Vein Occlusion Research Articles

Recanalization of occluded right innominate vein in presence of a persistent LeVeen shunt: A vascular access rescue case.

Superior vena cava syndrome (SVCs) is a common complication in hemodialysis patients due to central vein occlusions, often caused by prior catheterizations. Management can be challenging. To describe a successful endovascular approach to managing SVCs caused by right innominate vein (RIV) occlusion in a hemodialysis patient with a non-functional LeVeen shunt. An 80-year-old dialysis patient with upper limb edema and vascular access dysfunction was diagnosed with complete RIV occlusion around a long-standing LeVeen shunt. Recanalization was achieved via a percutaneous approach, including angioplasty and placement of a balloon-expandable covered stent, leaving the LeVeen shunt in situ to reduce risks. The procedure restored venous patency and improved vascular access functionality. Postoperative imaging confirmed excellent stent positioning and reduced venous congestion. At a 6-month follow-up, central vein patency was maintained. Endovascular recanalization is a safe and effective strategy for managing SVCs, even with a retained central venous device. This approach preserved vascular access and ensured successful long-term dialysis, offering insights for treating complex venous occlusions.

A multicenter single‐arm objective performance criteria trial evaluating the efficacy and safety of a dedicated venous sinus thrombectomy device for severe cerebral venous sinus thrombosis

AbstractAimApproximately 21% of patients with cerebral venous sinus thrombosis (CVST) are refractory to anticoagulation treatment and face poor prognosis. These patients may benefit from endovascular therapy. Although numerous studies have reported promising results with endovascular therapy, it remains challenging to obtain convincing evidence of its efficacy and safety due to the unique challenges posed by CVST, such as larger vessel diameters, distinct pathophysiology, and substantial clot burden. Therefore, dedicated endovascular therapy tools should be developed specifically for CVST. This study aimed to evaluate the efficacy and safety of a dedicated venous sinus thrombectomy device in patients with acute or subacute CVST.MethodsThis prospective, multicenter, single‐arm trial utilized an objective performance criterion design. Enrolled patients received treatment with a dedicated venous sinus thrombectomy device to recanalize occluded sinuses or veins. The primary objective was to compare the immediate postoperative recanalization rate with a preset target value to determine whether the device met the clinical application needs. The trial plans to enroll 146 patients from 11 tertiary medical centers in China.DiscussionThis trial is expected to fill a critical gap in endovascular treatments for CVST and support the development of reliable, dedicated thrombectomy devices for future studies.

Endocardial lead implantation in patients with vein access obstruction

Aim. To present the experience of lead implantation in patients with cardiac implantable electronic devices (CIED) and access veins stenoses/occlusions, evaluate the effectiveness and safety of different methods and propose a decision-making algorithm for the method of new lead implantation in such patients.Methods. The study includes 31 patients with CIED and access veins obstruction, which required implantation of new leads. Leads were implanted after recanalization of the veins with hydrophilic wires through long introducers, or after transvenous lead extraction (TLE) using TightRail sheath.Results. Recanalization of veins using guidewires followed by lead implantation through a long introducer was performed in 24 patients, in 9 of them, after recanalization as the second step during the same procedure, TLE was performed. TLE without preliminary recanalization with guidewire was performed in 5 patients. In two patients, leads were implanted after vein puncture medial to the occlusion. Successful new leads implantation was performed in all patients. Decision making algorithm for the method of leads implantation through obstruction veins in various clinical situations is proposed.Conclusions. Recanalization of occluded veins with guidewire and TLE in patients with CIED are effective methods for providing ipsilateral access for lead implantation through obstructed veins. The safety of TLE in patients with access vein obstruction requires further study.

Evolving practice patterns of young retinal specialists: A five-year comparison of treatment and surgical preferences

PurposeTo describe trends in demographics and practice patterns of young retina specialists over a five-year follow-up period. DesignA cross-sectional study of young retinal specialists conducted through an online social media platform to evaluate practice patterns for common conditions. MethodsAn anonymous survey was performed among U.S.-based young retinal specialists from a variety of practice environments in early stages of practice between August and September 2022. Results were compared to survey results from 2017. ResultsIn 2022, the survey population included 358 members with 101 respondents compared to 44 respondents in 2017. Most respondents preferred bevacizumab as first-line treatment for foveal-involving diabetic macular edema (DME) (60%), vein occlusions (54%), and macular degeneration (56%). Aflibercept was more popular as first-line for DME patients with poor vision (51%) compared to those with good vision (18%). For proliferative diabetic retinopathy (PDR) without macular edema, respondents prefer panretinal photocoagulation alone (43%) or in combination with anti-VEGF (48%) over anti-VEGF alone (10%). Respondents repaired rhegmatogenous retinal detachments using combined vitrectomy-buckle (20%), primary scleral buckle (10%), and pneumatic retinopexy (PR) (10%). The percentage of respondents who have used PR at least once increased significantly from 2017 to 2022. From 2017 to 2022, more respondents use masks (29.5% to 82.8%) and post-injection antibiotics (2.3% to 16.0%) when performing injections while a smaller minority use topical gel anesthesia (34.1% to 15.5%). ConclusionsSurvey results suggest more providers are more likely to observe good visual acuity in diabetic edema and use laser alone in PDR without edema. In addition, longitudinal trends show increased use of PR, masks and post-injection antibiotics, and decreased use of topical gel anesthesia.

Testosterone-Induced Central Serous Chorioretinopathy Mimicking a Choroidal Mass.

To describe a case of supplemental testosterone-induced central serous chorioretinopathy (CSCR) mimicking a choroidal mass in a 63-year-old male. Case report. A 63-year-old male patient on self-prescribed supplemental testosterone with CSCR mimicking a choroidal mass. A 63-year-old male presented with new onset vision loss, subretinal fluid, and choroidal mass in his left eye. Intravenous fluorescein angiography showed an enhancing choroidal mass involving the fovea. B scan ultrasonography revealed diffuse choroidal thickening. Given concern for a diffuse uveal melanoma, the lesion was biopsied showing non-diagnostic rare, atypical melanocytes. Four months after initial presentation, the patient was diagnosed with polycythemia vera. Fourteen months after diagnosis, he admitted to testosterone supplementation. Upon cessation of the testosterone supplement, the lesion progressively flattened to a chorioretinal scar with subretinal fluid resolution, and the return of normal choroidal thickness over the next 14 months. Testosterone supplementation has been linked to erythrocytosis and polycythemia vera. In the retina, testosterone supplementation has been linked to CSCR and both central and branch retinal artery and vein occlusions. This case demonstrates the importance of inquiring about all prescribed and over the counter medications in patients presenting with retinal lesions of unknown origin.

Long-term Outcomes of Stenting Superior Cava and Brachio-cephalic Vein Occlusion in Hemodialysis Patients with Arteriovenous Fistulas

Central vein occlusion (CVO) is a significant complication in patients undergoing chronic hemodialysis, often leading to dialysis inefficacy, disabling symptoms, and, most critically, major risk of access failure. Although stenting has been proposed as a technique to maintain vascular access patency following the recanalization of occluded central veins, the data supporting its long-term efficacy remains limited. This study aims to evaluate the long-term effectiveness of stenting occluded superior vena cava (SVC) and/or brachiocephalic veins to preserve vascular access patency, ensure continued dialysis efficacy, and relieve SVC syndrome. This study retrospectively reviewed all hemodialysis patients who underwent stent placement for CVO between January 2017 and August 2024 at two vascular centers in Reunion Island. The primary endpoints of the study were the primary, assisted primary, and secondary patency rates of the vascular circuit during follow-up. Additionally, patient demographics, medical comorbidities, postoperative complications, definitive access abandonment, and reinterventions were analyzed. This study included 21 patients with a mean age of 67years. CVO stenting initially provided symptomatic relief for all patients, resolving symptoms such as SVC or arm swelling in symptomatic patients. Over a median follow-up period of 41months (range, 3-80months), the primary patency rates were 67% at 12months, 42% at 24months, and 38% at 36months, whereas the secondary patency rates were 90%, 79%, and 60% at these same intervals. Twelve patients (62%) experienced clinically significant stent restenosis, necessitating one or several additional percutaneous transluminal angioplasties during follow-up, whereas five patients (24%) developed acute access thrombosis requiring thrombectomy and percutaneous transluminal angioplasty, with central stent involved for three patients. Three patients (14%) required extra-anatomic bypasses due to definitive stent occlusion, five patients (14%) had definitive access failure, and five patients (24%) died from unrelated causes. This review suggests that hemodialysis patients with symptomatic CVO can often be successfully recanalized and treated with stenting, leading to symptom resolution and, importantly, achieving promising secondary patency rates. Our long-term results highlight the necessity for regular reintervention and close follow-up, as a significant number of patients will experience restenosis, and ultimately definitive access failure. Therefore, CVO stenting should be considered a temporary solution, although for some patients, this strategy may prove highly effective, maintaining long-term patency without any restenosis. We studied central vein stenting for 21 hemodialysis patients with a mean follow-up of 41months. Long-term results showed primary and secondary patency rate of 38% and 60% at 36months. Twelve patients needed at least one reintervention, whereas five patients developed access thrombosis. Three patients required extra-anatomic bypasses, five patients had access failure, and five patients died. Hemodialysis patients with symptomatic occlusion of the superior vena cava or brachiocephalic vein can be successfully recanalized and stented, leading to symptom resolution and, notably, an encouraging secondary patency rate with efficient dialysis. However, a majority of patients will require multiple reinterventions including endovascular percutaneous transluminal angioplasty or extra-anatomical bypass due to symptomatic in-stent restenosis and thrombosis, and a significant number will experience definitive access failure. Central venous obstruction stenting is a valuable initial strategy but should only be performed without compromising further access, as it represents a salvage procedure with important risk of failure during prolonged follow-up.

Cervical Rib Causing Thoracic Outlet Syndrome with Left Subclavian Artery and Vein Occlusion, Presenting in 38 Years Old Male: A Clinical Case Report and Its Literature Review

Cervical Rib Causing Thoracic Outlet Syndrome with Left Subclavian Artery and Vein Occlusion, Presenting in 38 Years Old Male: A Clinical Case Report and Its Literature Review

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.

Procedural and long-term outcomes of tunneled transvenous leads

BackgroundLead-related venous stenosis and occlusion can complicate the insertion or replacement of transvenous leads in patients with cardiac implantable electronic devices (CIEDs). A possible solution is to tunnel the lead from the contralateral vasculature to the ipsilateral generator. Procedural complications and long-term outcomes remain unclear with this technique. ObjectiveWe sought to assess outcomes of tunneled transvenous leads. MethodsWe retrospectively identified all patients who underwent transvenous CIED lead tunneling to a contralateral pocket at our institution between 2014 and 2024. Clinical characteristics, indications for lead implantation, postoperative complications, and long-term outcomes were collected. ResultsWe identified that 27 patients underwent transvenous lead tunneling at our institution. Most patients were men (20, 74%) with a mean age of 68.8 ± 18.3 years. Most patients had nonischemic cardiomyopathy (16, 59%) with a mean ejection fraction of 29.3% ± 11.3%. The tunneled leads were coronary sinus leads (20, 74%), followed by defibrillator leads (5, 18.5%) and right ventricular pacing leads (2, 7.4%). Implantation procedures were primarily for device upgrade (18), lead revisions (8), or de novo lead placement (1). No postoperative complications were seen. Patients were followed for a mean of 2.2 ± 1.4 years. One tunneled defibrillator lead (3.7%) had low shock impedance 3 years after implantation, which was monitored and did not require an intervention. ConclusionIn patients with ipsilateral venous occlusion, contralateral lead tunneling appears to be an effective and safe approach to manage patients with CIEDs and occluded ipsilateral subclavian veins.

Deletion of myeloid HDAC3 promotes efferocytosis to ameliorate retinal ischemic injury

Ischemia-induced retinopathy is a hallmark finding of common visual disorders including diabetic retinopathy (DR) and central retinal artery and vein occlusions. Treatments for ischemic retinopathies fail to improve clinical outcomes and the design of new therapies will depend on understanding the underlying disease mechanisms. Histone deacetylases (HDACs) are an enzyme class that removes acetyl groups from histone and non-histone proteins, thereby regulating gene expression and protein function. HDACs have been implicated in retinal neurovascular injury in preclinical studies in which nonspecific HDAC inhibitors mitigated retinal injury. Histone deacetylase 3 (HDAC3) is a class I histone deacetylase isoform that plays a central role in the macrophage inflammatory response. We recently reported that myeloid cells upregulate HDAC3 in a mouse model of retinal ischemia-reperfusion (IR) injury. However, whether this cellular event is an essential contributor to retinal IR injury is unknown. In this study, we explored the role of myeloid HDAC3 in ischemia-induced retinal neurovascular injury by subjecting myeloid-specific HDAC3 knockout (M-HDAC3 KO) and floxed control mice to retinal IR. The M-HDAC3 KO mice were protected from retinal IR injury as shown by the preservation of inner retinal neurons, vascular integrity, and retinal thickness. Electroretinography confirmed that this neurovascular protection translated to improved retinal function. The retinas of M-HDAC3 KO mice also showed less proliferation and infiltration of myeloid cells after injury. Interestingly, myeloid cells lacking HDAC3 more avidly engulfed apoptotic cells in vitro and after retinal IR injury in vivo compared to wild-type myeloid cells, suggesting that HDAC3 hinders the reparative phagocytosis of dead cells, a process known as efferocytosis. Further mechanistic studies indicated that although HDAC3 KO macrophages upregulate the reparative enzyme arginase 1 (A1) that enhances efferocytosis, the inhibitory effect of HDAC3 on efferocytosis is not solely dependent on A1. Finally, treatment of wild-type mice with the HDAC3 inhibitor RGFP966 ameliorated the retinal neurodegeneration and thinning caused by IR injury. Collectively, our data show that HDAC3 deletion enhances macrophage-mediated efferocytosis and protects against retinal IR injury, suggesting that inhibiting myeloid HDAC3 holds promise as a novel therapeutic strategy for preserving retinal integrity after ischemic insult.

Tunneled Dialysis Catheter Insertion in External Jugular Vein by Nephrologists

Background External jugular vein (EJV) is used to insert tunneled dialysis catheter (TDC) in patients with no AVF and exhausted right internal jugular veins (IJV). There is scarce data on TDC insertion in EJV by nephrologists with fluoroscopy guidance. Materials and Methods This was a prospective observational study that included hemodialysis patients with exhausted right IJV access who underwent EJV TDC insertion, and excluded occluded ipsilateral brachiocephalic vein or superior vena cava, EJV < 5 mm diameter, or patients with existing EJV TDC. All patients underwent evaluation of central veins. TDC insertions were performed by a nephrologist using ultrasound and fluoroscopic guidance. The primary outcome was the successful insertion of EJV TDC and catheter removal within 6 months due to major catheter dysfunction or complications. Results EJV TDC was successfully inserted in 23/23 cases (100% success), of which 17 (73.9%) were in right side, and 21 (91.3%) were denovo insertions. Catheter dysfunction needing removal occurred in seven cases (30.4%) with subclavian vein thrombosis in five cases (21.7%) and infectious complications in two cases (8.6%). The censored catheter survival was 23/23 (100%) at 1 month, 22/23 (95.6%) at 3 months, and 13/20 (65%) at 6 months. Cases of EJV catheter removal had a significant association with drainage of EJV into subclavian vein as compared to other anatomical variants (p = 0.005). Conclusion EJV TDC insertion has a good technical success rate when performed under fluoroscopy. It is associated with an acceptable rate of catheter dysfunction, especially thrombosis, which is more common in EJV opening into subclavian veins.

Combined simultaneous bilateral central retinal artery and vein occlusion in a patient with lymphoma of the pancreatic head

Combined occlusion of retinal artery and vein is a rare event, and its occurrence in both eyes concurrently in a young patient is an even rare phenomenon. We report such a case in which a 45-year-old female presented with sudden loss of vision, 2 weeks following the third cycle of chemotherapy. Fundus findings and investigations pointed toward combined bilateral simultaneous retinal artery and vein occlusion. Vision did not improve despite treatment. To our knowledge, this extreme presentation of total occlusive disease and its association with lymphoma of the pancreas is the first to be reported in the literature. This case highlights the prothrombotic state induced by pancreatic malignancy and warrants periodic monitoring in such patients.

Single-center clinical experience of cyanoacrylate embolization method for incompetent perforating veins in treating CEAP-6 patients

ObjectiveThe most severe form of chronic venous insufficiency includes venous leg ulcers in the CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at the CEAP-6 stage. MethodsA total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months after the procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver operating characteristic analysis was used to estimate the probability of postoperative nonocclusion of the perforating vein based on the preoperative ulcers’ diameters and the perforating veins’ mean diameters. Univariate and multivariate binary logistic regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein. ResultsAt the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20 ± 3.48 cm2 to 0.28 ± 0.77 cm2 after the procedure (P < .001). On average, 3.5 ± 1.01 perforating veins were treated, with a diameter of 4.09 ± 0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85 ± 3.06 to 8.03 ± 3.53 postoperatively (P < .001). Patients with nonoccluded perforating veins had larger preoperative ulcer diameters (13.77 ± 1.78 cm2) than those with occluded perforating veins (6.24 ± 2.47 cm2; P < .001). The mean perforating vein diameter was also larger in nonoccluded perforating veins patients (4.45 ± 0.41 mm) than in occluded perforating veins patients (4.04 ± 0.38 mm; P < .001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cutoff point of 11.25 cm2 for the possibility of postoperative nonocclusion of perforating veins were 100% each. In contrast, those for the preoperative mean perforating vein diameter cutoff point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. The presence of diabetes mellitus increased the likelihood of incompetent perforator veins, remaining open by 3.4 times (95% confidence interval: 1.11-10.44; P = .032), whereas a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% confidence interval: 3.47-25.29; P < .001). ConclusionsThis study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.

Modeling of rabbit femoral artery occlusion by high-intensity focused ultrasound

One of the effective methods of artery and vein occlusion used in experimental studies and in clinical practice for certain diseases is local exposure of vessels to high-intensity focused ultrasound (HIFU). The wide use of this method in our country is limited by the lack of appropriate domestic equipment. At the Peter the Great St. Petersburg Polytechnic University, in the Laboratory of Ultrasound Technologies of the Center for Advanced Research, a stand for HIFU effects on various biological objects has been developed. There is no experience in using this device in angiology yet. The purpose of our research was to study the possibility of using Medusa 008, a high-tech mobile medical device designed for ultrasound diagnosis and personalized HIFU therapy, to model vascular occlusion and stop blood flow during irradiation. Materials and methods. The object of the study is the femoral artery of a rabbit. The source of HIFU is Medusa 008, the high-tech mobile medical device designed for ultrasound diagnostics and personalized HIFU-therapy with radiation frequency of 2 MHz (prototype). The following irradiation modes were used in the research: irradiation duration - 50 ms, pause between exposures – 10 ms, number of pulses – 20, 30, 40. The following energy values corresponded to these modes: 58 J, 87 J, 116 J. Irradiation of the femoral artery of an anesthetized rabbit was performed percutaneously. We used ultrasound to visualize the arteries and measure the blood flow velocity. According to ultrasound data, after HIFU irradiation, blood flow in the artery stopped. The factor contributing to arterial occlusion is the cessation of blood flow during irradiation. A histological examination of the area of the irradiated artery revealed structural changes in all layers of the vascular wall. Results. HIFU irradiation with intensity of 87 and 116 J has a significant dose-dependent destructive effect on the muscular arterial wall. The more intense damaging irradiation (116 J) causes smooth muscle cell necrosis. The time of direct influence on the vessel wall structures did not exceed 3 sec. During the experiment, we found that HIFU in the used modes causes temperature increase up to 45–60 оC, which is enough for thermal damage of cells in the irradiation zone. Conclusion. Thus, as a result of the above experiments, it was shown that Medusa 008, the high-tech mobile medical device designed for ultrasound diagnostics and personalized HIFU-therapy can be used to simulate vascular occlusion.

Myelin Oligodendrocyte Glycoprotein-Associated Disease Optic Neuritis With Concurrent Combined Central Retinal Artery and Vein Occlusion.

Myelin Oligodendrocyte Glycoprotein-Associated Disease Optic Neuritis With Concurrent Combined Central Retinal Artery and Vein Occlusion.

Exploring laser-induced acute and chronic retinal vein occlusion mouse models: Development, temporal in vivo imaging, and application perspectives.

Photodynamic venous occlusion is a commonly accepted method for establishing mouse models of retinal vein occlusion (RVO). However, existing model parameters do not distinguish between acute and chronic RVO subtypes. Large variations in laser energy seem to correlate with fluctuating retinopathy severity and high rates of venous recanalization during the acute phase, along with the variable levels of retinal perfusion during the chronic phase. After optimizing the modeling procedure and defining success and exclusion criteria, laser energy groups of 80mW, 100mW, and 120mW were established. Multimodal imaging confirmed that higher energy levels increased the incidence of retinal cystoid edema and intraretinal hemorrhage, exacerbated the severity of exudative retinal detachment, and reduced the venous recanalization rate. For the acute model, 100mW was considered an appropriate parameter for balancing moderate retinopathy and venous recanalization. Continuous imaging follow-up revealed that day 1 after RVO was the optimal observation point for peaking of retinal thickness and intensive occurrence of retinal cystic edema and intraretinal hemorrhage. After excluding the influence of venous recanalization on retinal thickness, acute retinal edema demonstrated a positive response to standard anti-vascular endothelial growth factor therapy, validating the clinical relevance of the acute RVO model for further study in pathogenic mechanisms and therapeutic efficacy. For the chronic model, the 120mW parameter with the lowest venous recanalization rate was applied, accompanied by an increase in both photocoagulation shots and range to ensure sustained vein occlusion. Imaging follow-up clarified non-ischemic retinopathy characterized by tortuosity and dilation of the distal end, branches, and adjacent veins of the occluded vein. These morphological changes are quantifiable and could be combined with electrophysiological functional assessment for treatment effectiveness evaluation. Moreover, the stable state of venous occlusion may facilitate investigations into response and compensation mechanisms under conditions of chronic retinal hypoperfusion.

Surgical intervention of Lemierre’s syndrome: a case report and review of the literature

BackgroundLemierre’s syndrome is a fatal and rare disease that is typically characterized by oropharyngeal infection and internal jugular vein thrombosis. Timely institution of appropriate antibiotics is the standard treatment.Case presentationThe authors report a case of Lemierre’s syndrome. A 67-year-old male patient of Han ethnicity in China suffered from a large inflammatory neck mass involving left internal jugular vein thrombosis diagnosed as Lemierre’s syndrome and finally cured by surgical treatment. In addition, a literature review was carried out through PubMed using the terms “Lemierre’s syndrome/disease and review, meta-analysis or retrospective study” and “Lemierre’s syndrome/disease and internal jugular vein”. This search yielded six articles that recorded surgical methods such as drainage, craniotomy, tooth extraction, and ligation of the occluded vein to give clinicians more ideas about the treatment of the Lemierre’s syndrome.ConclusionThis is the first review to summarize the conditions under which surgical treatment are conducted. Additionally, this is the first report of such a large inflammatory neck mass that was completely cured by surgical resection and internal jugular vein ligation. The authors also offer several conclusions regarding surgical intervention in Lemierre’s syndrome for the first time.

Combined Central Retinal Artery and Vein Occlusion-like Manifestations with Aplastic Anemia: Unveiling Pathophysiological Insights

Purpose: To report the association of a combined central artery and vein occlusion (CCRAVO)-like pattern with aplastic anemia and discuss the pathophysiology associated with ophthalmologic examinations. Methods: We report a female patient with aplastic anemia who presented with retinal hemorrhage, blurred optic disc margins, retinal whitening, peripapillary subretinal fluid, and venous engorgement. The authors described the evolution of ophthalmologic lesions in correlation with improvements in systemic conditions. Results: We discuss and correlate the ophthalmological findings of this patient (optic disc edema, vascular engorgement, subretinal fluid, among others) with the pathophysiology of Aplastic Anemia based on current literature. Conclusion: These findings provide a better understanding of the pathophysiology of this rare disease. In certain cases, ophthalmologic symptoms can be the first presentation, underscoring the importance of reporting ocular findings for the recognition of this disease, which entails significant systemic involvement.

Safety and effectiveness of transsplenic access for portal venous interventions: a single-center retrospective study.

To assess the safety and effectiveness of percutaneous transsplenic access (PTSA) for portal vein (PV) interventions among patients with PV disease. Adult patients with PV disease were enrolled if they required percutaneous catheterization for PV angioplasty, embolization, thrombectomy, variceal embolization, or transjugular intrahepatic portosystemic shunt (TIPS) placement for a difficult TIPS or recanalization of a chronically occluded PV. The procedures were performed between January 2018 and January 2023. Patients were excluded if they had an active infection, had a chronically occluded splenic vein malignant infiltration of the needle tract, had undergone splenectomy, or were under age 18years. Thirty patients (15 women, 15 men) were enrolled. Catheterization of the PV through PTSA succeeded for 29 of 30 patients (96.7%). The main adverse effect recorded was flank pain in 5 of 30 cases (16.7%). No bleeding events from the spleen, splenic vein, or percutaneous access point were recorded. Two cases (6.7%) each of hepatic bleeding and rethrombosis of the PV were reported, and a change in hemoglobin levels (mean [SD], - 0.5 [1.4] g/dL) was documented in 14 cases (46.7%). PTSA as an approach to accessing the PV is secure and achievable, with minimal risk of complications. Minimal to no bleeding is possible by using tract closure methods.

A pulmonary artery was embolized in a patient with an occluded pulmonary vein to manage massive hemoptysis

BackgroundStenosis and obliteration of the pulmonary vein can be developed by multiple diseases and might cause hemoptysis. Traditional therapy including surgical procedure and conservative treatments might be inappropriate choices to manage massive hemoptysis.Case presentationA 64-year-old man, diagnosed with advanced stage IVA lung squamous cell carcinoma, presented with dyspnea and recurrent, massive hemoptysis. An initial contrast-enhanced computed tomography revealed a giant tumor in the left lung hilus and occlusion of the left superior pulmonary vein. Despite immediate selective bronchial artery embolization and simultaneous embolization of an anomalous branch of the internal thoracic artery, the massive hemoptysis continued. Subsequently, embolization of the left superior pulmonary artery was performed, achieving functional pulmonary lobectomy, which successfully treated the hemoptysis without relapse during a six-month follow-up. The patient continues to undergo cancer therapy and remains stable.ConclusionsThis case successfully managed massive hemoptysis associated with lung cancer invasion into the pulmonary vein through functional pulmonary lobectomy via embolization of the corresponding pulmonary artery.