Ipsilateral Vein Research Articles

Anchoring guide catheter to facilitate recanalising occluded pulmonary vein in small children: a novel technique.

Transcatheter pulmonary vein recanalisation is challenging. Herein, we described a novel technique facilitating the recanalisation of occluded three pulmonary veins in two small children. This technique enhances the catheter's alignment and stability during the recanalisation process. Referred to as the "anchoring guide catheter" technique, it can be applied only when the ipsilateral vein is patent.

Optimizing pressure-guided cryoablation of pulmonary veins

Abstract Background Pressure-guided cryoablation (PGC) is a contrast-free technique used to isolate Pulmonary Veins (PV) in order to treat atrial fibrillation (AF). In this technique the main goal is to achieve a wedge curve to assure adequate vein occlusion(1). As the wedge curve is not always clear, we hypothesize that the wedge pressures (systolic, diastolic and mean) could be useful as reliable surrogate markers. Purpose The aim of this study is to evaluate wedge pressures in individual vein occlusions in a cohort of patients referred for PV isolation using PGC. Methods Between February 2022 and October 2023, 23 patients (7 female, 13 paroxysmal AF) underwent PV isolation using PGC protocol. No REDOs were included. The procedure was intended to obtain PV isolation with one shot of 240 seconds. All patients underwent computed tomography angiography or MRI of LA and PV. A 28-mm Cryoballoon and a Intracardiac echo were used in all the procedures. Invasive radial arterial and LA pressures were registered. We analysed all the shots per vein and compared data between successful and unsuccessful isolation. Multivariate statistical analysis was performed, being the PV isolation the main outcome. Results There were realized 125 applications in 92 veins, being isolated 100% of them. One vein (left superior) was isolated after application in inferior ipsilateral vein, so it was considered successful as there was no need of additional applications. Eleven applications were performed as a bonus, so they were not considered for the isolated-non isolated analysis. Wedge curve was obtained in 112/119 applications (the 7 applications with not adequate wedge curve were 3 in right superior and 4 in right inferior pulmonary veins). In 5 applications the graphic curve was not reliable, but the pressure values were registered. There were significative differences in nadir temperature, systolic, diastolic and mean vein pressures, and the presence of a wedge curve. In the multivariate analysis, the nadir temperature (OR 0.79 CI95% 0.70–0.90) and the diastolic vein pressure at occlusion (OR 1.16 CI95% 1.01–1.36) were the only independent predictor factors of PV isolation. Conclusion With these results, we conclude that the monitoring of diastolic PV pressure during applications and the nadir temperature are the best markers to predict a successful isolation in the PGC.Figure 1.Pressure waveformTable 1.Application characteristics

Impact of inter-lesion distance and first-pass isolation on outcomes of pulmonary venous isolation for paroxysmal atrial fibrillation.

Contiguity of ablation lesions is a critical determinant of success for paroxysmal atrial fibrillation (PAF) ablation. Evidence supports maintaining an inter-lesional distance (ILD) ≤ 6mm during pulmonary venous isolation (PVI). Meanwhile, first-pass isolation (FPI) on PVI outcome in follow-up was not deeply studied. The impact of ILD and FPI on PAF ablation outcomes was investigated. Consecutive PAF patients who underwent first-time antral PVI were recruited. Coordinates of ablation points were extracted from the electro-anatomical mapping system and analyzed using custom-developed software to determine the ILD. A gap is defined as ILD greater than 6mm. FPI was defined as the achievement of PVI by encircling the ipsilateral veins while simultaneously recording their electrical activity using a multipolar catheter. The primary endpoint was freedom from documented atrial arrhythmias including AF, atrial tachycardia (AT), or atrial flutter (AFL) lasting longer than 30s during follow-up. A total of 105 patients underwent first-time antral PVI. During 13.3 ± 0.6months of follow-up, atrial arrhythmias recurrence was noted in 22.9% of the patients. Atrial arrhythmia recurrence was significantly higher in patients with more gaps (> 2) (37.0% versus 11.9%, P < 0.01), and the number of gaps was an independent predictor of AF/AT/AFL recurrence. (Hazard ratio [HR] 1.20, 95% CI 1.03-1.40, P = 0.02). The group with FPI for at least one ipsilateral pair of PVs exhibited a decreased number of gaps (2.0 versus 7.0, P < 0.01) and demonstrated a significant correlation with a reduction of recurrence (HR 0.26, 95% CI 0.09-0.71, P = 0.01). Among 16 patients who underwent repeat ablation, the number of gaps during the index PVI was associated with PV reconnection (PVR) (P < 0.01). Gaps created during PVI are a modifiable determinant of AF/AT/AFL recurrence, and avoidance of gaps is crucial to improve clinical outcomes of PAF ablation. In addition, FPI exhibited a strong predictive capability for clinical success in patients with PAF.

Comparison of Contralateral vs Ipsilateral Vein Graft for Traumatic Vascular Injury Repair: A Cohort From PROOVIT.

Traumatic injury leading to arterial damage has traditionally been repaired using autologous vein graft from the contralateral limb. This often requires a secondary surgical site and the potential of prolonged operative time for patients. We sought to assess the use of ipsilateral vs contralateral vein grafts in patients who experienced traumatic extremity vascular injury. A multicenter database was queried to identify arterial injuries requiring operative intervention with vein grafting. The primary outcome of interest was need for operative reintervention. Secondary outcomes included risk of thrombosis, infection, and intensive care unit length of stay. 358 patients (320 contralateral and 38 ipsilateral) were included in the analysis. The ipsilateral vein cohort did not display a statistically significant decrease in need for reoperation when compared to the contralateral group (11% vs 23%; OR 0.41, 95% CI -0.07-1.3; P = .14). Contralateral repair was associated with longer median intensive care unit (ICU) LOS (4.3 vs 3.1days; P < .01).

The benefit of favorable venous outflow profile is mediated through reduced microvascular dysfunction in acute ischemic stroke.

Venous outflow (VO) is emerging as a marker of microvascular integrity in acute ischemic stroke. Using hemorrhagic transformation (HT) and infarct growth as mediators, we tested whether a favorable VO profile benefited functional outcome by reducing consequences of microvascular dysfunction. Patients receiving thrombectomy in three comprehensive stroke centers due to acute anterior circulation occlusion were included. VO was assessed semi-quantitatively by the opacification of ipsilateral vein of Labbé, Trolard and superficial middle cerebral vein. HT was graded on follow-up CT. Infarct growth volume (IGV) was the difference of final infarct volume and baseline core volume. The association of VO and functional independence (90-day modified Rankin Scale ⩽ 2) was examined by logistic regression. Mediation analysis was performed among VO, HT or IGV, and functional outcome in patients with or without recanalization, respectively. In 242 patients analyzed, VO was strongly correlated with functional independence and VO ⩾ 4 was defined favorable. In 175 patients recanalized, favorable VO was associated with a reduced risk of HT (OR = 0.82, 95% CI 0.71-0.95, p = 0.008), which accounted for 13.1% of the association between VO and favorable outcome. In 67 patients without recanalization, favorable VO was associated with decreased IGV (β = -0.07, 95% CI -0.11 to -0.02, p = 0.007). The association of favorable VO and functional independence was no longer significant (aOR = 4.84, 95% CI 0.87-38.87, p = 0.089) after including IGV in the model, suggesting a complete mediation. In patients with acute anterior large vessel occlusion, the clinical benefit of VO may be mediated through reduced microvascular dysfunction.

Insights into level of pulmonary vein isolation using pulsed-field ablation for atrial fibrillation and unexpected effects in the posterior wall

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Pulse field ablation (PFA) has emerged as an effective, safe and efficient tool for pulmonary vein isolation (PVI). Purpose We studied the extent of PVI, specifically the isolation of PV antrum, carina and left atria’s posterior wall after PFA with an ultrahigh density mapping (UHD). Methods We involved the first patients referred for atrial fibrillation (AF) ablation treated with a PFA multispline catheter. PFA-lesion extension was assessed with a voltage-map UHD mapping performed before and immediately after PVI. Results Sixty-one consecutive patients underwent PVI with PFA (62±10 year old, 23 women, 39 paroxysmal AF). Four out of 61 patients were excluded because their posterior wall was isolated with extra aplications on purpose. Acute results involved a 100% success of PVI and the only safety issue was a pericardial effusion in one patient managed conservatively. Mean procedure and fluoroscopy times were 59±39 min and 16±5 min, respectively. UHD immediately after PVI revealed early reconnection just in one vein (1/228 veins). PFA created wide antral circumferential lesions without electrical activity registered by UHD mapping inside the isolation area. There were no notch-like normal voltage areas at the anterior or posterior side of carinas. As a result of the PVI with this technology, it was observed the existence of a narrow corridor in the posterior wall in 8 patients (14%) and in another 8 cases right and left antral ablation converged at the posterior wall creating an unexpected isolation area. There was a significant relationship between LA posterior inter-carina distance and posterior wall´s level of isolation (77,1±7mm, no affectation; 68,8±7mm narrow corridor; 60,3±1mm posterior wall isolation (fig 1); p=0.036). Finally, it was a significant linear correlation between posterior inter-carina distance and the distance between the ipsilateral, antral levels of isolation at the posterior wall (fig 2, r=0.79, p=0.001) Conclusion(s) PFA creates wide antral circumferential PVI lesions involving the ipsilateral veins carina. Nevertheless, in small left atria it can create an undesired isolation or a narrow corridor in the posterior wall.

Local impedance drop guided versus lesion size index guided pulmonary vein isolation: long-term outcomes and chronic reconnections

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Insufficient lesion depth and discontinuity of lesion lines are reasons for reconnections after point-by-point radiofrequent pulmonary vein isolation (PVI). Different technologies have shown to be useful for prediction of effective lesions. Measurement of the magnitude of local tissue impedance drop (LID) and calculation of lesion size index (LSI) based on monitoring of contact force are examples for corresponding technologies. Purpose To compare the long-term outcomes of LID guided with LSI guided PVI. Methods In this retrospective study we compared two groups of patients who underwent point-by-point radiofrequency PVI for treatment of atrial fibrillation. In the LID-guided group (n=35) energy was delivered using an ablation catheter with local impedance monitoring. Ablation was terminated when LID reached a plateau (Fig. A). In the LSI-guided group (n=31) lesions were created using an ablation catheter with contact force monitoring until the target LSI was reached in each point (LSI=5 for anterior and LSI=4 for posterior segments, respectively, Fig B). The inter-lesion distance of &amp;lt;6 mm with power of 40 W for anterior and 30W for posterior segments was used in both groups. A gap-map and touch-up ablation was performed along the index ablation line if the first pass PVI did not occur, or in the case of an acute reconnection after 20 min of waiting time. In the long-term follow-up, a holter ECG was scheduled 3, 6 and 12 months after the initial ablation as well as symptom-driven visits with ECG registration. In case of symptomatic arrhythmia recurrence, a second procedure was performed including validation of PVI, mapping of reconnection site and RePVI, if necessary. Results All pulmonary veins were successfully isolated by encirclement of ipsilateral veins during initial procedure. During the 11.5±2.9 months follow-up, 12 out of 35 (34.3%) patients from LID-guided group and 5 out of 31 (16.1%) patients from LSI-guided group experienced arrhythmia recurrence. Kaplan-Meier survival analysis showed statistically significant higher probability of the arrhythmia recurrence in patients treated with LID-guided approach (log-rank=4.37, p=0.037, Fig C). Redo procedure was performed for 10 (28.6%) patients in LID-guided group and 3 (9.7%) patients in LSI-guided group and chronic pulmonary vein reconnections were detected in 7 out of 10 (70%) and 2 out of 3 (67%) patients, respectively (Fig D). Conclusions Despite initial successful isolation of all pulmonary veins, LID-guided ablation resulted in significantly higher probability of arrhythmia recurrence during the long-term follow-up as well as higher rate of chronic PV reconnections (although not statistically significant) as compared to LSI-guided ablation. This reflects the nature of contact force guided ablation anticipating the quality of catheter-tissue interface before each application, which is not possible with an impedance only guided approach.

Local impedance drop guided versus lesion size index guided pulmonary vein isolation: acute success and reconnections

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Insufficient lesion depth and discontinuity of lesion lines are reasons for reconnections after point-by-point radiofrequency pulmonary vein isolation (PVI). Different technologies have shown to be useful for prediction of effective lesions. Measurement of the magnitude of local tissue impedance drop (LID) and calculation of lesion size index (LSI) based on monitoring of contact force are examples for corresponding technologies. Purpose To compare the acute efficacy of LID guided with LSI guided PVI. Methods In this retrospective study we compared two groups of patients who underwent point-by-point radiofrequency PVI for treatment of atrial fibrillation. In the LID-guided group (n=35) energy was delivered using IntellaNav MiFi (Boston Scientific, MA, USA) ablation catheter. Ablation was terminated when LID reached a plateau (Figure A). In the LSI-guided group (n=31) lesions were created using Tacticath (Abbott, MA, USA) ablation catheter until the target LSI was reached in each point (LSI=5 for anterior and LSI=4 for posterior segments respectively, Figure B). The inter-lesion distance of &amp;lt;6 mm with power of 40 W for anterior and 30W for posterior segments was used in both groups. A gap-map and touch-up ablation was performed along the index ablation line if the first pass PVI did not occur, or in the case of an acute reconnection after 20 min of waiting time. In the post hoc analysis initial levels and drop of local and system impedance, average contact force and LSI were included in models predicting PV gaps. Results All PVs were successfully isolated by encirclement of ipsilateral veins with significantly longer median ablation time 30(IQR:27-35) min in LID-guided group as compared to LSI-guided group:25 (IQR:21-31) min (p=0.035). First-pass PVI was achieved in 97 out of 132(73%) circles (LID-guided:43 out of 70 [61%] circles vs LSI-guided:54 out of 62 [87%] circles, p=0.002). Acute reconnections occurred in 14 out of 132 (11%) circles (LID-guided:9 out of 70 [13%] circles vs LSI-guided: 5 out of 62 [8%] circles, p=0.54, Figure C). Overall, significantly more patients had PV gaps when LID-guided ablation was used as compared to LSI-guided (26 out of 35[74%] vs 13 out of 31[42%] respectively, p=0.016). In the post hoc analysis a LID&amp;lt;9.7Ω was the only predictive parameter for PV gap (sensitivity=96.4%, specificity=67%). Conclusions LSI-guided ablation resulted in successful PVI with significantly shorter ablation time and fewer PV gaps as compared to LID-guided. This reflects the nature of contact force guided ablation anticipating the quality of catheter-tissue interface before each application, which is not possible with an impedance-only guided approach.

Computed tomographic parenchymal lung findings in premature infants with pulmonary vein stenosis.

Developmental pulmonary vein pulmonary vein stenosis in the setting of prematurity is a rare and poorly understood condition. Diagnosis can be challenging in the setting of chronic lung disease of prematurity. High-resolution non-contrast chest computed tomography (CT) is the conventional method of evaluating neonates for potential structural changes contributing to severe lung dysfunction and pulmonary hypertension but may miss pulmonary venous stenosis due to the absence of contrast and potential overlap in findings between developmental pulmonary vein pulmonary vein stenosis and lung disease of prematurity. To describe the parenchymal changes of pediatric patients with both prematurity and pulmonary vein stenosis, correlate them with venous disease and to describe the phenotypes associated with this disease. A 5-year retrospective review of chest CT angiography (CTA) imaging in patients with catheterization-confirmed pulmonary vein stenosis was performed to identify pediatric patients (< 18years) who had a history of prematurity (< 35weeks gestation). Demographic and clinical data associated with each patient were collected, and the patients' CTAs were re-reviewed to evaluate pulmonary veins and parenchyma. Patients with post-operative pulmonary vein stenosis and those with congenital heart disease were excluded. Data was analyzed and correlated for descriptive purposes. A total of 17 patients met the inclusion criteria (12 female, 5 male). All had pulmonary hypertension. There was no correlation between mild, moderate, and severe grades of bronchopulmonary dysplasia and the degree of pulmonary vein stenosis. There was a median of 2 (range 1-4) diseased pulmonary veins per patient. In total, 41% of the diseased pulmonary veins were atretic. The right upper and left upper lobe pulmonary veins were the most frequently diseased (n = 13/17, 35%, n = 10/17, 27%, respectively). Focal ground glass opacification, interlobular septal thickening, and hilar soft tissue enlargement were always associated with the atresia of an ipsilateral vein. Recognition of the focal parenchymal changes that imply pulmonary vein stenosis, rather than chronic lung disease of prematurity changes, may improve the detection of a potentially treatable source of pulmonary hypertension, particularly where nonangiographic studies result in a limited direct venous assessment.

A novel local impedance algorithm and contact force sensing to guide high power short duration radiofrequency ablation is efficient and safe for circumferential pulmonary vein isolation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Local impedance (LI) drop can predict sufficient lesion formation during radiofrequency ablation (RF). Recently, a novel ablation catheter technology able to measure LI and contact force has been made available for clinical use. High power short duration (HPSD) RF ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure time. We used LI drop and plateau formation to guide duration of 50 Watt RF power applications for circumferential pulmonary vein isolation (PVI). Methods Consecutive patients with indication for de novo AF ablation (n = 32, age 65 ± 10 years) with paroxysmal (n = 16) or persistent (n = 16) AF underwent ultra high density 3D mapping of the left atrium and catheter ablation. Thereafter, ipsilateral PV encircling with 50 Watt RF-applications targeting an interlesion distance of ≤ 6mm and a contact force of 10-30g was performed. Duration of HPSD RF application between 7-15s was guided by impedance drop &amp;gt;20 Ohm and plateau formation of LI. Further ablation strategy was left to the investigator’s discretion. Esophageal temperature measurement was performed using a three thermistor catheter with temperature cut off 39.0°C. In case of temperature rise or very near esophageal contact to the circumferential line, RF application time was shortened to 7s. Patients underwent adenosine testing after PVI. Previously we performed all types of AF ablation using an LI guided HPSD ablation without contact force measurement capability in 80 patients. Results Complete PVI was achieved in all pts with only 13.5 ± 4.3 min cumulative RF application duration and an ablation procedure duration of 46.5 ± 10.4 min with the novel LI measuring catheter. First-pass isolation of ipsilateral veins was achieved in 75% of circles. Recurrence of PV conduction during waiting period (20min) and adenosine testing occured in 25% of circles, and was reablated in most patients with a single spot of HPSD application. Using 94 ± 36 RF application per patient, mean maximum LI drop was 23.6 ± 4.0 Ohm. Reconnected fibers were associated with low LI drop due to instability of contact in most cases due to breathing in case of difficult sedation of the patients. No serious complications occurred in all 32 pts using HPSD with the novel contact force catheter design. Conclusion Guiding of HPSD RF ablation by LI is highly efficient and safe. A novel local impedance algorithm in combination with contact force sensing enable short PVI times with low early recurrence of PV conduction. Prediction of permanent lesions seems possible and the only limitation seems to be unstable RF catheter contact due patients breathing. Follow up have to be waited.

Pelvic Venous Congestion Secondary to a Circumaortic Renal Collar in an Adolescent Female: Report of a Case

We report a 13-year-old girl who presented with a recurrent abdominal pain that started after her menarche. The abdominal palpation revealed tenderness over the left ovarian point. The laboratory study, ultrasonography, and abdominal X-ray were normal. The computed tomography and magnetic resonance imaging showed a double left renal vein with a retroaortic component, an increased left parauterine circulation, and ipsilateral ovarian vein engorgement. A diagnostic and therapeutic phlebography allowed a selective catheterization of a group of pelvic varicose veins draining to the left ovarian and to the internal iliac veins. There were no complications during the procedure and the symptoms disappeared 2 days later. Circumaortic left renal vein may cause hematuria, proteinuria, pelvic congestion syndrome, and massive hemorrhage during surgery. A conservative treatment is recommended for patients without gynecourological/renal symptoms or with mild hematuria. The endovascular treatment by gonadal venous embolization is safe and effective.

The clinical value of color Doppler ultrasound combined with vascular enhancement technology in the diagnosis of iliac vein compression syndrome

Objective To evaluate the clinical value of color Doppler ultrasound(CDUS) combined with vascular enhancement technology(VET) in diagnosis of iliac vein compression syndrome(IVCS). Methods From Jan 2016 to Oct 2018, 252 patients with the lower extremities chronic venous diseases(CVD) were selected in the Second Hospital of Hebei Medical University. The ipsilateral iliac veins of the affected limbs were examined by CDUS, VET and the combined diagnosis of IVCS before X-Ray venography(XRV). Iliac vein diameter stenosis ratio(DSR)>50% in transverse section was the criterion of ultrasound diagnosis of IVCS. The stenosis site of iliac vein and indirect signs of IVCS, such as presence of collateral circulation and the retrograde flow of internal iliac vein were recorded. The cases, which had the same results in CDUS, VET and both and XRV, were divided into IVCS group and non-IVCS group. The results of XRV were taken as the gold standard, the diagnostic efficiency of the above 3 methods in diagnosis of IVCS was calculated. The cases identically diagnosed by the most effective ultrasonic method and XRV were divided into DVT group and non-DVT group according to the deep vein thrombosis in lower limbs. In the non-DVT group, there were five groups of C2-C6 on the basis of the CEAP clinical grades of CVD in lower extremity. The relationship between IVCS and different CEAP clinical grades were analyzed. The locations of common iliac vein stenosis and collateral circulation formation and internal iliac vein reverse flow were evaluated for the diagnosis of the IVCS. Results ①XRV diagnosis of IVCS was used as the gold standard. Compared with CDUS and VET alone, the sensitivity and specificity of CDUS combined with VET was the highest(all P 0.05). ④For the proportion of the iliac vein stenosis sites, the prevalence of the primary section of left common iliac vein was much higher than those of the primary section of right common iliac vein and the middle-distal sections of bilateral common iliac veins(all P 0.05). ⑤In IVCS group, which had the same results of CDUS combined with VET and XRV, there were statistical differences in the positive rate of collateral circulation and the retrograde flow of internal iliac vein(χ2=6.717, P=0.010), and the former is higher than the latter. Conclusions CDUS combined with VET has a higher diagnostic efficiency for IVCS than VET or CDUS alone. The presence of IVCS is closely related to DVT of lower extremities, but not related to clinical class of CEAP. The most common site of IVCS is the initial segment of the left common iliac vein. The presence of collateral circulation can be used as indirect indicators for the diagnosis of IVCS. Key words: Ultrasonography, Doppler, color; Vascular enhancement technology; Iliac vein compression syndrome

"Intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism"

Introduction: Currently, parathyroidectomy represents the elective surgical treatment and the only one curative that relieves the patient of metabolic complications and improves the quality of life of the patient. Intraoperative confirmation of PTH is required to reflect the fact that the correct parathyroid gland has been extracted. Material and method: The study is retrospective. The period on which the data was gathered over a period of 2 years. The values of the PTH assay were obtained from blood drawn from the ipsilateral cephalic vein of the hyperproductive parathyroid gland: 1. at the moment of anesthesia induction; 2. at identification; 3. at 10 minutes after the extraction; 4. at 20 minutes after extraction. Results: We identified a number of 25 patients operated for primary hyperparathyroidism. Preoperative values of PTH were 380pg/mL with a maximum value of 821 pg/mL. PTH values decreased by 55% at 5 min, 68% at 10 minutes and 74% at 15 minutes. A marked reduction in PTH values occurred after the first 5 minutes while the interval between 10-15minutes associated a variation of only 8-10% decrease. Conclusion: Intraoperative PTH assay is a useful technique to predict the success of the intervention. The technique is standard although some issues have been raised and are still under discussion.

Insufficient cerebral venous drainage predicts early edema in acute intracerebral hemorrhage.

To explore the relationship between insufficient ipsilateral cerebral venous drainage and the development of perihematomal edema (PHE) and functional outcome in patients with acute intracerebral hemorrhage (ICH). We retrospectively reviewed our prospectively collected database for patients with acute spontaneous supratentorial ICH and analyzed patients who underwent baseline CT perfusion (CTP) within 6 hours of onset and noncontrast CT at 24 hours. Absence of filling of 1 or more of the ipsilateral superficial middle cerebral vein, vein of Trolard, vein of Labbé, basal vein of Rosenthal, and internal cerebral vein, evaluated on venous maps generated from baseline CTP, was identified as absent ipsilateral venous filling (AIVF). Relative PHE (rPHE) was calculated as the ratio of PHE volume to hematoma volume on follow-up CT. A total of 138 patients were included. Median absolute PHE volume on follow-up CT was 3.5 (1.0-9.3) mL and rPHE was 24.3% (9.0%-49.4%). One absent ipsilateral vein was observed in 38 (27.5%) patients, and 2 absent veins were observed in 5 (3.6%) patients. Multivariate analysis showed that AIVF was independently associated with large rPHE at 24 hours (odds ratio [OR] 4.032, 95% confidence interval [CI] 1.739-9.347, p < 0.001). Large PHE volume was independently associated with poor outcome (OR 1.109, 95% CI 1.009-1.218, p = 0.031). AIVF was observed in about one-third of patients with acute ICH, which might be attributed to hypoperfusion after ICH and was strongly related to the development of PHE. Identification of cerebral venous filling status might be a promising imaging marker for PHE and a potential therapeutic target in ICH.

Long-term follow-up of the stenting across the iliocaval confluence in patients with iliac venous lesions.

Stent implantation is the common treatment method for iliac vein (IV) occlusion. IV stents usually enter into the inferior vena cava (IVC) to partially or completely cover the contralateral IV, but it is still uncertain whether this can increase the risk of thrombosis in the contralateral IV. The purpose of this study was to investigate the effect of the stent position on the bilateral IVs patency. A total of 261 patients with symptomatic IV lesions, including 177 patients with non-thrombotic iliac vein lesions (NIVLs) and 84 patients with thrombotic iliac vein lesions (TIVLs), were implanted with IV stents between July 2007 and June 2017. The data of these patients were retrospectively studied. The follow-up time was 6-114 months, and the median time was 62 months. A total of 183 cases had stenting into the IVC for more than 5mm. The incidence of thrombosis in the contralateral IV was only 0.55% (1/183). A total of 17 short- and long-term cumulative cases had ipsilateral thrombosis on the stent side. There was no significant difference between the incidence of patients (8.79%, 7/78) with stenting into the IVC for less than 5mm and those with more than 5mm (5.46%, 10/183, P = 0.287). However, in the TIVLs group, the incidence of ipsilateral thrombosis between stenting positions less than 5mm (29.6%, 8/27) and those more than 5mm (8.77%, 5/57) was significantly different (P = 0.022). Stent implantation for NIVLs had an excellent long-term patency rate; the primary patency rate and the assisted primary patency rate were 97.7% and 100%, respectively. The entry of IV stents into the IVC was safe and had a very low incidence of thrombosis in the contralateral vein. Stenting less into the IVC increased the incidence of thrombosis in the ipsilateral vein, especially among thrombotic cases. Treatment of NIVLs using stent implantation had a better long-term patency rate. This principle plays an important guiding role in the endovascular therapy of IV lesions.

An unusual case of symptomatic deep vein thrombosis and pulmonary embolism after arthroscopic meniscus surgery

BackgroundAlthough thrombosis complication is rare after arthroscopic meniscus surgery, deep vein thrombosis and pulmonary embolism can be fatal. The associated risk factors and whether anticoagulant prevention after arthroscopic knee surgery is necessary have not reach consensus. Here we present a case of deep vein thrombosis and pulmonary embolism after a common arthroscopic meniscectomy.Case presentationThe patient had no risk factors except ipsilateral leg varicose veins. She present swell at knee and calf from postoperative 3 weeks, and developed dyspnea, palpitation, and nausea on 33th day, pulmonary embolism was confirmed with CT angiography at emergency department. After thrombolysis and anticoagulation therapy were administered, the patient improved well and discharged. And the intravenous ultrasound confirmed thrombosis of popliteal vein and small saphenous vein. Who don’t have common risk factors for venous thromboembolism.ConclusionsDespite the low incidence of thromboembolic complications after simple arthroscopy surgery, its life-threatening and devastating property make clinicians rethink the necessity of thromboprophylaxis and importance of preoperative relative risk factors screening.

Ipsilateral Prominent Thalamostriate Vein on Susceptibility-Weighted Imaging Predicts Poor Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke.

The impact of deep cerebral veins on neurologic outcome after intravenous thrombolysis in patients with acute ischemic stroke is unclear. We investigated the relationship between the appearance of deep cerebral veins on susceptibility-weighted imaging and neurologic outcome in patients who underwent thrombolysis. We retrospectively analyzed 109 consecutive patients with acute ischemic stroke who had pretreatment SWI and received intravenous thrombolysis within 6 hours. We calculated the signal difference ratio (defined as the relative difference in signal intensity between the ipsilateral and contralateral veins) of the thalamostriate vein, septal vein, and internal cerebral vein on pretreatment SWI. Only the signal difference ratio of the thalamostriate vein was significantly associated with poor outcome (3-month modified Rankin Scale score > 2, P = .008). The optimal threshold was relative hypointensity of the ipsilateral vein of >4.8% (sensitivity of 53.7% and specificity of 80.9%). We defined a signal difference ratio of the thalamostriate vein of ≥5% as an ipsilateral prominent thalamostriate vein. Patients with an ipsilateral prominent thalamostriate vein were more likely to have poor outcome (OR = 3.66; 95% CI, 1.25-10.68; P = .02) and a lower rate of successful reperfusion (reperfusion rate of ≥70%; OR = 0.35; 95% CI, 0.13-0.92; P = .03), compared with those without an ipsilateral prominent thalamostriate vein. However, patients with an ipsilateral prominent thalamostriate vein were still less likely to experience poor outcome when reperfusion was achieved compared with when reperfusion did not occur (80.0% versus 44.4%, P = .04). A pretreatment ipsilateral prominent thalamostriate vein was associated with reduced reperfusion after thrombolysis and poor outcome. More intensive reperfusion approaches may be required for patients with an ipsilateral prominent thalamostriate vein.

Transvenous lead placement and its pre-sternal tunneling to the contralateral side as a solution for pacemaker system upgrade in case of the subclavian vein thrombosis

Introduction. Chronic right ventricular pacing can deteriorate cardiac function. Consequently, pacemaker system upgrades are more frequently indicated. These interventions can be hindered by venous thrombosis. In literature, it is rarely described that this problem is resolved by implanting a new lead for left ventricle (LV) stimulation on the opposite side of the previously implanted pacemaker and then subcutaneously transferring it to the old pocket. Case outline. A 75-year-old male patient was hospitalized due to a planned pacemaker upgrade in December 2015. A dual-chamber pacemaker had been implanted due to sinus node dysfunction in 2011. During the previous 18 months he had been complaining about symptoms of heart failure. An upgrade to the cardiac resynchronization therapy (CRT) with a new CRT-P device was indicated due to the LV dilatation with the ejection fraction decrease, clinical deterioration, and the presence of high percentage of ventricular pacing. In October 2015, the mentioned intervention was unsuccessful due to total left subclavian vein thrombosis on the side of the previously implanted pacemaker. Anticoagulation therapy was ordinated and the reevaluation was postponed. During this hospitalization, venography confirmed total left subclavian vein thrombosis despite the anticoagulation therapy. It was decided to implant a new LV lead on the right side and then subcutaneously shift it by pre-sternal tunneling to the previous left prepectoral pocket. The intervention was uneventful. The first controls have shown stable pacemaker parameters. Conclusion. This case report confirms that contralateral lead placement and subcutaneous pre-sternal tunnelling of the lead is feasible and safe in patients with an implanted pacemaker, an indication for system upgrade and ipsilateral vein obstruction.

Totally Extraperitoneal Herniorrhaphy (TEP) after Ipsilateral Spermatic Vein Embolization: A Case Report

Introduction: Both totally extraperitoneal herniorrhaphy (TEP) and spermatic vein embolization are minimal invasive techniques gaining in popularity in the treatment of inguinal hernia and varicocele respectively. A previous spermatic vein embolization makes a TEP more difficult because of fibrotic changes of the spermatic vein. This is to our knowledge the first case report describing these difficulties and changes after spermatic vein embolization. Case Presentation: We report the case of a 37 year old male who presented with an uncomplicated left sided inguinal hernia and ipsilateral varicocele. He first underwent a percutaneous left spermatic vein embolization for a grade 3 varicocele and later a TEP for the inguinal hernia. Reduction of the peritoneum and proper mesh placement were complicated due to fibrotic changes of the spermatic vein. Due to the dissection and resection of the embolized spermatic vein there was minor blood loss, increased operating room time and postoperative pain was more then average. Conclusions: In case of a concomitant inguinal hernia and ipsilateral varicocele requiring embolization we propose to treat these diseases concomitantly or first treat the inguinal hernia and embolising the varicocele after repair of the hernia.

Prevalence of peripheral nervous system complications after major heart surgery.

We evaluated 374 consecutive patients from May 2013 to April 2014 who underwent major cardiac surgery. Each patient had an interview and a neurological clinical examination during the rehabilitation period. Patients with possible peripheral nervous system (PNS) complications underwent further electrodiagnostic tests. Among 374 patients undergoing major heart surgery (coronary artery bypass grafting, valvular heart surgery, ascending aortic aneurysm repair) 23 (6.1 %) developed 34 new PNS complications. We found four brachial plexopathies; four carpal tunnel syndromes; five critical illness neuropathies; three worsening of pre-existing neuropathies; two involvement of X, one of IX and one of XII cranial nerves; three peroneal (at knee), one saphenous, two median (at Struthers ligament), six ulnar (at elbow) mononeuropathies; two meralgia parestheticas. Diabetes is a strong risk factor for PNS complications (p = 0.002); we could not find any other relationship of PNS complications with clinical conditions, demographic data (gender, age) or type of surgical intervention. The mononeuropathies of right arms can be related to ipsilateral vein cannulation; position of body and stretching from chest wall retraction may be the cause of mononeuropathies of left arms (more frequent); the use of saphenous vein and position of the limbs may be the cause of mononeuropathies of the legs; surgical and anesthetical procedures can injure cranial nerves; respiratory failure and infection during the first days after surgery can cause critical illness neuropathies. Careful preoperative assessment and intraoperative management may reduce the risk of long-term PNS complications after cardiac surgery.