our experience and outcome with dialysis patients undergoing surgical bypass for symptomatic central venous obstruction and dialysis access salvage. There were three hemodialysis patients with severe venous hypertension secondary to subclavian vein obstruction who had functioning ipsilateral arteriovenous fistulae. All underwent cephalic vein (n = 2) or axillary vein (n = 1) to internal jugular vein bypass of the obstructed subclavian segment via an 8-mm polytetrafluoroethylene bridge graft. All patients had unsuccessful percutaneous transluminal angioplasty (PTA) attempts prior to surgical bypass. In two patients, a wire could not be passed through the occlusion; in the third, PTA was only transiently successful despite four repeated procedures. All patients had complete resolution of symptoms without operative mortality. The bypass grafts remained patent, allowing the arteriovenous fistulae to provide functional access for the entire duration of follow-up after surgery (3-8 months). Surgical bypass of a central vein obstruction relieves the symptoms of venous hypertension and prolongs the use of the existing hemodialysis access. This surgical option should be well recognized within the dialysis community.
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PMID:Surgical bypass of symptomatic central venous obstruction for arteriovenous fistula salvage in hemodialysis patients. 1834 73

Venous hypertension due to dialysis access is usually secondary to outflow obstruction. The bidirectional proximal radial artery arteriovenous fistula (PRAVF) has been proposed as a procedure to increase autogenous fistula utilization and is rarely reported to cause peripheral venous hypertension. We report here a case of peripheral venous hypertension from a PRAVF, the first report to our knowledge caused by a peripheral outflow obstruction. A proximal occlusion in the medial cephalic vein led to retrograde flow through the median antebrachial vein into the hand. We briefly discuss this complication and considerations of its management in relation to the bidirectional PRAVF creation.
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PMID:Peripheral venous hypertension of the hand: a complication of a proximal radial artery arteriovenous fistula. 1837 83

Cerebral venous anomalies may have a variety of clinical consequences. MR or CT venogram can assist the imaging diagnosis; yet, cerebral angiogram may be required to confirm or establish the correct diagnosis. Venous anomalies predisposing venous hypertension may be categorized into three major entities such as congenital variations, outflow obstruction, and increased blood flow. The degree of clinical presentations of venous hypertension depends upon the chronicity or acuteness. Venous hypertension may lead to venous congestion with edema, hemorrhage and encephalopathy. Endovascular therapeutic procedures may be employed to relieve venous congestion either from reducing blood flow or relieving obstruction. Those endovascular treatment options include embolization, thrombolysis and angioplastic stentings.
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PMID:Endovascular procedures for cerebrovenous disorders. 1864 39

Arterio-venous fistula (AVF) in the snuff-box region is one of the current techniques used for creating a vascular access in patients undergoing dialysis. The aim of this study is to find out whether ligating the distal vein in AVF in the snuff-box will bring about any change in the efficiency and complications of the fistula. Sixty patients (30 males, 30 females) suffering from chronic renal failure, who had been admitted for creating an AVF, were randomly divided into two groups after having filled out consent forms. After the AVF was made, the distal vein was ligated in the first group, but not in the second group. The patients were discharged after being given the necessary advice on how to take care of their fistula. They were examined on post-surgical days 1, 30 and 90. Early efficiency in the ligated and non-ligated groups was 100% and 96.7% respectively while late efficiency in the two groups was 90% and 83.4%, respectively (P > 0.05). The most common complication in both groups was thrombosis (11.7%). Venous hypertension and edema were observed in two patients (both from the non-ligated group) and infection of the surgical site was observed in only one patient. Our study suggests that, considering the high efficiency level and low complication rate, AVF at the snuff-box region constitutes one of the best possible vascular accesses for patients undergoing hemodialysis. Ligation of the distal vein prevents the development of venous hypertension in the fistula.
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PMID:The effect of ligation of the distal vein in snuff-box arteriovenous fistula. 1986 86


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