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Merashli M, Bucci T, Delgado-Alves J, Ames PRJ. Relevance of vein wall thickness in Behcet's disease: A systematic review and meta-analysis. Autoimmun Rev 2024; 23:103487. [PMID: 38040099 DOI: 10.1016/j.autrev.2023.103487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES To perform a meta-analysis on articles evaluating the common femoral vein wall thickness (VWT) in Behcet's disease and its possible clinical, laboratory and treatment correlates (BD). METHODS Systematic search of EMBASE and PubMed databases from inception to October 2023; we employed random effect meta-analyses for continuous outcomes. RESULTS The meta-analysis included 9 case-control and 1 cohort study: the VWT was greater in BD (n = 650) than in controls (n = 396) (p < 0.0001) with wide heterogeneity (I2 = 94.4%); a sensitivity analysis that included mean age of BD participants, gender, disease duration and activity, C-reactive protein, smoking status, immune-suppressive and anti-inflammatory medication, revealed that the heterogeneity variance was partly explained by age (p < 0.0001), male gender (p = 0.03), disease duration (p < 0.0001) and smoking (p = 0.06). The VWT was greater in BD with thrombotic/vascular (n = 189) than in non-thrombotic/vascular BD (n = 140) (p = 0.006) with no heterogeneity. CONCLUSION VWT is greater in BD than controls: age, male gender, disease duration and smoking relate to VWT that was greater in BD patients with a history of thrombotic/vascular disease. Prospective studies are required to assess whether VWT may be considered a vascular marker of disease activity.
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Affiliation(s)
- Mira Merashli
- Department of Rheumatology, American University of Beirut, Beirut, Lebanon
| | - Tommaso Bucci
- Department of General and Specialised Surgery, Sapienza University of Rome, Rome, Italy
| | - Jose Delgado-Alves
- Immune Response & Vascular Disease Unit, CEDOC, Nova University Lisbon, Rua Camara Pestana, Lisbon, Portugal
| | - Paul R J Ames
- Immune Response & Vascular Disease Unit, CEDOC, Nova University Lisbon, Rua Camara Pestana, Lisbon, Portugal; Department of Haematology, Dumfries Royal Infirmary, Cargenbridge, Dumfries, UK.
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2
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Wang L, Ye S, Wu H. A rare case of long venous tumor thrombi from the right femoral vein to the right ventricle visualized by [ 18F]-FDG PET/CT in a patient with chondrogenic osteosarcoma. Eur J Nucl Med Mol Imaging 2023; 51:312-313. [PMID: 37500791 DOI: 10.1007/s00259-023-06350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Lijuan Wang
- NanFang PET Center, NanFang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Shimin Ye
- NanFang PET Center, NanFang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Hubing Wu
- NanFang PET Center, NanFang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
- GDMPA Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
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3
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Cicek SK, Simsek B, Gundogdu C. Right Common Femoral Vein Invasion: A Unique Case of Inguinal Ectopic Breast Cancer. Vasc Endovascular Surg 2023; 57:914-918. [PMID: 37300453 DOI: 10.1177/15385744231183489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Ectopic breast cancer may present anywhere in the milk line, from the axilla to the groin which is extremely rare in the inguinal region. Despite morphologic differences, ectopic breast tissue presents characteristics related to orthotopic breast tissue in terms of function and pathologic degeneration. The case report describes the treatment of a unique ectopic breast carcinoma which was located in the inguinal region with a common femoral vein invasion. METHODS We present a unique case of an ectopic breast carcinoma presenting in an unusual anatomic location along the milk line. The study was approved by the local Ethics Committee (protocol no: 12.01.2023-2023/02) Informed consent was obtained from the patient. RESULTS The patient is surgically treated and supplemented with neoadjuvant chemotherapy,radiotherapy and endocrine therapy. Histopathological examination revealed the diagnosis of invasive ductal carcinoma. The right common femoral vein was reconstructed with bovine pericardial patch after totally removal of the mass. CONCLUSIONS This report alerts the reader to be cognizant of the unusual location of an ectopic breast cancer which was detected in the inguinal region with a common femoral vein invasion and discusses the treatment, suggesting novel therapeutic advice that could bring considerable clinical advantages. A multidisciplinary approach should be warranted in such cases to confirm a complete remission.
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Affiliation(s)
- Sevim Kuslu Cicek
- Department of General Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Baran Simsek
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Cemal Gundogdu
- Department of Pathology, Medicana International Hospital, Istanbul, Turkey
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Ni J, Chen M, Su Y, Gao Q, Liu L, Lu X. Right femoral vein and right dorsal artery thrombosis in childhood acute myeloid leukemia: A case report. Medicine (Baltimore) 2023; 102:e35121. [PMID: 37832057 PMCID: PMC10578772 DOI: 10.1097/md.0000000000035121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/17/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND It is rare for newly diagnosed (de novo) or newly treated acute myeloid leukemia (AML) complicated with thrombotic complications, especially combined arterial and venous thrombosis. METHODS We reported a 13-year-old boy diagnosed with AML and leukocytosis, who developed right femoral vein and right dorsal artery thrombosis during chemotherapy. After treatment with low molecular weight heparin, diosmin, and alprostadil, symptoms were relieved. Unfortunately, the child suffered from coagulopathy afterward, which was unexpectedly caused by vitamin K deficiency. RESULTS After supplementation with vitamin K and prothrombin complex concentrate, coagulation function recovered. CONCLUSION For childhood AML patients with high thrombotic risks, close monitoring during anticoagulant treatment was necessary. Concomitantly, we should be alert to past medication history and combined medication use, especially those that may lead to vitamin K deficiency, secondary bleeding, and coagulation disorders. Rational use of antibiotics, anticoagulants, and antitumor drugs must be guaranteed.
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Affiliation(s)
- Jiaqi Ni
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yali Su
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qianqian Gao
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingjun Liu
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Lu
- Key Laboratory of Birth Defects & Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
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5
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Li D, Wang L, Li Z, Li L, Wang Q, Zhang L, Guo Z. Application of CT Scan in Diagnosis of Iliac-Femoral Vein Thrombosis after Hip Replacement. Scanning 2022; 2022:8428963. [PMID: 35832301 PMCID: PMC9236830 DOI: 10.1155/2022/8428963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Based on the knowledge of the previous film, the CT scan was used to diagnose the disease of women and men after the diagnosis of atherosclerosis by scanning the CT microscope. This article first examines the existing medical procedures in China, highlighting the advantages and disadvantages of various systems in terms of usability and user experience. Combined with the actual needs of hospitals, this paper developed a set of preoperative intelligent measurement system (MIPS) based on pattern recognition for total skeletal joint replacement. It is beneficial for doctors to better observe the lesions of patients before surgery and carry out necessary operations in the PATIENT DR film. In the process, the model is used to identify the patient, and the patient is given a fake score based on the characteristics of the DR film. In nonsymptomatic patients, 13.5% had muscle contraction > 50%, 2.0% had muscle contraction 70%, and the mean pelvic area was 23.48%. The left ventricular muscle has a 45.0% contraction rate, the left ventricle has a 70% contraction, and the median contraction rate is 47.58%. The right muscle, which is inserted between the right artery and the inner lymphatic artery, is the most common type of compression of the right muscle, accounting for 59.26%. In terms of the mean muscle contraction rate on the right side, patients with DVT with right muscles were higher than patients with DVT with left ventricles (48.54% to 22.29%, P < 0.001). The mean incidence of left ventricular DVT patients was higher than that of right ventricular DVT patients (71.88% versus 45.83% P < 0.0011).
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Affiliation(s)
- Dong Li
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
| | - Lishan Wang
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
| | - Zhanxin Li
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
| | - Libin Li
- Respiratory Department of Hebei General Hospital for Veterans, Xingtai, Hebei 054000, China
| | - Qingwei Wang
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
| | - Li Zhang
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
| | - Zhigang Guo
- North China Medical&Health Group Xingtai General Hospital, Xingtai, Hebei 054000, China
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Garland J, Ondruschka B, Broi UD, Palmiere C, Glenn C, Morrow P, Kesha K, Stables S, Tse R. Levels of haemolysis have no effect on femoral vein post-mortem tryptase levels. Med Sci Law 2021; 61:250-255. [PMID: 33653191 DOI: 10.1177/0025802421998851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Haemolysis is reported to be an artefact that may alter post-mortem tryptase levels. However, previous studies did not sample peripheral blood using newly standardised methods. Recent studies have shown that some previously recognised peri- and post-mortem confounders can be muted by careful sample collection with first clamping and then sampling the femoral vein. This prospective study investigated the relationship between the degree of haemolysis of the blood samples and femoral vein post-mortem tryptase levels when sampled using this recommended method. Seventy consecutive post-mortem tryptase levels in non-anaphylactic deaths were compared to the degree of haemolysis of these samples, and results showed no significant correlation between them. The mean post-mortem tryptase level was 9.5 μg/L. This study demonstrated that the effects of haemolysis on femoral vein post-mortem tryptase was negligible when the blood was sampled using the recommended sampling method. Future studies on post-mortem tryptase as well as other typically used blood markers in forensics are recommended to adopt this method of blood sampling in routine practice.
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Affiliation(s)
- Jack Garland
- Forensic Medicine and Coroners Court Complex, NSW Health Pathology, Australia
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Germany
| | - Ugo Da Broi
- Department of Medicine, Section of Forensic Medicine, University of Udine, Italy
| | - Cristian Palmiere
- CURML, University Centre of Legal Medicine, Lausanne University Hospital, Switzerland
| | - Charley Glenn
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, New Zealand
| | - Paul Morrow
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, New Zealand
| | - Kilak Kesha
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, New Zealand
| | - Simon Stables
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, New Zealand
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, New Zealand
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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7
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Gromadziński L, Paukszto Ł, Skowrońska A, Holak P, Smoliński M, Łopieńska-Biernat E, Lepiarczyk E, Lipka A, Jastrzębski JP, Majewska M. Transcriptomic Profiling of Femoral Veins in Deep Vein Thrombosis in a Porcine Model. Cells 2021; 10:cells10071576. [PMID: 34206566 PMCID: PMC8304794 DOI: 10.3390/cells10071576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Deep vein thrombosis (DVT) is a severe disease affecting the human venous system, accompanied by high morbidity and mortality rates caused by early and late complications. The study aimed at analyzing the changes in the transcriptome of the femoral vein caused by DVT in the porcine model based on the formation of the thrombus in vivo. The study was performed on 11 castrated male pigs: A thrombus was formed in each left femoral vein in six animals; the remaining five served as a control group. Total RNA was isolated from the left femoral veins of the experimental and control animals. High-throughput RNA sequencing was used to analyze the global changes in the transcriptome of veins with induced DVT. Applied multistep bioinformatics revealed 1474 differentially expressed genes (DEGs): 1019 upregulated and 455 downregulated. Functional Gene Ontology annotated 1220 of DEGs into 225 biological processes, 30 molecular functions and 40 cellular components categories. KEGG analysis disclosed TNF, NF-κB and apoptosis pathways’ overexpression in DVT samples. A thorough analysis of the detected DEGs indicated that a dysregulated inflammatory response and disturbed balance between clotting and anti-clotting factors play a crucial role in the process of DVT.
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Affiliation(s)
- Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland
- Correspondence: (L.G.); (M.M.)
| | - Łukasz Paukszto
- Department of Plant Physiology, Genetics and Biotechnology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (Ł.P.); (J.P.J.)
| | - Agnieszka Skowrońska
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland; (A.S.); (E.L.)
| | - Piotr Holak
- Department of Surgery and Radiology with Clinic, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| | - Michał Smoliński
- Clinic of Cardiology and Internal Diseases, University Clinical Hospital in Olsztyn, 10-082 Olsztyn, Poland;
| | - Elżbieta Łopieńska-Biernat
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| | - Ewa Lepiarczyk
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland; (A.S.); (E.L.)
| | - Aleksandra Lipka
- Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland;
| | - Jan Paweł Jastrzębski
- Department of Plant Physiology, Genetics and Biotechnology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland; (Ł.P.); (J.P.J.)
| | - Marta Majewska
- Department of Human Physiology and Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland; (A.S.); (E.L.)
- Correspondence: (L.G.); (M.M.)
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8
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Yven C, Gouny P, Nasr B. Epithelioid Hemangioendothelioma of the Lower Limb, Discovered by a Claudication. Ann Vasc Surg 2020; 72:665.e1-665.e4. [PMID: 33227473 DOI: 10.1016/j.avsg.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 01/17/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare case of a tumor with different clinical behaviors and a difficult anatomopathological diagnosis. The diagnosis of EHE is usually confirmed by postoperative histopathologic examination. Actually, it is a challenge to put a correct diagnosis and to propose aggressive treatment. We report a case of an EHE of the left lower limb discovered in a 53-year-old claudicant woman. Surgical resection, arterial, and venous bypass were performed. The histology demonstrated EHE with a low mitotic index, emerging for the femoral vein.
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Affiliation(s)
- Cedric Yven
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Pierre Gouny
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Bahaa Nasr
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France; INSERM UMR 1101, LaTIM, Brest, France.
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9
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Wang SI, Park EH, Hwang HP, Kim JR. Myositis ossificans of the thigh causing external compression of the superficial femoral artery and vein: A case report. Medicine (Baltimore) 2020; 99:e22810. [PMID: 33120802 PMCID: PMC7581180 DOI: 10.1097/md.0000000000022810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Myositis ossificans (MO) is a benign condition characterized by heterotopic bone formation in the skeletal muscle of extremities. Marked variation can occur in the incidence and location of the bone formed as well as resulting complications. Femoral vessel obstruction caused by MO is an extremely rare but disabling complication. Arterial occlusion may aggravate ischemic conditions, resulting in necrosis in the lower extremity. PATIENT CONCERNS We report a 41-year-old female with progressive pain and swelling of the right thigh region for 1 year. DIAGNOSES We diagnosed it as obstruction of the superficial femoral artery and vein caused by external compression of the MO between the sartorius and vastus medialis of the thigh. INTERVENTIONS AND OUTCOMES Adherent tissues and mass were excised with care without damaging the femoral artery or the vein. However, normal morphology did not recover due to loss of elasticity of femoral vessels. Therefore, after resection of the narrowed region of the femoral artery, a femoral-to-femoral graft interposition using the greater saphenous vein was performed. At 12 months after the surgery, vessel reconstruction computed tomography images confirmed normal continuous flow of the femoral artery. LESSONS Vascular compression and peripheral inflammatory response due to MO can cause loss of normal vascular morphology. Surgical excision of the mass and the involved femoral artery segment followed by femoral arterial reconstruction should be considered for lesions that do not spontaneously regress to prevent functional impairment and secondary complications in extremities.
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Affiliation(s)
| | | | - Hong Pil Hwang
- Department of Surgery, Jeonbuk National University Medical School, Research Insitute of Clinical Medicine of Jeonbuk National University–Biomedical Research Insitute of Jeonbuk National University Hospital, 567 Baekje-ro, Dukjin-gu, Jeonju 561-756, Republic of Korea
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10
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Mühlberger D, Wenkel M, Papapostolou G, Mumme A, Stücker M, Reich-Schupke S, Hummel T. Surgical thrombectomy for iliofemoral deep vein thrombosis: Patient outcomes at 8.5 years. PLoS One 2020; 15:e0235003. [PMID: 32555683 PMCID: PMC7302664 DOI: 10.1371/journal.pone.0235003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. Methods Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. Results The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous refilling time was 16.3 seconds, while the mean value of the non-treated contralateral legs was 25.6 seconds and therefore significantly higher (p<0.05). Conclusion Even though venous hemodynamics are significantly inferior in the treated legs, this study demonstrates excellent patency rates and good clinical outcome after surgical thrombectomy of iliofemoral veins.
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Affiliation(s)
- Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- * E-mail:
| | - Martin Wenkel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Georg Papapostolou
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Markus Stücker
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stefanie Reich-Schupke
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
- Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
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11
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Idilman IS. Inter-arterial saphenofemoral junction: A rare anatomical variation. J Clin Ultrasound 2019; 47:439-441. [PMID: 30900749 DOI: 10.1002/jcu.22726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/03/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
Several anatomical variations involving the great saphenous vein have been described in the literature. Some of them concern the saphenofemoral junction, including duplication, ectasia, and different numbers of tributaries. In this case series, a rare, distinct variation, the inter-arterial saphenofemoral junction was reported.
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Affiliation(s)
- Ilkay S Idilman
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
- Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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12
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Sebastian T, Hakki LO, Spirk D, Baumann FA, Périard D, Banyai M, Spescha RS, Kucher N, Engelberger RP. Rivaroxaban or vitamin-K antagonists following early endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis. Thromb Res 2018; 172:86-93. [PMID: 30391776 DOI: 10.1016/j.thromres.2018.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/16/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal anticoagulant following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) is unknown. METHODS From the Swiss Venous Stent registry, an ongoing prospective cohort study, we performed a subgroup analysis of patients with acute IFDVT who underwent catheter-based early thrombus removal followed by nitinol stent placement. Duplex ultrasound and Villalta scores were used to determine patency rates and incidence of the post-thrombotic syndrome (PTS) in patients treated with either rivaroxaban (n = 73) or a vitamin K-antagonist (VKA; n = 38) for a minimum duration of 3 months. RESULTS Mean follow-up duration was 24 ± 19 months (range 3 to 77 months). Anticoagulation therapy was time-limited (3 to 12 months) in 56% of patients (47% in the rivaroxaban group and 58% in the VKA group, p = 0.26), with shorter mean duration of anticoagulation in the rivaroxaban group (180 ± 98 days versus 284 ± 199 days, p = 0.01). Overall, primary and secondary patency rates at 24 months were 82% (95%CI, 71-89%) and 95% (95%CI, 87-98%), respectively, with no difference between the rivaroxaban (87% [95%CI, 76-94%] and 95% [95%CI, 85-98%]) and the VKA group (72% [95%CI, 52-86%] and 94% [95%CI, 78-99%]; p > 0.10 for both). Overall, 86 (86%) patients were free from PTS at latest follow-up, with no difference between the rivaroxaban and the VKA groups (57 [85%] versus 29 [88%]; p = 0.76). Two major bleeding complications (1 in each group) occurred in the peri-interventional period, without any major bleeding thereafter. CONCLUSIONS In patients with acute IFDVT treated with catheter-based early thrombus removal and venous stent placement, the effectiveness and safety of rivaroxaban and VKA appear to be similar. CLINICAL TRIAL REGISTRATION The study is registered on the National Institutes of Health website (ClinicalTrials.gov; identifier NCT02433054).
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Affiliation(s)
- Tim Sebastian
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | | | - David Spirk
- Institute of Pharmacology, University of Bern, Switzerland
| | | | - Daniel Périard
- Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Martin Banyai
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | | | - Nils Kucher
- Clinic for Angiology, University Hospital Zurich, Switzerland.
| | - Rolf P Engelberger
- Medical Faculty, University of Bern, Switzerland; Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
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13
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Affiliation(s)
- Chana A Sacks
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Shahmir Kamalian
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Peter T Masiakos
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - George A Alba
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Eva D Patalas
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
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14
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Silva DMS, Lins EM, Marques SRB, Albuquerque AV, Aguiar JLA. Experimental study of femoral vein reconstruction with sugarcane biopolymer tubular graft. Rev Col Bras Cir 2018; 45:e1837. [PMID: 30088524 DOI: 10.1590/0100-6991e-20181837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/17/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to evaluate, through Doppler flowmetry, venography, histology and clinical evolution, the use of sugarcane biopolymer (BP) tubular grafts in the reconstruction of femoral veins in dogs. METHODS we submitted eight adult dogs to femoral vein reconstruction, on the left with BP tubular graft and on the right with autologous vein. In the postoperative period, the animals underwent clinical evaluation and femoral vein Doppler flowmetry. After 360 days, we reoperated the dogs and submitted them to femoral vein phlebography with iodinated contrast. We removed the segments of the femoral veins containing the grafts and sent them for histopathological evaluation. RESULTS the dogs did not present hemorrhage, hematoma, surgical wound infection or operated limb edema. One animal had superficial venous dilatation in the left inguinal region. Phlebography performed 360 days after the first surgery showed that three (37.5%) BP grafts and seven (87.5%) grafts from the control group (C) were patent. In the histopathological evaluation, we found an inflammatory reaction, with neutrophils and lymphocytes on the external surface of both groups. In the intimal layer of the grafts and in the outer layer in the two groups, we observed fibrosis. CONCLUSION based on the results obtained with the experimental model used, BP presents potential to be used as a tubular graft for venous revascularization. However, new research must be performed to confirm its efficacy in the revascularization of medium and large diameter veins, which could allow its use in clinical practice.
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Affiliation(s)
| | - Esdras Marques Lins
- Universidade Federal de Pernambuco, Departamento de Cirurgia, Recife, PE, Brasil
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15
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Wang L, Jia L, Wei F, Lu Z, Wang B, Dong H, Sun G, Yu H, Zhang R, Jiang A. Correlation of Caveolin-1 With Vascular Intimal Thickness for Different Locations of Catheter Tips in a Dog Model. Iran J Kidney Dis 2018; 12:232-239. [PMID: 30087218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Many studies have reported increased intimal thickness around the catheter tip after catheterization. Caveolin-1 is a protein in the endothelial cell that acts as a shear sensor causing vascular remodeling. This study aimed to elucidate the suitability of different catheter locations and determine the role of caveolin-1 in canine models. MATERIALS AND METHODS Tunneled silicone 14.5-F catheters were inserted into the left jugular vein and right femoral vein in 8 dogs. The dogs were separated into 2 groups by catheter location and were followed up for 28 days. All dogs underwent extracorporeal circulation 3 times a week. After animal sacrifice, histological and immunohistochemical assays were performed to measure specific cell populations. RESULTS There were higher catheter dysfunction rates and lower blood flow rates in the right femoral vein group compared to the left jugular vein group. There was intimal hyperplasia around the catheter tip in both groups with no significant difference between the two groups. There were caveolin-1 expression in the intimal layer of venous wall around the catheter tip location sites in both groups. CONCLUSIONS These findings indicate that different catheter tip locations may influence catheter function and specific targeting of caveonlin-1 could be a strategy of possible future novel therapies for catheter-related vein stenosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Aili Jiang
- Department of Kidney Disease and Blood Purification Centre, Institute of Urology and Key Laboratory of Tianjin, 2nd Hospital of Tianjin Medical University, Tianjin, China.
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16
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Ouali S, Boudiche S, Ben Halima M, Jebbari Z, Kacem S, Mourali MS. Atrial flutter ablation by femoral approach in a woman with azygos continuation of an interrupted inferior vena cava and dual chamber pacemaker. Tunis Med 2018; 96:448-450. [PMID: 30430491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This report describes a case of isthmus-dependent atrial flutter ablation by the femoral approach in a 54-year-old woman with a previously unknown absence of the inferior vena cava (IVC) and dual chamber pacemaker. Despite looping of the catheters, ablation and termination of atrial flutter were performed successfully without function alteration of the pacemaker leads. This is the first report of an inferior-to-superior approach for ablation of atrial flutter in the absence of the perihepatic IVC with the presence of chronic indwelling leads in the area targeted for radiofrequency.
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17
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Affiliation(s)
- I Hudson
- Department of Orthopaedic Surgery, Kingston Hospital, Kingston-upon-Thames, Surrey
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18
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Braithwaite I, Shirtcliffe P, Jurevics R, Beasley R. Gaming: a 21st century variant of seated immobility thromboembolism. N Z Med J 2018; 131:66-68. [PMID: 29389932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Richard Jurevics
- Department of Radiology, Hutt Valley District Health Board, Lower Hutt
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19
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Pokrovskiĭ AV, Ignat'ev IM, Gradusov EG. [Results of endovascular treatment of obstructive lesions of veins of the iliofemoral segment]. Angiol Sosud Khir 2018; 24:57-68. [PMID: 29924776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of the study was to assess the immediate and remote results of endovascular treatment of obstructive lesions of the veins of the iliofemoral segment. PATIENTS AND METHODS We performed balloon angioplasty and stenting for iliofemoral venous thrombosis in a total of 75 patients. Of these, 60 patients were subjected to stenting of post-thrombotic obstructions and 15 patients underwent stenting of non-thrombotic obstructive lesions of the iliac veins (for May-Thurner syndrome - in 11, for extravasal tumour-induced compression and cicatricial stenosis - in 4). Stenting was performed using self-expanding stents Wallstent (Boston Scientific, n=84) or S.M.A.R.T. (Cordis, Johnson & Johnson, n=16). The stent diameter varied from 12 to 18 mm depending on the venous segment to be stented. The average number of the implanted stents amounted to 1.3 per patient. Efficacy of endovascular intervention was evaluated by measuring the pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS Technical success of endovascular intervention amounted to 92%. Stent thrombosis in the immediate postoperative period occurred in 7 (9.3%) patients. Of these, three patients were subjected to catheter-directed thrombolysis with restoration of patency of the stented venous segment of the limb. Stent occlusion within 48 postoperative months was diagnosed in 4 cases. Two patients underwent successful repeat angioplasty and stenting. Stent restenosis of not less than 50% at 36 months of follow up was observed in 5 (16%) patients. Repeat stenting was performed in 1 case. Dynamic control of stent patency was carried out by means of ultrasonographic duplex scanning. Also performed were control multispiral computed tomography-phlebography and roentgen contrast-enhanced phlebography. Cumulative primary and secondary patency at 60 months in post-thrombotic lesions amounted to 72 and 81%, respectively, in non-thrombotic lesions to 85% (primary patency). The VCSS values demonstrated a significant decrease in manifestations of chronic venous insufficiency. The mean value of the composite parameter decreased from 14.2±4.2 to 7.5±2.6 (p<0.001), the malleolar circumference decreased from 272.3±6.7 to 250.6±6.1 mm (p<0.01). Permanent healing of trophic ulcers was noted in 5 (71%) patients. CONCLUSION The method of endovascular angioplasty and stenting for obstructive lesions of the veins of the iliofemoral segment is a minimally invasive, safe, and highly effective therapeutic modality, which is confirmed by significant improvement of the limb's condition and good remote results of patency of the venous segments restored. Endovascular methods should be wider implemented into the clinical practice.
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Affiliation(s)
- A V Pokrovskiĭ
- Institute of Surgery named after A.V. Vishnevsky under the RF Ministry of Public Health, Moscow, Russia; Russian Medical Academy of Continuous Professional Education under the RF Ministry of Public Health, Moscow, Russia
| | - I M Ignat'ev
- Interregional Clinical Diagnostic Centre, Kazan, Russia; Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia
| | - E G Gradusov
- Russian Medical Academy of Continuous Professional Education under the RF Ministry of Public Health, Moscow, Russia
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20
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Gavrilov SG, Son DA, Lebedev IS, Savinkova KI, Temirbolatov MD. [Possibilities of local phlebectomy in correction of pelvioperineal venous reflux]. Angiol Sosud Khir 2018; 24:86-90. [PMID: 30321151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The work was based on the results of examination and treatment of 43 female patients presenting with varicose transformation of pelvic, perineal, and lower-limb veins. The inclusion criteria were as follows: the presence of visually determined varicose transformation of the veins of the external genital organs, perineum, posterior surface of the thighs, as well as valvular insufficiency of the mentioned veins by the findings of ultrasonographic angioscanning (USAS). The following exclusion criteria were applied: the presence of pregnancy, symptoms of pelvic venous plethora (PVP), and varicothrombophlebitis. In 33 women correction of the pelvioperineal reflux (PPR) was performed with the help of local phlebectomy on the large pudendal lips and perineum, with the maximally possible mobilization of the vessel within the limits of the operative wound. Miniphlebectomy with the use of Varady phleboextractors was performed in 10 women presenting with isolated varicose transformation of the subcutaneous veins of the posterior femoral surface. The duration of follow up of patients amounted to 3 years. The criteria for efficiency of the carried out treatment were as follows: freedom from varicose syndrome both in the perineum and on the lower extremities, as well as no PVP symptoms during the whole term of follow up. Varicose syndrome of the external genital organs, perineum and posterior surface of the femurs was successfully eliminated in 100% of patients. Meticulous mobilization and removal of the veins of the labia majora, perineum and subcutaneous femoral veins is a reliable method of removing pathological reflux of blood from the intrapelvic to superficial veins of the perineum and lower limbs. 100% of our patients were found to be free from relapses of either vulvar or perineal varicosity, with no evidence of lower limb varicose veins. Local phlebectomy is an efficient method of elimination of varicose syndrome induced by PVP in patients with dilatation of intrapelvic, vulvar and perineal veins.
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Affiliation(s)
- S G Gavrilov
- Chair of Faculty Surgery No1, Therapeutic Department, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
| | - D A Son
- Chair of Faculty Surgery No1, Therapeutic Department, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
| | - I S Lebedev
- Municipal Clinical Hospital No1 named after N.I. Pirogov, Moscow, Russia
| | - K Iu Savinkova
- Chair of Faculty Surgery No1, Therapeutic Department, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
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21
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Cooley BC, Szema L, Chen CY, Schwab JP, Schmeling G. A murine model of deep vein thrombosis Characterization and validation in transgenic mice. Thromb Haemost 2017; 94:498-503. [PMID: 16268462 DOI: 10.1160/th05-03-0170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryDeep vein thrombosis (DVT) occurs with high prevalence in association with a number of risk factors, including major surgery, trauma, obesity, bed rest (>5 days), cancer, a previous history of DVT, and several predisposing prothrombotic mutations. A novel murine model of DVT was developed for applications to preclinical studies of transgenically constructed prothrombotic lines and evaluation of new antithrombotic therapies. A transient direct-current electrical injury was induced in the common femoral vein of adult C57Bl/6 mice. A non-occlusive thrombus grew, peaking in size at 30 min, and regressing by 60 min, as revealed by histomorphometric volume reconstruction of the clot. Pre-heparinization greatly reduced clot formation at 10, 30, and 60 min (p<0.01 versus non-heparinized). Homozygous FactorV Leiden mice (analogous to the clinical FactorV Leiden prothrombotic mutation) on a C57Bl/6 background had clot volumes more than twice those of wild-types at 30 min (0.121±0.018 mm3 vs. 0.052±0.008 mm3, respectively; p<0.01). Scanning electron microscopy revealed a clot surface dominated by fibrin strands, in contrast to arterial thrombi which showed a platelet-dominated structure. This new model of DVT presents a quantifiable approach for evaluating thrombosis-related murine transgenic lines and for comparatively evaluating new pharmacologic approaches for prevention of DVT.
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Affiliation(s)
- Brian C Cooley
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin 53226, USA.
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22
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Abstract
Spontaneous septic thrombophlebitis is a rare complication of Staphylococcus aureus bacteraemia. Its true incidence is unknown as septic thrombus is not often considered as a source in the typical 'screen' of tests used to find the source of a bacteraemia.Positron emission tomography computerised tomography (PET-CT) is becoming increasingly available to physicians, is highly sensitive and yields specific anatomical information regarding abnormal metabolically active sites in infection, inflammation and neoplasia.In this case, PET-CT enabled the identification of the source of a septic thrombus and enabled focused management. PET-CT should be considered as part of the raft of tests used to identify an obscure source of fever/bacteraemia.
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Affiliation(s)
- Patrick Harnett
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Shaifali Jain
- Southend University Hospital NHS Foundation Trust, Southend, UK
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23
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Abstract
Background The intraoperative anatomy of the saphenofemoral junction can vary from the 'textbook' description of six independent proximal tributaries: three medial - superficial external pudendal, deep external pudendal and the posteromedial thigh branch - and three lateral - superficial epigastric, superficial circumflex iliac and the anterolateral thigh branch. Varicose veins can recur following inadequate initial open surgery with failure to identify, ligate and divide these tributaries. An appreciation of common anatomical variations could minimise recurrence rates following surgery. This study aimed to identify common anatomical variations within our patient cohort. Methods This prospective observational study documented diagrammatically the anatomy of saphenofemoral junction in a consecutive series of 172 patients undergoing unilateral, primary saphenofemoral junction ligation for symptomatic superficial venous insufficiency. Diagrams recorded the number of tributaries and their relationship to the saphenofemoral junction, the existence of bifid systems and the relationship of the external pudendal artery to the saphenofemoral junction. Results In sum, 110 women and 62 men with a mean age of 47.2 (IQR 21-77) years were studied. The median number of saphenofemoral junction tributaries was 4 (IQR 0-7). In 74 cases (43.0%), at least one tributary drained directly into the common femoral vein (IQR 0-4), commonly the deep external pudendal (91.9%). The anterolateral thigh branch was identified in 62 cases (35.8%) and the posteromedial thigh branch in 93 cases (53.8%). The external pudendal artery was identified in 150 cases (87.2%) and was superficial to the great saphenous vein in 36 cases (20.9%). Conclusions Significant variations exist in the saphenofemoral junction anatomy. Familiarity with anatomical saphenofemoral junction variations is imperative to ensure operative success and reduce recurrence. Thorough dissection of the common femoral vein is necessary not only to ensure all proximal tributaries are identified and ligated but also as a safety mechanism in preventing avulsion trauma of direct common femoral vein tributaries.
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Affiliation(s)
- Panos Souroullas
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
| | - Rachel Barnes
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
| | - George Smith
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
| | - Sandip Nandhra
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
| | - Dan Carradice
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
| | - Ian Chetter
- Academic Department of Vascular Surgery, Hull Royal Infirmary, Hull York Medical School, Hull, UK
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Ryzhkin VV, Lobastov KV, Vorontsova AV, Schastlivtsev IV, Barinov VE, Naumov EK, Laberko LA. [Clinical efficacy of electric stimulation of crural muscles in comprehensive treatment of post-thrombotic disease]. Angiol Sosud Khir 2017; 23:73-81. [PMID: 28902817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the study was to evaluate clinical efficacy of electromyostimulation (EMS) of the crural muscles as part of comprehensive therapy for post-thrombotic disease in patients with residual venous obstruction in the femoropopliteal segment. We carried out a prospective comparative clinical study enrolling patients having endured a fist episode of clinically unprovoked venous thrombosis of the femoropopliteal segment and completed the standard 6-month course of anticoagulant therapy and presenting with ultrasonographic signs of complete recanalization of the proximal venous segments (stenosis of 20% and more from the vessel's initial diameter), as well as scoring 5 points and more by the Villalta scale. The study included a total of 60 patients (38 men and 22 women, mean age 58.5±11.4 years) subdivided into two groups consisting of 30 patients each. Patients of both the Study and Control Groups underwent comprehensive therapy including wearing a compression knee sock (23-32 mmHg), a course phlebotrophic drugs, and dosed walking (not less than 5,000 steps a day). The Study Group patients were additionally subjected to daily electrical stimulation of the crural muscles with the "Veinoplus VI" unit (three 30-minute sessions a day). The duration of the follow up amounted to 12 months. The criteria for assessing therapeutic efficacy were as follows: severity of the disease by the VCSS and Villalta scales, quality of life as assessed by the CIVIQ-20 questionnaire, and lack of relapses of the venous thrombus. Clinical and instrumental assessment of the patients' condition was carried out monthly, with the disease's severity and quality of life assesses each 6 months. Relapses of venous thrombosis were registered in 7 (23.3%) patients from the Control Group and were not observed in patients undergoing EMS (p=0.011). In 5 cases, thrombosis was asymptomatic and in 4 cases it was presented by reocclusion of the involved venous segments. Patients of the Study Group were found to have a decrease in the disease's severity, reflected in points: VCSS (9.9±1.6 - 7.8 ± 1.6 - 6.1±1.5 (p <0.0001)); Villalta scale (18.9±3.9 - 12.8±4.0 - 8.3±2.7 (p<0.0001)); CIVIQ-20 score (67.8±8.4 - 51.3±8.4 - 40.0±10.5 (p<0.001)). The Control Group patients showed a similar tendency for the disease's severity: 8.1±2.8 - 7.3±2.1 - 7.2±2.1 points by the VCSS (p=0.014); 12.7±6.7 - 10.9±5.6 - 10.2±5.4 points by the Villalta scale (p=0.002), but not for quality of life: 48.2±19.3 - 46.7±17.3 - 47.4±16.2 points by the CIVIQ-20 (p>0.05). On the background of using EMS, the alterations in the studied parameters were characterized by higher velocity and intensity (p<0.05). The use of electromyostimulation as part of comprehensive treatment for post-thrombotic disease makes it possible to efficiently eliminate both subjective and objective signs of venous insufficiency, improve patients' quality of life and decrease the risk for the development of relapsing venous thrombosis.
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Affiliation(s)
- V V Ryzhkin
- Ivanteevka Central Municipal Hospital, Ivanteevka, Moscow Region, Russia
| | - K V Lobastov
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia; Municipal Clinical Hospital No24, Moscow, Russia; Clinical Hospital No1 of the Administration of the RF President's Affairs, Moscow, Russia
| | - A V Vorontsova
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia
| | - I V Schastlivtsev
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia; Clinical Hospital No1 of the Administration of the RF President's Affairs, Moscow, Russia
| | - V E Barinov
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia; Clinical Hospital No1 of the Administration of the RF President's Affairs, Moscow, Russia
| | - E K Naumov
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia; Municipal Clinical Hospital No24, Moscow, Russia
| | - L A Laberko
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia; Municipal Clinical Hospital No24, Moscow, Russia
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25
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Тrutyak RI. [Not Available]. Klin Khir 2016:48-50. [PMID: 30479114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Results of treatment of 71 patients, suffering an acute idiopathic deep veins thrombo' sis (DVT) of lower extremities,were analyzed. In 32 (45.1%) patients rivaroxaban was applied, in 39 (54.9%) — varfarin. The term of anticoagulant therapy was determined in accordance to the D—dimers level. Recurrence of the DVT, of massive hemorrhage or pulmonary thromboembolism in the follow—up groups were absent. In 29 (74.4%) patientsa constant dose of varfarin was lined up during minimal recommended period. For reduction of the DVT occurrence risk a rivaroxaban may serve as an alternative to varfarin.
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Kurstjens RLM, de Wolf MAF, Konijn HW, Toonder IM, Nelemans PJ, de Graaf R, Wittens CHA. Intravenous pressure changes in patients with postthrombotic deep venous obstruction: results using a treadmill stress test. J Thromb Haemost 2016; 14:1163-70. [PMID: 27061685 DOI: 10.1111/jth.13333] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials Little is known about the hemodynamic consequences of deep venous obstructive disease. We investigated pressure changes in 22 patients with unilateral postthrombotic obstruction. Common femoral vein pressure significantly increased after walking, compared to control limbs. Common femoral vein hypertension could explain the debilitating effect of venous claudication. Click to hear Dr Ten Cate's perspective on postthrombotic syndrome SUMMARY Background Little is known about the hemodynamic consequences of deep venous obstructive disease. Objectives The aim of this study was to investigate the hemodynamic effect of postthrombotic obstruction of the iliofemoral veins and to determine what pressure parameters differentiate best between limbs with post-thrombotic obstructive disease of the iliofemoral veins and those without obstruction. Methods Twenty-two participants with unilateral obstruction of the iliac and common femoral veins underwent a standardized treadmill test with simultaneous bilateral invasive pressure measurements in the common femoral vein and dorsal foot vein. Results Mean age was 42.8 ± 11.9 years and 86.4% of participants were female. Postthrombotic limbs showed a mean common femoral vein (CFV) pressure increase of 28.1 ± 21.0 mmHg after walking, compared with 2.1 ± 6.2 mmHg in control limbs (26.0 mmHg difference; 95% confidence interval [CI], 17.1-34.9). Less difference was observed in the dorsal foot vein (net drop of 36.8 ± 22.7 mmHg in affected limbs vs. 48.7 ± 23.1 mmHg in non-affected limbs, 11.9 mmHg difference; 95% CI, -1.3 to 25.0). Change in CFV pressure after walking yielded the best discrimination between affected and non-affected limbs (area under the receiver operated characteristic curve of 0.94 [95% CI, 0.85-1.00], compared with 0.57 [95% CI, 0.37-0.76] in the dorsal foot vein, P < 0.001). Conclusions Common femoral vein pressure significantly increases during ambulation in patients with iliofemoral postthrombotic obstruction, which could explain the debilitating effects of venous claudication. This is an indication that patients with an iliofemoral obstruction may benefit from further treatment that resolves the deep vein obstruction. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/show/NCT01846780.
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Affiliation(s)
- R L M Kurstjens
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - M A F de Wolf
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - H W Konijn
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - I M Toonder
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - P J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - R de Graaf
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - C H A Wittens
- Department of Vascular Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany
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Abdul W, Hickey B, Wilson C. Lower extremity compartment syndrome in the setting of iliofemoral deep vein thrombosis, phlegmasia cerulea dolens and factor VII deficiency. BMJ Case Rep 2016; 2016:bcr2016215078. [PMID: 27113791 PMCID: PMC4854131 DOI: 10.1136/bcr-2016-215078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/03/2022] Open
Abstract
Acute compartment syndrome requires urgent fasciotomies to prevent irreversible muscle damage. We present a case of massive iliofemoral deep vein thrombosis (DVT) presenting as acute compartment syndrome. A healthy 21-year-old man presented with a 2-day history of worsening left leg pain with swelling and bluish discolouration. Clinical diagnosis of compartment syndrome secondary to phlegmasia cerulea dolens (PCD) was made and he underwent emergency fasciotomies. Postoperative venous duplex confirmed a massive iliofemoral DVT and intravenous heparin was started. Following skin grafting, the patient made a good recovery. Massive iliofemoral DVT is an uncommon cause of compartment syndrome and has been reported in lower limbs, secondary to PCD. Failure to treat early carries a high degree of morbidity, with amputation rates up to 50% and mortality rates between 25% and 40%. It is important to recognise compartment syndrome as an acute presentation of PCD. Urgent fasciotomies can prevent limb amputation and mortality.
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Affiliation(s)
- Wahid Abdul
- Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ben Hickey
- Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Chris Wilson
- Department of Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
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Costache II, Buburuz AM, Fotea V, Cozma A, Aursulesei V. THE "DARK SIDE" OF DEEP VEIN THROMBOSIS--CASE REPORT. Rev Med Chir Soc Med Nat Iasi 2016; 120:293-297. [PMID: 27483707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Venous thromboembolism (VTE) is an increasingly common cause of morbidity and mortality in cancer patients. In various malignancies the incidence of thrombosis ranges from 5% to 60%, that is four times higher in cancer patients compared to the general population. Large retrospective studies have shown that in men the tumors which are most commonly associated with VTE are lung cancer and pancreatic cancer and, in women cancer of the genital area, pancreas, colon and rectum. Thromboembolic events may often occur before the cancer diagnosis. We present the case of a 41-year-old female patient with a history of genital cancer which was surgically treated and who is now admitted for clinical signs of ileofemoral deep vein thrombosis (DVT) of the left leg. The diagnosis was confirmed by laboratory data and Doppler ultrasound and the patient received anticoagulant treatment. Given the history of the patient, abdominal and pelvic ultrasound and computer tomography (CT) were performed to detect the cause who predisposed to the thrombotic event. These confirmed the ovarian cancer, this time on the right side, and the presence of hepatic and pulmonary metastasis. This case highlights the importance of screening for a cause of the thromboembolic event in patients, especially in those who have a history of a neoplasia.
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Kuznetsov MR, Sapelkin SV, Boldin BV, Leont'ev SG, Neskhodimov LA. [Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis]. Angiol Sosud Khir 2016; 22:82-88. [PMID: 27626254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily). The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition of venotonics (original highly-purified diosmin) to anticoagulants from the first day demonstrated safety of this therapeutic regimen (with no cases of clinically significant haemorrhagic complications revealed) and its high efficacy as compared with monotherapy with rivaroxaban. A combination of diosmin with rivaroxaban turned out more efficient than a combination of diosmin with warfarin.
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Affiliation(s)
- M R Kuznetsov
- Chair of Faculty Surgery, Urology of the Therapeutic Faculty of the Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
| | - S V Sapelkin
- Institute of Surgery named after A.V. Vishnevsky under the Public Health Ministry of the Russian Federation, Moscow, Russia
| | - B V Boldin
- Chair of Faculty Surgery No 2, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
| | - S G Leont'ev
- Chair of Faculty Surgery, Urology of the Therapeutic Faculty of the Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
| | - L A Neskhodimov
- Chair of Faculty Surgery No 2, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
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30
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Petrishchev NN, Tsibin AU, Semenov DU, Berkovich AE, Yukina GU, Blum NM, Efimov AN, Bursian AA, Senchik KU. [Applying HIFU for the obliteration of the veins in the experiment ]. Patol Fiziol Eksp Ter 2016; 60:89-93. [PMID: 29215255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The effect of high-intensity focused ultrasound (HIFU) on venous wall structure was studied in the rabbit model. Special setup was developed for ultrasound generation and vessel targeting. Methods. The essential part of the setup is spherical focusing power irradiator with following characteristics: power supply voltage of 25 V, frequency of 1.9 MHz, ultrasound intensity in the focal spot ~8.7 kW/cm2. Results. Single 15-s exposure of the femoral vein to HIFU resulted in partial desquamation of the endothelium, vacuolization of myocyte cytoplasm, misarrangement and coagulation of collagen fibers. Pulsed HIFU (5 pulses for 5 s each) caused protein coagulation in all layers of venous wall (v. cava posterior) as well as the appearance of the areas of fibrinoid necrosis, severe endothelial desquamation, and intimal detachment. HIFU-induced collagen structural changes in media and adventitia of the vein suggest that HIFU exposure resulted in local temperature increase up to ~60°С. In some experiments, adjacent to the vein muscles were also exposed to HIFU. In this case, edema of the interstitium and muscle fibers was registered, as well as fragmentation and coagulation of some fibers, altered staining patterns and neutrophil infiltration. These changes could be attributed to the development of acute muscle injury (acute fasciitis). Perivascular adipose tissue also demonstrated edema and lipolysis, red blood cell diapedesis, and leukocyte infiltration. Conclusion. The observations on structural changes in the venous wall after HIFU exposure could lay the ground for future experiments on HIFU - mediated obliteration.
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Shaya SA, Saldanha LJ, Vaezzadeh N, Zhou J, Ni R, Gross PL. Comparison of the effect of dabigatran and dalteparin on thrombus stability in a murine model of venous thromboembolism. J Thromb Haemost 2016; 14:143-52. [PMID: 26514101 DOI: 10.1111/jth.13182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/13/2015] [Indexed: 01/26/2023]
Abstract
UNLABELLED ESSENTIALS: Does thrombus stability alter the presentation of venous thromboembolism and do anticoagulants alter this? In a murine model, we imaged a femoral vein thrombus and quantified emboli in the pulmonary arteries. Dabigatran decreases thrombus stability via factor XIII increasing embolization and pulmonary emboli. This cautions against the unapproved use of dabigatran for acute initial treatment of deep vein thrombosis. BACKGROUND Venous thromboembolism (VTE) is a collective term for deep vein thrombosis (DVT) and pulmonary embolism (PE). Thrombus instability possibly contributes to progression of DVT to PE, and direct thrombin inhibitors (DTIs) may alter this. AIM To develop a model to assess thrombus stability and its link to PE burden, and identify whether DTIs, in contrast to low-molecular-weight heparin (LMWH), alter this correlation. METHODS Twelve minutes after ferric chloride-induced thrombus formation in the femoral vein of female mice, saline, dalteparin (LMWH) or dabigatran (DTI) was administered. Thrombus size and embolic events breaking off from the thrombus were quantified before treatment and at 10-min intervals after treatment for 2 h using intravital videomicroscopy. Lungs were stained for the presence of PE. RESULTS Thrombus size was similar over time and between treatment groups. Total and large embolic events and pulmonary emboli were highest after treatment with dabigatran. Variations in amounts of pulmonary embolic events were not attributed to variations in thrombus size. Large embolic events correlated with the number of emboli per lung slice independent of treatment. Embolization in factor XIII deficient (FXIII(-/-) ) saline-treated mice was greater than that in wild-type (WT) saline-treated mice, but was similar to WT dabigatran-treated mice. CONCLUSION We have developed a mouse model of VTE that can quantify emboli and correlate this with PE burden. Consistent with clinical data, dabigatran, a DTI, acutely decreases thrombus stability and increases PE burden compared with LMWH or saline, which is a FXIII-dependent effect.
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Affiliation(s)
- S A Shaya
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - L J Saldanha
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - N Vaezzadeh
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - J Zhou
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
| | - R Ni
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - P L Gross
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
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Yaroglu Kazanci S, Yesilbas O, Ersoy M, Kihtir HS, Yildirim HM, Sevketoglu E. Cerebral infarction and femoral venous thrombosis detected in a patient with diabetic ketoacidosis and heterozygous factor V Leiden G1691A and PAI-1 4G/5G mutations. J Pediatr Endocrinol Metab 2015; 28:1183-6. [PMID: 25968433 DOI: 10.1515/jpem-2015-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/16/2015] [Indexed: 11/15/2022]
Abstract
Cerebral infarction is one of the serious neurological complications of diabetic ketoacidosis (DKA). Especially in patients who are genetically prone to thrombosis, cerebral infarction may develop due to inflammation, dehydration, and hyperviscocity secondary to DKA. A 6-year-old child with DKA is diagnosed with cerebral infarction after respiratory insufficiency, convulsion, and altered level of consciousness. Femoral and external iliac venous thrombosis also developed in a few hours after central femoral catheter had been inserted. Heterozygous type of factor V Leiden and PAI-14G/5G mutation were detected. In patients with DKA, cerebral infarction may be suspected other than cerebral edema when altered level of consciousness, convulsion, and respiratory insufficiency develop and once cerebral infarction occurs the patients should also be evaluated for factor V Leiden and PAI-14G/5G mutation analysis in addition to the other prothrombotic risk factors.
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33
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Tkachuk OL, Gudz OI. [APPLICATION OF LARGE SUBCUTANEOUS VEIN AS MATERIAL FOR DISTAL SHUNTING IN CRITICAL ISCHEMIA OF THE LOWER EXTREMITY TISSUES]. Klin Khir 2015:44-46. [PMID: 26263643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
While performing autologous reconstruction of distal arteries in 24 patients in chronic critical ischemia of the lower extremity tissues the method of a large subcutaneous vein mobilization, using a ring-like desobliterator,was applied. This have permitted to reduce the procedure traumaticity, comparing with a standard method. Additional application of pharmacological vasodilatation of venous transplant have permitted to avoid the risk, connected with impact of hydraulic vasodilatation on the venous wall functional state.
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34
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Prasol VA, Mishenina EV, Okley DV. [Tactics of the patients management in continuing acute thrombosis of deep veins]. Klin Khir 2015:36-38. [PMID: 26072541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Experience of active tactics of treatment application in 18 patients, suffering an acute thrombosis in system of lower vena cava, is presented. Possibilities were estimated and efficacy of active surgical tactics proved in continuing deep vein thrombosis on early stage were estimated. Active tactics, using catheter--governed thrombolysis, permits to escape pulmonary thromboembolism and to reduce a severity of further chronic venous insufficiency.
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35
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Levchak IA. [Choice of fistulas optimal diameter while performance of thrombectomy from ileo-femoral venous segment]. Klin Khir 2015:38-40. [PMID: 25842678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of investigation of arterio-venous fistula (AVF) hemodynamics, depending on its diameter, were adduced. There were operated 98 patients for deep veins thrombosis (DVTH) of ileo-femoral segment, in 82 (83.7%) of them the extraction of a flotation thrombus with femoral vein ligation was performed, in 16 (16.3%)--thrombectomy from the ileo-femoral segment veins, in 14 (14.3%)--the intervention was added by formation of AVF. While AVF formation a lateral branches of femoral vein of a necessary diameter were applied. In all the patients AVF have closed spontaneously in terms from 3 to 10 weeks. While the accelerated blood flow presence in 1 (7.1%) patients a rethrombosis have occurred. Pulmonary thrombosis in operated patients did not occurr. Application of active surgical tactics in treatment of DVTH of ileo-femoral segment securely prophylacts the pulmonary thromboembolism, application of thrombectomy together with AVF formation of optimal diameter guarantees the essential reduction of the rethrombosis and complications occurrence rate.
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36
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Shvalb PG, Griaznov SV. [Minimally invasive method of correction of valvular insufficiency of the femoral vein in various causes of its origin genesis]. Angiol Sosud Khir 2015; 21:84-87. [PMID: 26035569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Presented herein are the results of treatment of patients with chronic venous insufficiency and trophic ulcers of lower limbs on the background of varicose disease and postthrombophlebitic syndrome. The treatment consisted in removal of pathological deep vertical venous reflux by means of a modified method of dosed narrowing of the femoral vein according to P.G. Shvalb's technique [1]. The obtained outcomes confirmed the necessity of influencing the pathological vertical deep venous reflux in patients with severe forms of chronic venous insufficiency and pronounced retrograde shunt along deep veins.
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Affiliation(s)
- P G Shvalb
- Regional Clinical Cardiological Dispensary, Ryazan, Russia
| | - S V Griaznov
- Regional Clinical Cardiological Dispensary, Ryazan, Russia
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37
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Zatevakhin II, Shipovsky VN, Barzaeva MA. [Remote results of implantation of cava filters: analysis of errors and complications]. Angiol Sosud Khir 2015; 21:53-58. [PMID: 26035565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The authors carried out comparative assessment of efficacy of cava filters (CF) for prevention of pulmonary artery thromboembolism in patients presenting with iliofemoral thrombosis with flotation of thrombi, as well as analysed complications in the remote postimplantation period. A total of 266 patients were examined within the terms from 1 month to 10 years after CF implantation. Depending on the type of the implanted device, all patients were subdivided into 3 groups: group 1 (n=65) consisted of patients with one-level CF, group 2 (n=112) comprised those with "sandglass" and "shuttle" type two-level cava filters, and group 3 (n=89) was composed of patients with the implanted CF "TrapEase" and "OptEase". In the remote period relapsed PATE was revealed in 5.2% of cases. Embolism in the CF was noted in 9.3% of cases, with the incidence rate of this complication not depending on the type of the implanted device. However, total occlusion of the inferior vena cava after embolism was observed 2 times more often in patients of the 2nd and 3rd group. In the first group recanalization of the intrafilter space occurred in one third of cases. Chronic occlusion of the inferior vena cava was revealed in 13.9% of cases, most frequently in group 2. Total occlusion of the inferior vena cava with the development of inferior vena cava syndrome was diagnosed in 24.1% of patients with thrombotic lesion below the level of renal veins confluence. This complication was associated with both characteristics of CF and technical errors of implantation, and was also encountered more frequently in group 2.
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Affiliation(s)
- I I Zatevakhin
- Surgical Diseases Department No1, Russian National Research Medical University named after N.I. Pirogov, Municipal Clinical Hospital No57, Moscow, Russia
| | - V N Shipovsky
- Surgical Diseases Department No1, Russian National Research Medical University named after N.I. Pirogov, Municipal Clinical Hospital No57, Moscow, Russia
| | - M A Barzaeva
- Surgical Diseases Department No1, Russian National Research Medical University named after N.I. Pirogov, Municipal Clinical Hospital No57, Moscow, Russia
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Quarto G, Genovese G, Apperti M, Amato B, Benassai G, Furino E. Is the fibrotic parietal thickening a reliable parameter for diagnosing previous asymptomatic deep vein thrombosis? Ann Ital Chir 2015; 86:427-431. [PMID: 26428260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Research of a starting point to debate about the possibility of identifying a unique sign of previous DVT. MATERIAL OF STUDY A retrospective study involving 202 outpatients with venous insufficiency of the lower limbs (CEAP classes C 4/6), classified according to the affected venous district. Patients positive for deep vein thrombosis (DVT) were subjected to Compression Ultra Sound test (CUS test) with measurement of the wall thickness at the point of formation of the thrombus and at fixed points of common femoral and popliteal veins used also in the patients with negative history of DVT RESULTS: Among total group, only 19 patients (9.40%) had an history of DVT. No one of them had a superficial incontinence. The measurement of wall thickness in positive DVT history patients (group A) resulted in an average value of 1.10 mm (s.d=0.06), while the average value obtained in negative DVT history (group B) was 0.55 mm (s.d.= 0.20). However, in 13 patients wall thickness was > 1mm (mean: 1.04 mm). The difference between the averages of group A and B was statistically significant (p <0.05). DISCUSSION In all positive DVT history patients and in 13 ones with negative history we found an increase in wall thickness, with a value > 1 mm. Can the wall thickening more than 1 mm be considered an indicator of previous DVT? Can it be considered a "marker" for thrombophilia status? CONCLUSIONS The usefulness of a sign of previous DVT (even if asymptomatic), detected during a routine Doppler ultrasound check of lower limbs, could be a warning bell to investigate thrombophilia status. KEY WORDS Chronic Venous Insufficiency, Duplex ultrasound, Hypercoagulability, Post-thrombotic Syndrome, Venous Thromboembolism.
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Cameliere L, Palcau L, Felisaz A, Coffin O, Gouicem D, Berger L. Intimal angiosarcoma from the common femoral vein in a 27-year-old patient. Ann Vasc Surg 2014; 29:364.e11-4. [PMID: 25463330 DOI: 10.1016/j.avsg.2014.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022]
Abstract
Intimal sarcoma is a rare and aggressive vascular pathology. The literature describes about 140 cases. Because of late diagnosis, the median survival time is only a few months. Presentations vary from the localization. The most common symptoms are intravascular obstruction or embolization. Diagnosis is difficult and vascular surgeons do not know the treatment very well. We present the first case of intimal angiosarcoma of the common femoral vein presenting with a deep venous thrombosis and discuss diagnosis and therapeutic approach.
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Affiliation(s)
- Lucie Cameliere
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France
| | - Laura Palcau
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France
| | - Aurélien Felisaz
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France
| | - Olivier Coffin
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France
| | - Djelloul Gouicem
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France
| | - Ludovic Berger
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France.
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Kornej J, Dinov B, Blann AD, Rolf S, Arya A, Schmidl J, Husser D, Hindricks G, Bollmann A, Lip GYH. Effects of radiofrequency catheter ablation of atrial fibrillation on soluble P-selectin, von Willebrand factor and IL-6 in the peripheral and cardiac circulation. PLoS One 2014; 9:e111760. [PMID: 25390649 PMCID: PMC4229097 DOI: 10.1371/journal.pone.0111760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/30/2014] [Indexed: 01/19/2023] Open
Abstract
Background Catheter ablation (CA) of atrial fibrillation (AF) is associated with inflammatory response, endothelial damage and with increased risk of thrombosis. However, whether these processes differ in peripheral and cardiac circulation is unknown. Methods Plasma markers (von Willebrand factor (vWf), soluble P-selectin (sPsel) and interleukin-6 (IL-6)) were measured by ELISA at three time points in 80 patients (62±10 years, 63% males, 41% paroxysmal AF) undergoing CA. These were at baseline – from femoral vein (FV) and left atrium (LA) before ablation; directly after ablation – from the pulmonary vein (PV), LA and FV; and 24 hours after procedure – from a cubital vein (CV). Results The levels of vWF and IL6 – but not sP-sel – increased significantly 24h after procedure (p<0.001). Baseline vWF was significantly associated with persistent AF (Beta = .303, p = 0.006 and Beta = .300, p = 0.006 for peripheral and cardiac levels, respectively), while persistent AF (Beta = .250, p = 0.031) and LAA flow pattern (Beta = .386, p<0.001) remained associated with vWF in cardiac blood after ablation. Advanced age was significantly associated with IL6 levels at baseline and after ablation in peripheral and cardiac blood. There were no clinical, procedural or anti-coagulation characteristics associated with sP-sel levels in cardiac blood, while peripheral sP-sel levels were associated with hypertension before (Beta = −.307, p = 0.007) and with persistent AF after ablation (Beta = −.262, p = 0.020). Conclusions vWF levels are higher in persistent AF and are associated with LAA rheological pattern after AF ablation. Increase of peripheral vWF and IL6 levels after procedure supports current AF ablation management with careful control of post-procedural anticoagulation to avoid ablation-related thromboembolism.
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Affiliation(s)
- Jelena Kornej
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
- * E-mail:
| | - Borislav Dinov
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andrew D. Blann
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Sascha Rolf
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Arash Arya
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Josephine Schmidl
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Daniela Husser
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig, Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
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41
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Calik MW, Carley DW. Cannabinoid type 1 and type 2 receptor antagonists prevent attenuation of serotonin-induced reflex apneas by dronabinol in Sprague-Dawley rats. PLoS One 2014; 9:e111412. [PMID: 25350456 PMCID: PMC4211887 DOI: 10.1371/journal.pone.0111412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/02/2014] [Indexed: 01/31/2023] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) in Americans is 9% and increasing. Increased afferent vagal activation may predispose to OSA by reducing upper airway muscle activation/patency and disrupting respiratory rhythmogenesis. Vagal afferent neurons are inhibited by cannabinoid type 1 (CB1) or cannabinoid type 2 (CB2) receptors in animal models of vagally-mediated behaviors. Injections of dronabinol, a non-selective CB1/CB2 receptor agonist, into the nodose ganglia reduced serotonin (5-HT)-induced reflex apneas. It is unknown what role CB1 and/or CB2 receptors play in reflex apnea. Here, to determine the independent and combined effects of activating CB1 and/or CB2 receptors on dronabinol’s attenuating effect, rats were pre-treated with CB1 (AM251) and/or CB2 (AM630) receptor antagonists. Adult male Sprague-Dawley rats were anesthetized, instrumented with bilateral electrodes to monitor genioglossus electromyogram (EMGgg) and a piezoelectric strain gauge to monitor respiratory pattern. Following intraperitoneal treatment with AM251 and/or AM630, or with vehicle, serotonin was intravenously infused into a femoral vein to induce reflex apnea. After baseline recordings, the nodose ganglia were exposed and 5-HT-induced reflex apneas were again recorded to confirm that the nerves remained functionally intact. Dronabinol was injected into each nodose ganglion and 5-HT infusion was repeated. Prior to dronabinol injection, there were no significant differences in 5-HT-induced reflex apneas or phasic and tonic EMGgg before or after surgery in the CB1, CB2, combined CB1/CB2 antagonist, and vehicle groups. In the vehicle group, dronabinol injections reduced 5-HT-induced reflex apnea duration. In contrast, dronabinol injections into nodose ganglia of the CB1, CB2, and combined CB1/CB2 groups did not attenuate 5-HT-induced reflex apnea duration. However, the CB1 and CB2 antagonists had no effect on dronabinol’s ability to increase phasic EMGgg. These findings underscore the therapeutic potential of dronabinol in the treatment of OSA and implicate participation of both cannabinoid receptors in dronabinol’s apnea suppression effect.
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Affiliation(s)
- Michael W. Calik
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - David W. Carley
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
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42
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Asbeutah AM, Al-Azemi M, Al-Sarhan S, Almajran A, Asfar SK. Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy. J Vasc Surg Venous Lymphat Disord 2014; 3:147-53. [PMID: 26993832 DOI: 10.1016/j.jvsv.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to monitor the changes that develop in leg veins of primigravida women during pregnancy. METHODS Sixty primigravida women volunteered to undergo clinical evaluation and duplex ultrasound examination of both lower limb veins to monitor changes in vein diameter and valve closure time (VCT) during pregnancy and 3 months postpartum by duplex ultrasound. A total of four readings were taken for each subject, one reading for each trimester and the last reading at 3 months postpartum. RESULTS The mean (± standard deviation) age of participants was 26.82 ± 2.47 years; 39 limbs (32.5%) and 65 limbs (54.2%) developed C1-C3 venous changes during the second and third trimesters, respectively. Three months post partum, 36 limbs (30%) continued to have C1-C2 changes. Only four limbs in four subjects developed varicose veins along the great saphenous vein, and their VCT was more than 1 second. These subjects were found to have a family history of varicose veins. Duplex examinations showed that there was a gradual increase in the diameter and VCT from the second trimester through the third trimester of pregnancy in all examined venous segments. These changes were statistically significant by Friedman and related-samples Wilcoxon signed rank tests within the same legs (P = .001) but not between legs in the same subject (P > .05), even with adjustment for body mass index (P = .001-.049). CONCLUSIONS In primigravida women, lower limb veins showed gradual increase in vein diameter and in VCT starting from the second trimester. These changes reverted to baseline in most cases 3 months after delivery.
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Affiliation(s)
- Akram M Asbeutah
- Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait.
| | - Majedah Al-Azemi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Samah Al-Sarhan
- Department of Obstetrics & Gynecology, Maternity Hospital, Al-Ihgaqi Center, Ministry of Health, Kuwait City, Kuwait
| | - Abdullah Almajran
- Department of Community Medicine and Behavioural Sciences, Health Sciences Centre, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sami K Asfar
- Department of Surgery, Faculty of Medicine, Kuwait University and Vascular Surgery Unit, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait City, Kuwait
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43
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Chernukha LM, Shchukin SP, Archakova TM. [Thrombotic complications of severe forms of varicose disease: modern approach to diagnosis and treatment of hereditary thrombophilia and immunohistochemical peculiarities of vascular wall]. Klin Khir 2014:31-36. [PMID: 25675784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Experience of treatment of 176 patients, suffering thrombotic complications of severe forms of the lower extremities varicose disease (VDLE), was analyzed. In 20 patients, suffering varicothrombophlebitis (VTHPH) in severe forms of VDLE, morphological and immunohistochemical changes in the venous wall and surrounding tissues were studied. There were examined 28 patients, in whom thrombotic complications of the VDLE have had occurred, using diagnostic complex "PLR genetics thrombophilia". Recurrent course of thrombotic complications and coexistence of VTHPH and thrombosis of deep veins have had constitute the main criterion of such patients selection. The groups of patients, suffering severe forms of VDLE, were delineated, depending on thrombotic process localization, differentiated tactics of their surgical treatment was proposed.
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44
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Oike N, Ogose A, Kawashima H, Umezu H, Inagawa S. Extraskeletal myxoid chondrosarcoma arising in the femoral vein: a case report. Skeletal Radiol 2014; 43:1465-9. [PMID: 24818862 DOI: 10.1007/s00256-014-1897-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/27/2014] [Accepted: 04/11/2014] [Indexed: 02/02/2023]
Abstract
Soft tissue tumors arising in deep veins of the extremities are uncommon, although a few cases of synovial sarcoma or leiomyosarcoma arising in the femoral vein have been documented. However, to the best of our knowledge, an extraskeletal myxoid chondrosarcoma (EMC) arising in the femoral vein has not been reported in the English literature. We report a case of EMC arising in the femoral vein of a 70-year-old man who presented with right leg edema and was diagnosed with a deep venous thrombosis (DVT) by computed tomography (CT). Magnetic resonance imaging (MRI) revealed a mass in the right proximal thigh that was diagnosed as myxomatous sarcoma by aspiration cytology, and anticoagulant therapy was initiated. The mass was surgically resected en bloc, including the femoral vein and surrounding soft tissue, and the femoral artery was preserved. The femoral vein was not reconstructed. The histologic diagnosis was an extraskeletal myxoid chondrosarcoma. The patient received postoperative local radiation treatment, with a total dose of 60 Gy, and is currently doing well with no evidence of local recurrence or metastasis at 8 months after surgery. In summary, this case report shows that EMC can arise in the femoral vein, and that reconstruction of the femoral vein is not always necessary during surgery for soft tissue tumors.
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Affiliation(s)
- Naoki Oike
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, 757-1 Asahimachi-dori, Niigata, 951-8510, Japan,
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45
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Buzmakov DL. [Disabling pathogenetic causes in postthrombotic disease of the lower extremities]. Klin Khir 2014:48-50. [PMID: 25675788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Prospective investigation of etiological and pathogenetic causes of the disabling complications incidence in the lower extremities postthrombotic disease (LEPTHD), influencing activity of these patients, was conducted. The examined patients were divided into two groups, in 62 (58.5%) patients a disability was absent, and in 44 (41.5%) disability was established. Profound clinical examination was conducted, including determination of subfascial pressure on the shin, ultrasound duplex scanning of venous system, electroneuromyography of the lower extremities, estimation of the D-dimer, levels antithrombine-III activity in general and regional blood flow. The leading factors, which causes the LEPTHD patients activity restriction, were determined, basing on the results analysis.
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46
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Fokin AA, Soshchenko DG. [Comparative analysis of quality of life of patients in the early and remote periods of iliofemoral phlebothrombosis]. Angiol Sosud Khir 2014; 20:102-107. [PMID: 24722027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors present in the article the results of studying quality of life of patients at various terms after endured iliofemoral phlebothrombosis (from 0 to 60 months), who, depending upon embologenicity of the thrombus in order to prevent pulmonary embolism, were either subjected to implantation of a cava filter or not. The patients were subdivided into two groups: the study group (129 subjects) included those presenting with acute or recently endured iliofemoral phlebothrombosis and a cava filter implanted at various time having elapsed after. The comparison group consisted of 96 patients with endured iliofemoral phlebothrombosis within the same terms and having received conservative treatment without implantation of a cava filter. Quality of life was assessed by two questionnaires, i.e. MOS-SF-36 and CIVIQ. The authors concluded that the patients with endured iliofemoral phlebothrombosis without implantation of a cava filter in the anamnesis demonstrated slightly better measures of quality of life.
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47
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Lyzikov AA. [The venous outflow dynamics after the femoral vein extirpation for reconstruction of the aorto-ileal segment vessels]. Klin Khir 2013:38-40. [PMID: 24501987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The outcomes of a femoral vein extirpation for reconstruction of the aorto-ileal segment vessels (RAISV) were analyzed. The RAISV, using femoral vein, was conducted in 14 patients in 2010 - 2013 yrs, including in 7--for late complications of the earlier performed operations, in 2--for the artificial prosthesis suppuration and in 5--for the lower extremities critical ischemia in a decompensated stage. The femoral vein application for arterial reconstruction constitutes a secure procedure in a sense of a venous outflow preservation. Its disorders were transient and did not demand the conduction of an additional treatment.
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48
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Haliga R, Drug VL, Negru D, Ambarus V, Neghina I, Sorodoc L. Unmasking a young adult migratory deep venous thrombosis--case report. Rev Med Chir Soc Med Nat Iasi 2013; 117:924-928. [PMID: 24502070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Venous thromboembolism is a known complication of cancer which impacts on patient mortality and quality of life. The primary site of cancer is an important risk factor, with highest rates observed in patients with brain, pancreas, gastric, kidney, ovary and lung cancers. The extent of metastatic spread further adds to the risk. In this article, we present the case of a young patient who was diagnosed with an aggressive form of pancreatic neoplasm with secondary determinations, without any previous digestive symptoms, with the occasion of a recurrent and migratory deep venous thrombosis (DVT).
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Affiliation(s)
- Raluca Haliga
- University of Medicine and Pharmacy Grigore T. Popa-lasi, Faculty of Medicine
| | - V L Drug
- St. Spiridon Hospital, Gastroenterology Department, Romania
| | - D Negru
- St. Spiridon Hospital, Radiology Department, Romania
| | - V Ambarus
- St. Spiridon Hospital, Third Internal Medicine Clinic
| | | | - L Sorodoc
- St. Spiridon Hospital, Second Internal Medicine Clinic, lasi, Romania
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49
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Tsapenko MV, d'Uscio LV, Grande JP, Croatt AJ, Hernandez MC, Ackerman AW, Katusic ZS, Nath KA. Increased production of superoxide anion contributes to dysfunction of the arteriovenous fistula. Am J Physiol Renal Physiol 2012; 303:F1601-7. [PMID: 22993073 PMCID: PMC3532470 DOI: 10.1152/ajprenal.00449.2012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/17/2012] [Indexed: 11/22/2022] Open
Abstract
Vascular access dysfunction causes morbidity in hemodialysis patients. This study examined the generation and pathobiological significance of superoxide anion in a rat femoral arteriovenous fistula (AVF). One week after AVF creation, there was increased production of superoxide anion accompanied by decreased total superoxide dismutase (SOD) and Cu/Zn SOD activities and induction of the redox-sensitive gene heme oxygenase-1. Immunohistochemical studies of nitrotyrosine formation demonstrated that peroxynitrite, a product of superoxide anion and nitric oxide, was present in increased amounts in endothelial and smooth muscle cells in the AVF. Because uncoupled NOS isoforms generate superoxide anion, and NOS coupling requires tetrahydrobiopterin (BH(4)) as a cofactor, we assessed NOS uncoupling by determining the ratio of BH(4) to dihydrobiopterin (BH(2)); the BH(4)-to-BH(2) ratio was markedly attenuated in the AVF. Because Src is a vasculopathic signaling species upstream and downstream of superoxide anion, such expression was evaluated; expression of Src and phosphorylated Src was both markedly increased in the AVF. Expression of NADPH oxidase (NOX) 1, NOX2, NOX4, cyclooxygenase (COX) 1, COX2, p47(phox), and p67(phox) was all unchanged, as assessed by Western analyses, thereby suggesting that these proteins may not be involved in increased production of superoxide anion. Finally, administration of tempol, a superoxide anion scavenger, decreased neointima formation in the juxta-anastomotic venous segment and improved AVF blood flow. We conclude that the AVF exhibits increased superoxide anion generation that may reflect the combined effects of decreased scavenging by SOD and increased generation by uncoupled NOS, and that enhanced superoxide anion production promotes juxta-anastomotic stenosis and impairs AVF function.
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50
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Tachikawa M, Ikeda S, Fujinawa J, Hirose S, Akanuma SI, Hosoya KI. γ-Aminobutyric acid transporter 2 mediates the hepatic uptake of guanidinoacetate, the creatine biosynthetic precursor, in rats. PLoS One 2012; 7:e32557. [PMID: 22384273 PMCID: PMC3288109 DOI: 10.1371/journal.pone.0032557] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 02/01/2012] [Indexed: 12/14/2022] Open
Abstract
Guanidinoacetic acid (GAA) is the biosynthetic precursor of creatine which is involved in storage and transmission of phosphate-bound energy. Hepatocytes readily convert GAA to creatine, raising the possibility that the active uptake of GAA by hepatocytes is a regulatory factor. The purpose of this study is to investigate and identify the transporter responsible for GAA uptake by hepatocytes. The characteristics of [(14)C]GAA uptake by hepatocytes were elucidated using the in vivo liver uptake method, freshly isolated rat hepatocytes, an expression system of Xenopus laevis oocytes, gene knockdown, and an immunohistochemical technique. In vivo injection of [(14)C]GAA into the rat femoral vein and portal vein results in the rapid uptake of [(14)C]GAA by the liver. The uptake was markedly inhibited by γ-aminobutyric acid (GABA) and nipecotinic acid, an inhibitor of GABA transporters (GATs). The characteristics of Na(+)- and Cl(-)-dependent [(14)C]GAA uptake by freshly isolated rat hepatocytes were consistent with those of GAT2. The Km value of the GAA uptake (134 µM) was close to that of GAT2-mediated GAA transport (78.9 µM). GABA caused a marked inhibition with an IC(50) value of 8.81 µM. The [(14)C]GAA uptake exhibited a significant reduction corresponding to the reduction in GAT2 protein expression. GAT2 was localized on the sinusoidal membrane of the hepatocytes predominantly in the periportal region. This distribution pattern was consistent with that of the creatine biosynthetic enzyme, S-adenosylmethionine:guanidinoacetate N-methyltransferase. GAT2 makes a major contribution to the sinusoidal GAA uptake by periportal hepatocytes, thus regulating creatine biosynthesis in the liver.
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Affiliation(s)
- Masanori Tachikawa
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- Division of Membrane Transport and Drug Targeting, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Saori Ikeda
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Jun Fujinawa
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Shirou Hirose
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Shin-ichi Akanuma
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Ken-ichi Hosoya
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- * E-mail:
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